I’m not entirely sure I am completely normal or typical, but I felt I should share my gestational diabetes experience with others. For those that haven’t been following my pregnancy journey, I will start from the beginning.
I skipped the one hour glucose tolerance test at 24 weeks of pregnancy and went straight for the three-hour test. I had polycystic ovary syndrome (PCOS) prior to my pregnancy which made me insulin resistant. My fasting glucose levels were generally in the 80’s or low 90’s, but my A1C was in the 5.9-6.1 range. I was on 1000mg of Metformin daily prior to pregnancy, and I continued taking the medication until I hit the second trimester per my obstetrician’s recommendation.
To even manage to ovulate or conceive, I had been working hard to fight my insulin resistance and PCOS with diet, exercise and Metformin. l managed to lose quite a bit of weight (I received my PCOS diagnosis shortly after ballooning up to 250 lbs for the first time in my life) which seemed to have some influence on my hormones. I managed to have a period without Provera within a timely fashion and then ovulated and conceived on that cycle. To say this was a miracle and surprise is an understatement!
At 16 weeks gestation, my obstetrician ordered my A1C to be checked again. It was the lowest it had ever been at 5.7. But, that didn’t last for long.
Around 22 weeks, I noticed that I was unreasonably tired. My thoughts were even foggy a times. There were days that I felt like I couldn’t even type a coherent sentence. Not sure whether this was just pregnancy brain and fatigue or something else, my obstetrician and I opted to complete the glucose tolerance test as soon as possible at 24 weeks.
I failed miserably. My one hour levels were bad, but sadly, my two hour levels were awful!
Since then, I began cutting back on my carbohydrate intake. I went to the two-hour diabetic teaching session and received a glucometer with a personalized nutritional plan. I quickly realized that the amount of carbohydrates recommended by the nutritionist wasn’t going to work for me. I was having a blood glucose spike after almost every meal.
So, I cut out some more of the carbohydrates. The nutritionist had recommended I get 100 grams of carbohydrates daily. I cut back to about 80 grams daily. My levels then began to stay within normal ranges.
Around 30 weeks, I suddenly began experiencing low blood sugar problems. I increased my carbohydrate intake to compensate. My numbers stabilized until week 31 when I suddenly began having spikes again. I cut back again, hoping this would help.
It took until 32 weeks for my numbers to stabilize again and remain consistently in normal range without spikes or crashes. Also at 32 weeks, a growth scan was completed. My son’s abdominal circumference was measured to be in the 97th percentile. This didn’t match his other numbers; so it was thought that my gestational diabetes was out of control.
My obstetrician put me on glyburide, 25 mg in the morning. This was the lowest available dose.
The first morning, my blood glucose levels bottomed out within a couple of hours of taking the medication. It happened again at lunch, and again in the evening. The next morning, I woke up with low blood glucose levels. For breakfast, I had my usual (two scrambled eggs with shredded cheddar cheese and 8 oz of milk). My blood glucose levels shot up to 151. Two hours after that reading, my numbers had tanked again, reaching 69. I stopped taking the medication. I also lost seven pounds that week (week 33).
My obstetrician agreed that this medication was not the solution for me. She advised me to keep trying with my diet. We also began weekly visits at this point so she could complete non-stress tests to monitor for oxidative stress. She was concerned that my placenta would fail because it does sometimes occur in women with gestational diabetes. She also said that the placenta tends to degrade a bit sooner with some women with gestational diabetes. To safeguard against stillbirth, she felt much safer completing non-stress tests weekly even though I argued for bi-weekly stating that I could complete kick counts.
Let me stress at this point that I strongly believe in my intuition. I have a good sense of my body. I don’t panic easily. I can tell when something isn’t right. I wasn’t being careless with my son’s life when I advocated for bi-weekly visits, but rather I was advocating for her to trust me as well.
It was obvious after speaking to her that she would forever blame herself if anything happened to my son if she agreed to bi-weekly testing. I decided my autonomy wasn’t worth it because denying the weekly appointments might result in her being overly cautious in her judgement or recommendations (I was/am really, really trying to avoid a c-section or induction).
I further limited my diet to approximately 60-70 grams of carbohydrates a day and increased my protein intake significantly. I also made a point to jog in place, dance, or walk for about 10 minutes after breakfast and lunch each day. At least once a week, I would go walking in the evening as well for 30 minutes. My numbers were suddenly beautiful! I had numbers that looked like a normal person’s numbers.
