We had our repeat anatomy scan yesterday and everything looks good. Baby is exactly on track for gestational age, despite my weight struggles. We have a growth scan in 4 weeks and they're going to do a fetal echo at the same time. Apparently it's normal for early GD diagnoses buy neither the specialist or my OB are really concerned about anything.
In fact, my OB is so happy with my glycemic control that he is fine with waiting until 36 weeks (instead of 34) to start NSTs, unless something changes in the next few weeks. We'll see if my dietitian agrees (that appointment is in half an hour).
As a plus size mom on a strict MNT program, compounded with these constant colds, I'm having trouble maintaining my intake weight much less gaining the 10-15 lbs they target. I'm down 10-12 from intake. My OB doesn't care but the diabetes team scolds me about it. I was diagnosed much later in my first pregnancy and lost 15lbs in 3rd tri. 😬 I have massive anxiety about weigh ins because it's not possible to work the MNT program (designed for someone 80+ lbs lighter than me) and not lose. But they don't have a program designed for someone my size, and I am actually eating healthfully for me and my baby. Cannot wait to get off this hamster wheel and resume just managing prediabetic tendencies!
@kyrwyn that’s awesome news about NSTs and baby’s current size! Way to go mama!
would you mind explaining how the intake weight thing works? I’m just curious how they have you so carefully manage your sugars, which is so hard already, but also worry so much about your weight? My dads a type one diabetic and it’s SO hard for him to do any kind of weight loss because his sugars flux so much-much less while pregnant!
Married: 12/19/15
BFP: 9/4/17 EDD: 5/16/18 DD born 5/10/18 Postpartum Complications
@alli392 Sure! So my intake weight is just what I weighed at my first OB appointment. I'm a large person, and I fall in the obese BMI category for my height. But once you hit a BMI of 30.0, the recommendation is the same regardless of how large you are: 11-20 lbs overall gain, with a 0.5lb / week rate in second and third trimesters. It doesn't matter if your BMI is 31 or 50, the recommendation is the same. There's not yet a body of literature that suggests a range for safe weight loss, even in obese patients, during pregnancy. This might change someday, but it's hard to get oversight committees to approve studies changing the standard of care for pregnant patients, so it'll probably take a lot longer to build that scientific evidence.
The targets for weight gain in pregnancy actually don't change with GD (!!!) despite making significant changes to your diet and exercise. The average American diet has 250-300 g of carbohydrates per day. The recommended GD diet for my medical group is 125-150 g of carbohydrates a day, specific meal spacing, pairing carbohydrates with protein, and macro breakdowns for each meal. Studies have shown that 10-15 min of moderate exercise within one hour of eating can lower post-meal blood sugars, so my practice recommends this too. I expect that most significantly obese people (like me) who halved their carbohydrate intake, including giving up all sweets and many types of breads, and started walking 30-45 min a day, would probably lose some weight.
Hiding a bunch of diabetes info behind this spoiler tag because it's probably only interesting to me, @alli392, and anyone who gets diagnosed in the next month or two.
Type I diabetics are wholly dependent on insulin for glucose metabolism while many Type IIs and pre-diabetics are insulin resistant, meaning that they use the insulin they make inefficiently. I fall in the latter group (my mom is Type II). During pregnancy body can't make enough insulin, or use what it makes efficiently enough, to overcome the added insulin resistance from pregnancy hormones. So I can either reduce the carbohydrates I eat through managed nutrition (GD diet) and exercise, or I can supplement with insulin (some practices allow other meds). During the day, I can manage with diet and exercise (so far). Just before dawn, your liver dumps sugars so that you have enough energy to get up and start your day. Your insulin metabolism is supposed to keep your blood sugars from getting too high after this pre-dawn dump, but mine can't keep up. There's no exercise/diet fix for this. I take a small dose of long-acting insulin to give my body some help handling this pre-dawn effect. Compared to a Type I diabetic, I take a very tiny dose of insulin and in a way that doesn't practically impact glucose absorption from the foods I eat. Insulin use is correlated with weight gain for many diabetics, but since the way I'm taking it isn't connected to what/when/how I eat, it's less of a risk for me. The net is that I'm losing weight from diet changes and increased activity, and that weight loss outpaces the weight gain I have from pregnancy (mostly because I'm starting at such a large weight number). The systems and scientific studies aren't built to study or support people my size, so it's a poor fit for building expectations of what will actually happen for me. But most of the dietitians (and even my OB) haven't read the 30+ scientific papers that I read to understand GD in the context of my situation, so they follow protocol even when the protocol doesn't make sense for me.
Since I weighed 270 at intake, they'd like me to get up to 280-290 by delivery, but I'm currently 257-260 and likely to lose more. My OB doesn't care because the baby's on track, but my dietitian cares because I'm not on the charts they use to assess progress.
