Diabetes/Gesational Diabetes and birth defects?

[midori1999]

I am quite anxious now. I had GD in my last pregnancy and was also tested for type 2 towards the end of last year, which I was told I didn't have.

I am now pregnant again, 8 1/2 weeks and when I booked with the midwife last week she said that as I had tested my fasting sugars twice since I had been pregnant and they had been 6.9 and 7.5 that she would book me for a GTT ASAP and I am going for this on Monday. She also suggested I should be on 5mg of folic acid.

I tested my sugars this morning and fasting was 6.5, one hour post breakfast (of two slices of seeded bread with a tiny bit of marmalade and a cup of tea, no sugar) was 12.3, which is quite high.

I'm now worried that if my sugars have been like this since the start that there is a risk of the birth defects associated with type 1 and 2 diabetics and that the higher dose of folic acid is too late to make any difference. Are these levels high enough to worry about, or am I being paranoid?

Sorry to hear you're worried.

From what you've said about your readings, yes they are too high & will require treatment. I think in your case, the blood tests will just confirm GDM. In which case you'll be referred to a joint diabetes/obstetric service. But keeping checking your bloods & record in a blood sugar diary or notebook meantime. This will mean the diabetes team can make a quicker assessment of medication needs.

Although different units have different protocols & standards, in our unit the target is for fasting blood glucose levels to be

Thank you for replying. I think I'll feel better once I am diagnosed and referred to the joint obstetric/diabetes team.

My levels this afternoon have been better, which has made me feel better too. Certainly last time fasting and post breakfast were the readings I had most trouble with.

Thanks again.

I hope you do feel reassured, Midori.

As I've scented an expert on here, can I hijack a little? I'm 31 weeks and failed a GTT at 27 weeks. Ever since I've been diet-controlled and all my day levels are fine. My GTT problem was my fasting level and that has been over 5 for the last month. It's now crept upwards to the point where I'm worried it will go over. Up till now I haven't been doing much exercise or having an evening snack (never saw a dietician so didn't know I should) but I've read both are good ways of reducing fasting levels. The advice on snacks seems very contradictory though. Any advice on the best thing? I tried peanut butter and cheese on oatcakes last night (two separate ones!) and it brought the level down but not by enough that I felt reassured.

Thanks Styffybyng, my levels have been high most of the weekend now since I've been testing, although my fasting this morning was ok.

I found in my last pregnancy when I had GD snacks made no difference to my fasting readings, but they apparently do for some people. I was on insulin last time and felt I still had poor control, my fasting readings ranged from 6.1 to 7 and post meals were almost always over 8, breakfast usually 9-11. I was really careful about what I ate. My diabetic team felt I had good control and certainly DD was born at 37+6 weighing 6lb 15oz and no hypo. I went into labour naturally.

Insulin resistance increases with the duration of pregnancy, so in effect the diabetes progresses & can requiretreatment as the pregnancy goes on.

Fasting levels are not hugely influenced by bedtime snacks (unless you're having inappropriate foods eg large pizza, night-time eating etc).

It's more likely that metformin tablets are needed to stop the liver producing glucose overnight & reduce insulin resistance.

It's more the amount of carbohydrate to consider at bedtime - 20g carbohydrate is a reasonable amount to be having at this time so 2 oatcakes are within this limit.

I've read that for some people a snack at bedtime with carbs and protein (in variously unclear combinations!) can lower fasting levels, and I'd like to give that a go before any treatment. I've previously not been having anything at all after dinner and last night's snack definitely made a difference. It's just that advice on what to have is completely inconsistent!

It's just my fasting level that's an issue, and I've been told I can still have a homebirth if I remain diet-controlled so I'll do whatever I can to see if that's possible.

I'm glad your fasting level was better this weekend, Midori, and that you had such a nice result last time!

I should say that at the moment my fasting levels are still around 5.5 so obviously bad if they keep rising but potential to get them back down to a better level.

Just a thought, but of you're keen to avoid meds, could you try a walk or some exercise before bed or extra exercise during the day? My friend managed to stay diet controlled this way and I have to say exercise helped me a lot last time.

Midori, I started my great walking programme yesterday and for the last two evenings I've jumped about a bit before bed! I've ordered a pregnancy exercise DVD and I'm planning a longish walk today. I've been nervous up to now because last pregnancy I had horrendous SPD but so far this has held off this time round so I need to be less cautious. This morning's sugars are Too High and I had a more proteiny snack last night so I think the slightly higher carbs were better the night before.

If I have to be on meds I will but I want to give all this a few days first.

