Gestational Diabetes - Large abdominal circumference

[PamRavenscroft]

Hi, I'm 31 weeks and was diagnosed with gestational diabetes a few weeks ago. I'm trying to control with diet & exercise but my fasting levels are often very slightly over (5.1, 5.2, 5.3). My hospital has a very low cut off point of 5.0 for fasting. I was prescribed metformin but asked to wait till the results of my growth scan, which I had today, before I started taking it. All baby's measurements were nice & normal except the abdominal circumference which was on the 95th percentile. I am trying to work out the significance of this - obviously it means the sugar is going to the baby, but other than its tummy it isn't 'big'. I hate taking medication when pregnant but am I being an idiot for not? As my levels are so borderline I have been reluctant to start on meds but after today's scan I just don't know what to think. Any advice, previous experience etc. would be hugely appreciated! I lurk on the Jan 2014 thread but haven't posted yet - I'm hoping Tarka will see this!!

Romily I expect that they will want you to wait til 36 weeks before they discuss delivery options as things can change so much between now and then. You might find that your babies growth has even out a bit since your last scan.

I had a very positive induction at 38 weeks with dd despite my body not being ready at all beforehand so I am quite pro-induction (I've also had abdo surgery with complications so very keen on avoiding cs) - ie I'm pretty biased! That said, another option is "trying" induction but setting the bar for moving to cs quite low if things aren't progressing. So not an elcs but not a crash section either.

Tarka I'm only on metformin b & d
Think I'm heading for insulin, whatever's best I will do tho, fasting bloods seem ok so just need to work on carb intake and what I can handle. Other half had so much more carbs with/after dinner and got a much lower level. Grrrr@stupid body!

Romily I'm now going to stop stressing about birth options and put my faith in the care team, my only issue is with forceps- I will b highlighting that if they think they would need to use them in a VB then I would push for an elcs. Hope your consultant listens to you on Wednesday

Just did my 2hrs after dinner and metformin tab......
5mins before exact time I got 7.6
6mins after exact timing I got 6.7
Confused.com lol

Oh I see. It's just that if you were on insulin 3.3 would be considered too low! I don't think it's a problem if you are not on insulin though as your body can't naturally take you too low for you (if that makes sense) and metformin works in a different way.

Have you calibrated your testing kit recently with the fluid? I often wonder how accurate my readings are and have had a few incidences when my results have been really strange so I've tested again and they are normal.

I agree about forceps. I'm not sure i would attempt an induced vb if the baby were back-to-back for example because I think if baby were b-2-b and I was labouring on my back then the chances of success would be quite low.

Dd was positioned really well and literally shot out with very little pushing despite me being flat on my back and having an epidural. This baby is currently head down and face "down" so as far as they can tell well positioned.

curlywurlylass I have a midwife appointment Monday, so I will ask for further clarification. My understanding is that my particular hospital likes you to get to 39, if not 40 weeks, in an ideal world, but they will induce/do a c-section earlier if it seems you're heading into preeclampsia territory. Even then, I believe if it's mild preeclampsia the hospital advocates hospital bed rest/monitoring until 37 weeks.

romily iv been asking for c sec all the way through my pg from week 12(obviously I had more issues than just gd but they were more mental than physical) and they only really discussed it with me at my last growth scan (32 weeks) and agreed, I will get my date next Wednesday. When I spoke to the consultant he tried to get me to try vb and said if I were to be induced they would not allow any problems to arise and first sign of any issues they would take me straight for emcs anyway. I said I wasn't happy with that as out of my 3 vb every one had problems with their heart rate when I contracted and my last vb was a nightmare. my first dc ended up in emcs and I had to be put to sleep so I didn't get to see him born and neither did dp really don't want that to happen again, so id rather just cut out the middle man as it were and go for c sec and having gd made me even more not want vb. I think if you want a c sec just be clear why and they should be fine with it. Good luck for Wednesday!

Heart, my fasting readings keep doing the same thing! I'm always a little over and it's really annoying even though before bed I'm fine I keep upping my insulin and it still isn't doing anything, dp recons I'm sleep snacking in th middle of the night

heart and terilou try eating some almonds or a piece if cheese before bed - that helps bring my fasting reading down - the reason it can be higher than post meal readings is because your body starts to take glucose from your liver (don't quote me on that but it's something similar!) if you're hungry. Great excuse for a bedtime snack! I just couldn't get mine down enough in the end though (my hospitals cut off is 5 for fasting) & am now on metformin.

curly you poor thing you must be fed up! I bet you'll be glad to have the baby finally & for all these nasty pregnancy ailments to be over with.

I am really hanging out for my 36 week growth scan (its not for another week) to see whats happening with the baby's size & especially it's tummy so I can really start to come to terms with what the birth is really likely to be like.

