Gestational Diabetes Freak Out!

[OnABabyDiet]

Hi. I'm 36+3 and over the past few days my blood sugar levels have been steadily increasing to the point where I feel like no matter what I eat/don't eat/do/exercise that I can't control it.

Saw the diabetes specialist at the hospital yesterday who said it would be pointless medicating me at this late stage and hormones usually level out after 36wks anyway so levels shouldn't carry on increasing.

Can people please recommend any meals / snacks that they have found to help keep sugar levels low in late pregnancy? Thanks

[lotsofcheese]

Am sorry to say you've had crap advice. If your blood glucose levels are above target despite diet & exercise, starting medication is the next step. Going on for another 4 weeks or so with high levels is not acceptable. How high are your levels?

Do you have a contact number for your diabetes nurse?

[May09Bump]

I think I would get a second opinion, I had GD from the test and it couldn't be control by diet / exercise (I was super strict) - they put me on insulin and I had to have it by IV during labour because sugar levels could go all over the place during. Did they test for ketones? because if they are high they need to do something to get them down.

I got really stressed trying to manage it by diet, in the end it rose so high I booked myself into the maternity ward and got them to check sugar / ketones - then they admitted I should be on insulin.

Diet wise, you should be able to get some meal plans from the hospital nutritionist usually attached to the diabetic clinic.

Sorry you are going through this - its not pleasant having worries at this special time.

[DinoSnores]

I'm really surprised by that advice because we normally advise treatment even at a late stage. It won't make a huge difference to the baby's growth, but it can prevent problems from neonatal hypoglycaemia (because the baby is used to getting higher glucose levels from the mother, so the baby makes more insulin, so when born, the baby still has a bit too much insulin and can become sleepy and difficult to feed due to neonatal hypoglycaemia).

Obviously it depends on your specific levels and how close they are to the targets but I'd consider getting back in touch with your diabetes team to check what their plan would be.

[OnABabyDiet]

Thanks for the advice.
My levels are not astronomical - they have increased from averaging 5 to averaging 5.6 (fasting) and from avg 5.4 to avg 6.9 (post meals). The specialist described them as "borderline". Maybe I am just a worrier but definitely want to check I am doing the right thing by my baby.

Can I see my GP about this or would I have to go back to the hospital? Thanks

[lotsofcheese]

Different centres have different targets; in ours it's below 8mmol within an hour of a meal & less than 5.5mmol fasting. We introduce medication (metformin first, then insulin if targets are still not met) if 2 readings are above target.

Your GP won't be able to help; the diabetes care team at hospital manage gestational diabetes. Did you see a nurse or consultant? When is your next appointment at clinic?

[GoldenDaffodil]

Your levels wouldn't be considered too high by the team looking after me. Mine have to be below 5.5 fasting and below 7.8 an hour after meals. Occasionally I'll get something close to 7.8 after a meal but every time I've mentioned it my diabetic nurse has always said this is ok. When you said you saw a specialist was it a Dr, Nurse or both? They should definitely have given you a number to call if you've got any concerns. If they didn't the hospital switchboard should be able to put you through to the diabetic antenatal team/clinic. Your levels honestly sound well controlled to me though. Mine are similar and I'm
not on any medication.

[OnABabyDiet]

Thanks - my targets are 5.5 for fasting and 7.0 2 hrs after meals. It is the fasting ones that I am concerned about, my reading this morning was 6.2. I had 1 slice of wholemeal toast with peanut butter before bed last night, which I thought was a sensible choice (please correct me if I'm wrong!)
On Tuesday I saw a diabetologist - I assume this is a diabetes consultant? I am having a section sometime in the next 3 weeks due to breech baby so he said that he's not too concerned. I might be worrying about nothing but appreciate any advice / reassurance. Thank you.

[lotsofcheese]

I agree 6.2 is too high for a fasting reading. If you have another high reading tomorrow morning (or today is your 2nd raised fasting level in a row) I would be phoning your diabetes nurse specialist/centre.

Your only other option is to skip supper altogether, but that's perhaps not a solution if you're hungry at bedtime.

[DinoSnores]

Okay, so your numbers really aren't too bad and you are on target for the vast majority of the time, so I can see why they've not advised more treatment at your last appointment. Fasting sugars of 5.6 are very, very unlikely to have an effect on your risk of problems and your post-prandial (after eating) blood sugars are excellent.

(A diabetologist is a doctor who specialises in diabetes and may or may not be a consultant.)

Do you need supper? I'd be inclined to skip it but if you do really need it and your fasting sugars are still up tomorrow, then consider calling your diabetes team in case they would consider treatment.

[GoldenDaffodil]

I agree with dinosnores. You could try skipping supper to see if that brings the fasting level down but the fasting readings are a little high so it's worth seeking further advice. This is the first time I've had GD so I'm not sure about whether medication would be advised for slightly increased fasting readings.

[DinoSnores]

coolas, HbA1c is entirely irrelevant in pregnancy so is not used at all for deciding treatment during pregnancy.

The reasons for that are that red cell turnover can be increased in pregnancy due to a number of reasons including anaemia and because HbA1c only really gives you an overview of the glycaemic control of the last 3 months (particularly the last 6 weeks) so just isn't responsive enough in the time pressure of pregnancy.

The OP has been given very appropriate targets (they do vary between hospitals as there is no national/international consensus so every place does things slightly different depending on which guidelines they follow). Meeting those targets on a day to day basis is far more important in pregnancy.

As for normal life with T1DM or T2DM, the HbA1c target will depend on the patient, other issues, if they are TTC etc, but will often be around 6.5-7%.

As for the treatment that might be offered, it is either metformin or insulin, but it will depend on the patient's results etc.

[OnABabyDiet]

Thanks everyone. I took your advice and didn't eat after 8pm last night and my fasting level was 5.7 this morning - still over target but definitely an improvement from 6.2!
Fingers crossed I can keep it under control for the next 3 weeks!

[DinoSnores]

Excellent, onababydiet.

(coolas, as a diabetes specialist at a hospital, I am quite confident that I know what I am talking about and think that my comments are quite reasonable!)

[lotsofcheese]

Just as an aside, the use of the word "borderline" when applied to diabetes, really infuriates me.

Either you have targets & intervention levels, or you don't. What's the point in having them if you don't act upon it? Assuming you've been asked to check glucose levels 4X daily (not much fun!), yet your healthcare team are procrastinating & saying "borderline" about acting upon your levels above target.

OP, if you were attending our diabetes obstetric service, we would probably have started you on metformin already. We give all our gestational diabetes patients metformin on their 1st appointment, with instructions to start it if they have 2 (yes, 2) readings above target (unless there's a really obvious explanation for them eg drinking full sugar cola by mistake).

Ok, rant over!