Help - gestational diabetes

[Phyllis Stein]

Hi all,

I know there's been a few threads about this lately, but really just wanted to know if anyone is/ has been in the same boat as me.

I've just been diagnosed with GD, but I don't fit any of the usual 'risk factors' - I'm skinny, vegetarian, exercise every day & have no family history (there's doesn't seem to be much I can change except to cut out all sweets etc).
Not only that, but the levels from my 1 & 2 hour glucose tests were sky-high - 10.7 & 11.4 respectively! I've just started monitoring my levels, and they're still quite high (mostly in the 7 range), even though I've started a low GI diet. I'm starting to think I'll need insulin soon at this rate. :(

Anyway, has anyone else had such high levels & managed to control them with diet/ exercise? Any advice etc would be sooooo appreciated right now.

[AM]

Hi Mahna Mahna :)

I have dug up some reading which MAY help a little...

Have a read of this article.

http://parenting.ivillage.com/pregnancy/pcomplications/0,,9z3m,00.html

over 12 pages...

and there is a whole heap here.

www.gentlebirth.org/archives/gestdiab.html

and here

www.childbirthconnection.org/article.asp?ck=10025

Here is an exerpt from an article by Michel Odent, (Womb Ecology) famous French Ob, he refers to Gestational Diabetes as being a diagnosis without a disease. He practises Evidence Based Care. :yelclap:

QUOTE:

Another routine screening practiced in certain countries is for so-called gestational diabetes. This is the reason for using the glucose tolerance test. If the glycaemia (amount of glucose in the blood) is considered too high after absorption of sugar, the test is positive. This diagnosis is useless because it merely leads to simple recommendations that should be given to all pregnant women. These are recommendations regarding lifestyle, particularly dietary habits and exercise. Dietary recommendations must focus on the quality of carbohydrates. The most useful way to rank foods is according to their ‘glycaemic index’. Pregnant women must be encouraged to prefer, as far as possible, low glycaemic index foods. A food has a high index when its absorption is followed by a fast and significant increase of the blood glucose level. In practice this means, for example, that pregnant women must avoid the countless soft drinks that are widely available today, and that they must also avoid adding too much sugar or honey in their tea or coffee. Glycaemic index tables of hundreds of foods have been published in authoritative medical journals. These tables must be looked at carefully, because the data they provide are often surprising for those who are still influenced by old classifications contrasting simple sugars and complex carbohydrates. Such classifications were taking account the mere chemical formula.

From such tables we can learn in particular that breakfast cereals based on oats and barley have a low index. Wholemeal bread and pasta also are low-index foods. Potatoes and pizzas, on the hand, have a high index and should therefore be consumed with moderation. Comparing glucose and fructose (the sugar of fruit) is a way to realize the lack of correlation between chemical formula and glycaemic index. Both are small molecules with six atoms of carbon and have pretty similar chemical formulas. Yet the index of glucose is 100…versus 23 for fructose. This means that pregnant women must be encouraged to eat fruit and vegetables.

The benefits of a regular physical activity in pregnancy should also be a routine discussion during prenatal visits, whatever the results of sophisticated tests. A huge Canadian study demonstrated that the only effect of routine glucose tolerance screening was to inform about three per cent of pregnant women that they have gestational diabetes (20). The diagnosis did not change the birth outcomes.

[benji's_mum]

I went through this with my pregnancy. I hated needles so I tried to maintain low levels through diet and exercise. It didnt work :no: so DH injected insulin into my thigh every morning for the last few weeks of my pregnancy.

Your dietition will usually give you a list of recommended food.

