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June 2020 Moms
kyrwyn
member
GD information and support
kyrwyn
member
I'm starting this thread as place to share information regarding gestational diabetes and its management. First off, I'm so sorry you have to be here too. Secondly, you are a strong, badass Mama and you will totally get through this. 
A bit about me: This is my second GD pregnancy. I was diagnosed in late 2nd tri with DS1, and in 1st tri with this pregnancy. Between pregnancies, I was diagnosed as prediabetic and had been managing my A1C through diet and exercise. I have a BS in Biochemistry and an MS in Data Science (lots of statistics) and a professional background in medical devices and diagnostic development. The biological pathways involved in glucose management, study design and interpretation, and how medical testing devices are built and deployed (as well as medical tests) are all very familiar to me. I choose evidence based (meaning scientifically supported) viewpoints whenever possible to inform my choices.
What is GDM?
Gestational diabetes mellitus (GDM or GD) is diabetes that first presents during pregnancy and may go away after pregnancy. It is a metabolic disease similar to Type 2 diabetes, as opposed to an auto-immune disease like Type 1. As pregnancy progresses and the placenta grows in size, the placenta secretes more hormones. These hormones contribute to insulin resistance, making your body less efficient at using the insulin you make. Around 26-28 weeks, you need 2x as much insulin to cover your glucose regulation than you did pre-pregnancy. At 36 weeks, you need 3x as much insulin. In up to 10% of pregnant women, our bodies cannot either create enough insulin to keep up or cannot use what we do make efficiently enough and this results in GD.
What did I do to cause this?
Nothing.
Even if you've been a couch potato for the last 6 months, eating chocolate and french fries with abandon, this is not a "lifestyle choices" disease. While risk factors include age and BMI, the most influential risk factors are tied to family history and pre-existing conditions. Also, the jury is still out on whether obesity causes insulin resistance or if insulin resistance causes obesity -- we know they're correlated, in that obese people are more likely to have Type 2 (or pre-) diabetes, but we don't yet know WHY. And yes, maternal age is a factor. However, the study that showed age is related to GD diagnoses suggests a cutpoint of 25 years old. Meaning that all soon-to-be moms who are older than college students have an increased risk of GD.
What do I do now?
You'll be given tools to help decrease the stress on your metabolism -- either through managed nutrition and exercise, or with additional medication -- and to monitor your blood sugars. I'll be honest, the diet and exercise and testing is annoying and restrictive, and I hate poking myself multiple times a day too, but the worst part of GD is emotional, social, and logistical. Give yourself a lot of space to feel what you need to feel, and to bow out of food-based activities that might make you feel deprived or resentful. Rally your supporters (hopefully your partner is on board) and keep in mind that this is an intense but short struggle. In my first GD pregnancy, DH went on a nightly after dinner walk with me EVERY NIGHT until baby was born and ate what I ate whenever we were together. (He lost 10lbs.) This pregnancy, he takes almost every toddler bedtime so I can walk and he eats what I eat when he's home (with more leeway, since I feel less strongly about other people eating things I can't have this time around).
Don't:
Compare yourself or your management plan to other diabetics. Type 1 and 2 diabetics have entirely different control targets and control philosophies than GD patients. While they are trying to maintain safe-for-them blood sugar levels to minimize long-term side effects, you'll be trying to mimic entirely normal non-diabetic control. Many pre-diabetics and Type 2 diabetics are managed by their hgA1C -- a test taken a few times a year that approximates the average blood sugar level over the past 8-12 weeks. GD is managed through fasting and post-meal tests, every day, until the baby is born. Averages mask a lot of sins... Individual measurements leave little wiggle room. Additionally, the GD control targets for fasting and post-meal tests are significantly more restrictive than for Type 1 or 2 diabetics. Non-pregnant people also have more leeway to experiment with artificial sweetners, etc, which may not be approved for use during pregnancy.
Force yourself to see the bigger picture. My dietitian tells me a lot about "learning lifelong skills" and I couldn't hear it in my first GD pregnancy. It's completely okay to absorb the info you need to get through this pregnancy, and then go back and revisit things if you need or want to later.
