Shall we chat about diabetes?

Oh, diabetes.

I did not have gestational diabetes when I was pregnant with Claire, so I was floored when I found that I had tested positive for gdm ("gestational diabetes mellitus" is the official name; "gdm" is the official abbreviation) when I was pregnant with Lily. I absolutely did not see it coming and was very upset about it (I blame it on the hormones). It was just so overwhelming. There were no indicators in my regular life that would point toward diabetes. How do you even start living a diabetic lifestyle? Especially when nauseated, hungry, not hungry, craving specific foods, only wanting carbs? HOW? 

Those were only a few of my many questions.

I wrote about it a little bit here and here the first time around. I was sent to a session with a nutritionist at that time which was mostly unhelpful, so I dug in to do my own research (I was an English major, so I am very comfortable with research, guys.). I gathered some really helpful, basic information about how diabetes and a diabetic diet work and then cobbled together several go-to snack options and learned how to manage my carbs during meals. I managed my blood sugar incredibly well, according to my doctor. This kept me and Lily healthy, kept Lily's birth weight to a reasonable/healthy weight (6 lbs, 15 oz), reduced/eliminated her risk of jaundice due to diabetes, and kept my weight gain in check (I only gained 2 pounds in the last 7 weeks of pregnancy). It wasn't the most fun, but I found a groove to making it manageable (and that didn't involve lots of sugar-free foods).

In normal pregnancies, doctors (or midwives) test for gdm at the beginning of the 3rd trimester. This is because it's around that point in pregnancy that the placenta begins producing hormones that can interfere with your glucose/insulin balance. When you deliver your baby/placenta, your body usually returns to normal (i.e. non-diabetic). Because each pregnancy involves a different placenta, you can end up not having gdm with one but having it with another (me, case-in-point). However, once you've had gdm, your chance of developing it again is remarkably higher. It's standard practice for OBs to run an early glucose test for women who have previously had gdm (me) at the end of the first trimester with subsequent pregnancies. 

So, I took an early test at 13 weeks. I failed my 1-hour on the early test, but rather than going back for the 3-hour follow-up test, I opted to start the diet and regularly check my sugar for a week and then go back for an assessment appointment. I was still so nauseated and fighting so many migraines that I knew having to fast for and then take the 3-hour test was a disaster waiting to happen. I also knew that the chances of me passing the 3-hour test, based on my glucose reading after the first + my history with gdm, were very low. Everyone was fine with that plan, so that's how we proceeded. I've been on a diabetic diet and checking my glucose 4 times/day since 13 weeks (this includes over Thanksgiving and Christmas). I'm currently 31 weeks, so I've been doing this for a while at this point.

During my Lily pregnancy, I was able to completely manage my diabetes with diet only. This time, my body is responding differently. During the day, I can manage my diabetes very easily with my diet, thanks to all the info about counting/portioning/balancing I gleaned last time. Normal protocol is that a woman with gdm checks her blood sugar 4 times a day: when she wakes up/before eating (fasting) and then 2 hours after each main meal (post-prandial). My fasting numbers have been my problem this time. I can't control my glucose while I'm sleeping (obviously...because I'm not snacking on a time frame while I'm sleeping). Fasting numbers are particularly important because they gauge a little more accurately how your body does regulating glucose and insulin on its own. So, my higher fasting numbers have led to me taking medication this time around.

I started out on a lower dose of metformin right at Christmas time, and it managed all of my numbers really well. Around the time I crossed the third trimester threshold, though, it became less effective, and my fasting numbers, particularly, started creeping back up. My theory is that this happened because that's around the time that the placenta begins producing the complicating hormones in earnest. My doctors recently upped my dosage for a little while to see if that will take care of things. If it doesn't help significantly, we move onto insulin until delivery (shots...every day...groan). I'll try to keep you posted.

Technically, my status as Type A-2 GDM (medication-dependent) classifies me as "high risk" (I didn't know this for quite a while), which means that I get extra ultrasounds as we near the end of pregnancy. They're having me go in for 3 extra ultrasounds to check on the baby's growth and fluid levels- just to make sure that the insulin imbalance isn't negatively impacting her environment. Around the 36 week ultrasound, they'll look at whether or not they'll want to deliver at 38 weeks, rather than 39. 

What with all the nausea and vomiting, migraines, and diabetes, I'm just livin' it up over here during pregnancy. It's a regular par-tay. The good news is that I've put on a reasonably low amount of weight (and then crash-lost some on three occasions, thanks to having stomach viruses/migraines). That will be helpful when I'm trying to fit back into my non-maternity pants. Silver lining?

I'll probably do a post or two about the specifics of what I eat and how I count carbs/fats/proteins at some point. I had a lot of trouble finding a really helpful breakdown of information my first time through, so I'm going to do my part to help a sister out, should someone in need of information about gdm stumble across my blog. All under the heading of "I'm not a professional- don't sue me," of course. :)