[sparkleymum]

I have GD and was started on insulin straight away but my results weren't as high as yours. I was only 0.2 above the normal range. I think all doctors are different in their approach, I would just follow whatever your Dr recommends.
My dr said she hasn't had a macrosomic baby (big baby, large birth weight) for years cause she keeps such tight control on her girls with diabetes. I'm on the special low GI diet and insulin.
Its scarey to start and I cried alot but I've been on it for a few weeks now and although I still flinch a little its sort of become normal now and not such a big deal.
The Dr said it is normal that your body will have more and more need for insulin as the pregnancy progresses, it is the sign of a healthy pregnancy. So maybe even if your just on diet now, there is a chance you will need insulin at some point. Dont be too worried, it is great that they picked it up and you can look after yourself and baby now. The most important thing is that you keep your blood sugars under control. if your noticing 2 or 3 high ones in a week you need to go back and see your specialist or else see your GP if you cannot get in touch with your specialist.

It will be ok, dont worry. So many people have GD with no risk factors, its just one of those things but it is so important for your babies well being that you know now and can start controlling it. It will all be fine and once baby is born you can put all this behind you.

When did you have your last scan? You will need regular scans to check on the growth of bubs. I just had one yesterday and bubs is exactly on the 50th centile so he's the exact size and weight for gestational age, so far so good, but it is early days for me yet, I have quite a few more weeks to go.

[Phyllis Stein]

Thanks everyone for your advice.

ApprenticeMomma, those links made fascinating reading, and affirmed what my instincts were telling me too. Thanks! :thumbsup:

sparkleymum, thanks for that. I haven't had many scans as yet - booked in for one at 33 weeks (for other reasons), and am hoping that's all I'll need. Bubs is measuring a few weeks ahead of dates, but that happens in 'normal' pregnancies too, so I'm trying to be optimistic!

[mumwiththree]

I found out today that I have Gestational Diabetes. Was hoping there was a thread on bubhub so I could talk to other mums about it but haven't been able to find one except for this one. You may recognise me from the FEB 08 thread.
I was told that I can't go full term but am unsure how early they will be bringing me on. I asked if this meant a C/S but she said they try and avoid them if possible. The baby is already 6 pound, well that was a week ago when I had my last scan.
I'm feeling a bit depressed about it. Don't know if that's a normal response.

[sparkleymum]

Hi mumwithtwo, sorry to hear about your dignosis, but on the up side you haven't long to go now and it will all be over. Do you know why they want you to have the bubs early? From your post I would think its because they think the baby might be big, but I'm not too sure. I guess you will be having another scan in a week or two to check on the growth, that could change everything. Bubs may be growing at a normal rate and they could be happy with that, so wait and see what happens. Don't panic just yet. I fthey do bring bubs out early it would only be cause thats whats best for baby.
So what have they recommended you do now? Are they going to put you straight onto insulin or diet?

I know its a really scarey thing to deal with and I cried for a week after I got diagnosed, so I totally understand how horrible you are feeling right now.

[mumwiththree]

Sparkleymum - I think they want to bring me on early because of the size of bubs. He was already 6 pound, and that was a week ago. And the nurse also said they like the birth to be in a controlled environment as they need to keep a check on my blood sugar levels during labour.
I have to see the Doctor on Monday, and also the diabetes clinic so hopefully I'll know more then. I just try and look at it on the bright side, that I will be meeting my little man a bit sooner.

[Oscar's mum]

The baby is already 6 pound, well that was a week ago when I had my last scan.

I would never ever ever trust a scan they can be completely off. In all honesty you could go on to have an average size baby.



I've just been diagnosed with GD, but I don't fit any of the usual 'risk factors' - I'm skinny, vegetarian, exercise every day & have no family history (there's doesn't seem to be much I can change except to cut out all sweets etc).

You would be suprised how many ppl diagnosed with GD do not fit the usual risk factors.

[sparkleymum]

you'll know a little more after you visit clinic. Do you know what your GTT results were? Although you may not remember a sthe numbers probably didn't make alot of sence to someone who didn't have diabetes before.

