I “had” Gestational Diabetes (GD) during Aellyn’s pregnancy. I say had with quotes because it went down like this: I failed the 1 hour and then the 3 hour and that’s it. I never had another bad number. My fastings were always in the 70s or 80s. I definitely think I fell into the many women who are wrongly diagnosed with this due to poor clinical diagnostic criteria. This bad diagnosis led to interventions such as looming induction near 40 weeks and continuous electronic fetal monitoring. This pregnancy I’m not likely to make it 40 weeks and I’m expecting much more interventions. I have chosen to go with a more medicalized birth for my twins so I was less worried about getting a GD diagnosis this time.
Well I failed the 1 hour with flying colors. My 1 hour number was 207. Failing is 140. I failed so spectacularly that I didn’t have to take the 3 hour (which is good because I think fasting for 12 hours in inhumane for pregnant women). So I dug out my glucomoeter and started taking my fasting blood sugar just to see if things were like I expected from last time.
Well, they aren’t. My fasting (first thing in the morning) blood glucose (BG) has been: 120, 130, 121, and 119. Those are obviously all over the “under 90” criteria. My post-prandial (2 hours after meal) have been 173 and a whopping 257.
So, it was with trepidation that I went in to talk to the nutritionist today. I actually cried! I mean I’m pregnant and emotional but I’m usually pretty positive about my treatment with an “I can tackle this” mentality. I think this brought out several sub-conscious prejudices I didn’t realize I had.
See when I say “I had GD but it is well controlled with diet” I didn’t think there was more behind it than that. But there is. There is a “because I’m healthy and take care of myself – *I* didn’t need medication.” Diabetes is something that happens to “bad” people who don’t eat right and often to “fat” people. I’m fat but I’m healthy. So of course I didn’t need medication.
This time it looks like I’m going to need medication so this must mean I’m “bad” in the way I eat and I had it coming because I dare to be fat.
Wow! What a lot of sub-conscious prejudice to come bubbling up all at once in front of the nutritionist!
I can’t be the only person who has felt this way. Skinny or fat, being diagnosed with GD feels like a failure on your part. If you had eaten differently this wouldn’t be happening to you. Right? Wrong. Let’s look at what GD really is.
In every pregnancy insulin resistance happens during the second trimester. It is supposed to happen, it needs to happen. Hormones produced by the placenta, namely cortisol, progesterone, human placental lactogen, prolactin and estradiol
bind to receptors that insulin would normally attach to in order to allow glucose into the cells. This increases the amount of glucose circulating in the blood stream which makes your body amp up its insulin production. The reason this is normal and desirable in pregnancy is your body needs that extra glucose available to perform the monumental task of building babies!
In a twin pregnancy you either have a larger single placenta (in the case of identical twins) or two whole placentas pumping those hormones into your blood stream. For this reason, twin pregnancies have two to three times the incidence of GD.
No one knows why some women’s bodies can’t compensate with an increase in insulin and require management through diet and/or medication. Risk factors include family or personal history of GD, obesity, age, and ethnic background. However, a full 60% of GD patients have no discernible risk factor. It just happens.
(side note: whenever a “risk” factor list includes obesity I’m always skeptical. Using weight as an assignment doesn’t tell us if that person was a healthy (eats right, gets exercise) person or not. I imagine if they quantified it by “health” instead of just weight they might find that many obese people are at risk because they eat Krispy Kreme for breakfast AND many skinny people are at risk because they eat Krispy Kreme and both groups over-tax their pancreas. But, no one looks at it like that. They look at the number only.)
It isn’t my fault (or yours) if you have GD. And if you do have GD and end up on medication you aren’t a “bad” patient. You can’t “good student” yourself out of this one. If your care provider makes you feel it is your fault get a new care provider.
Mine did not make me feel it was my fault. She assured me it was not and that having to go on a pill or insulin did not describe levels of failure. She looked at my diet and although I was eating too large of a breakfast (have you ever been pregnant and then woke up in the morning?) and too small of a lunch, in general my diet was in line with a good diabetic diet. She gave me some hints and tips here and there but no major changes. I have to go back in on Friday to see how my numbers are. Given that my diet isn’t changing that much I’m pretty sure on Friday I’ll need at least an oral medication intervention or perhaps even insulin given how high my numbers are.
And that’s ok.