GD research? Fasting issues.

punkrockabye · April 2012

The doctor wants me at 60-80 fasting and 130 or below one hour past meals. Fasting has ranged from 80 to 88, and post meal it's almost always 90-110. So, in my opinion, very low. Not TOO low, but really, 91 after I eat a nearly 60 carb lunch?

I'm almost certain they'll try to put me on insulin for my fasting numbers being "high." That's a one way ticket to an induction that--at this time--I don't feel is warranted.

ACOG and the World Health Organization state that 95 is the maximum recommended fasting number. I have spent HOURS reading scholarly journal articles and research studies, all reaching the same conclusion: fasting at or below 95 is what we should aim for. My provider just "treats it aggressively."

I feel that, with my fasting numbers below 90 consistently, AND with such great post meal numbers, this is getting a little absurd. Based on all my research I am planning on declining treatment further than diet and monitoring like I'm doing now unless my numbers become harder to control, which is always a possibility; I am absolutely not opposed to treatment if I feel it is warranted. But I will be in for a huge fight on Wednesday.

I'm just wondering if anyone has done similar research and might have some links handy. I'm kind of burnt out on it from these past few days, not to mention I spent 6 years in college/grad school looking over journal articles! If I wasn't promised induction at 39 weeks I'd be much less concerned... but that's a whole other issue--there is no research supporting/validating a need for induction in GD patients who are well controlled with medication, if the only reason given is GD.

juliane2004 · April 2012

I have type 1, NOT gestational diabetes, so that might make a difference.

I am aiming for under 97 for fasting. 60, fasting, is WAY too low in my opinion. 75 as a minimum for me. Under that, and I treat with juice for going too low.

DCsara · April 2012

I was also told under 95 for fasting is good by the diabetes nurse, my doc said generally I should aim to have fasting under 100. I am taking a small dose of oral medication called glyburide to help do that and I still get fasting numbers between 100-110 sometimes (mostly due to eating right before bed or sleeping like 5 hours or something), though the majority are in the mid-90's and my doc isn't concerned, said they look pretty good. I am by no means an expert, but your doctor sounds way out of line with what I've been told.

When I was first diagnosed with GD I came across an article (I unfortunately can't find it now) that said that too much emphasis is placed on fasting numbers in diabetes, that basically its one thing if they start out high and then go higher during the day, but if they are just slightly elevated, like 110, and blood sugar though the day is normal, it's not a big deal because blood sugars under 120 are not shown to cause health issues and a lot of people's blood sugar will spike right around dawn....it's not that it's necessarily been that high all night long either.

punkrockabye · April 2012

I agree that 60-80 is crazy, I believe the 60's are considered hypoglycemia, which is dangerous in itself! But the paperwork given to me, which the clinic made and makes copies for everyone, says to aim for fasting numbers between 60 and 80. Since I'm in the 80s and everything else has been great, who knows, they may not mind. But in my experience with how they operate, they're going to want to put me on insulin because my fasting is not below 80, and I feel like I need to be as armed as I can. I might have to exercise my right to make an informed refusal unless they can show me some actual research to read. Of course, this means more "dead baby" talk, which assumes I'm dumb enough to cave at the slightest threat. This isn't me just not wanting to go on insulin--it's me wanting to avoid 1.) unnecessary treatment, and 2.) something that I have been told already will lead to an induction. I don't think this is a case of me searching and just seeing what I want to see, though.

I know in late pregnancy it can be harder to keep numbers under control so many women who are fine with diet alone end up needing meds, and I understand that and would be completely willing to do what I need to do IF my numbers start going out of the range of what is considered standard by, oh, EVERYONE. Same with, for example, my potential blood pressure issues; you better bet that if my BP spikes and goes insane and can't be controlled, I'll agree to whatever needs to be done. I'm just getting so many mixed signals from them: no blood pressure meds yet despite slightly elevated readings, but the threat of insulin if my fasting numbers are above 80.

Butterbrot · April 2012

That sounds like a real hot mess. I have diet-controlled GD, and I can understand your frustration. I was told by the dietician that my fasting numbers should be under 90, but then the doctor at the hospital said they need to be under 80. I should be under 120 an hour after eating, which sometimes works, but sometimes doesn't. But it's totally late in the game for me ... you still have a ways to go. Is it possible for you to switch providers? You're obviously intellegent and well-informed, and to me it sounds like you're on a very slippery slope towards completely unwarrented intervention.

punkrockabye · April 2012

Butterbrot:
That sounds like a real hot mess. I have diet-controlled GD, and I can understand your frustration. I was told by the dietician that my fasting numbers should be under 90, but then the doctor at the hospital said they need to be under 80. I should be under 120 an hour after eating, which sometimes works, but sometimes doesn't. But it's totally late in the game for me ... you still have a ways to go. Is it possible for you to switch providers? You're obviously intellegent and well-informed, and to me it sounds like you're on a very slippery slope towards completely unwarrented intervention.