I think if bubs is big they do worry about that. Macrosomic babies (big babies) can be very big and chubby and look lovely but often have very underdeveloped lungs, that is why they keep a close eye on the babies weight. You will prob have another scan to check on the weight. If bubs is still measuring very big for dates then the baby probably is big and they would be right to act on that.

Like Oscars mum said sometime scans can be a little out, they are user dependant and you can get a scan from one person saying 5 lbs and another saying 6, but generally with macrosomia they can tell just by looking without even having to do the measurements that the baby is alot bigger than they would expect.

Follow the advice of the diabetic clinic, they wont put you worng, they are experts on this condition and will do the very best for you and your baby. Dont be scared, it will all be OK, you haven't long to go and it will all be a distant memory and you will have a gorgeous little baby in your arms.

[KiahsMum]

With your diet for GD remember all carbohydrates need to be moderated and that includes fruit and vegetables not just sugar. I managed to get to the last two weeks of my pregnancy on diet and exercise alone but bub only gained 10 ounces in the last 6 weeks as I was being overly fanatical about my diet as I wanted to avoid insulin.

I know there is a lot of stuff coming out about GD being a false diagnosis or it making no difference to mum and bub during pregnancy but I think it is safer to follow the doctor's guidelines with this as there is a lot of research showing issues with the lungs of babies whose mothers have GD. I also know that when my sugars were high I would feel sleepy and couldn't do much but when I kept them under control felt much better.

Some women find there is not a lot they can do to control their GD simply due to the way their hormones and insulin resistance ability reacts and need the insulin shots, it is nothing you have or have not done, simply the way your body copes.

As for needing to have an early birth my specialist (endicronologist) said I didn't need to deliver early, but would not be allowed to go overdue, mind you I had other things of concern at the time but apparently this is fairly standard with GD.

[mumwiththree]

Kiahsmum - Thanks for all the info. The diagnosis kind of explains alot of what Ive been feeling. Been so tired this pregnancy which is different to last time. And when everyone keeps telling me that at this stage I should be feeling great, I just want to sleep all the time.
And my hair has been awful, not what it usually is when I'm pregnant, which is shinier and thicker.
Went out the other week and walked past a Baskin and Robins and decided I wanted an icecream. Worst idea I've ever had. One of the flavours, (sounds gross now, but at the time sounded good), was cheesecake, with cheesecake chunks in it.
On the drive back home which was half an hour, I think we stopped about 4 times for me to throw up. Then when I got home, I felt so sick, had to take a panadol and lie down for an hour.
I think that the diagnosis explains why it made me so sick.

[Ky]

mumwithtwo ... I wouldn't worry too much about the size they are telling you your bub is already. My ds was born at 36 weeks weighing 13lb2oz after having had well controlled (with insulin) diabetes, so your bub is still doing fine at that weight!

OK ... now for my big ramble - please forgive me :ecomcity:

As for the diabetic diet - there are a lot of hidden carbs that can trick you into eating more than you realise. Also, some react differently in different people.

My diet has to be kept incredibly strict as even basmati rice, sweet potato, rolled oats and all pasta will send my sugars sky high. I am on huge doses of insulin and although it seems to me that I am approaching the plateau near the end of my pregnancy where I need less each day (still almost 300 units a day!), I still need to be incredibly strict.

The biggest risks to bub are that every time your blood sugars get too high, their little body produces an excess amount of insulin to get them to a safe level for bub and then at birth they end up taking ages for their body to adjust to making less insulin and therefore end up fighting low blood sugars for a while. They are also more likely to be surrounded by far too much amniotic fluid which causes a risk of premature rupture of membranes and cord prolapse. Bub may be born way too early and as the body has been concentrating on turning excess sugar into fat, their lungs may not be developed properly. There is also increased risk of bub being born with fluid around their heart.