Good luck! It must be frustrating to be borderline for meds if you want a home birth. I would have loved a home birth, but it's out of the question for me as I'm too high risk for other reasons, let alone the GD, so I'm just resigned to it really. I have had all my births consultant led though and they've all been great no intervention, so that helps.

It IS frustrating! I also have an extremely cautious clinic who medicate earlier than others so feel a lot of pressure to not even be borderline. This whole thing is making me so stressed and depressed I can't believe it's actually doing me or the baby much good. But I know I have nothing to complain about compared to what you've been through.

Of course you can complain! its probably easier for me in a way as I'm just resigned to it.

Not that I'm a control freak, but I finger pricked before and after my GTT. Was 5.9 before and 11.7 after two hours, so I think it's safe to say I've flunked. Oh well, better I know. Hopefully the Hugh sugars I've had haven't caused damage, I think HBA1c gives a better indication, so hopefully that's ok.

I hope it is too. Mine was fine despite my fasting level at that time being 6.3.

I've put in a call to the dieticians at my clinic to discuss snacks, and been on a 40 minute walk (with a tantrumming toddler in the snow) and hoping to have another one this afternoon after nap time.

Although your sugars are high, they still are nowhere near as high as someone with full diabetes so hopefully you will avoid the complications that can set in. (An expert speaks.)

Midori, I'm now worried...did your midwife test your bloods or did you do it yourself? Like you, I had GD in my last pregnancy and am now 11 weeks...I mentioned at booking that I'd previously had GD (controlled with diet and exercise, which was due to the great advice that you and others gave on this website!) and she said that I should have the GTT at 28 weeks, as before. Nothing was mentioned about testing earlier, nothing was mentioned about a higher dose of folic acid...and I'm ashamed to say that I have been merrily eating sweets, ice cream and carby foods in the knowledge that I will most likely have to stop all of that in the last 3 months of the pregnancy. Help...!
Sorry for thread hijack.

I'm sorry if I've worried you rumtum.

I honestly doubt you need to worry, although I think it is standard to test for GD at 16-20 weeks when you've had it before, so maybe check that with your midwife? It's quite unusual for GD to happen in the first trimester and I suspect I had impaired Glucose tolerence or type 2 before pregnancy that was undiagnosed tbh. It's not standard to need higher dose folic acid just because you have had GD before.

I just checked my sugars myself a couple of times out of curiosity really and my midwife booked my glucose tolerence test, which I had this morning, based on the results of the readings I got.

I was just speaking to a friend who had GD in her first and second pregnancy and she was tested at 16 weeks in her second and baby is now born and absolutely fine.

Thanks for the reassurance :) I checked NICE guidelines and if you've had GD before you should either be offered early self-monitoring or a GTT at 16-18 weeks, so I guess they'll make a decision on that based on my booking bloods.

All the best in your pregnancy and with controlling your sugars, I imagine I'll be with you again in a few weeks time

It would be great if we could have a GD thread. Past ones seem to have been really helpful to people but my attempt to resuscitate one of them the other day went nowhere.

The dietician said she'd never heard of bedtime snacks affecting fasting bloods. I was rather surprised. I wouldn't have been if she'd said she didn't believe in the theory but to have never heard of it was a bit . A simple google brings up pages and pages of stuff, and doctors and dieticians all over the place seem to be recommending it. But she was very nice and has gone off to look it all up and see what she thinks. In the meantime she said exercise before bed might definitely have an effect. Today I've managed two walks, both with a toddler in meltdown, and my pre-dinner blood was 4.0, which feels pretty good. I've also bought some cinnamon capsules and physillium husks, both of which might possibly reduce blood sugars, which I'll have at bedtime.

Interesting about what happens in subsequent pregnancies. I had no problem in my first pregnancy. If we do decide to have a third, would I be able to refuse a GTT and just do my own thing?

I shall start a new GD support thread then and we can all chat there? Or just us Stiffy if Rumtum is lucky and avoids it this time and BO one else joins in....

It can't just be us! We can't be the only people on the whole of Mumsnet pricking our fingers four times a day. A new thread sounds great.

Hi there! T1 diabetic here - after meal spike of 17.9 today

Just to reassure you - it's your HBA1C which is the best indicator of risk regarding birth defects and other problems. That's a three month average of blood sugars - despite daily spikes of around 12 mine is 5.8 at the mo and has been similar throughout pregnancy.

Baby #1 was perfect

Hi! Come and join us on the new thread.

Thanks Mylittlepuds. Yes, having looked into it I noticed it was HBA1C that is the indicator of risk, so hopefully mine will be OK. It was 5.9 the whole way through last time.

Feel free to crash our other thread, even type 1 is gestational in pregnancy after all....