Just received a shielding letter but no one knows why!!

[theviewfromhalfwaydown]

I’m freaking out a bit that there’s something wrong with me I don’t know about. I received a shielding letter but have no idea why I have it. I’m slightly overweight but haven’t been weighed by a dr in 10years and that was just after I’d given birth to my youngest. I have no underlying health conditions I know about and I’m only 38. All I can think of is that I had gestational diabetes but that was years ago. I’ve already had the first jab as I work in healthcare but I’m worried they know something I don’t. I’m not going to shield as I don’t think I need to and I want to work but it’s still thrown me quite a bit.

@NeedsImprovement01 oh yes, absolutely agree with that. No GP should remove someone from the list without consultation first (and appropriate checks!)

What has really shocked me about these threads is how many ladies were not told about increased lifetime risk and have not received routine checks.

I guess because I live in an area with a high prevalence it has really been drummed in to me (to quote if I exercise and eat really well maybe I can avoid T2 until I am 60). Even in post natal they shout at GD mums eating anything sweet because they have to stay eating like they had GD because of the type 2 risk. This seems a very different experience to what some ladies have reported!

Sorry, yes I did mean has there been any evidence for undiagnosed diabetes having an impact on COVID outcomes for women with a previous history of GD/other risk factors.

@NeedsImprovement01 Agreed. I remember when I was diagnosed I was a complete mess. Both my brothers have type 2 so I was convinced I had undiagnosed type 2. I was very borderline and the team weren’t sure I even had it, but I remember saying to them “but how will my postpartum know if I have diabetes if I just stick to a good diet? Surely I have to eat my old diet for it to show diabetes?” - they responded with “That’s the point, we don’t want you to go back to your old diet! And no matter what happens, make sure you make time for yourself each day and get a walk in.”

I’m still on some GD groups and there are so many posts from GD pregnancies talking about what junk food and sweet treats they are packing in their hospital bag for when baby arrives. There’s a celebrity I follow on Instagram who had GD and all she has done since she gave birth is eat fish and chips, ice cream, sweets etc. I read a study that showed if given correct postpartum dietary and exercise advice which is then followed, the risk is delayed or eliminated. I’m sure the majority of the 50% that develop within five years are those who aren’t aware it’s a lifelong commitment.

I was never told by the NHS that I'd be at increased risk for life... I remember one midwife telling me that as soon as the placenta comes out the problem will resolve. A friend of my Dad's did say GD could be "an early warning sign" and after my son was born I did improve my diet a lot. But that has gone out the window due to the stress and total loss of routine in lockdown. When I'm trying to work with three kids at home fighting all day my instinct is to go looking for sugar... I'm going to email my GP for a blood test today.

I knew it was an increased risk but was under the impression it was slightly increased... not “up to 50% develop T2”

I eat a diet to avoid type 2 as my father died from complications, uncle both feet amputated, brother and his daughter both housebound and other brother type 1. I remember giving all this information at each GD pregnancy and have never been called for a test after birth. I didn’t even no it was a thing to be tested. I know I am ok as I have kept testing my levels monthly. Enough family members to keep me supplied with sticks

Know not no

I was shocked to read 50% in 5 years, probably with an increase in older mums and obesity at a population level the statistic has got worse in recent times.

As we know there is a lot lifestylewise we can do to reduce our personal odds, but there is still a genetic factor.

I presume everyone also knows there is an increased risk of the baby developing diabetes and being obese. Again some of that risk is likely to be due to correlation with lifestyle but some is I believe thought to be genetic.

All the people on here telling others what to do - I don’t think anyone should be making assertions at all. I’ll bet most if you aren’t even doctors. Usually there are a combination of reasons why people are clinically vulnerable. Most of us don’t know what they are because we’re not scientists and we don’t have access to the data.

@SugarbabyMilly True to a degree, but you would know if you were CEV. It’s a group of people with very specific conditions.

The point is that one of them was mistakenly included (Gestational Diabetes) and it has been confirmed to be wrong by a Diabetes specialist who actually worked on the tool it self.