My ds was in the neonatal unit for 26 hours after birth - he was actually quite healthy due to my having had steroid shots 6 weeks earlier and his lungs were well developed. He was still fighting low blood sugars when we were discharged, although it was being managed with low birthweight formula suppliments to ebm feeds. It's really hard having to do heel prick blood tests on your bub several times a day to keep an eye on their sugars, so the better your gd is controlled, the less of a chance you will have to go through this heartache.

Because I have had GD with all 4 of my pregnancies, I am now a type 2 diabetic outside of pregnancy (I'm also 38yo and they told me I would be by the time I turned 40) and my children are also at risk of having either GD (the girls obviously!) or developing type 2 later in life. I have made it a mission in life to teach my kids about healthy choices, to encourage exercise and to not be frightened if they ever need treatment. This doesn't mean that they don't have treats etc - it's just that we make them treats!

It's not all scary, doom and gloom.

I don't gain a heap of weight. Ideally, you would gain some weight over the course of your pregnancy whether on a diabetic diet or not. I lost 15kg each time with my first 2 pregnancies, the 3rd ended at 11 weeks and I had already lost 6kg at that point. I was being silly with my diet and not really restricting the correct things and as a result ended up feeling a bit unhealthy etc. This time (I'm now 38 weeks), I have gained nearly 10kg and have never looked or felt healthier!

The diet may be restrictive, but it isn't too expensive and actually can be a really tasy experience! Experimenting with different flavours and finding out the particular spices etc that lower the GI rating of foods can be fun! (cinnamon is wonderful!) There are times when you can have little treats, so you never fully go without - just keep in close contact with your diabetes educator/dietician/endocrinologist and they will let you know how you are going! I was even told just before Christmas to go out and be naughty a few times as I had done so well in the previous months! It was nice having permission to enjoy a few treats! That said, I really didn't feel like anything sugar laden or over the top in carbs, it just isn't part of what I crave any more!

There are some nice surprises ... some ice cream in small quantities is actually pretty low GI! Don't rely on packaging that states a product is low GI .. if there are more than 25g of carbohydrates per 100g of product, they are outside the low GI category and even if they are under the 25g limit, it makes a difference what the carb content is made up of.

A good dietician will give you a pretty comprehensive list of ideal, not so ideal and "please avoid" foods - try and get referred to one who deals exclusively with gestational diabetics as they are pretty cluey when it comes to the little quirks that are the added complication of fluctuating pregnancy hormones added into the mix.

OK ... I hope that I have managed to encourage rather than scare anyone ... it is really something that is pretty simple to deal with once you are into a habit/routine. You will find yourself feeling much better for it!

[Phyllis Stein]

Thanks for sharing that Elias - it's really helpful to hear stories like yours.

mumwithtwo - when I was first diagnosed with GD, bubs was apparently measuring 3 weeks ahead of dates. I've been eating really healthily since then, and my last scan (1 month after diagnosis) had bubs at exactly average weight for dates. Sooo, either the scans were way out (as others have suggested) or you may still have time to influence bubs final weight.

Luckily, they haven't mentioned inducing me early or anything like that. Unless I was 100%convinced bubs was "too big", I wouldn't be letting them anyway. Induction carries extra risks that I'd prefer to avoid if at all possible! Plus, those last few weeks to term are important for bubs lung development, especially those born to GD mums.

[Ky]

I am having this bub at 39 weeks by ecs.

Both of my others were born by c/s and there is no reason this time why bub should be born early ... in fact there are reasons why she should stay in there as long as possible (suspected severe heart problems) and she isn't going to be huge as I had much better education and support this pregnancy than I have ever had.

