Short Version: I debate whether to insist on a test for gestational diabetes, conclude yes, and ask for any info you have.

So here's a thing about the last appointment. We all know that, if I was in Australia, I would be due for my routine gestational diabetes screening in a few weeks, right? Well, they don't routinely screen for it here.

"Your urine glucose seems to be fine on dipstick," said SOB when I asked him about it, "so I don't see a need. I always recommend my pregnant patients don't eat too much refined carbohydrate anyway - you shouldn't be eating a lot of cakes, biscuits, sweets, that kind of thing. In moderation is fine, but not to excess."

The thing is, I haven't been able to eat any of that stuff at all for months. Neither have I been able to eat rice, potatoes, breakfast cereals, white bread, pizza, pastry, green peas, or sweet drinks (including fruit juice and flavoured milk), and I need to stick to a strict eating, sleeping and exercise routine. If I don't, I end up with nausea, often vomiting, the type of headache that lingers - quite literally - for days, and an inability to sleep through the night due to excessive hunger. Oh, and P.S. - a positive urine glucose dipstick.

I also have a family history of type two diabetes, and although myself and my sisters are currently nulliparous, a significant proportion of my close cousins have been diagnosed with gestational diabetes in pregnancy. I have no official diagnosis of PCOS, just a somewhat irregular cycle, a suspiciously crazy response to stims, and a mysterious history of recurrent early pregnancy loss.

Would you test me? I'd test me.

At the appointment, however, I was too seduced by the idea of not having to drink that horrible glucose solution to argue. Besides which, I reasoned, what would it change? I'm already on a fairly strict diet, and it appears to be controlling my blood glucose quite well. "Appears", that is, according to the urine glucose dipsticks I do every few weeks, and the fact that I feel fine as long as I don't misstep at all.

I'm not really into self-diagnosis. One lesson I've learned over the past few years is that, if sufficiently worried, I can even convince myself I have the plague. The story above seems almost definitive enough to suggest we bypass testing and just go straight to the treatment phase, but it doesn't mean I actually have the condition. I have, after all, on two separate pre-pregnancy occasions, had a glucose tolerance test and a fasting insulin and glucose test, and everything came up normal. Still, that was then, and in any case it's not like an amniocentesis or a laparoscopy, with risks as well as rewards - it's just a little blood and a nasty drink. Why wouldn't I do it?

I'm going to have to ask again at the next appointment. In the meantime, what can you tell me about gestational diabetes? What is the actual diet and how does it differ from what I'm eating at the moment? What are the exercise recommendations? What sort of monitoring does it need (in terms of glucose levels and also pregnancy progress)? I might as well occupy myself by reading up in advance.


18 Comments

Jess said...

I'm afraid I don't know a thing about it, BUT my assvice to you, considering your family history, is to get it checked. Like you said, it can't hurt. And then you could more SPECIFICALLY watch what you're eating and all that jazz.

And PS....I love the title.

Rachel Inbar said...

This is why I think you're right in being tested: untreated GD causes a baby to grow with proportions that are different from a non-GD baby. The shoulders, for one, are broader - a baby weighing the same as a non-GD baby can get stuck in the birth canal because of this. With a GD diagnosis, you automatically go for c-section here if your baby is over 4kg (for non-GD - 4.5kg).

I had GD only in my pregnancy with Nomi & then I had passed the early screening and was only diagnosed during week 39, when the weight estimate was high - 3.85kg - at which point I did the 3-hour test (& failed) & was sent for induction (too late to treat it). We had a heck of a time deciding whether a vaginal birth would be safe & the doctors didn't give us a clear recommendation (too risky, a vaginal birth with a GD baby that's too big can end badly), but finally we weighed all the data we had and decided to go ahead with it. Seriously scary stuff.

You asked about the diet & I don't know because I never got there. Sometimes, though, diet isn't enough & you need insulin. The stuff you have to drink is like you poured the tea into the sugar bowl (and then forgot to put the tea bag in), but you just down it and then forget about it. (This I say after having done the 100g test twice during this pregnancy.) It's not fun, but it doesn't begin to compare with other things you've gone through to reach this point, in terms of being unpleasant.

