I'm stealing the first part of this week's journal from an email I sent to the ICAN (International Cesarean Awareness Network) email list.
I mentioned before that I am very high risk for diabetes so this pregnancy I have been monitoring my own sugars. Last pregnancy I failed the one-hour test and passed the three-hour "with no problems". This pregnancy though my AM fasting numbers were always on the high side (around 100-105) which I didn't realize was high because I'm familiar with the non-pregnant OK number of 120. My dad who is an insulin dependent diabetic was told to keep his fasting sugars below that, but my OB said the "new" OK level is now 90 - 95. My post meal one hour and two hour sugars are almost always really good unless I eat rice and then they are a little high. Often my two hour post dinner sugar will be below 100, but when I wake in the am my sugar will be higher . . . this has never made sense to me! At around 21 weeks my fasting sugars went up to 110-115. I also had a cold and I know that illness can make your sugars higher, but they remained there for two weeks and didn't go down significantly when my cold got better. (I later found out that I wasn't using nearly as large of a drop of blood as I should have. Had I been using a larger drop my sugars might have been lower. When I get a high reading I find that if I test again with a bigger drop it is significantly lower! I bet with all these higher sugars part of the problem was not using large enough of a drop!)
My midwife suggested that I might be borderline and she suggested I take the GTT. Since I failed the 1 hour last pregnancy I figured I'd just ask my OB to send me for the 3 hour rather than deal with it twice. The midwife agreed that made sense. The OB reluctantly agreed as well. He doesn't do the test until 28 weeks and I was 23 weeks when I asked him to give me the lab slip (recall that I'm still seeing the OB because I have an HMO, but on July 1 I switch to a PPO which covers the midwife and I am ditching the OB).
I have my own meter so I took my sugar right when I arrived at the lab and then again right after they drew my blood each time. I looked up what your levels should be on the internet. Below is what I found. First I have listed the NDDG scale then the Carpenter scale and finally my numbers (according to my glucose meter) in parenthesis.
Fasting 105 - 95 (89)
1 hour 190 - 180 (171)
2 hour 165 - 155 (139)
3 hour 145 - 140 (117)
So to me it looks like I passed with flying colors. I took this test Monday and still had not heard back from the doctor so I called today. He called me back, but I wasn't here and left a message that I had failed the test. He said my fasting level was too high, but all my other levels were ". . . . well, lets call them . . . hmm . . . well they were normal." I'm guessing maybe he meant they were a little on the high side of normal? He had told me before that my fasting level should be below 90 and my fasting level is never that low when I monitor myself unless I eat no carbohydrates at all after lunchtime. It's weird. I can eat a big dinner with steak and potatoes and salad or veggie and a bowl of ice cream for desert and my two-hour sugars will be below 90, but when I wake in the am they are 115! That makes no sense to me! I have a diabetic friend who said that her doctor told her to take her fasting sugar immediately when she wakes because if you are up and about too long your liver will dump sugar and cause a higher reading. I don't know if there is truth to this or not. My dad has never heard of this, but I have also read that if you fast for too long your sugars can rise. If it is true I was awake for about 30 minutes when I took my own sugar, but I had to wait at the lab another 30 minutes before they took my fasting sugar. Could it have gone up during that time?
Of course the doctor did not tell me what my numbers were in the message. But I had always been told that you pass the GTT as long as no more than one of your numbers is too high. Well three of mine were fine according to the doctor, and all four of mine were fine according to my own testing. He said that it is urgent that I need to go on the diet ASAP. First I'm trying to figure out why it is so urgent if I am basically borderline if diabetic at all. Secondly I had to ask him to test me early. He wants to wait until week 28 so why suddenly is he stressing (and stressing me out) about a result that he normally wouldn't have even have found out for another 4 weeks. And the worst part of this is being in the middle of a move I have to sit around all day tomorrow waiting for another phone call from him!
So I'm annoyed, a little worried, a little . . . interrupted by the doctor calling me back just now!
Here's the scoop. My fasting sugar was 102 which means in that half hour I was waiting for my blood to be drawn it raised 13 points or my meter is that far off (which I doubt). I actually forgot to ask about the other numbers, but he said they were just fine. But he is officially calling me a gestational diabetic! I feel like he just wants to slap me with another label to try to convince me not to have a VBAC, although he didn't say a thing about that. He was impressed with my knowledge of GD and said that he's sure everything will be fine. His nurse will be calling me tomorrow and giving me the info on the nutritionist. I hope the nutritionist is a good one. My dad's and brother's have been hit or miss. The first one my dad went to my dad and mom knew more about nutrition than she did!