I think the take home is - speak to your GP, but if you had GD and have had the all clear since, and have no other conditions, there is nothing to panic about.

It’s not just about GD or any other conditions, it’s also concerning medications you take in addition to other factors as well. There was also some research in Wuhan which looked at certain blood types being more vulnerable.

@SugarbabyMilly Ok, you’re overthinking it but I can see why because I did too when I first got my letter. It doesn’t take into account any of those things. It’s the list on the calculator and any conditions on your medical record, not blood type or any of the other things speculated about in the media. It’s not that sophisticated!

You can have a look yourself -
www.bmj.com/content/371/bmj.m3731

Anyway, you’re totally right in that nobody should take it with a pinch of salt - so please know I’m purely referring to the gestational diabetes situation as there are many, many women who received letters in error due to this.

I was warned about the increased risks, and I also read a lot about GDM at the time. The NHS dietary advice for GDM and diabetes generally is terrible though IMO, far too carby. I ate a low carb diet before and during pregnancy because it suited me better as it was - it was one reason why I found it so easy to control GDM with diet (because my GDM was controllable with diet, it isn’t always, and because I didn’t find it hard to continue to stick to that kind of diet because I was used to it). And I continued with low carb afterwards (not as strict because the evidence about breastfeeding and low carb is patchy, but still low sugar and few grains). I didn’t have GDM in my second pregnancy. The only blood sugar spikes I have ever had were with the GTTs in my first pregnancy - which says that I clearly wasn’t able to handle sugars in that quantity but I wasn’t consuming them in that quantity anyway fortunately.

@HereComesATractor yes I agree. The advice really is terrible - the information I had was saying it was ok to eat toast!

@HereComesATractor Interestingly many trusts advise you need to eat at least 150g carb per day in the 3 days leading up to your OGTT.

Even if a non diabetic performed an OGTT on a low carb diet it’s highly likely they’d fail it. The body just isn’t prepped for that kind of glucose. Nobody actually told me this, but it’s readily available information online

Oh that is interesting, I didn’t know that. However with the same low carb diet during my second pregnancy I didn’t have a problem with the two GTTs I had ( at 16 weeks and 28 weeks). I was strict too as I anticipated having GDM again and didn’t want to risk high sugars for the baby

I must have been lucky second time round!

From what I’ve just read, the reason that people who had GD are being advised to shield is that when you get Covid it can trigger the same response as the hormones in pregnancy which trigger GD. I.e your blood sugar goes all over the place and your immune system can’t focus on fighting the disease.

When I had the test for GD, I knew something was wrong as I had felt very ill for most of the pregnancy up to diagnosis. And when I started injecting insulin I felt better.

@SugarbabyMilly It’s really not. It’s been confirmed that historic GD is not a risk factor. I saw the speculation on the GD groups about this if that’s what you saw, but it simply isn’t the case. Prediabetics have not been asked to shield. They are far more at risk than someone who once had GD. You shield if you have type 2 (or any of the other conditions on the list) in combination with other risk factors also on the list.

@HereComesATractor It’s such an odd one. I’m keen for another little one some day, but the thought of pushing myself further down the diabetic route scares me. What’s worse is that I never had an OGTT so nobody could be 100% I had it as my bloods were very borderline.

@doireallyneedaname - where is it confirmed? I just read something on diabetes U.K. also how can you know you’re not at risk if you’ve not been offered a blood test?

@SugarbabyMilly That’s the whole point - if you haven’t had a follow up postpartum after GD; you COULD be at risk because you may have undiagnosed type 2. If say, however, you had an hba1c three months ago and it was all clear, and you have no other risk factors ok the calculator, then you ignore the letter.

Partha Kar confirmed it on his Twitter. He’s the NHS national diabetic advisor and he actually worked on the QCovid tool which is what all of this is working from.

@SugarbabyMilly Diabetes UK is talking about current gestational diabetes, not historic. Current gestational diabetes could be a problem, and they are looking into it at the moment.