Some Food Information Resources to Get You Started
I'm in California, and our GD patient/provider education program is called "Sweet Success". Here are some resources from the patient education site:
MyPlate for Gestational Diabetes: https://www.cdph.ca.gov/Programs/CFH/DMCAH/CDPH%20Document%20Library/NUPA/MyPlate-Handout-GestationalDiabetes.pdf
Food Guide: https://www.cdappsweetsuccess.org/Portals/0/Documents/Nutrition/Food%20Guide_Eng_web.pdf
The Food Guide has a couple pages about serving sizes for various foods. This was the most valuable handout I got from my dietitian the first time around!!!!
For your reference until you meet with your care team, my meal targets (grabs of carbohydrates) are:
Breakfast: 15g
AM Snack: 15-30g
Lunch: 30g
PM Snack: 15-30g
Dinner: 30-45g
Bedtime Snack: 15-30g
This equates to about 150g (120g-180g) of carbohydrates per day. Generally they will advise no milk/yogurt or fruit before lunch.
A bit about me: This is my second GD pregnancy. I was diagnosed in late 2nd tri with DS1, and in 1st tri with this pregnancy. Between pregnancies, I was diagnosed as prediabetic and had been managing my A1C through diet and exercise. I have a BS in Biochemistry and an MS in Data Science (lots of statistics) and a professional background in medical devices and diagnostic development. The biological pathways involved in glucose management, study design and interpretation, and how medical testing devices are built and deployed (as well as medical tests) are all very familiar to me. I choose evidence based (meaning scientifically supported) viewpoints whenever possible to inform my choices.
What is GDM?
Gestational diabetes mellitus (GDM or GD) is diabetes that first presents during pregnancy and may go away after pregnancy. It is a metabolic disease similar to Type 2 diabetes, as opposed to an auto-immune disease like Type 1. As pregnancy progresses and the placenta grows in size, the placenta secretes more hormones. These hormones contribute to insulin resistance, making your body less efficient at using the insulin you make. Around 26-28 weeks, you need 2x as much insulin to cover your glucose regulation than you did pre-pregnancy. At 36 weeks, you need 3x as much insulin. In up to 10% of pregnant women, our bodies cannot either create enough insulin to keep up or cannot use what we do make efficiently enough and this results in GD.
What did I do to cause this?
Nothing.
Even if you've been a couch potato for the last 6 months, eating chocolate and french fries with abandon, this is not a "lifestyle choices" disease. While risk factors include age and BMI, the most influential risk factors are tied to family history and pre-existing conditions. Also, the jury is still out on whether obesity causes insulin resistance or if insulin resistance causes obesity -- we know they're correlated, in that obese people are more likely to have Type 2 (or pre-) diabetes, but we don't yet know WHY. And yes, maternal age is a factor. However, the study that showed age is related to GD diagnoses suggests a cutpoint of 25 years old. Meaning that all soon-to-be moms who are older than college students have an increased risk of GD.
What do I do now?
You'll be given tools to help decrease the stress on your metabolism -- either through managed nutrition and exercise, or with additional medication -- and to monitor your blood sugars. I'll be honest, the diet and exercise and testing is annoying and restrictive, and I hate poking myself multiple times a day too, but the worst part of GD is emotional, social, and logistical. Give yourself a lot of space to feel what you need to feel, and to bow out of food-based activities that might make you feel deprived or resentful. Rally your supporters (hopefully your partner is on board) and keep in mind that this is an intense but short struggle.
In my first GD pregnancy, DH went on a nightly after dinner walk with me EVERY NIGHT until baby was born and ate what I ate whenever we were together. (He lost 10lbs.) This pregnancy, he takes almost every toddler bedtime so I can walk and he eats what I eat when he's home (with more leeway, since I feel less strongly about other people eating things I can't have this time around). Don't:
Compare yourself or your management plan to other diabetics. Type 1 and 2 diabetics have entirely different control targets and control philosophies than GD patients. While they are trying to maintain safe-for-them blood sugar levels to minimize long-term side effects, you'll be trying to mimic entirely normal non-diabetic control. Many pre-diabetics and Type 2 diabetics are managed by their hgA1C -- a test taken a few times a year that approximates the average blood sugar level over the past 8-12 weeks. GD is managed through fasting and post-meal tests, every day, until the baby is born. Averages mask a lot of sins... Individual measurements leave little wiggle room. Additionally, the GD control targets for fasting and post-meal tests are significantly more restrictive than for Type 1 or 2 diabetics. Non-pregnant people also have more leeway to experiment with artificial sweetners, etc, which may not be approved for use during pregnancy.