The OB did agree that I am very borderline and it is probably not too much of a concern. He said with diet I should be able to control it. But again I'm trying to figure out what I can do with my diet to change my fasting number. I eat dinner and my sugar is just fine when I go to bed and it raises during the night. I told him this and he said this is worse than someone who goes up after meals because it means the baby is in a high sugar environment all night long. He said if that is true than most likely he will put me on insulin. No way am I agreeing to that without seeing a specialist. A fasting sugar of 102 in the AM I do not think is a reason for insulin. Maybe I'm ignorant, but I'd rather have a slightly large baby than risk messing with insulin and having my sugar go too low during the night! I'm wondering if I hop on the treadmill before bed if it will help me bring down that AM sugar. My mom had a good suggestion. She said for a few nights in a row wake and take my sugar every 2 hours during the night and see if it is peaking right before I wake or if it is peaking earlier. I think I'll try that, but not tonight - I'm too tired. I'll wait until the weekend when I will have some help taking care of my son the day after not getting good sleep!
I'm frustrated though. I don't see how I can lower that number with diet alone. I've tried and the only thing that brings it below 100 is to eat absolutely no carbohydrates after 2pm. The week I went on a high protein diet (steak only cause I have aversions to all other meats), cheese, veggies and a little bit of fruit only, no bread, pasta or rice - well I ended up in agony from IBS. If I don't eat a certain amount of low fiber carbohydrates like breads and pastas I get mucousy diarrhea all day and horrid cramps, and I become housebound! I haven't been officially diagnosed with IBS. They were still doing tests when I got pregnant, but I have had issues with it ever since my gall bladder was removed when I was 6 weeks postpartum (almost 2 years ago). The GI specialist's guess (he admits he has no clue really) is that I'm pumping out too much bile directly into my stomach and it is irritating my intestine. My blood work is completely normal, my stool samples are normal (no blood) and the Barium swallow I did showed nothing abnormal. I do have reflux too (also aggravated since the surgery) and the next step was a barium enema, then a colonoscopy, but I found out I was pregnant. Anyway I'd rather have another 10 lb baby than deal with the agony of full on active IBS for the next 4 months!!! It's bad enough when I have an attack once or twice a week!
I don't know when I'm seeing the nutritionist. I hope it is before my midwife appointment next Thursday. I can't wait to discuss this with her as well. I think until then I might try hopping on the treadmill before bed and see if that helps at all.
I wrote that email last Thursday and early on Friday the nurse called me and said she had made an appointment for me for next Wednesday morning. I am looking forward to seeing and talking to the nutritionist. I have gotten a lot of feedback from members of the ICAN list including some midwives, and also from StorkNet's expert forum. It seems that with gestational diabetes the goal is to keep your fasting sugar below 110 and to keep your two hour post meal sugars below 120. I was doing this before without changing anything in my diet! This is so confusing! I also put a call in to my midwife who has Fridays off so she will hopefully be calling me tomorrow.
I got a taste of what it would be like to have twin toddlers on Friday as well! My good friend who has a son 4 days older than Tommy (22 months) and a son who is about three and a half has been really sick lately. She is recovering from bronchitis and last week she started getting abdominal pains. She had been to urgent care and the emergency room and they don't know what was wrong. I headed up for the day to help her out (she lives about 40 minutes away). We went to the park, to their Music Together class and then lunch. During lunch she started feeling much worse again so we headed off to the ER. I was there about four hours watching the boys who were quite a handful. Her boys were actually remarkably well behaved considering they were without their mommy and overtired. I was completely pooped chasing after them. It got especially tiring when they realized they could open the automatic door. Fortunately at about the time they made that discovery four 9 year old boys from a baseball team arrived with their teammate who had jammed his thumb. They entertained the boys and chased after them some. Soon after my friend's husband came and I followed him back to their house with the boys. I never let Tommy watch TV, but after this long day I just plopped all the boys in front of the tube and lied down on the couch. They ended up all climbing on me and cuddling with me. I knew they were tired, but they weren't about to go to sleep before their parents got home! I got lots of hugs and kisses from them all and the two hours before their parents finally came home went very quickly. Her boys got very upset when I left their house and her youngest, who is much more verbal than Tommy, learned how to say my name! He was crying "Miss Mish Peas NO!" Which we figured meant please don't go! Her oldest calls me Miss Michelle and he calls Tommy Baby Tommy. It is not just plain Tommy he always says "Baby Tommy" even though he really isn't a baby anymore! My friend said the next morning when he woke up he again was crying for Miss Mish! Unfortunately they still don't know what is wrong with my friend. All her tests came out negative. This is the same friend who was going to come help us move and clean so obviously that didn't happen!
