Saturday, June 18, 2011

Gestational Diabetes

Three points. Three points between what seems to be an otherwise healthy and uneventful pregnancy and the mess I'm facing now.

I'm beyond frustrated. Several weeks ago I was diagnosed with Gestational Diabetes. But I think it's bunk (or as my doctor told the diabetes nurse at my clinic who then told me:  I'm "having difficulty coming to terms with my diagnosis").

First, I was just surprised I found myself in such a rare category. According to the American Diabetes Association, GD affects just 4% of all pregnant women.  And according to the Mayo Clinic white women, "for reasons that aren't clear," [kind of a sketchy quote, I realize] are less likely to develop GD than African American, Latina, Asian, or Native American women.

So, it's a relatively uncommon condition (96% of pregnant women won't have GD). And, if I'm doing my math right (no guarantees), a woman with a Scandinavian heritage such as myself could consider herself as having less than a 4% chance of developing GD.

There are other "risk factors," of course. Obesity is one (I'm a bit plump, but not obese), having high blood pressure (nope, mine's great), being older than 25 (okay, I'll cop to this one), and having high blood sugar (again, nope) all tend to be factors.

Essentially, this came out of left field for me and my mind is still swirling with it all.

And truthfully and sincerely, I'm not certain the diagnosis itself was appropriate. Here's why:

The basic [very general] idea behind GD is that you've begun to have difficulty processing/maintaining healthy levels of glucose/sugar in your blood; these high glucose levels end up making their way to your baby. On this diet of extra sugar, a baby may grow larger than your body was meant to birth (which varies by each and every woman, of course. Many women deliver 11+ lbs fine and dandy). A "too big" baby is at heightened risk of becoming malpositioned during birth (and thus possibly of getting stuck).

But here are my initial issues with my diagnosis:

First~ my blood sugar levels (which I've now been checking 6x daily for going on a month) are all excellent. Every day. Excellent.

Second~  my hemoglobin A1C test (which shows my average sugar levels over the past 6-12 weeks) was fantastic (it was 4.9).

Third~ the reason I've been diagnosed is due to just 3 little points.


I had decided (against my better judgement) to take the 1-hr glucose test when offered (well, not so much offered as told to take it. Because it's routine. And I thought, hey, if it makes them happy, okay). This test doesn't, by itself, diagnose gestational diabetes;  instead, it quickly helps identify who may require a second look/test. The morning of the test I took my thyroid meds, waited 30 mins, ate an egg scrambled in whole milk, waited 45 mins, drank the nasty glucose (50 g), and then an hour later had blood drawn. The providers would have considered the results as normal if they were between 70-140. I tested 147.

I wasn't concerned with the test results. I knew I'd fudged a bit with the breakfast thing (I was supposed to wait 60 mins after eating to take the glucose, but was running out of time that AM. And I didn't eat a well balanced meal.) But my doctor was concerned. When I refused to take a 1/2 day of work to do the 3-hr follow-up diagnostic test she "called in some favors" to schedule me with a weekend clinic. A clinic, I should add, for which testing would be out of pocket for me. ::sigh:: I checked on the cost of the test. It'd cost less than taking 1/2 day off of work, so I decided to just do it and hopefully calm my doctor's fears.

The morning of the 3-hr test I was careful to show up having totally fasted since the night before. Hungry and thirsty, they started the poking. Eventually they found a vein. (Over the course of the morning I was poked 8 times for the 4 required draws. Super nice.) With my fasting blood drawn, I drank a higher concentrate of glucose than I'd ever eat in corresponding food stuffs in real life (100g) and then sat around and waited. Had my blood drawn, waited, had my blood drawn, waited, etc. 


The results:

     Fasting--79 (normal)
     1 hour--170 (normal)
     2 hour--157 (abnormal. They wanted between 70-154)
     3 hour--147 (abnormal. They wanted between 70-140).

For a diagnosis of GD the 3-hour test requires two abnormal/high readings. One abnormal reading is considered within normal parameters. So let's toss that final draw out (why the last one? Because why not.). Now let's take a peek at the other abnormal number, taken two hours after I'd ingested that ungodly high amount of glucose. My body took care of it except for 3 points. 3 points too high.

