In this post, I wanted to talk about gestational diabetes (GDM); I almost had it with my first pregnancy, and then was diagnosed with it during my next two pregnancies. For those of you who may not be familiar with the term GESTATIONAL DIABETES, let me give you a bit of a rundown on what it is. Buckle up, because this is a long one!
Gestational diabetes (or if you have a close long-standing relationship with it like I do, you can just call it GD), is a type of diabetes that develops during pregnancy. This means that the amount of sugar (glucose) in your blood is more elevated than it should be. Normally, a lot of the food we eat is broken down into glucose. When glucose moves into our bloodstream, a hormone known as insulin directs the glucose into the cells of our body. These cells then use the glucose for energy. It is believed that while pregnant, due to a combination of pregnancy weight gain and hormonal effects (because of additional hormones from the placenta), your body may not be able to use the insulin the way it usually does. During this time of “insulin resistance”, your body needs more insulin in order to do its job. If your body can’t make enough insulin, the glucose builds up in your blood and you have gestational diabetes.
So, say you have gestational diabetes, but then it goes away soon after the birth of your baby; what’s the big deal?
Unfortunately, uncontrolled GD creates several risks for both the mother and the baby. High blood pressure is more likely to occur in a mom with GD. Babies can be born with low blood glucose, since their bodies have been used to the higher sugar in-utero, and premature babies may have underdeveloped lungs. Babies can also be large at birth (ouch!!) due to the extra glucose and insulin in-utero, which can lead to complications during labour. And if you manage to get past all these risks unscathed, there is an increased risk of type 2 diabetes for both the baby and mother later on in life. That being said, most women who have GD give birth to completely healthy babies when they manage their blood glucose well.
Being diabetic during a pregnancy carries a lot of emotional, physical and mental baggage. I have never felt as vulnerable, and yet strong, as I have through this experience. And being a diabetic, even if only for a few months, really changes your perspective on life.
With my first pregnancy, I didn’t necessarily eat more than normal, but I didn’t eat that healthy. During the first trimester, the sight of most foods was nauseating. Unfortunately, I found that eating certain foods like fries, egg and bread made me feel better. I gained weight at a normal rate, however, and once the first trimester passed and my nausea improved, I resumed eating like I did pre-pregnancy. I had stopped working out at 9 weeks since I had bleeding early on in my pregnancy. Being a novice, I didn’t want to do anything that might hurt the baby, so I chose to stop using the treadmill.
An oral glucose tolerance test (OGTT) is done in pregnancy to check for gestational diabetes. This screening test is usually done between 24-28 weeks, and involves you ingesting a sugary glucose drink that is usually an obnoxious orange colour; your glucose level is then checked by a blood test one hour later. If the results are higher than expected, a second longer test will be done another day, with a higher glucose amount in the drink and hourly blood tests.
Since GD develops in the second half of pregnancy, I did my first OGTT at 26 weeks, and went about my regular life. Around this time, my prenatal care was switched from my family physician to my obstetrician. Somehow, in the transition process, my slightly elevated result from OGTT got missed. Upon my second meeting with OB I was told that I need to go for another OGTT to rule out gestational diabetes. I passed by the skin of my teeth.
When I got pregnant with my second child, I was very aware of the high likelihood that I may fail my OGTT. I ate extremely carefully and tried to remain active, in spite of the all-day-long nausea. I was hopeful that I may be able to prevent what I thought would be a failure. But, alas, I wasn’t so lucky this time, and ended up testing positive for gestational diabetes. After the initial sense of failure, sadness and shock started to wear off, I knew my goal was to keep the baby and myself as healthy as possible. I attended a three-hour long class teaching me about GD and how to control it through diet and exercise. I met moms who were first time diabetics, as well as those who were seasoned GD mothers. I felt less alone and was determined to get through this. To keep my blood glucose level in a good range and maintain a healthy pregnancy, I had to do frequent blood work, received a dietary plan that I had to follow, and stay active.
I had very few blips in my glucose readings, until the final few weeks when it became more difficult to control my sugars. Walking after meals helped greatly, even if it was only a 10-minute waddle around the block at work. I was able to adequately control my blood glucose, and insulin or other medications were not required.