Tom and I went down to the new house on Saturday and had quite an adventure! I did a second steam cleaning in the parlor that was actually quite dirty! I started doing a vinegar rinse last time and the water came up black so I used soap instead. The vinegar rinse I did Saturday was coming up pretty brown as well so I will be doing one more rinse. While I did that Tommy and Tom vacuumed the study. Then I started in there while they vacuumed the hallways, master bedroom and Tommy's room. Tommy actually hangs on and pushes the vacuum to help! If Tom wasn't keeping him occupied he would come in and move the steam cleaner and I don't have the strength to fight him and keep it on course. The study carpets were even filthier than the parlor ones so I will definitely need two more rinses there as well! I started in on Tommy's bedroom while Tom went to the store to get some cold drinks. I went to refill the water tank and got back to the bedroom and the steam vacuum was gone. Tommy had dragged it to the parlor all the way on the other side of the house while I was in the kitchen. I was hurting quite a bit from all the work so I lied down on the floor with him to rest for a while when I heard Tom pulling up. Suddenly it sounded like the sprinklers were going off. The landlady said nothing about them being on a timer so I got up and looked out the window. There was a huge geyser of water shooting up by the driveway and falling all over Tom's car. Have I mentioned that Tom has a convertible! Instead of backing up he was quickly trying to get the top on. It was actually funny watching him! It turns out right at the edge of the drive was a sprinkler they installed and the pipe was just a weak plastic pvc pipe. Tom barely bumped it pulling in and it snapped. Fortunately we have his cell phone (we don't have a phone down there yet. Service is on, but we don't have a spare phone to leave there) so I got on with the water company and they tried to talk me through where to find the shut off valve. I couldn't find it so they said they would send a serviceman out. After I got off the phone I finally found the valve they were talking about and we shut it off, but it did nothing but shut the water off to the house. There should have been a second valve to shut the outside water off, but there wasn't. While we were waiting a neighbor came by asking if we needed help. We showed him the valve and he agreed that there should be a second one. The he ran to his van and got a tool out and turned off the water at the street. We called the water company and cancelled the service call. This neighbor, well actually the fiance of our neighbor, is a handyman and does all kinds of work. He investigated the sprinkler and determined that it was done wrong. They tapped into the main water line and didn't install a shut off valve so it is not to code. He offered to get a pressure cap and come back on Sunday to fix it so we could turn the water back on until we did something more permanent, but we said we'd just wait until Tuesday when my dad gets here. I had the perfect amount of water in the tank to finish steam cleaning the bedroom so I did that and then we closed up and headed home. I know my stress level is better because I actually found the whole experience amusing instead of annoying, although of course I am annoyed that I can't do any more cleaning at the house until probably Wednesday now. Between all the problems we have had and all the setbacks my parents have had it's hard to do anything but laugh right now! When I called my mom that night we were half crying and half laughing at everything!
My parents have been delayed a few more days due to another thing breaking on their RV engine and bad weather. It was raining a lot and actually snowed in Santa Fe a few days ago so they couldn't go on a test drive nor could my dad do some of the under engine work. He didn't particularly want to lie down in the mud (most of the driveways and even many of the roads in Santa Fe are unpaved). But they were able to go yesterday and finished cleaning and packing and hit the road this afternoon and plan on being here Tuesday mid-day. They live about 1200 miles and 22 hours away.
Today I left Tommy home and did some shopping for things for the new house, shelf paper and cleaning supplies. I've been feeling nauseous and ended up napping most of the afternoon. Tomorrow I have about two weeks worth of laundry to fold and hang (two baskets and Tommy's crib are overflowing with clean laundry). When that is done I guess I'll try to pack some more. I'm not sure what to pack at this point. My friend might be coming over if she is feeling better. I have a massage scheduled at six and even though I told Tom he has to be home by 5:30 then I have my doubts that he will actually get home early. It would be nice to have her here as a back up! I am really looking forward to the massage, but I can't take Tommy. A week and a half ago my sacrum went out and it or the baby was pressing up against my sciatic nerve. I had two days where all I could do was sit. Even lying down was very painful. Things seem to have popped back into place though. I hope it stays that way!
I am going to try to write my week 25 journal a little early. I think I mentioned I see the nutritionist on Wednesday and I also have a make-up midwife appointment on Thursday. My appointment was last week, but I got the time screwed up in my head and I got there at 2:30 instead of 2:00. She was running behind anyway so I just rescheduled. Hopefully she will call me back tomorrow to talk about the gestational diabetes diagnosis. I'm really anxious to hear what she has to say about all of this.
This is the ongoing saga journal entry I guess! It is now Monday night and I did get a call back from my midwife early this morning. She says I do not have gestational diabetes. She said the standards the OB is using are very controversial and very new. The current ACOG standards are still the ones I had listed above, and the more generous NDDG scale. She said there has been no proven improved maternal or fetal outcome with keeping fasting sugars below 105. And at this borderline number that I have the only risk to the baby or myself is a slight increase in the baby's size. I'm not worried at all about that! I am still planning on seeing the nutritionist and will then talk further with my midwife on Thursday and together plan to take or leave the nutritionist's suggestions.