Three points. Not all that alarming. Why isn't it alarming? Because your body processes glucose at different rates throughout the day depending on what the heck it is you're doing. If you're walking or exercising or stretching it draws more glucose from the blood to feed your muscles than if you're sitting around on your rump reading. And what was I doing in the waiting room at the lab? I was waiting. On my rump. Reading. I wasn't even stretching my arms or walking to the bathroom. Just sitting. Statuesque. After the results came back I asked the doctor whether that third draw could have been lower by three points or more if I'd only walked around the lobby a little bit. She admitted that it very well may have been lower if I'd stretched my legs, yes. But then she said that that was irrelevant. Because I hadn't stretched my legs. And thus the test shows what it shows and that's that. Per her clinic's practice I have GD. End of discussion.

Except that it's not the end. Suddenly there's so much more to talk about and decide!

What does a diagnosis like this mean? First off, it means that I've been asked to "manage" my blood sugar levels. A woman with GD is supposed to keep her fasting numbers between late 70s-early 80s and her post-meal numbers are supposed to be <120 two hours after a meal. That's compared to the <140 that non-diabetic mothers should maintain as their normal. Why the difference between normal population and a woman with GD? My doctor said that it's because the normal population are trying to stay healthy for 20 years in the future. That's vs. a woman with GD who is growing a baby right now, and thus any higher blood sugar could directly impact the fetus today.

Okay. Fine. Stricter rules for a mother with GD. Except... what if I hadn't been diagnosed with GD? If that second glucose test's third draw had been 3 points lower because I'd dropped my book on the floor and had had to bend down and pick it up? Well then, in that case, the normal non-diabetic numbers would be just find and dandy for me during my pregnancy. A blood sugar level up to 140 after two hours of a meal wouldn't hurt the baby at all if only I hadn't been diagnosed with GD.

Uh-huh.

But whatever. So I'm supposed to keep my blood sugar super low. Lower than normal. Okay. So I start to use the glucose meter 6x a day (fasting/pre-breakfast, post-breakfast, pre-lunch, post-lunch, pre-dinner, post-dinner). And what do my numbers show? Fasting and pre-meal numbers in the 70s and low 80s. 2 hour post-meal numbers <120. Interesting... So there's nothing to worry about, right? My numbers are sublime?

Wrong. Worry! Worry!

I've been instructed that I must now have weekly (weekly!) "non-stress" tests at the hospital to ensure the baby is doing well. I'm also supposed to go in for several ultrasounds to try and gage the baby's weight (though, as the doctor admits, ultrasounds can be off by 1 lb or more...) and if I'm found to be growing a baby over the 75th percentile in weight (anticipated to be about 8 lbs at term) I will be pressured to induce labor early. If I require medication to maintain my blood sugar levels they'd induce at 38 weeks but if I'm able to maintain without medication they'll "allow" me to go till 40 weeks. And, at the shocked look on my face, my doctor said that she'd even consider allowing me to go to 41 weeks.

Non-stress tests. Ultrasounds. Scheduled induction. If I refuse the interventions, refuse even one of them?  Then I'll be transferred to High Risk OB/perinatology at the hospital and be required to have the remainder of my prenatal care and my delivery with them.

I don't want a surgeon at my birth. I don't want to spend my time and money (and lose my earned time off at work, which is perilously low as it is) to go in for weekly "non-stress" tests (not stressful for the baby, perhaps! But what about the mama?!) in addition to my normal prenatal appointments. I don't want to give ultrasounds (which are perhaps their best imaging tool but nevertheless sorely lacking when it comes to deciding whether a baby is "too big" for a woman to birth) the power between "allowing" me to continue to nurture my baby in the womb or being "required" to evict it early.

I am not a happy camper. And I have some decisions to make. Quickly.

6 comments:

Anonymous June 20, 2011 at 1:32 PM  

I understand that you have a birth plan and that everything in your mind should go that way. From your first birth I think you should understand that it doesn't always go that way. However, at the end of the day you have to respect that the hospital is just doing their job to make sure your baby and you stay healthy.