Force yourself to see the bigger picture. My dietitian tells me a lot about "learning lifelong skills" and I couldn't hear it in my first GD pregnancy. It's completely okay to absorb the info you need to get through this pregnancy, and then go back and revisit things if you need or want to later.
Some Food Information Resources to Get You Started
I'm in California, and our GD patient/provider education program is called "Sweet Success". Here are some resources from the patient education site:
MyPlate for Gestational Diabetes: https://www.cdph.ca.gov/Programs/CFH/DMCAH/CDPH%20Document%20Library/NUPA/MyPlate-Handout-GestationalDiabetes.pdf
Food Guide: https://www.cdappsweetsuccess.org/Portals/0/Documents/Nutrition/Food%20Guide_Eng_web.pdf
The Food Guide has a couple pages about serving sizes for various foods. This was the most valuable handout I got from my dietitian the first time around!!!!
For your reference until you meet with your care team, my meal targets (grabs of carbohydrates) are:
Breakfast: 15g
AM Snack: 15-30g
Lunch: 30g
PM Snack: 15-30g
Dinner: 30-45g
Bedtime Snack: 15-30g
This equates to about 150g (120g-180g) of carbohydrates per day. Generally they will advise no milk/yogurt or fruit before lunch.
Re: GD information and support
I'll write up some tips for you as soon as I get a chance. The most important thing is to make sure your lancet device has an adjustable depth gauge, and start with the absolute lowest setting. The second most important thing is to use the SIDE of your finger pad, not the center of your fingerprint. I can get all 4 sticks for a day out of one finger without having residual pain. That gives my finger 7-8 days to heal fully before I come back to it. (I skip over my thumbs)
Wash your hands with soap and warm water (warm matters) and skip the alcohol wipe.
Reasoning: Warm water increases blood flow, and the water softens your skin while the alcohol dries it out and tightens it. For finger sticks you don't actually need the alcohol wipe, unless you have zero other options. I will even rinse my previously-washed hands with water from my water bottle over using an alcohol wipe when I have the opportunity.
Rubs your hands and milk your fingers or whatever it is you do to get blood into your fingertips BEFORE you stick yourself. It's way easier than trying to do the same while also avoiding the tiny droplet you're nursing up to size. (There is some data that milking your fingertip to produce a blood droplet biases the glucose readings. Take this with a massive grain of salt because the measurement inaccuracy of capillary blood based glucometers is usually +/- 10-20% at post-prandial levels and GD management targets and protocols already have to deal with this uncertainty.)
If you're scared about it hurting, pinch your fingertip where you intend to stick yourself with your nails from the other hand for a little bit, then do your fingerstick. I usually find that the "ouch" from pinching myself overshadows the "ouch" from the stick.
The blood droplet you need for your test kit is probably significantly smaller than you think. Mine's 0.4 microliters. Read through your test device's manual to see what it says. Once you figure out what that droplet size looks like on your finger, you won't spend a lot of time and sanity trying to punch bigger holes in yourself to get bigger droplets.
Keep a folded paper towel in your test kit. I've never had a fingerstick that just closed itself over magically with a little bit of time and pressure. Also, I dislike bleeding on stuff. I tear off tiny pieces to press against my finger afterwards and one paper towel last a long, long time that way.
Use a new lancet needle each time. (Eh...) I was religious about this in my first pregnancy but now I think I've used the same needle for the last week (28 sticks)... so... find what works for you. I use a much lower depth setting this pregnancy, and I'll restick if I have to. Last pregnancy I didn't want to have to stick myself twice for anything, so I was willing to have it hurt more if it meant I'd be done for sure. Choose your poison.
I keep an empty water bottle in my car for when I have to test "on the road" ... obviously less applicable now that we're all safer at home, but a tip for the future.
I have a biohazard container for sharps that I use for my insulin needles. In theory, I schedule a drop off with the county, hand over the container and pay the disposal fee. But I still have my sharps from my first pregnancy on top of the tallest cabinet in my house ... because when I was done I just effing didn't want to deal with it.