I've been debating switching. Unfortunately I am on medicaid until after delivery, so I believe anywhere I go I will be treated as if I am stupid and should just smile and nod. They're already pretty annoyed with me for having an informed opinion. The specific hospital itself would give me a great shot at a natural birth, for a hospital, but I'm unfortunately enrolled in the medicaid "clinic."

I know in the end that I have the right to make the final decision. The doctors know I have that right as well. But since they see so many people who don't know, I'm not exactly what they want to deal with. I guess I'm just going to have to see how this goes, if they do try to push insulin, how they react to me insisting that I have done so much of my own research and currently do not consent to further treatment unless my numbers become harder to control. I'm just trying to think of a better, more mature response to the inevitable dead baby card, since a string of expletives and "how stupid do you actually think I am to cave in to your completely baseless scare tactics?" won't really work well for me.

It's already bad enough that I am forcing all of this food into me. I have zero appetite, which with the addition of zofran, I am now sure isn't related to nausea. I have to eat so much so often that it seems very counter intuitive; I am already obese, and forcing food down my throat when I feel that there is physically no more room in my stomach just seems wrong. The other day I was trying to eat my required snack and it almost came back up halfway through it because I was stuffed. If they're worried about big babies, making an already fat mom eat 24/7 despite being full is a sure way to get a big baby, I'd think. But I know what is recommended in terms of eating frequently so I am trying to, but it's extremely unpleasant. Aside from meals like pasta, most of what I ate before was about 30g of carbs, so I am having to literally double the size of my meals.

L8kissie · April 2012

Kaiser tends to be aggressive too, but I'm aiming for 89 or lower for fasting. I'm not there yet and it's bugging me. The daytime numbers are dandy. Oh well. I vote you bring in some research to your next appointment and use it for discussion.

L8kissie · April 2012

DCsara:
I was also told under 95 for fasting is good by the diabetes nurse, my doc said generally I should aim to have fasting under 100. I am taking a small dose of oral medication called glyburide to help do that and I still get fasting numbers between 100-110 sometimes (mostly due to eating right before bed or sleeping like 5 hours or something), though the majority are in the mid-90's and my doc isn't concerned, said they look pretty good. I am by no means an expert, but your doctor sounds way out of line with what I've been told.
When I was first diagnosed with GD I came across an article (I unfortunately can't find it now) that said that too much emphasis is placed on fasting numbers in diabetes, that basically its one thing if they start out high and then go higher during the day, but if they are just slightly elevated, like 110, and blood sugar though the day is normal, it's not a big deal because blood sugars under 120 are not shown to cause health issues and a lot of people's blood sugar will spike right around dawn....it's not that it's necessarily been that high all night long either.

If you end up finding it, can you please post that article? Fasting is my only issue.

Butterbrot · April 2012

punkrockabye:
Butterbrot:
That sounds like a real hot mess. I have diet-controlled GD, and I can understand your frustration. I was told by the dietician that my fasting numbers should be under 90, but then the doctor at the hospital said they need to be under 80. I should be under 120 an hour after eating, which sometimes works, but sometimes doesn't. But it's totally late in the game for me ... you still have a ways to go. Is it possible for you to switch providers? You're obviously intellegent and well-informed, and to me it sounds like you're on a very slippery slope towards completely unwarrented intervention.
I've been debating switching. Unfortunately I am on medicaid until after delivery, so I believe anywhere I go I will be treated as if I am stupid and should just smile and nod. They're already pretty annoyed with me for having an informed opinion. The specific hospital itself would give me a great shot at a natural birth, for a hospital, but I'm unfortunately enrolled in the medicaid "clinic."
I know in the end that I have the right to make the final decision. The doctors know I have that right as well. But since they see so many people who don't know, I'm not exactly what they want to deal with. I guess I'm just going to have to see how this goes, if they do try to push insulin, how they react to me insisting that I have done so much of my own research and currently do not consent to further treatment unless my numbers become harder to control. I'm just trying to think of a better, more mature response to the inevitable dead baby card, since a string of expletives and "how stupid do you actually think I am to cave in to your completely baseless scare tactics?" won't really work well for me.
It's already bad enough that I am forcing all of this food into me. I have zero appetite, which with the addition of zofran, I am now sure isn't related to nausea. I have to eat so much so often that it seems very counter intuitive; I am already obese, and forcing food down my throat when I feel that there is physically no more room in my stomach just seems wrong. The other day I was trying to eat my required snack and it almost came back up halfway through it because I was stuffed. If they're worried about big babies, making an already fat mom eat 24/7 despite being full is a sure way to get a big baby, I'd think. But I know what is recommended in terms of eating frequently so I am trying to, but it's extremely unpleasant. Aside from meals like pasta, most of what I ate before was about 30g of carbs, so I am having to literally double the size of my meals.

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