High-Risk Pregnancy

How do I talk to my doctor about my GD concerns?

 

So I need a little bit of help here.  I am still fairly new to the whole GD thing.  I have started monitoring my blood sugar numbers and some days are better than others.  As of right now I am not taking any meds, but I was on metformin for PCOS prior to getting pregnant and may need to get back on it. 

The question I have for you ladies is how do I address concerns I have for my baby with my doctor?  Like today I woke up with a fasting number of 266, my highest fasting number yet.  I was concerned so I called into my doctor's office, and had to leave a message, but it took them almost 4 hours to call me back.  When the nurse did call me back she informed me that my doctor wanted me to call the diabetes education rep. and have her tell me what she wants to do.  This is just an educational type person, not a specialist, but a dietitian. (And since this is "Education" my insurance only covers 4 visits in a calendar year, and I am worried because I still have a lot of weeks to go until our little man is here)  My doctor has not said anything about seeing any specialist, or even doing further monitoring on my baby.  It worries me because our baby was already in the 85 percentile for size at 19 weeks, and I am afraid that he is going to grow too large too fast and end up harmed.  I have an appointment with my OB tomorrow, the first once since being diagnosed with GD four weeks ago and I want to tell her I am concerned and basically my expectations as far as care goes.  How do I go about doing this without offending her?  I am afraid she is going to be dismissive when I bring it up, as she has done this with other pregnancy scares we have had in the past.  I am starting to feel uncomfortable with her, and the lack of care I feel my baby is getting.   

Am I just being paranoid? I know that there is a large number of women who are diagnosed with GD, and they go on to have wonderful, healthy babies. I am just one of those who needs a "plan of action" for every situation that may arise I guess. I just need some help from some women who have been there, and how to talk to my OB to get the most positive outcome possible.     

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Re: How do I talk to my doctor about my GD concerns?

  • I would make a list of questions before you go.  Frankly, I can't believe they haven't seen you since your diagnosis - 4 WEEKS AGO.  When I got diagnosed with GD they had me start testing my blood sugar right away and set up a follow-up appointment with the doctor one week later.  I have been able to treat mine with diet and exercise only but I'm sure they would be concerned if I had a fasting number that high.  My fasting number is supposed to be under 90 and my 2 hour post-meal numbers are supposed to be under 120.  I go once a week for check-ups and to have my numbers reviewed.  They also set me up with a dietician within a week of my diagnosis. 

    How have your numbers been otherwise?  Have they given you a diet/meal plan to follow?

     Here's a list of questions I asked when I had a follow-up and a summary of what I was told:

    1) How does the GD diagnosis change my care?

    more frequent appointments but so long as my numbers are good and my fundal measurements/weight is on point, no difference

    2) Will I have more ultrasounds, growth scans, etc?

    only if I have to go on meds or if my week to week fundal measurement makes  a big jump

    3) Is there a difference in care depending on whether I am able to treat it with diet/exercise or if I have to go on meds?

    If have to go on meds, will definitely have to have growth scans.  May also mean I have to be induced early depending on growth

    4) How is the care for my child different after he is born?  if exercise/diet controlled only difference is he will have his blood sugar tested periodically right after born.  If have to go on meds he has to go to NICU to be monitored for a day

    Also - I have noticed that my numbers have been creeping up the last few weeks despite exercise and diet.  At my last visit the OB said that it's not uncommon around 32-34 weeks for this to happen because the placenta is releasing more hormones.

     Hope this helps.

    ETA - did want to point out that I'm high risk because of my age (37) and previous miscarriages so that may be why I went straight to weekly appointments after the GD diagnosis

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  •   Educate your self, read about GD, and write down anything you want to talk to your dr about. This is your health and your baby, stand up for your self if your Dr just dismisses your concerns. High blood sugar is not something to just ignore, its a life threatening issue to your baby. There are millions of good, accredited webpages, books, medical journals about Gd and its just as easy to get your hands on information now as opening up goggle and looking for it. If your Dr still blows you off, you are not so far along that you can't find a new one. 

      As for size, Gd does cause larger babies, but a lot can happen between now and then and you could delver a normal size baby. I was at 90% at 20 weeks, and now at 36 weeks I am in the 40%, your baby could of just had a growth spurt earlier.  

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  • Speak up dont be afraid of offending your dr. 266 for fasting is so high wow I would think you would need to be on insulin. My dr is freaked out with my highest fasting at 101, Im on insulin at night to control my fasting number. Also you should be seeing an endo as well as the dietician and you still have a while to go in your preg if they are not helping you then you need to find a new dr that will.GL
  • If your doctor is dismissive any time you have genuine concerns, it's time for a new doctor.  A fasting number of 266 is way too high.  You likely need to be insulin controlled and monitored by a GD specialist!  I don't want to scare you, but too much glucose not only can lead to large babies that need c-section deliveries, but it also increases the chances of blood sugar issues for your baby immediately after they are delivered and can increase their risk of diabetes and obesity during their life.  It is very important to manage this condition.  Your doctor should be very concerned with that fasting number and if she is anything but concerned, you need to find someone else who will give you proper care!
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  • 266 for fasting is not acceptable at all and having a number that high your doctor should have taken steps immediately to get you on a meal plan and to have that class on GD.  If I have any number over 200 I am supposed to call my OB and the GD nurses to get further directions on what steps to take.  I would definitely have a long list of questions and make sure you get all the answers you need.  If your doctor is still nonchalant about it then I would consider a different doctor.
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