If you just started testing, they'll hopefully give you a bit of leeway to tweak your diet and exercise to figure out what works for you. Everyone tolerates different carbs in different ways. I can have potatoes but rice KILLS ME on my numbers. My mom? Had to give up potatoes in her early 60s because she couldn't tolerate them anymore.
I tend to undereat on the target carbs slightly and walk 20 min after each meal, because walking can drop my number 10-30 points over not walking. Nothing I do (except taking my meds) makes a damn bit of difference on my fastings.
I have monthly growth scans too. It's routine protocol for GD pregnancies. You'll probably have NSTs closer to go time too. Lots of checking in on both of you! Try not to feel guilty about whatever's happened up to this point. You just take care of yourself, work the program, and the rest will follow.
I found that after about a month the sweets cravings died down significantly. It's a rough first month though. Fruits started to taste much sweeter to me and filled that gap pretty nicely. I hope you're able to find sugar free alternatives and sweet-enough snacks to get you through. How many weeks do you have to go?
Things are going well for me. My numbers are holding steady, despite being in the hormonal ramp up. I'm keeping my fingers crossed that I can keep my insulin dose low (it's 18 units right now) for the next 7-8 weeks and then I should be around the point where I leveled off and even started to drop back last pregnancy. I'm selfishly sort of glad that the big Easter celebrations got cancelled, so I don't have to sit around piles of candy and repeatedly test my willpower and resolve.
The good news is that it doesn't take much exercise to help out your numbers, so your 1-2 laps are probably awesome for your sugars!
Let me know if you want a count down buddy (95 days down, 80 days to go over here!). Knowing there's an end in sight (and your favorite foods will return!) is something to celebrate.
@sheshe3386 Back to normal (87) today. Phew. Maybe it was just all the quarantine stress catching up with me and a poor night's sleep. I have to send in my numbers again next week, so we'll see what they say then. ❤️ I'm extra grateful that they widened the fasting range between my pregnancies. Last time around 90 and higher was "high"... This was the source of so many tears.
i made the mistake of having a piece of pizza for lunch bc some doctors brought it in for the nurses and I didn’t have time to get something else and my after lunch blood sugar was 150. Dang it! I miss being a normal human lol. I’m really grieving the loss of food already and I still have like 10 weeks left
I really had to set myself up well with home packed lunches when I worked somewhere with communal food during GD. It's so hard to resist. And just about nothing that's quick and easy to grab has the right macros. Thank goodness for all the keto people who sprung up in the last year or so, so there actually are some non-salad options out there!
The food loss/restriction grief is real. And it may stick in weird ways even after you can have your favorite foods back. It took me about 6 months after my first was born to rehabilitate my relationship with food after GD. The good news is that IF you ever need this info again sometime in life, you'll have a head start on it. During grad school my A1C slid into the prediabetic range, but I had it back to normal within 3 months by making far less extreme tweaks than GD requires.
Notes on insulin injections: They're not always entirely painless, but the needles are very short (8mm) and super fine gauge. Most of the time I only feel the tip of the needle against my skin and maybe the first 0.5mm of it moving in. In 100+ injections this time, I've only bled once. If you're only slightly high, you'll be injecting very small doses (mine is currently 180 uL) so you don't feel a bolus under your skin.
You've got 60-ish days to go (by the time insurance fills your meds, etc). Go with whatever feels best to you!
The dietician said that some people eat so little sugar, especially high fructose corn syrup, like is in the Glucola drink, that they get a bad reading during the 1 hr or 3 hr tests, that their bodies just can't process it well. So, if I don't drink that nasty stuff or anything like it, which I have no interest in doing, I have no problem (Sidenote: sweets have been my biggest aversion since I got pregnant, even just looking at candy or a cupcake makes me puke). My doctor's office seems to disagree and continue to treat me like I have GD. I understand that GD just happens with some people and if my results seemed to show it, I would be okay with accepting that diagnosis. But I feel this is a waste of time and adding very unnecessary stress to my already stressful life. To add to the problem, my OB/GYN office has disappointed me in their care over the course of this whole pregnancy (like forgetting to order the Glucose test!). Each appointment, I see a different provider who shuffles me in and out the door within 5 minutes tops, just takes a measurement, looks at my chart and makes zero effort to get to know me, ask if I am okay or have any questions or concerns. When I tried to discuss why I believe the GD diagnosis should be disregarded and what the dietician said, they shut me down immediately. Now I am getting really scared that this "high risk" flag will be stuck to me unfairly and I will continue to be treated like a number not a person during the last few weeks of this pregnancy and into delivery. This office is the only OB/GYN in my whole county thanks to living in a rural area, so no chance of changing providers.
