Gestational Diabetes, Blood Glucose 10.5mmol, Reason for Concern?

[midori1999]

I had my first GD clinic last Weds. They asked me to monitor my blood glucose, stick to a healthy diet with sensible portions of complex carbs and see them next week.

I can't seem to get my fasting blood glucose down, but this morning after breakfast my reading was 10.5mmol. Do I need to do anything about this, is it a reason to worry? Or quite normal?

what did you have? If your reading is high but you KNOW its because you had something "bad" then I wouldn't worry too much. See what it is at 2hrs. A few one off higher readings are not an issue so long as it doesn't STAY high for hours. If this it keep happening, keep a detailed food journal and go back to the clinic in a week or so. Bear in mind fruit and fruit juice can give very high readings, whilst seemingly healthy.

I don't know about GD, but in Insulin Dependent Diabetes a reading of 10.5 after eating would be fine. You could check again 2 hours after eating and see how it is then.

If you are worried phone them tomorrow to go over your results so far. And watch out for hidden sugars - fruit juice is nearly as sugary as coke!

think trixie and I might be psychically linked with those x-posts!

Thanks for replying. Breakfast was 40g of mueseli and an apple. I know that can be bad for some people, but I had museli yesterday and it brought my reading lower than before breakfast. I did have it with an egg yesterday though. Apples don't seem to negatively effect my readings either, but it could be the combination?

My highest other reading was 8.8, although they have been more over my targets than under and I've been really careful about what I eat. I can't seem to tolerate any 'normal' bread, for example, even if very seeded wholegrain, but did have a wholemeal pitta yesterday which seemed fine. My before breakfast reading is always over the 5.9 they said it should be under.

I got hold of the DOU who told me to ring the diabetes nurse on the 24 hour number. I couldn't get hold of her but left a message. They said to ring back in half an hour or an hour if I still can't get hold of the diabetic nurse.

I'll see what my reading is before and after lunch and make sure I eat something which I know has given me good readings in the past. I don't want to panic, but was already high risk before the GD diagnosis and lost twins at 23+5 last year, so it's hard not to worry. The diabetes literature they gave me said if you had a reading on over 10mmol in pregnancy you needed to check your urine for ketones, although it was referring to type 1, so not sure if the same applies to GD only?

If your fasting rate is too high then I think that's the route of the problem, your body just isn't coping with your blod sugar. I expect you'll have to go on insulin control (I've been threatened with it but always managed to bring my readings back under control).

As your fasting rate is too high then it shows it really isn't your diet to blame. I'm not surprised you are worrying but I think they will just want to bring you in and teach you how to use insulin (which I'm told really isn't that bad) as soon as possible.

I'm afraid I don't know about ketone testing but I've had a few readings over 10 (personal high 12.8 - oops) and haven't been tested. But I've never had more than one in double figures in any one week. I've been on my "final warning" for going on insulin for a month now but I'm keeping my readings low enough with very strict diet control (basically I eat protein, fat and a raw veg, not good for a long term diet between now and my induction on 4th April).

BTW, eggs (pure protein) really slow digestion which will have slowed the sugar release from the muesli. I can't cope with muesli - too much dried fruit and carb in it for me. I can only eat bread with protein (eggs or wholenut peanut butter). The weight of carb in a pitta is much less than a slice of bread which is maybe why you can cope with that or it may be what you ate it with, cheese on toast or cheese in a pitta may be okay for you too because of the protein and fat in the cheese.

Let us know how you get on.

I echo what happycamel has said - the egg will certainly have made a difference to your muesli earlier in the week.

When I had GD with DD a couple of years ago I was never able to lower my pre-breakfast level (fasting level) so after a couple of weeks of trying I was put on 1 injection per day of long-acting insulin. Made all the difference. It really doesn't hurt (I think the finger pricking hurts more), and is very easy to get used to. Injections are usually done with 'pen' needles now which are loaded up with insulin, you just need to screw a very fine needle on to it, dial up how much you need, and push! I also found when I had GD that I needed to avoid all bread (except pitta) and all breakfast cereals - even porridge - I've never eaten so many eggs!

Understandable that you are worrying, but hopefully some of the advice in these posts will have gone some way to help you understand the different readings you've been having.

I have had Type 1 for 25 years and am now 32w with DC5. I am insulin dependent and would say to you that it would seem so much easier than to have to treat by diet alone. Don't be worried about taking insulin if that is what is required - it is not a prison sentence.

The advice about ketone testing is universal for all diabetes, and does apply to you. Basically ketones are produced when the body does not have enough insulin circulating to take up the glucose in your blood and use it for energy. The body then has to use another form of energy which will be fat or muscle, during this process waste is produced - ketones which can alter the acidity of your blood. The process can be reversed but if left for a significant amount of time - a day or so rather than hours - this can become very serious to your health.

Keeping a strict food diary is excellent advice as it takes time to learn what each piece of food does to your blood sugars and which will alter as your pregnancy progresses. I have found that bread and cereal are no-nos for me, I tend to eat less carbohydrates (much smaller portions) during my pregnancy than I would normally, without cutting them out completely. Fruit is healthy but the sweeter ones particularly oranges and dried fruit push my levels up dramatically, this also includes most fruit juices.

