GD information and support

preggoeggo2345 · April 2020

@kyrwyn Thanks again for your perspective and sharing your own experiences. It's reassuring to hear that you got through all the annoying stuff , while also working a very demanding job. Also funny to me how there seems to be pattern of dietitions and doctors disagreeing.

I think a lot of my worries about being pushed into a birth experience that I don't believe is best for us has to do with my misgivings about being bounced around by all the different providers at my OB/GYN's office and their wildly different takes on everything. My next appointment is with a MW, whom I've heard is wonderful and totally supports natural birth. I'm hoping we can build a good relationship and I can request to have all following appointments with her or the other MW, whom I have met and also seems great. This way, I'll feel like we are on the same page at least. I'm lucky in that I don't have any other complications thus far and baby is healthy and very active!!! Kudos to you for being so strong and brave in dealing with your challenges! We are all very fortunate to have your presence on this forum. Thanks!!!!

aes324 · April 2020

Thank you so much for this thread, it has been a big help to me. I also chose to start Metformin (to help my evening and fasting numbers) with the understanding I can change to insulin if it doesn’t work. I have taken it for 8 days now, and just had my 3rd day of passing numbers! I will say, my Dr warned me that it takes a few day for Metformin to build up in your system/take full effect (my google search said 3-5 days). I saw steady improvement, but it took 5 days to get all numbers within range. I did not experience the GI side effects I was warned about.

I have been re-classified as high risk only because I require medication to control the GD; if I could control it with just diet my status would not have changed at my OB.

kyrwyn · April 2020

@aes324 @sheshe3386 How are you ladies doing with metformin? Are your numbers looking good? Thinking of you!

@preggoeggo2345 @NikkiSings @hyperlynne (And anyone I missed) How are you doing? I hope everything's looking great for you!

aes324 · April 2020

@kyrwyn still looking good, I am a little afraid to say that I cheated and ate a higher carb count than I should have for lunch today and my numbers were still very much in range! I have my OB appointment appt and ultrasound tomorrow. How are you doing?

sheshe3386 · April 2020

@kyrwyn my blood sugars are looking better. I haven’t had any bad side effects either so I’m grateful for that! How are you doing?

kyrwyn · April 2020

@aes324 @sheshe3386 great news! I'm so happy for you both.

My fasting numbers are borderline (90-94) so I'm expecting an insulin increase soon. My breakfast numbers are slightly higher than the past month, but they should drop when my fasting ones do. They're around 100-110, so still perfectly safe.

Still counting days: 66 or fewer to go! Which means I'm almost 2/3 done (I had >180 days to go when I was diagnosed).

aes324 · April 2020

@kyrwyn what numbers do they have you targeting? I am supposed to stay below 96 fasting and 120 two hrs after meals.

I thought I was doing well, but the OB said since my evening and fasting numbers are still close to the threshold she wanted to go ahead and increase to twice a day metformin. She was confident that should be enough to get me through the rest of the pregnancy without needing to increase further or swap to insulin.

She also said that as long as my numbers stay in range like they currently are, she will probably let me go to 39 weeks. However, she said it’s likely at my age (35) that my blood pressure will increase towards the end and that may trigger an earlier date.

kyrwyn · April 2020

@aes324 My targets are below 95 fasting, and below 140 one hour after a meal (or 120 two hours after a meal). They really want me to test at one hour, so that's what I've been doing.

Since I'm on insulin, adjusting my dose is easier -- I just pull more into the syringe. Aside from the mental gut punch (even though I know why it's happening it still feeeeeeeels like failure to me), it's no biggie. I actually feel really lucky this time around because my prior pregnancy was before they relaxed the targets. We used to have to keep under 90 fasting and under 130 after one hour.