I had my son, and unfortunately his glucose was low at birth. They supplemented him with formula, and I fought back tears thinking this was happening because of me. But he was a fighter, and his glucose came up to “normal” within 12 hours.
After that, I became almost obsessed with keeping diabetes away. I ate very carefully and worked out religiously. I was, and still am, determined to not get diabetes, both for myself and for my kids.
Now, it’s my third time being pregnant, and I have GD again. When I told my mother I was pregnant with my third child, she actually got upset at me. She couldn’t understand why I would put myself at risk of getting GD again. I knew it was extremely likely that I would get GD again; and I did. It has been even harder this time around. I have two kids to take care of, so self-care often gets neglected and meals aren’t as well timed as they should be; but I am still doing my best.
I have frequent consultations with dieticians and doctors, and I am determined not to need insulin this time as well. Controlling how many carbohydrates you eat is the mainstay of gestational diabetes management. Eating too much can raise your blood glucose levels, while eating too little can affect your energy levels and the baby’s growth. Carbohydrates are found in grains, fruits, milk and all things sweet. Proteins, vegetables and fats have little or no effect on glucose so those don’t generally need to be reduced while you have gestational diabetes; but instead, they can help in other ways such as keeping you full. As always, a balanced diet of carbs, proteins and healthy fats is important.
I try to control my carbohydrates daily, by eating three meals and three snacks spaced evenly through the day. I have been given a thorough list of the amount of carbs in frequently consumed food, and what a typical serving size is. To be honest, these lists have opened my eyes to the nutritional information found on food and has actually changed the way I eat even when I’m not pregnant. Generally, my carbohydrate targets are 30g for breakfast; 45g for lunch and dinner; 15-30g for the two snacks earlier in the day, and 15g plus some protein for the bedtime snack.
Testing blood glucose during GD is very important, as it is the only way to know if you are maintaining your glucose within target. It also helps you to see the effects that the food you eat, and your physical activity, have on your blood glucose. With my second pregnancy, I had to test once every morning, and then one other time in the day, two hours after a meal. I was supposed to test my blood glucose at different times during the day.
This time, the guidelines for checking blood glucose are stricter. I am to check my blood glucose using a blood glucose meter 4 times a day: first thing in the morning (fasting) and then two hours after the first bite of each meal. I have to record what I eat at every meal and snack and then each of my blood glucose values as well as if I did any activity that may have impacted my test results. My fasting blood tests always gives great results, and my breakfast values have been decent so far too. However, my lunch and dinner values have slowly started creeping up. My levels have sometimes been slightly higher than the suggested maximum. It’s also imperative for me to walk for 10-20 minutes right after lunch and dinner to keep my glucose below that maximum number. In spite of being active and eating well, if the space between my meals is inconsistent and if I go too long without eating, my glucose is automatically higher. Therefore, it’s important to make a good plan with your dietician and follow it. Don’t be like me lol. Overall, I am proud of how I am doing. I am working hard to keep my glucose under control, and the positive feedback from my family, dieticians and doctor keeps me going. I am in the home stretch and have possibly just a month or so to go with gestational diabetes.
If for some reason, before I give birth, I still need insulin, I will need to remind myself that in no way is this a failure. It just means that my body had a higher level of insulin resistance and I needed some help, and that’s ok. Insulin does not hurt the baby, and most likely I would not need it after giving birth. That being said, my goal is still to not have to start insulin. I am a goal- oriented person; that’s just how I function.
I look forward to when this is all over, and I can just eat a bagel without guilt or concern and not have to worry about pricking my finger two hours later. I am nervous about my baby’s health, as every expecting mom is, and I am aware of the reality that my child may be hypoglycemic at birth. I have done everything I can, and I need to remember that. Gestational diabetes sucks. It really does. It sucks to not be able to eat whatever I want when I am pregnant, like all my other pregnant friends did. It sucks to make sure I eat at the right time, even if it means eating in my car. It sucks to poke my finger at my desk at work, and hope that nobody sees me doing it, because it’s none of their business. It sucks to have so many doctor appointments and ultrasounds and dietician discussions. It sucks to be constantly thinking about diabetes, and it honestly does cast an ugly shadow over an otherwise normal pregnancy. But you know what, I am thankful for this pregnancy despite all of this. And having gestational diabetes, only makes me appreciate the end result even more.