The levels advocated are different for non-insulin dependent because it is harder to control. My levels should be between 4-7 and no higher than 9 for an hour after any meals. However I have always had lower levels than this and over time know what each meal's effect will be.

I wish you all the best and like I said don't be scared if you need insulin - it really isn't bad. Let us know how you are doing.

Thankyou very much for the replies. My before and after lunch readings were well within targets (after not so much so, but still under) so I feel more relaxed now, especially after reading the replies. I couldn't get hold of anyone in the end, but will speak to them on Weds or ring first if I get another reading over 10.

I have already been keeping a food diary as I see the dietician for the first time on Weds, so thought it would be helpful. I am aware of what I should and shouldn't be able to eat and that it varies for every person and also that protein and fat should be coombined with carbs, although I have to admit, I didn't realise what an effect not doing so would have and thought as there were nuts in the museli that would count as protein. Obviously not enough!

Are there any ways to get my 'fasting' (morning) blood glucose down? I'm not hungry before bed, but did try a snack of nuts one night to see if it helped as someone had suggested it might, but it made no difference. Would having dinner later/earlier maybe help? We usually eat around 6 or 7pm. I rarely snack after that tbh as I am just not hungry. My before bed readings are OK, not always under the 5.9, but not usually far over.

Sorry, just to add... I'm not really worried about insulin. I already inject clexane daily, which is painful, but I find it OK. I'd rather just get my levels under control and I feel like I am trying really hard and it's not really working. Maybe the dietician will spot a schoolboy error on Weds.

The only other thing you could try to get your fasting level down is a bit of gentle exercise after dinner. Maybe a walk now the evenings are lighter or a bit of housework (don't shout at me, just a suggestion). I've also been told to make sure I drink enought because apparently dehydration slows the metabolism.

Glad to hear your readings are better under control and good luck for Wednesday.

Thanks again. I do walk quite a bit anyway as I have 4 dogs and they get walked in three seperate lots. I did go for a walk at around 9.30 last night, just for 25 minutes or so, but my reading was still 6.2 this morning. They aren't massively high, the highest has been 6.5, but they have never been within targets. I'll try another walk tonight and see if that helps.

I do drink quite a lot, but not much water in the evenings, so will try and sip a glass of water over the course of the evening.

Thankyou once again, just to update.

I saw the nurse at the GD clinic on Weds. As I suspected they put me on insulin. They also moaned at me for losing weight and suggested I was 'starving' myself, although I only mentioned one or two meals, and felt I was eating lots, just small carb portions and more meat/cheese/veg/fruit. I had only lost 300g, so not loads!

I can't seem to tolerate bread at all, even though the nurse said I should be able to if it's wholemeal and seeded, which it is. On Weds morning I had had a breakfast of one slice of toast, half a tin of low sugar beans and two scrambled eggs and that gave me another 10.5 reading.

The nurse was mean to ring me yesterday to see how I am getting on with the insulin, but she didn't. I will ring her Monday. It's slow acting insulin, 12 units at night before my bedtime snack. It has helped me morning readings, but not loads, they are just under the 5.9 at 5.8 or 5.7. Yesterday my after meal readings were all over target, some of the same meals (eg. tiny jacket potato, tuna and salad) gave me much lower readings last week. This morning I thought I'd try two slices of seeded toast with lots of peanut butter, but again, it gave me 10.9, so I am going to keep off the bread completely for now.

If anyone has any good breakfast suggestions I'd appreciate them. She told me I need to include carbs, but I don't seem to be able to. (any cereals, porridge, bread etc) Seeded Ryvita seem OK, so going to try them tomorrow with cream cheese, but don't fancy that everyday!

I spoke to the nutritionist three times altogether!

My understanding is that your fasting morning blood glucose can be more to do with the liver releasing some glycogen during the night. When my post evening meal blood sugar is lower I sometimes eat two oat cakes with cheese as a snack before bed.

I understand that you are aiming to not go too high nor too low with the blood sugar as much as possible. It takes trial and error.

For breakfast I mainly have eggs or bacon with one slice of german rye bread. The heavy bread that doesn't expire for a month. I find breakfast very boring now mind you!
Good luck.

I put butter on the bread.

Hi Midori,

protein and fats don't lower your blood sugar, but if you have them with carbs it can slow the release of sugar, keeping your readings a bit steadier. So a snack of nuts or similar wouldn't lower your blood sugar - bt may stave of hunger pangs for carbs!

Good carb-free/low-carb snacks for me:

nuts
cold meats
cheese
omelette (nice for breakfast with a bit os smoked salmon).

Foods which are more sugary than many people think:

dried fruit
fruit juice
milk (cheese better due to the fat content)
no added sugar products (not the same as sugar-free)

mashed and jacket potato sugars go into your blood sugar more quickly than, say boiled, because they are more broken down. A little potato salad might be worth a try as an alternative.