In my first pregnancy (I was 37), my blood pressure rose to borderline around 37 weeks. I was already doing non stress tests (NSTs) and they said as long as those continued to look good, they'd let me go to at least 39 weeks. At 37+6 baby failed an NST (insufficient fluid, and he was napping instead of being responsive), so I was sent to the hospital that night to be induced. He was born at 38 weeks on the dot! Even with this history (and being almost 40 now), they scheduled my repeat C for 39+1 and seem perfectly happy with that plan as long as my numbers stay fine. I'm on a low dose aspirin each day as a preventative measure. Fingers crossed that your numbers stay great and that you get the birth plan and experience you're hoping for!

sheshe3386 · April 2020

Ugh! My fasting numbers are creeping up again. I was 112 this morning. I’m feeling defeated and frustrated. All of my other numbers are fine but that fasting one doesn’t want to cooperate

kyrwyn · April 2020

@sheshe3386 Hang in there! It's not anything you're doing wrong. Hormones are on a huuuuge ramp right now and needing to adjust meds is totally normal. (But yes, it still feels awful and defeating. So sorry, friend.) Fasting is my pitfall too. Around 36 weeks things should stop getting progressively harder and plateau. Or even drop back a little. You're almost there!

aes324 · April 2020

@sheshe3386 I am glad I am not the only one struggling. I felt confident after my appointment, and then have had 2 bad days...

sheshe3386 · April 2020

They bumped me up to 1000 mg metformin at night now instead of the 500. I hope it starts working. These fasting blood sugars are playing games with me.

kyrwyn · April 2020

I'm keeping my fingers crossed for you both! Titrating medicine doses is frustrating. Hopefully everything normalizes soon and you can just think about maintaining until you're through. ❤️

NikkiSings · April 2020

Hi, thanks so much for tagging me to check in @kyrwyn. I was really pumped last week, because a nurse at our birth center told me a few weeks ago that I had to keep 2/3 my numbers within a good range to be 'OK,' and only 13% of my numbers were high (over 95 fasting and over 140 post-prandial). Note: My situation is that I'm low-risk and fine to birth at the birth center as long as we can manage GD with food and exercise.

I had my virtual 33 week appt last Thursday and turned in my numbers after...next day got a voicemail that my fasting numbers were 'high' (maybe 6 total since March 26th? Spread out between 96 and 101). They said they'd like to see me next week (34 weeks) ahead of my scheduled 36 week appointment. They were willing to do it virtual, but said I could come in if I wanted so I'm going in. I don't go many places these days and I'd just like to make eye contact with someone. Anyway! The receptionist who booked me didn't know more, but just said they wanted to see me sooner than 36 weeks. I'm doing my best to stay calm (thank goodness for anti-anxiety herbs!), but I am a little nervous I'll end up high risk and we'll be transferred out of the birth center. The good news is 1) I gave myself injections for INVOCell IVF back in September, so no biggie there and 2) I really love my OB and have actually missed her while being at the birth center! Anyway, long story but i should know more after my appointment Thursday. I was surprised to hear that 1-6 points above 95 is so concerning for fasting numbers. My post-prandials are pretty good for the most part, and I have to give my husband mad props for being awesome about both grocery shopping and cooking the past month or so. Thanks for listening and hope you're all well!

kyrwyn · April 2020

@NikkiSings Hopefully they just want to review and tweak your bedtime snack!

The cut offs for control are pretty all or nothing, which irks me in a million tiny ways as an analytical scientist... but... this is what happens when science is proceduralized for clinical practice. (A rant for a different time). I hope it's good news and minor changes for you. I know that you're in the highest point of your glucose regulation "challenge" if you're 33-36 weeks, so they probably just want to see you ASAP to make changes while those changes will be helpful. If it's any peace of mind, 36 is where my insulin dose stopped slowly climbing and actually got pulled back in my first pregnancy. You're almost to the end of the "ramp" up of hormones. Great job, Mama!

NikkiSings · April 2020

Thank you so much @kyrwyn! It means a lot that you are taking the time to respond and share your knowledge here. Grateful! 💗

aes324 · April 2020

@kyrwyn My next appointment isn’t for a week and a half, but the last 4 days I have had 2/4 numbers out of range. Should I wait for my appointment or call the nurses tomorrow? I am 30+2

kyrwyn · April 2020

@aes324 Did your medical team give you any guidance for when to call? Mine told me to call if I have three highs within a week in any category (fasting, breakfast, lunch, or dinner). Given what you've mentioned, I'd call and check in rather than wait. My diabetic management team can adjust my doses over the phone, which is much more convenient than having to go in. They may also review your meal plan and see if there's any suggestions or substitutions they can help you make to stay closer to target. Good luck! ❤️

sheshe3386 · April 2020

@aes324, I had 3 high fasting blood glucose numbers and contacted my office and they gave me instructions to increase my metformin then. We communicate through e-mail so it’s a little easier and more accessible but I’d give it a shot. You’re being responsible so I’m sure they’ll actually be happy you contacted them.