Wow @kyrwyn I’m impressed! Not only that you’ve obviously done your research but also that you can dumb it down enough for the rest of us to understand. I haven’t dealt with GD complications, but you’ve got my respect for taking charge and handling it like a champ!
@kjack86 Thanks! I got super tired of hearing about how my GD was largely due to my weight last time (not scientifically supported!) and decided to pull my own lit review out of PubMed. It's nice to have the education/literacy to do that, and I'm grateful for my education/background. My OB file now has a big pink sticky on it that reads "RESEARCH TRAINED SCIENTIST" and we communicate a lot better after the stack of papers (with highlighted abstracts) that I handed him.
@kyrwyn okay maybe I’m also just a science nerd, but that was seriously super cool to read and made way more sense than any GD literature I’ve ever read. I’m so impressed! And that sticky note on your file is awesome 😂
I had no idea that your body dumped more insulin in before dawn or that the difference between type I and type II (especially in pregnancy) was like that. I’m so used to how my dad manages his and has for years that it’s interesting to read how differently you have to handle yours.
Since I have an autoimmune condition (lupus) and my dads type I mimics autoimmune diseases (late onset, certain other factors), they watch my sugar closely too. I don’t have any other risk factors for GD but in case it ever happens, I want to know as much as I can! Guess I know who to talk to
Married: 12/19/15
BFP: 9/4/17 EDD: 5/16/18 DD born 5/10/18 Postpartum Complications
Re: February Appointments
In fact, my OB is so happy with my glycemic control that he is fine with waiting until 36 weeks (instead of 34) to start NSTs, unless something changes in the next few weeks. We'll see if my dietitian agrees (that appointment is in half an hour).
As a plus size mom on a strict MNT program, compounded with these constant colds, I'm having trouble maintaining my intake weight much less gaining the 10-15 lbs they target. I'm down 10-12 from intake. My OB doesn't care but the diabetes team scolds me about it. I was diagnosed much later in my first pregnancy and lost 15lbs in 3rd tri. 😬 I have massive anxiety about weigh ins because it's not possible to work the MNT program (designed for someone 80+ lbs lighter than me) and not lose. But they don't have a program designed for someone my size, and I am actually eating healthfully for me and my baby. Cannot wait to get off this hamster wheel and resume just managing prediabetic tendencies!
would you mind explaining how the intake weight thing works? I’m just curious how they have you so carefully manage your sugars, which is so hard already, but also worry so much about your weight? My dads a type one diabetic and it’s SO hard for him to do any kind of weight loss because his sugars flux so much-much less while pregnant!
Married: 12/19/15
BFP: 9/4/17
EDD: 5/16/18
DD born 5/10/18
Postpartum Complications
BFP: 10/1/19
EDD: 6/12/20
The targets for weight gain in pregnancy actually don't change with GD (!!!) despite making significant changes to your diet and exercise. The average American diet has 250-300 g of carbohydrates per day. The recommended GD diet for my medical group is 125-150 g of carbohydrates a day, specific meal spacing, pairing carbohydrates with protein, and macro breakdowns for each meal. Studies have shown that 10-15 min of moderate exercise within one hour of eating can lower post-meal blood sugars, so my practice recommends this too. I expect that most significantly obese people (like me) who halved their carbohydrate intake, including giving up all sweets and many types of breads, and started walking 30-45 min a day, would probably lose some weight.
Hiding a bunch of diabetes info behind this spoiler tag because it's probably only interesting to me, @alli392, and anyone who gets diagnosed in the next month or two.
Compared to a Type I diabetic, I take a very tiny dose of insulin and in a way that doesn't practically impact glucose absorption from the foods I eat. Insulin use is correlated with weight gain for many diabetics, but since the way I'm taking it isn't connected to what/when/how I eat, it's less of a risk for me. The net is that I'm losing weight from diet changes and increased activity, and that weight loss outpaces the weight gain I have from pregnancy (mostly because I'm starting at such a large weight number). The systems and scientific studies aren't built to study or support people my size, so it's a poor fit for building expectations of what will actually happen for me. But most of the dietitians (and even my OB) haven't read the 30+ scientific papers that I read to understand GD in the context of my situation, so they follow protocol even when the protocol doesn't make sense for me.
Since I weighed 270 at intake, they'd like me to get up to 280-290 by delivery, but I'm currently 257-260 and likely to lose more. My OB doesn't care because the baby's on track, but my dietitian cares because I'm not on the charts they use to assess progress.
I had no idea that your body dumped more insulin in before dawn or that the difference between type I and type II (especially in pregnancy) was like that. I’m so used to how my dad manages his and has for years that it’s interesting to read how differently you have to handle yours.
Married: 12/19/15
BFP: 9/4/17
EDD: 5/16/18
DD born 5/10/18
Postpartum Complications
BFP: 10/1/19
EDD: 6/12/20