Thursday, July 23, 2020

Facing the Prospect of Gestational Diabetes

Last month at my Ob appointment I took the dreaded glucose test. The one where you drink a super sugary mostly flat soda-like beverage and an hour later your blood is tested for blood sugar levels. So for the second time in my motherhood journey I failed. I was deeply upset but just assumed it was going to be another repeat from my first pregnancy.  

The first time I failed was for my first pregnancy twenty years ago. I returned a week later to take the 3 hour test. I was in good spirits and confident that I'd pass this one no problem. This is the test where you fast overnight then drink a twice as much sugary drink and have your blood drawn every hour for 3 hours after. It's a long dreadful day of sitting in a doctor's office, without food or drink. It is punishing hard for a pregnant woman to do, especially if she happens to have a robust appetite. I was so hungry and I suspect my blood sugar levels were so low that morning it was making me feel lightheaded and ill. I drank the beverage and waited. The first hour was fine. The drink filled in the lack of sugar (carbohydrates) in my system and I felt less terrible. They took the first sample and then I sat for another hour. By this point I was so hungry and thirsty I was feeling poorly. (This was done in the middle of summer so I was feeling very hot sitting in that stuffy waiting area.) I sat in the chair and my blood was drawn for the second time. I began to feel very bad. I told the staff in the lab I was feeling lightheaded and so thirsty. They disregarded my insistence of feeling terrible, laughing it off because drinking the glucose is so yucky. I sat in the chair and felt like I must have looked pale, I felt like I was very pale. I told them one more time by this point I knew I was going to pass out. The Lab tech was finishing up with my blood draw and that's when I very sternly told him I was going to black out. He smirked, rolled his eyes and made fun of me for being too squeamish about having my blood drawn. In his haste to get the next patient in he began pulling me to my feet trying to get me to stand up. Then everything went black. Next thing I knew I was on the floor with 10 medical personnel standing over me with horrified faces. They kept calling my name and asking me if I knew where I was etc. I remember yelling at them all for being so stupid and careless. I was furious and embarrassed. The Lab tech guy blamed me, accused me of not telling him I was feeling faint. I believe at this point profanity fell from my lips. I ended up having to stay there even longer to be monitored before I could go home. It was the worst experience of medical care I have ever endured. This is why taking the glucose test is such an anxiety filled task. (Oh! Yes, I ended up passing this 3 hour test and was cleared from having Gestational Diabetes for my first pregnancy.)

Being faced with taking another 3 hour test was not looking like a good way of spending my day. I strongly declined taking the 3 hour test. For one thing being pregnant and sitting in a doctor's office for 4 hours during a pandemic didn't sound like a good idea to me. What happens when you refuse the 3 hour test? For starters your doctor will just assume you have Gestational Diabetes and you will be sent to a Maternal Fetal Medicine specialist. Then you will need to have your blood drawn to test your Hemoglobin A1C levels. This is the blood test given to check for Type 2 Diabetes or pre-diabetes. You cannot do anything to change the outcome of this test. Your A1C levels will reveal how well your body has been able to process sugars in your blood for the past two to three months. They want to get a baseline to see if you may be pre-diabetic and not know. This is often the reason why some women develop Gestational Diabetes, they were already pre-diabetic. In my case my A1C level was in the normal range. That gave me hope that the failed glucose test was just a fluke and that I would be cleared.  


Earlier this month I met with the Maternal Fetal Medicine doctor. I was instructed to begin a two week blood sugar level (BSL) monitoring program. I was given a large packet of information about having a healthy nutritious diet, how to portion control, and how to read food labels. The nurse began to explain everything to me and stressed how important it is to eat a well balanced diet. This is where I began to feel shamed for a presumption of my eating habits. Precisely why women who have been diagnosed with Gestational Diabetes feel so terrible about themselves. I sat there in that room and felt such anger and frustration. I felt like I was being accused of eating loads of junk foods and terrible foods. I wanted to burn all the papers given to me and scream. Infuriated is a good description of my attitude. I am being completely honest here because women are chronically mistreated by medical staff about anything having to do with weight and diet management. I listened to the nurse as she continued to tell me how to read nutrition labels and how to make sure that I see the importance of portion control. I haven't felt like a surly teenager in years. At that moment, that is exactly how I felt, nodding my head and trying to look interested. I was given a prescription for blood sugar testing supplies. Once the nurse began to tell me how to use the glucometer I began to give her my full attention. I would need to test my BSL 4 times a day. Once at waking, then 1 hour after each meal: breakfast, lunch, dinner. She gave me a sheet to track my numbers and the target ranges I should be seeing. For fasting in the morning I need to be under 95 mg/dL, then 1 hour after each meal I need to be below 135 mg/dL. After the nurse finished her portion I met with the doctor. She was pleasant and friendly but I sensed that she had determined that I was pre-diabetic and in denial about my status. I left feeling disappointed and still frustrated. I went home and set to work learning about Gestational Diabetes. 

After the first week of tracking my BSL what became apparent was that it looked like I was out of control. What they didn't see was my diligent tracking of every bite of food and every sip of beverage I consumed. That was a week of experimentation. Trying various foods to see what would happen to my BSL. To them it looked like I had a disaster diet. I was told to follow the "diet" plan and track for another week and was instructed to seek the help of a nutritionist. I was conflicted with this instruction. I was angry because I knew that I had been able to keep my BSL within range when I ate the right balance of foods. I was also interested in seeing what I could learn from the nutritionist. From day one of this tracking I kept detailed records because I knew it would come in handy.

 I met with the nutritionist via a web meeting. I had sent her my spreadsheet of the food I ate, my BSLs, and the nutrition content of every thing. She was completely blown away by my organization with record keeping. With everything recorded she was able to tell me that my diet is NOT the problem. In fact she said I could show other women how to eat properly! Ahhh vindication! Based on her expertise as being a nutritionist for diabetics she told me that my diagnosis for Gestational Diabetes is going to be the result of my overnight fasting problem. Which means that the placenta is blocking my body's insulin controls. Hormones are running the show. 

At the second week follow up appointment I think that the doctor presumed that I was going to be a total wreck with consistently high BSL all day long. I gave her my spreadsheet to review. After consulting with the nutritionist and seeing my paperwork she agreed that my diet was not the problem. In fact she said that it was the farthest thing from being the problem. (Duh!) Based on my numbers it was revealed that my problem was with over night fasting. She confirmed that the placenta was the source of my blood sugar problem. And that means I have Gestational Diabetes. Darn! Unfortunately that meant I was going to require nighttime insulin injections. More needles. Off I went feeling a little bit victorious. My nutrition was optimal just as I had communicated to the doctor on our first meeting. That is what I wanted, validation that I was not eating poorly or being lazy or any other number of negative beliefs people have about diabetes. 

My journey is not over yet. I still need to keep track of my BSLs four times a day, and now with the nighttime insulin injections I have to keep monitoring my morning fasting levels. I have a feeling that my fasting levels are going to continue to frustrate me. 

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