aes324 · April 2020

Thanks @sheshe3386 and @kyrwyn! I emailed them this morning and they responded saying that it has only been 4 days since I changed my Metformin dose and it takes a while to go into effect. I feel like I should have seen some indication of improvement by now, but I will give it a couple more days.

kyrwyn · April 2020

@aes324 Thinking of you. I hope your numbers improve as your new dose kicks in.

NikkiSings · April 2020

Hello! Just an update that I had an in-person appointment today to discuss numbers. One of the midwives and a midwife student reviewed my last week of numbers, which had 2 'high fasting' numbers (96 where the want 95). My postprandials were all good (woot!!). I left feeling so much better! I believe they want me to call if I have 3 or more over w/in the same category, and I'll be booking a virtual appt in a week to check in again. Bonus, I got to hear baby's heartbeat, which I hadn't since mid-March.

Hope you're all well!

kyrwyn · April 2020

Hi @NikkiSings ! I'm glad your appointment went well, and that you've got more guidance on your numbers. FX everything keeps looking good. You're doing an awesome job, Mama!

aes324 · April 2020

I had another check-in today. Dr. was really happy with both blood sugar numbers and blood pressure numbers. She said if I keep them in range I should be able to go to 39 weeks! Last visit was the only time I have had elevated blood pressure, but she had then said it would probably be closer to 36. 39 sounds much better

How is everyone else doing?

kyrwyn · April 2020

@aes324 That's wonderful news! I'm so happy for you! I had a check in this morning and everything looks good, too. My NSTs got pushed back by two weeks, so I don't have to start them until 36 weeks and I "graduate" from managed diabetes care the same week and then just have to call in if my numbers are out of range instead of checking in every few weeks. We're all so close!

NikkiSings · May 2020

Yay @aes324 and @kyrwyn! I had a good check-in yesterday too. My 36-week appointment is in person next Thursday.

This week I learned smoothies don't really work for good numbers, even if they have a lot of protein in them. Live and learn! Happy Friday.

knottie5f87c3dab44057e4 · May 2020

Why woman on insulin get induced

aes324 · May 2020

just curious, what meters do you guys use? I have the one touch ultra2, and just recently saw several blogs about how inaccurate it can be...

kyrwyn · May 2020

@aes324 I have an Accu-Check Guide, previously I had a OneTouch Verio ... while meter accuracy has improved somewhat between my pregnancies, you're still looking at a 10-20% measurement inaccuracy on individual readings in the post-prandial ranges we're testing for. So, scientifically speaking, "not great." But all of the ACOG recommendations for management have been built with this imprecision in mind and it's why they look for trends (3 highs in a week) rather than single point measures out of bounds.

Somewhere in your meter's user manual are the specifications for accuracy, and instructions on how to calibrate it -- which we also never do as GD patients. As an analytical scientist, this drives me absolutely bonkers. I just try to keep my head down and not try to analyze the methodology too hard, as GD will be over for all of us soon.

Knottie -- That's a question you really should discuss with your care team. Generally speaking, women whose GD is managed through medication (insulin, metformin, glyburid, etc) are considered to have poorer glycemic control than those whose GD is managed by diet and exercise alone. Poor glycemic control is associated with higher risks of other complications, and with various challenges for baby. Medical guidance does not yet distinguish between medication used to control fasting impairment (overnight only) and medication used to manage postprandial response.

Usually these additional potential risks are managed through added screening and appointments, so your care team can identify problems early and intervene or recommend an early delivery. This is where your medical group and OB's practices come into play. If they routinely induce at a certain gestational age with no other indicators, you should ask why and have them explain the medical research or literature that backs that position. My medical group does not have a blanket policy about inducing GD patients (with or without insulin management) at a given number of weeks, but they do perform added screenings and any problems uncovered during those screenings might lead to inducing. I hope this helps.

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