Fast forward to 36 weeks, where another growth scan was completed. My son’s abdominal circumference suddenly looked like an average baby’s! His weight is estimated to be in the 54th percentile!
For those that don’t know why I keep mentioning abdominal circumference, let me explain. The baby of a woman without gestational diabetes is expected to take glucose from mom and use it to build fat storage. The key to this is, though, that the glucose the baby turns into fat is usually distributed evenly over the body. The baby’s body takes these small, consistent doses of glucose and has no trouble producing an appropriate amount of insulin to facilitate the storage of glucose as fat. In a baby that has a mother with uncontrolled gestational diabetes, the baby is receiving random large doses of glucose. The baby’s body produces large amounts of insulin to facilitate storage which builds fat, but the body tends to store most of this glucose in the form of abdominal and chest fat. This excess fat can cause problems at birth such as difficulty breathing. To read more, you can check out the American Diabetes Association site.
So, if the abdominal circumference is large while the rest of the baby’s body doesn’t match, then the possibility of after-birth complications increases.
I’m not a doctor, but that is the jist of my understanding of what happens. Please don’t take my word for it, but talk to your doctor if you want to understand the disease process.
I am 36 weeks 4 days today. On 36 weeks 2 days, it was as if suddenly everything had changed. I began having symptoms of early labor. That wasn’t the strange part, though.
Suddenly, my blood glucose levels began to drop. The next day, my numbers were even lower. I crashed in the middle of Walmart, despite having ate a snack as usual about 30 minutes prior. I was dizzy the rest of the day, which is typical when I have either had a crash or a spike. I thought perhaps I would be much better the next morning (today).
Through the night last night, I had three contractions powerful enough to wake me up. Things seemed to be progressing just a bit toward labor.
After I got up this morning, I realized that my dizziness hadn’t gotten any better. I also saw that my fasting glucose levels had hit the lower acceptable limits at 75. I called my doc.
She called me back as I was making breakfast. She informed me that it sounded like my placenta had switched gears on me. The placenta releases hormones that increases insulin demands, which is typically no big deal for most women. In someone who is insulin resistant, though, this is what triggers the high blood glucose levels and thus gestational diabetes.
I’m not going to pretend to understand the pathophysiology of what is happening right now with my placenta, though. She said that my placenta is preparing for birth, though, and that this changes which hormones are being produced. This also means that my placenta does has an expiration date that is sooner rather than later.
I informed her of my labor symptoms as well, knowing they weren’t significant or consistent yet, but she was pleased. She said that it sounded as if everything was progressing perfectly. She advised me to increase my carbohydrate intake significantly. She also said that she expected real labor to begin within the next couple of weeks.
She said she wondered if my low numbers meant that my body was eating away at my fat reserves, converting fat to energy. This is a concern because this process releases ketones. A significant amount of ketones in the blood can result in diabetic ketoacidosis, Long list of symptoms later, ketoacidosis can be really dangerous leading to seizure, coma and death if left untreated.
She cautioned me to be patient with the increase of carbohydrate intake. She said to expect some spikes, but that I shouldn’t back off on my intake without giving it a couple of days.
That conversation was this morning. For lunch, I had pizza. I haven’t had more than one small piece of pizza since around week 22 of pregnancy. Today, I had four pieces of pizza. That’s how many sounded good, so I went with it. Nervously.
An hour later, my blood glucose level was 91! A fasting blood glucose level that is considered ideal is between 75-95. Needless to say, this was amazing! I promptly stocked up on dark chocolate covered almonds to keep with me at all times in case of crashes, though (always pick something that has some sugar but also a bit a protein).
I have been snacking all day. This has been difficult because I’m also having bouts of nausea to go with my contractions. For dinner, I had chicken and dumplings (along with some other healthy things, but those items aren’t important). An hour later, my blood glucose levels were at 110! Another miracle!
It’s like I’m suddenly normal! Well, that’s relatively speaking anyway.
As my labor symptoms increase, I will have to guard against low blood sugar it seems. This is quite a switch for me, but a welcome one nonetheless.
I will continue to monitor my glucose levels four times daily (at minimum) and I will update my blog for any new developments. I don’t know any two people that have had the same exact experience where gestational diabetes is concerned, but I do know that others’ experiences have been so invaluable to me along this journey.
Have you had a similar experience with gestational diabetes? How did it progress as you neared labor and delivery? I would love to hear your story in my comments section!