Gd doesn't have to be a big pregnancy complication - it is more like an inconvenience when you have the right support and attitude :)

[mumwiththree]

My biggest concern is that because I was diagnosed with only just over 4 weeks to go, is all of what I'm doing going to make such a drastic change that bub will be in a healthy weight range? Of course I'm still going to eat better and try and do all I can, but with only 4 weeks til I'm full term, I still worry.
I went to the clinic yesturday and spoke to the Diabetes Educator, the Diatition and a doctor.
When I was first called in to see the Diabetes Educator, there was another couple in there aswell. The Educator started taking us through the different pamphlets on a better diet when the ladies husband pipes up and says that they hadn't actually been told that she has Gestational Diabetes. So the Educator went out of the room to speak to someone and a doctor comes in. So I ask the doctor if she wants me to leave, she says no, then goes straight ahead and tells this poor couple, in front of me, that yes she has Gestational Diabetes then walks out of the room.
I couldn't believe it. So impersonal not to mention a breach of confidentiality! I appologised to the couple, but they said it wasn't my fault. So then the educator comes back in looking a bit surprised at how the doctor had handled it aswell.
After we had finished and before the Dietitian came in, I just said to her how bad I felt for her hearing this all in one day. At least I had the time over the weekend to get used to the idea.

I have another ultrasound booked in but not sure of when as I have to wait for them to send me my appointment by mail. Hopefully bub hasn't put on too much more weight since the last scan on the 4th of Jan where he was about 6 pound. I had to weigh myself yesturday which is something I haven't done much of, and discovered I've put on 17 kilos! Yikes! The most I've ever put on with my last two pregnancies were 12 kilos. Is this another common thing with GD?

[Ky]

Maternal weight gain isn't common, in fact it is more likely that you will gain very little or even lose quite a bit of weight.

I lost 15kg in each of my first 2 pregnancies and 6kg in my third. This is the first time I have gained weight and it has been approximately 10kg - my endocrinologist is really happy that I have actually gained this time!

At this point in your pregnancy, the need to control your blood sugars is less about the size of bub and more about bub being born with blood sugars in a healthy range rather than too low as they can get extremely sick because of it.

My ds looked like he didn't belong in the neonatal unit when he was born as he was so incredibly huge, but he was just as sick as the other babies as they were struggling to get his blood sugars even up to 3.0 - they were feeding him hourly on low birthweight formula with added glucose and it still took several days for his sugars to start stabilising.

Bub's weight is not the concern - I know you are the one that has to have the baby, but there really isn't anything you can do about it and really, hearing what your bub was estimated to weigh at your last ultrasound, it actually just sounds a little bit higher than normal, not really very big at all. Remember that the ultrasound usually has an accuracy to +/- 420g.

[mumwiththree]

Trying to eat the right things is trickier than I first thought. Yesturday, I kept thinking I was eating the right stuff but kept getting high readings when I checked my blood sugars.
I'm really trying coz I know I'm doing this for my baby, but it isn't as easy as first thought. Especially when I'm used to eating what I want and when I want. Finding I'm hungry alot.

[Ky]

It is hard to get used to what will keep your readings down ... I had to find out by trial and error that I really can't afford to eat rice, pasta, sweet potato etc. I also found that I tended to get pretty hungry a lot of the time until my body got used to the new routine.

If you want to pm me roughly what you eat ... I would be happy to make any suggestions etc. I am happy to offer any support that I can (at least until Sunday evening - my last day before I go to hospy!).

I'm having the opposite problem now ... my blood sugars are getting too low and I am having to adjust my insulin downwards each day ... it's just that I am at the end of my pregnancy when my body is needing less.

[sparkleymum]

Elias, at what point in your pregnancy were you diagnosed. I was diagnose very early on and take insulin at dinner time and bedtime.

For about 4 weeks now I have been on 4 units at dinner and 30 units at night and haven't had to adjust it at all. Is this normal? I was told that as pregnancy progressed my need for insulin would continue increasing but it seems to have stayed the same from about 25 to 29 weeks. Do you think this is OK?

