Monday, December 27, 2010

Sweet Times

Have I mentioned how much I like data, especially plotting data?

I loved being pregnant. I can't describe how much I loved being pregnant. My hormones on a normal day might be totally out wack, but something glorious happened while Jack gestated: I felt good, like, really good. My skin cleared up, infertility treatments were over, my stress subsided, and I basked in the glow of my increasingly round belly. Leg cramps and round ligament pain? Who cares, when you feel the baby kick and stretch! Not all women feel so good during pregnancy -- I was really lucky.

Yet, I still had some trouble, and it had to do with my blood sugar. During pregnancy, it is normal to become increasingly insulin resistant as you near term. This is nature's way of ensuring that your baby gets a high dose of glucose and can put on lots of fat in the last trimester. Sometimes nature goes a little overboard, and your blood sugar gets to be so high that it puts your baby at risk.

A friend of mine was just diagnosed with gestational diabetes. She came over this morning and I loaned her my glucose meter, so that she can keep track of her blood sugar until she is able to see the high risk doctor. I feel so much for her, because I know how stressful gestational diabetes can be.

Gestational diabetes is just awful, just terrible. It's hard to describe the awfulness. You are 100% focused on growing a little being, doing every single thing you can to ensure its future health and happiness... but what you eat is potentially hurting your tiny co-pilot. If you're like me, you thought you knew what "healthy" was, you had careful, obsessive plans for your good nutrition during pregnancy, and you get thrown for one hell of a loop when you find out that your whole food philosophy needs to do a 180. There you are: forgoing whole wheat pasta with fruit salad, and instead sneaking a glug of olive oil onto your egg breakfast and asking for extra meat with your carefully portioned serving of bland rice. You have to stop eating fresh berries (in season, in Connecticut!), and instead find yourself peeling back the plastic on a pre-packaged mozzarella stick and pounding down the peanut butter. How can this possibly be healthy, you wonder? You are stressing out about every single morsel of food. Food becomes the enemy, and it is a necessary evil.

There are no hard and fast rules. Every doctor will tell you something different. Current research keeps bringing the glucose targets lower, and lower, and lower. And here's the real awful part: no matter what you do, it will get worse. No matter how good you are, your insulin resistance will increase and your blood sugar will keep going up. By the end of it, even with insulin injections before each meal, the most I could tolerate for breakfast was 3/4 cup boiled quinoa (30g carbs) with 1 tbsp heavy cream, 1 tsp agave nectar and a handful of nuts on top. Then one cheese stick an hour later, and one piece of fruit after that. Even a single slice of rye bread (unsweetened) sent my sugar soaring. Stressful. So stressful.

Sometimes I would explain that I had gestational diabetes, and a person would react with surprise: "But you're so thin!". I hated that. Gestational diabtees has nothing to do with being thin or not being thin, just like infertility has nothing to do with being stressed or not being stressed. Gestational diabetes is not the woman's fault and it cannot be prevented. So much about reproduction is assumed to be under the woman's control, and yet so little of it is.

So how do you know if you have gestational diabetes? First, you go to a lab, drink 75g of glucose, and have your blood drawn 1 hour later. If that result exceeds cutoff, you take the 3 hour test: 100g of glucose. Here are the cutoff values:
  • Fasting: 95 mg/dl
  • 1 hr: 180 mg/dl
  • 2 hr: 155 mg/dl
  • 3 hr: 140 mg/dl
If you exceed 2 values, you've got The Diabetes.

In my case, I failed the 1 hr test. I hit 187. If you hit 190, many doctors will skip the 3 hour test and diagnose you with GD right there. My doctors weren't concerned. I took the 3 hour test: 76, 140, 141, 139. Now, of course I didn't exceed cutoff... but... notice anything funny? My glucose didn't drop, at all. That's weird. That's really, really weird. I can't emphasize the weirdness enough. It is not normal for your body to be unable to clear glucose after 3 hours.

You're fine! My doctors at the group practice I went to told me over, and over, and over again. You're fine! You passed! Celebrate!