I'm sure other people will have more ideas.

It sounds like you are doing really well. I'd be delighted with all those 5s and I have been diabetic for 15 years! Remember that pregnancy does play havoc with your insulin and energy demands so sometimes you will do everything right and still get a high reading. If it is a little on the high side make sure and have plenty of water and take it easy til you can contact you clinic or it comes down.

Warburtons does a small seeded batch loaf which is only 10g of carb per slice, about half that of a full size loaf. Might be worth a try. A slice of that with some peppered mackerel would be yummy for breaksfast

Hang in there. You are doing amazingly well.

Thankyou. I feel like I'm doing dreadfully and keep wondering if I'm making silly mistakes but I'm being so careful. I'm avoiding fruit juice all together and just drinking water, the odd cup of decaff tea or occasional diet soda. The only sweet things I am eating are fruit and I'm sticking to low GI ones, which don't seem to have a negative effect, or sugar free jelly or mullerlight, which again, seem ok.

My readings are still all over the place. Before breakfast was over target, next two readings ok, then after lunch of a wholemeal pitta with cream cheese and roasted peppers, celery and carrot sticks and a spoonful of humous, it was 9.6 AND I'd been for a walk after lunch.

9.6 is an OK reading for after eating - unless your nurse says otherwise.

Testing after eating can give a negative picture. At your next appt ask when you should be testing - I'd imagine they'll say wait at least 2 hrs after eating.

Thanks again.

They've told me to test 7 times daily (before and after each meal and then again at bedtime before my insulin and snack) and given me a printed sort of diary to record it in.

I'm supposed to be under 5.9mmol before meals and bedtime and under 7.8mmol 1 hour after meals. I know that's different to the guidelines for non gestational diabetes, but I think for GD they seem to like you to stay as near as possible to what a non diabetic would be.

These seem like quite tight targets for after meals, but I don't know that much about GD. Maybe they will suggest more insulin - seems like you are doing all you can. But try not to worry about the slightly higher readings - they might not be on target, but they are not horrendous. I am sure they will suggest a fix soon.

I sometimes wash my hands again re test. Sometimes it is better, sometimes it is the same.

So glad I found this tread....
I was diagnosed at 31 weeks (very annoyed about it actually, since despite strong family history nobody bothered to test me earlier, it should be done latest at 28) and my doctor appointment was at 32 weeks. There was no dietitian in the hospital for my first appointment and the nurse told me to avoid obvious white carbs. I did avoid these and tried out some other things, 3 of my post-breakfast readings were above 10. at my next appointment at 33 weeks I was suggested insuline which I declined and prescribed the metformin tablets. i read the warning for the tablets and they looked horrible "do not take while pregnant" was the worse one. so i am much stricter with my diet now, excercise more and my values since monday are all in range. i am sure the doctor will be annoyed with me for not taking the tablet!! but it just didn't feel right. is anyone taking them?

but otherwise similar experience: hardest to control the breakfast. I am eating now omellet from two eggs and skimmed milk and something else into it (parsley, tomatoes, mushrooms), a very-very thin=transparent slice of rye bread with a very-very thin layer of low sugar marmelade + piece of salmon or ham. muesli didn't work for me, two slices of bread with ham or cheese as the nurse suggested neither.

i eat small portions of fruit (5 grapes or one small banana or a third of an orange for snack work)

hummus is excellent and nuts, no reaction to them whatsoever. printed out the GTI levels today. because I am really missing fruits, looks like I can it twice as much cherries and pruns compared to grapes or oranges. still learning.
would be nice if we all keep the tread. i was feeling very stressed and left on my own to figure it all out.

hi apelsinnka,

would you consider going on insulin? It is so much easier to eat a balanced, varied diet and control your sugars while on insulin, and it doesn't have the contraindication in pregnancy that Metformin does. Marmalde will affect your blood sugar, even the so-called lower sugar ones. Whatever you do don't start having dried fruit, it is particularly sweet!

hi fallingandlaughing
my friends who had the diabetis in pregnancy all tell me that I should work hard on diet and excercise and try to avoid insulin if I can. the weight of my baby was average and this week my values are much better. all in range apart from one 9.5 1 hr after lunch today. I am still learning.

I feel that I was diagnosed quite late and wasn't really given time to learn to deal with it. this week I learned what works: two plums are good for snake, small bananas always work. bread is tricky, even the very healthy one (only works if one piece and with raw vegetables and lean protein), didn't work today with a chicken-vegetable soup. tricky but I would love to stay on diet only.

i will try dry apricot for breakfast, I am getting used to it, but breakfast is the hardest one

just found out that the metformin tablets are not allowed for pregnant women in germany at all :((

The thing is, from what I understand, Gestational Diabetes is a progressive condition - i.e. it will get harder to control the further into pregnancy you get. It can be extremely difficult to control it through diet & exercise alone. I had a small daily dose of insulin every day for the last few weeks of my pregnancy and it made the whole situation far more manageable. I Stopped taking the insulin for GD the day my baby was born and my blood sugars went back to normal almost immediately following her birth.