Any advice I can get from this group as to what GD normally looks like and if/how anyone has dealt with a false diagnosis would be amazing!
Forgive me for not tagging you. I hope you come back to read this. If your numbers are good and your meals are naturally compliant, then the only real change to your lifestyle will be the 4 tests per day and logging your food -- which are stressful, I get it, but should be on the manageable side of full-on GD treatment. Generally speaking the risk of not monitoring you with a failed OGTT is higher than the risk of poking yourself an annoying number of times a day, and that's how your OB's office is probably viewing things.
The additional care that comes with late 3rd tri GD pregnancies that are NOT insulin or medicine-managed is usually an additional growth scan, and possibly NSTs (though it's unlikely they'd be more than 1 per week with the current medical situation), based on ACOG guidance. You'll probably meet with a diabetic counselor, who will keep confirming your opinion that this is annoying BS. They'll probably watch you more carefully for pre-eclampsia and may suggest you take a low dose aspirin with your prenatals. As long as everything keeps looking fine, you're just one of the up to 10% of moms who get dinged with this.
My medical group doesn't have additional restrictions on GD patients in delivery unless they're insulin managed (the only medicine they've approved). So it really shouldn't limit your delivery options. And most GD cases resolve with delivery, so there's not necessarily a lasting stigma or healthcare flag though you are statistically more likely to develop some form of insulin resistance or diabetes later in life (which isn't an absolute surety, it just means to have your A1C checked at your physical and worry about it if it ever comes up).
If the cost of testing supplies is a hardship, you can bring that up with your provider. Diabetes testing isn't cheap! They may have programs to help.
If you're 33 weeks then you have 7 more to go! There's also still 3-4 weeks of ramp up in insulin needs as hormones from the placenta increase throughout late pregnancy. If you make it to 37 weeks without seeing your numbers rise, you are fortunate and very likely off the hook for any post-delivery concerns. Best of luck.
I get what you are saying and will continue to do 4xday pokes just to make sure they stay off my back. It's just really hard for me personally, as I work with my hands a lot since we run a farm and its been super busy lately, even during this Coronivirus crisis (only difference is now I work 50 hrs/week vs. 85 hrs/week before). Glad to hear, though, that this "flag" shouldn't hinder my birth options! Hopefully, that remains the case as I have had to also fight with them to understand that I believe that I am at least 2 weeks farther along than the due date (had only been off of birth control for barely 3 months and cycles were not yet regular when we got pregnant). Nausea of first trimester went away at 9 weeks, first kicks felt at 12 weeks, genetic screening was abnormal but fine at follow-up test (common issue if pregnancy is farther along than supposed to be at test), 20 week anatomy put baby in 97th percentile for size...all things that match due date being too far out, which half of the providers I've seen at the office agree is probably the case. So, if my baby seems large in the lead-up to the due date, I'm afraid they will pressure me to have c-section or induce out of fear that he's so big b/c I have GD, not because he is 2 weeks older than they think and perfectly healthy.
In my past experience (in California), there was still a huge push for vaginal delivery regardless of your GD status. I was induced due to rising blood pressures, a failed NST and low amniotic fluid, but even when I asked I didn't get to skip being induced and go straight to the c-section. I happened to tolerate all of the meds during my induction poorly, which has nothing to do with GD, and ended up at an emergency c.
During my first pregnancy I worked in a biotech lab. Having to completely get out of my PPE, wash hands, find a compliant snack or meal (then walk or test as necessary), get back in all my PPE, and get back at the bench without compromising my experiments was a massive pain in the butt. It's a logistics nightmare. I'm so sorry you have to live with it for the next couple months.