[mumwiththree]

I looked up on the internet menu plans for GD, and got a site that has recommendations for when you go shopping. It was all based in Vic, but though the food would be the same in shops here in Brisbane, so I printed it out and took it with me today when I did the shopping. Took a bit longer but feel it was worth it. I now have things in the cupbourd, fridge and freezer I can eat. It's just making sure I eat the right amounts of these.
And I think as far as me putting on so much weight this pregnancy compared to my last two is because I was only diagnosed with 4 weeks to go til I'm full term, so for most of my pregnancy I've been eating what I want and when I want. Maybe you only lose weight or not put on alot during pregnancy if you know you have GD from conception, so you are watching what you eat throughout your pregnancy. Have I got this right?

[Ky]

Maybe you only lose weight or not put on alot during pregnancy if you know you have GD from conception, so you are watching what you eat throughout your pregnancy. Have I got this right?

I don't know ... I was diagnosed at 28 weeks (9 weeks to go) in my first pg and lost 15kg, at 30 weeks (6 weeks to go) in my 2nd pg and also lost 15kg, at 10 weeks (ended a week later) in my 3rd and had already lost 6kg and then at 9 weeks this time and have gained 10-12kg!

I think the only reason I have gained this time is that I have been given better advise and support than I ever had the other times. I have been on insulin every time and that doesn't seem to make a huge difference - I just know that I have probably been a lot better informed about diet and exercise etc this time than ever before.

At least there is not a heap of time left for us now ... :yelclap:

My dd is excited - she and her brother are telling anyone and everyone they meet that it is only 4 more sleeps until bub arrives ... but in private she tells me "only 4 more sleeps until you can stop your insulin, Mum" ... what a sweety :kiss:

[mumwiththree]

Well I was told at my last appointment last week that I wouldnt be able to go full-term, so I was expecting to be induced at around 38 - 38 1/2 weeks. Then at my appointment today, I had a doc who I think doesn't believe in GD. He pretty much scoffed at it. Then when I asked if I was still going to be delivering early, he laughed and said there was no reason for me not to go full-term.
Has anyone else been given different opinions as to whether they should deliver early or go full-term. It's very frustrating. I'm just waiting to see what I'll be told at my next visit to the doctors.
I don't mind going full-term, as that's what I should aim for so bub is fully developed (lungs). But because DH and I don't have any family here in Brissie, I have organised my Mum to be here for when the time comes, she can stay with DD and DS. Before I was diagnosed, she had booked her flight for the 6th of Feb, but then thought she would have to change it to be here earlier, then today I tell her not to change it. It's so hard not knowing if I'm coming or going.:hair:

[firsttimemum1]

Hi mumwithtwo

I had GD with my first pregnancy and my obstetrician told me he wouldn't let me go further than 39 weeks and booked me in for an inducement. I also had high blood pressure as well.

I was told by him it depends upon how well you are controlling your sugars. If the sugars continue to be high, then it is best to have the baby sooner because of their growth rate and your health. You can have a bigger bubby, which may make it harder for you to give vaginally. My sugars were under control but he still wanted me to have the birth at the 39 week. By the time I actually went in it was 39 1/2 weeks. Luckily, I came a few days earlier than the inducement date.

When I was seeing the Diabetes Educator, I also saw their Gestational Diabetes doctor, so really I was under the care of two doctors, diabetes educator and dietician.

a) How many weeks are you and are your sugars under control.

b) Have you spoken with your CHN or Diabetes Educator or the doctor on their team. When I was seeing the Diabetes Educator, I also saw their Gestational Diabetes doctor. So if you are seeing an educator, maybe you should ask to see if they have a doctor who deals with gestational diabetes (which I suspect they would because that would be the person to write the script for insulin should you need it).

I hope that helps

Shel

[mumwiththree]

firstimemum1 - My readings have been pretty good, and when I do get high ones, I know it's because I've eaten the wrong thing. I see the Diabetes Educator before I go in and see the doctor. I might ask at the next appointment, which is only 12 days before I'm due as to whether there is a Diabetes Doctor I can speak to. I'm in the public health system, so where I go for my appointments, you get what ever doctor you get, so I'm not sure if I can be picky.