Tuesday, July 26, 2011

Gestational Diabetes

Well, I finally have an official "problem" with this pregnancy. The test says that I have gestational diabetes. But unless someone can convince me that the standard interpretation of the test trumps my history, experience, and other aspects of the test, I don't accept the diagnosis.

I've had a problem with hypoglycemia all my life - that's low blood sugar, due to my body's overreaction and overproduction of insulin after I consume sugars. At least, that's how I've diagnosed myself, since no doctor seems interested in testing me. I know I have a problem with sugar because if I eat too much sugar (or simple carbohydrate) without protein and fat, I crash about two hours later. And when I crash, it's very, very bad. All my symptoms are in-line with those of low blood-sugar. It's still a serious problem that has to be managed, but it's not due to pregnancy, and it's not diabetes. The glucose tolerance test just seemed to confirm my self-diagnosis.

So here's how it works. You fast for eight hours. Then you have a blood draw. Then you drink a huge, super-sugary drink. Then you have your blood drawn at one, two, and three hours after consuming the glucose. If two or more of your blood-sugar levels are above a certain threshold, then you are diagnosed with gestational diabetes.

My levels were:

  • fasting: 68 (normal is less than 100)

  • one hour: 193 (normal is less than 180)

  • two hour: 175 (normal is less than 155)

  • three hours: 50 (normal is less than 140)

Did you catch that last level? 50! That is why I would never, ever, eat pancakes for breakfast, or even fruit and toast, or even cereal with whole milk, or even a bagel with cream cheese. Even those smaller amounts of sugar without enough protein and fat will cause me to crash. I'm better off not eating. A blood glucose of 60 or less is considered hypoglycemic, and at 50, I was technically in insulin shock, which can be very dangerous. Not one person I've spoken with yet seems to care about that last level, which makes me crazy. This is the first time I've been unhappy with my ob-gyn for just following the rules. But apparently, the way it works is that he just orders the test and, based on the black and white results, refers me to a diabetes center.

Now, I didn't expect my earlier readings to be so high as to fail the test, and that might be a part of what I call my existing hypoglycemia, or it might be due to pregnancy. I did have one bad experience about a month ago - I ate a McFlurry, which is more sugar than I'd normally consume at once. But I had just eaten a huge hamburger and felt like I could handle it. I never did crash, but I had a different reaction: I got the sweats and a rapid heartbeat. Adam told me that it sounded like too much sugar. I don't know - I've never had that feeling before. So indeed, I might be having more trouble getting the insulin process started during pregnancy, and maybe I do have gestational diabetes on top of my existing condition. I'd like to find out more once my body is back to normal. There is also something called "occult diabetes," where the body is extremely slow to react to blood sugar, and then overreacts. That sounds like me, but the crash is not supposed to happen until about five hours after consumption of the sugar to be a candidate for that condition. I've noticed that, during this pregnancy, my crash is taking longer than usual. I would have expected the low level at two hours, not three, but three is still early for occult diabetes. Still, I might have some variation of that. And the fluctuation in my levels is not a good thing, one way or another.

But the point of all this is that I already know how to manage my condition. My dad has the exact same problem and he taught me how to avoid sugars without protein, especially in the morning. I've experimented with this for years. I've found that I do need some carbs in the morning - just a small amount, and always with protein. I've found that nuts don't balance out the carbs as well as meat, so a peanut butter and jelly sandwich can be a risky meal unless I've eaten a lot of good protein earlier in the day. I've found that there is almost no difference in effects on me between simple and complex carbohydrates so I rarely distinguish between them. I also need to eat more often than most people, and when I feel a certain kind of urgent hunger, I know I have to eat immediately, and I know that I have to eat a certain kind of thing, to avoid the crash. But I also know that I can eat desserts at night, as long as I've eaten well during the day. I know a lot of things. I know what works for me. And I'm not going to go on some standard diabetic diet (which probably contains more carbs than I eat anyway because complex carbs are supposed to be good!) unless someone can give me a compelling reason to do so. I'm not giving up my occasional ice cream after dinner in exchange for disgusting whole grain bread for breakfast which I know will make me sick.

So now I have to go to some kind of educational class, which I dread. If it is some standard thing about gestational diabetes, it will probably be a complete waste of my time, but maybe there will be someone with a brain who will actually talk to me about my particular case. And I'm going to have to monitor my glucose levels. That I won't mind doing. After I failed the one-hour test earlier this month, my father-in-law lent me a finger-prick kit to use for a week and I tested every m0rning, and after a few meals. It was fun to actually know my levels. (I was always in the 70's or 80's in the morning, and under 110 after meals. No signs of elevated levels at all, because, dammit, I was eating properly, not drinking sugar-water!)