Good luck with the test. I really regretted not having done the 100g test earlier with Nomi (even though it turned out she was not affected by it).

Caro said...

Sounds like it is sensible to get the test. I don't think it's routine here either but I don't have as many risk factors.

Vee said...

If you feel better knowing then have it done I say.

The glucose drink isn't that bad...really. I had heard all these horror stories about how disgusting it was and after I had I wondered what all the fuss was about.

Shelby said...

The diet- is awful! When I was pregnant with my daughter, here is what I ate:
breakfast- protein and one starch (eggs and a piece of toast with a tiny bit of butter)
snack at 10 AM- one protein and one starch (nuts and some crackers, cheese and crackers, peanut butter and some crackers, or half a PB sandwich
lunch- veggies, protein, a starch, fruit, milk
snack at 2 or 3- same as earlier snack
dinner- same as lunch
snack at 8- same as earlier snack

Let's just say I got really sick of eggs, nuts and crackers. All starches were pretty much whole grain. For me, the diet didn't help my sugars at all. I still ended up on Gly.buride twice a day to help lower my sugars. That helped a lot. That, and I had weekly ultrasounds and non-stress tests after about 30 weeks.

This time, I've got a different perinatologist, and she started me on the Gly.buride right away. They also did a fetal echo, because apparently the high sugars can cause deposits/thickening of the arteries of the baby's heart. This time, my dose is double what it was last time, because my fasting levels were a mess. But now they're good. This time, the only diet she told me to really follow was to avoid starch before bedtime, and NOT eat any starch for breakfast. Obviously avoid any sweets and white breads/rice.

Another risk factor associated with GD/D is pre-term labor. Which I'm learning about pretty quickly. I'm not there yet, but all the warning signs are there.

Definitely get tested! The glucola drink they'll give you really isn't that bad. Especially if it's cold. Thankfully this time I didnt have to do it, since I was already diagnosed.

megan said...

i would test you too....and not just becuase i had to be. it's just that i too have the possible PCO, family history, and miscarriage history and those are all the reasons my clinic wanted to test me...
i failed the initial screen and am now awaiting the results of my three hour tour.

Heather said...

I don't have any experience with it and for once in my life I don't have assvice...Wait, I'm sure I can come up with something. Stay hydrated?

Um, not so sure - but know that I'm thinking about you. This sounds really rough and I hate that it isn't easy. Wish it could be easy and you could just enjoy this part. Maybe a rough pregnancy equals an easier "terrible twos" stage? We can only hope.

Here I am said...

Hi,
Get tested, this way you'll know for sure, although I can totally understand your apprehension. I had my glucose screening today and I'm thinking I probably failed it. Before pregnancy, I had my glucose tested and it was 93, and I was told that normal is under 100-- so I'm thinking that was close to 100 pre-pregnancy, who knows what it is now. Scared, but at the same time, if I do have it, it's manageable and I hear it goes away after pregnancy. Anyway-- good luck whatever you decide!

My Reality said...

It doesn't sound like your diet would change much. And my guess would be even if you did have GD, you would have things under control with the diet.

It sounds to me like you would feel better about getting the test, so I guess you get to drink the icky stuff.

Karaoke Diva said...

I agree, you should get tested, if only to set your mind at ease.

Karaoke Diva said...

And, to me, the glucose drink just tastes like flat soda. A little ooky, but really not that bad.

one of the girls said...

If you're debating it- do it.

Like Vee said, it wasn't really all that bad. What I had to drink was a fizzy orange-soda-like drink. (I'm not harping on the blood draws because we are all pros at those!!)

It certainly wouldn't hurt to know, so you could madify if necessary.

ms. c said...

oh shoot, that last comment was from me...

Cibele said...

I'm afraid that I will to lear about all of thsi soon!

Samantha said...

I'd get my levels checked, given your history, and given that it's not a test that has potential to cause harm.

Congrats on the boy!

The Town Criers said...

I can't tell you really anything about GD but I do think you should test. It's a simple blood test and the consequences for leaving it undiagnosed could be big. And it gives you peace of mind.

Schatzi said...

Sure, I'd test ya.
Really, why not? Sorry, no info to add on the diet.

Hopefully all comes out normal... but then at least you know.

TeamWinks said...

I'd test you!

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