I celebrated by engaging in a google-freakout and buying a glucose meter. I tested at home: 130-160 after every meal, and we're talking 130-160 after things like a normal serving size of brown rice. My sugars were too high for a healthy pregnancy. I brought the values back to my doctor.

You're fine! You passed! You don't have gestational diabetes! Don't worry about the numbers! Cut back on the carbs a bit, and your numbers will be fine.

The scientist in me got a little obsessed. I read everything I could get my hands on. Normal pregnant women don't go above 120. I continued testing. 140. 150. 160. My weight gain slowed -- significantly. Back to the doctor.

Well, you're probably fine. Your baby will be fine. If you're stressing about this, go talk to the nutritionist, maybe she can help you cut out some more carbs. But hey, you passed your 3 hr test! Isn't that great?

The nutritionist spent a good deal of time frowning and rereading my food log. And you're sure they won't treat you with insulin?, she said. She helped me figure out a few more places where I could cut out carbs in my diet. 160. 170. 180. I slowly stopped gaining weight.


*It's hard to put the absurdity of their priorities in context. The baby sees blood sugar. That's it. My blood sugar was high. The baby was gaining a ton of weight. End of story.

The second nutritionist was horrified by my doctors. I was eating 120g of carbs a day (normal would be about 240) and my sugars were still high. She didn't know what to do. She suggested I try to get transferred to a high risk doctor. She gave me the name of a nurse: Nancy. Talk to Nancy, she said, Nancy will help you even if you don't get transferred.

I called high risk. I talked to Nancy. That night, I started eating carbs again. Over the next week, I would lose 3 pounds. My blood sugar remained high. Far too high.

I received a phone call. My doctor was confused: why had I called Nancy? I explained the issue, again. OK, said the doctor, we'll put you on this experimental drug that pregnant women aren't actually supposed to take (it happens to be teratogenic in the first trimester)... that'll fix your sugar and it will be so easy for you.

Inside my head, I lost it: just give me the goddamn insulin. This isn't about easy! I know how to inject it. Insulin will enable me to eat. It will protect my baby. Insulin is extremely safe, when used properly. I firmly requested to be transferred.

So the high risk doctor put me on insulin. Insulin: the wonder drug. I can't tell you what a relief the insulin was. We had to crank my dose up pretty damn high, but eventually, the insulin did its job and my blood sugar normalized.

Let me give you the timeline of events:

26 weeks: failed the glucose tests
28 weeks: picked up a glucose meter, noticed the high values
34 weeks: FINALLY got to see the diabetes doctor
35 weeks: started taking insulin

Now the real kicker just happened recently. I went to see a diabetes doctor last week. I told her this story. She asked if I was officially diagnosed with gestational diabetes. I said that her guess was as good as mine. She asked what my pre-breakfast dose of insulin (humalog) was. I said 18. Her jaw dropped. She said "18. As in 1-8? That's a LOT of insulin". I said "I know. Tell that to the doctors at my group practice". She looked at my chart... no diagnose of gestational diabetes, anywhere!

My advice to pregnant women everywhere? If your glucose tolerance test results are elevated but still "normal", stop eating sugar and find yourself a blood glucose meter. The cutoff values set for glucose tolerance tests are a load of crap. They were designed, originally, to predict the likelihood that the mother would develop type II diabetes. They were not designed to protect the health of the child... that job appears to be up to the mom.

4 days before Jack was born. He would be a very healthy 8 pounds!


  1. It's interesting what different experiences we had with GD. I was diagnosed right away with Ari. I was given a GD diet, but if I completely blew it my glucose readings always stayed low. I think I don't react well to the glucose test-- I was close to failing it with Greta too-- but I have no other GD symptoms. Low readings ALWAYS. I could eat cake and cookies and still have low readings.

    So, maybe we should all just have glucose readers and skip the big old test.

  2. Jenica, you are very lucky! It was miserable, absolutely miserable. No matter what I ate, my blood sugar soared. Although actually your experience does appear to be the case for most women with gestational diabetes (that they can deal with it with minor dietary modifications, or that their postprandial values are fine even if they fail the OGTT).

    I agree about the glucose readers. I feel like a better way to check for GD would be to have women take a few readings during the week. That would be a far better indicator of what their blood sugar is like during their normal week.