My GD dietitian and my OB often disagree, FWIW. It was intensely annoying in my first pregnancy, but this time around they seem to just grumble at each other across interoffice email and leave me alone for the most part. For example: my dietitian is upset that I haven't gained weight, my OB is ecstatic that I'm at a healthier weight than last pregnancy and does not at all care if I don't gain. Who knows, it may work out in your favor! If you get out of the dietitian appointments, great! Maybe you can just scan/photograph your numbers and email them in to check in if your OB insists on dietitian monitoring but your dietitian insists you don't need to come in. Coronavirus has opened up some great telehealth options I didn't have last time!
I will say that my OB doesn't like to let GD patients go past 40 weeks. Frankly, I was SO OVER dealing with GD that I also didn't want to go over 40 weeks either. My first came at 38 weeks on the dot and my second has a scheduled c planned for 39+1 (if we make it that far). But again, I was induced for a medical reason regarding the continued safety of my pregnancy for my baby and not just because I was a gestational diabetic.
That said, metformin does have side effects that get better over time. The primary side-effect is gastrointestinal discomfort—I couldn't eat very much in the first few weeks. Insulin may also have side effects, though, I'm simply not aware.
I am a 2nd time Gestational Diabetic and have found this 2nd child and it some aspects its been easier but in many aspects its been so much harder because of lack of support and just being nervous to hit up a grocery store to make this more manageable. I have had much more difficulty keeping my numbers low. I am getting my after meal numbers on track with extra walks since I'm working from home + watching my three year old son but the past two days,my fasting numbers have been high which NEVER happened with my first one.
Few questions:
1) is anyone else finding that the stress of quarantine is causing their numbers to rise? (Maybe just me or wishful thinking)
2) if anyone else had to go on insulin for fasting numbers, what does that look like? is it just a shot at night?
I was a big baby when I was first diagnosed with my first little one but got used to the finger pricks after a week or so. Is the insulin hard to get used to?
65 days and counting!
I definitely have higher stress days and see it reflected in my numbers. But I also run higher when it's hot outside, when I've slept poorly, when my anxiety is peaking, etc. I had a check-in with my dietitian today and she said that safer-at-home is causing stress (can raise your numbers) and food availability issues for a lot of the GD moms she talks to. A lot of pantry staples aren't exactly diabetic friendly!
First off, high fasting numbers are not caused by anything you can do wrong. It's purely a hormonal thing. All the walking in the world won't fix it, so I hope you can give yourself some grace and know it's just crappy luck. @sheshe3386 and I are right there with you.
I've been on insulin in both pregnancies for fasting numbers. I was a total and complete wreck at the beginning in my first one, but now it's just another annoying aspect of GD. I will still be celebrating when it's over. I give myself one injection of long-acting insulin at 10pm with my bedtime snack. I use syringes, not pens, so I measure my own dose. The needles are really short (8mm) and super fine. If I don't have my glasses on, I can't even force my eyes to focus tightly enough to see the needle. I am hyper-sensitive for touch, but even I can only feel the tip of the needle when it rests on my skin and in the first 0.5mm of going into my skin. If you keep your insulin at room temperature, you probably won't even feel the tiny volumes you'd be injecting as they move in.
The first time around I was CONVINCED that I could feel my injection site the next day and super whiny about it. So one day I marked the spot next to my injection with a pen... just so I could PROVE to my GD team I could feel it. And what I found is that the soreness I was feeling the next day was some totally normal other pregnancy pain and it was 6+ inches from my injection site. Like so many other things, giving yourself sub-cutaneous injections is a huge mind game.
I'd say it took me about a week to not be as big of a baby about it. And about a month and a half to be more or less over it. I've done over 100 injections this pregnancy and most of what I complain about in the moment is how it's hard to get my arms around my bump these days to target my squish love handles.
It takes awhile to titrate your dose. They'll start low and move you up 10% or 20% at a time until you find a dose that controls your numbers. Also it's normal for your fastings and insulin needs to rise as you progress in pregnancy. What works for you now many not work next week -- again, this is not some failing on your part, it's hormonally driven and outside your control. Insulin needs usually peak between 36 and 37 weeks and may even drop down after that.
I hope this helps.