Thomasin June 21, 2011 at 6:51 AM  

I agree, the MD/hospital are just doing their job. However, while some of their job is to provide me with information and then support me, another [rather significant] part of their job is covering their butts. I understand that (it's part of my job in my office too and I don't find anything specifically malicious about it) but it doesn't mean I have to blindly accept it as part of my prenatal care. The interventions they propose may lead to very real and negative results (induction is not something a woman should accept unquestioningly, but especially a mama hoping for a VBAC). But this is all more about prenatal care than my birth plan (which is understood to be a birth guide, subject to change if complications develop, of course, just like any plan. Nevertheless my autonomy as a patient must always be front and center). My first birth would have been a vaginal breech delivery if I'd had the money to travel to the birth center nearby which attends them or if I'd been able to find an MD who had experience--lacking the $ and access to an experienced MD, a c-section fully covered by my insurance at the time was my best choice. I made it and must stand by it. But I don't believe that this scenario is the same. I AM healthy, as is my baby, and I find the interventions required of me to stay with my PCP unfortunate and unreasonable. But thank you for the comment (friend, family or stranger? The "anonymous" intrigues me!); I feel a blog post coming from all this. :-)

Kristin C. June 21, 2011 at 1:32 PM  

Is it possible that you can re-take the 3 hour test (and walk around this time)? Frustrating!

Tara June 21, 2011 at 11:25 PM  

Oh Thomasin what a bummer! Seems so much is now out of your control, how frustrating!! I'll be taking that test soon and they looked at me like I had two heads when I asked of they had a glucose drink without artificial dyes and flavor after they handed me the bottle of orange goop! Needless to say they did not have an alternative.

It seems like a lot of extra work and stress for you. And you are right about the inaccuracy of ultrasounds, two days before B's birth they said she was 7.5 lbs but she was 6 lbs 2 oz. at birth.

Hope your numbers go smoothly and that baby makes their appearance when they are good and ready!

Elizabeth White June 22, 2011 at 6:31 PM  

I had never thought about walking around during the 3 hour test... I wonder if I would have had a more positive result... I did find it odd that they didn't want you to leave the building though..(because I would have walked around out side if anything..with my little timer :)
I sure hope that you are able to convince your doctor with the results of your GD Finger poking tests that you are indeed free of GD. The numbers will speak for themselves. If anything I will be praying that you do not need to go on any meds for the GD...that way they hopefully won't want to induce. *and things can progress naturally...

Anonymous May 24, 2013 at 9:13 PM  

oh i just found this post and i am feeling much what you felt then! i had a reading on my GTT out by 0.2 (yes you read that right) and i was diagnosed with gestational diabetes... they lowered the numbers in australia just a couple of months before i took the test (we have the toughest GTT numbers in the world now!)... so if i'd taken the test just a couple of months earlier or in any other state in my country or most other countries (but the one i am living in) i would be considered NON-gestational diabetes...

instead i am being forced to monitor my blood glucose every day (and like you did i have been going for a month now with perfectly normal readings)... this is my 3rd pregnancy as well... where my blood sugars were similar the other 2 pregnancies... both those babies were average birth weight, no complications perfectly healthy babies delivered naturally!

i am beyond frustrated with the whole thing... i am annoyed that i have to watch everything i eat so carefully or i am threatened with the possiblity of taking insulin... i'm sure most pregnant women have the odd spike in blood sugar too... i've worked out any of my "spikes" (which are still minor by anyone's terms) are caused when i am stressed out or haven't had enough sleep.... but do these other mums who measured 0.2 lower than me have to go through what i am? no...

and my baby is measuring perfectly- not large at all- so the whole thing is really doing my head in... i still have a few weeks to go, but i am sick of eating such a restricted diet... i'm sick of stressing about everything i put into my mouth... i'm sick of worrying about how my labour is going to be managed when it's time to have the baby... the whole thing is just horrible and i feel like i got caught up in a technicality and they are ignoring what the hundreds if testings i have done since that test have told them :(
amy

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