And I'm not clear on what the risks of gestational diabetes are for me or my babies, except that it might cause them to be bigger. If that's the only downside, then maybe I should just start eating more chocolate anyway.


  1. That's infuriating, but all too common. http://robbwolf.com/2008/06/25/gestational-diabetes/

    Women become more insulin resistant in pregnancy to keep glucose levels steady for the fetus: why this is a mystery for the medical profession I really don't know. I seriously doubt you have gestational diabetes. Can you fight this stupid class it by asking for an HbA1C test, as in the example above?

  2. In utero exposure to diabetes (whether gestational or no) is associated with obesity, glucose intolerance, and development of diabetes in the child later in life. Notice I said associated with, not caused by -- take it for what it's worth.

    The kind of serum glucose monitoring you've already done is far more, and far more instructive, than most women ever do. You are already much more aware of your nutritional patterns than most people. Take the class for what you can get out of it, which may be nothing or may surprise you and give you some useful information, but don't assume that the instructor knows more about you than you do.

    There is a complicated relationship between placental hormones and insulin production and resistance in the mother. If you enjoy reading medical journalese, the intro to this article is a pretty good summary:


  3. Thanks, Monica. That article fits exactly my situation. Nobody ever explained to me that pregnant women become more insulin resistant in general (and the speculative cause makes sense). But if that's the case, it explains why my hypoglycemia is delayed and less strong during pregnancy (even at that 50 level, I wasn't crashing as hard as I would have expected). Also, if the fact that I do eat a low carb (and relatively low sugar) diet and have for years could make me more sensitive to a huge glucose load, then that would explain why my levels were higher than "normal" for those first two hours (although I passed the test with my first pregnancy in 2006). My levels are high because the test is designed to put a super load on the average person who already overloads on sugar to begin with, and I don't do that.

    It's just so obvious to me that I already know exactly how to manage this, and that I'm probably going to get really bad advice in the class. Maybe I'll amuse myself by taking notes in the class to show how ridiculous the nutritional advice is.

    I've left a msg with my doc to see if I can do the Hb1Ac test, but I don't have high hopes. But thanks again!

  4. Yikes, Kathy. That article is too much for me. But it sounds like you are echoing the idea that this is all more complicated than a simple yay or nay to "gestational diabetes." Actually, I suspect that expert diabetes doctors know this, but that they make the diagnosis and set up the protocols based on helping the most people with the least cost. A lot of people probably do benefit from the nutritional advice and control their sugars because of it. I just hate getting lumped in.

  5. Hey Amy, I'm just a few days behind you, 31 weeks on Saturday (with a singleton). After reading stuff like what Monica pasted above* and hearing stories about how awful the standard test was, my midwife and I decided I would just test myself 3 days in a row, fasting, 1hr, and 2hr after a normal breakfast. I ended up testing way more than that, just out of curiosity. My numbers were just what you got: 70s/80s fasting, 110 or so after breakfast, a little higher if I ate cereal. I'll never know how my numbers would have come out after drinking glucose, but I suspect not great.

    The midwife, who has been delivering babies for 20+ years, was not concerned about the consequences of diet-controlled GD on my pregnancy, but told me that if I end up transferring to the hospital that they will treat me as if I have GD unless I have a negative test. What that means, I gather, is mostly that they would be quick to assume that the baby is too big for vaginal delivery.

    * For the record, the numbers the midwife quoted me were 50 & 75g of glucose, not 100 & 150g!!

  6. Sara, I saw on Facebook that you are expecting - congratulations! This is one reason I wish I could have gone with a midwife again. But alas, I truly do need the expert care of a high-risk OB with the twins. Well, at least that's what I'm comfortable with. My OB is actually not concerned at all either. He's basically following protocol. I did the 100g test but I do see there are others.

  7. Well, my doctor still wants me to go. He says the HbA1C test isn't helpful because we're concerned about my future glucose levels, not my past, and because my hormonal changes could cause my levels to rise significantly from here. So the daily monitoring is what he really wants, and that makes sense to me (even though I'll be looking more for low levels!), so I'll go.

    But I'm printing out that article that Monica linked to and bringing it with me!