Does anyone know if there are any specific complications for a baby after the actual birth if it has a big tummy? (90th percentile last growth scan, but everything else normal & overall on the 60th percentile size wise).

What a day! My blood sugar readings are all over the place and I can't figure out why. Ah well clinic this week so hopeful they will have some suggestions.

Mine have been a bit squiffy this week too romily, things that always given me low readings are suddenly high. I am being fairly lazy on the exercise front but I'm knackered! I wonder if its a hormonal thing? I'm nearly 35 weeks, what about you?

Um...... Got admitted again yesterday after high bloods at gest diabetes clinic and again after midwife/consultant found similar BP and ++protein
Just saw doctors and asked when i might get out.... She said probably not without having baby!!!! So looking at getting steroids, insulin drip and baby in the next week! Feck :)

My testing has been up and down. Got confused this morning waiting on nurse testing bloods (they really shouldnt shout breakfast is served when they havnt tested your bloods, i had to eat so tested my own got 5.4, then im sure nurse only left it 1hr before doing the after meal test and got an 8.9, way too high :(

That's rubbish curly. Kind of exciting that you might be having the baby soon though! How many weeks are you? I had something similar happen to me with dd1 - went in with bleeding at 33 weeks, came out for a few days & was back in with waters gone at 35 - and that was that - they induced me 2 days later. It wasn't exactly the way I pictured it in my head but I was glad to have all the faffing about finished & a healthy baby. So try not to let it get to you too much - by the time baby arrives you will just be glad it's all over. Sounds a bit rubbish that they didn't test your bloods before breakfast though - you would think they'd be really on top of that in there?

Hi ladies,

Sorry to hear lots of people having to do the obsessive finger pricking! I am only 12 weeks pregnant, had GD last pregnancy, diagnosed at 34 weeks so was expecting I might get it at some point this time... however was disappointed to have glucose in my urine at my booking in (10 weeks).

I was totally diet controlled last time, and have decided for now to monitor the situation myself as I had a pretty bad experience with the diabetes clinic last time.

I just wondered if you ladies could help me out with your targets? I'm sure last time my post meal one was lower than 7.8 after 1 hour, which I can achieve no problem... it's the fasting one I am more concerned about. Last pregnancy it ranged from 4.5-5.0, but this one I am getting more like 4.8-5.4, having monitored nearly two weeks now.

Do you ladies mind letting me know what your hospital targets are? My understanding is NICE guidelines is under 5.9 fasting for GD?

Thanks so much for any help.

sister below 5.9 fasting then below 7.8 at 1hr after eating.

curly have asked how you were on the antenatal thread. What do they think is up? Pre-e or something gd related? I found the antenatal/induction ward were pretty useless with food suitable for diabetics so I got dh to bring food in for me.

I will be 32 weeks on Thurs and my bloods are just random and frustratingly high. I have a scan, monitoring and the clinic this week so if there is anything untoward happening they will be able to spot it.

It crossed my mind the other day how lovely it will be to have a small handbag again instead of lugging about tonnes of medication and insulin. Plus being able to eat oodles and oodles of chocolate will be bliss!

Thank you very much Tarka, would be great to know any other hospital guidelines if people have the chance.

I second taking food into the hospital. Not long now for some of you ladies to be munching on toast and marmite (well, that was my snack of choice) without the prospect of a blood test soon!

Will keep an eye and see if I can share any experiences from the end of my last preg.

I'm so looking forward to not being diabetic anymore Romily. I'm 35 weeks now so only have 1 scan/consultants appt left before induction. Also realised that I probably only need to put in one more repeat prescription for test strips etc. Today I have mostly been craving carrot cake and Percy pigs so have added both to my post birth eating list!

My sugars have been all over the place for ages but so far baby has been growing normally and fluid levels also level so don't think the worst. I can't imagine how high my levels would be if I didn't know I had gd and was eating "normally" so I think that is where most of the risk with gd lies.

sister my results have to be between 3-5 for fasting and under 7, 1 hour post meal. My hospital are quite strict result wise,

curly you could well be the first thread baby, eeek!

My numbers are all over too, I havnt been able to keep the morning ones down then last night I forgot to take my bed time insulin and this morning my numbers were in range .

Can I ask, is anyone's baby measuring small for gestational age?

I'm 33+5 and am having scans done fortnightly right now (due to start fetal non-stress tests at week 35). Baby today measured on the fourteenth centile, but his abdominal measurement is only sixth centile. I wonder if part of this is because of the restrictive GD diet.

It seems you can't win with GD. They fear a gigantic baby, but equally a small one sends the perinatologists into a flurry of panic.

Thanks teri, does seem VERY strict. My old hospital was below 5 for fasting too but I found that consultant very obtuse and not evidence based (I asked for evidence!!), I then swapped hospital and I think it was as per the NICE guidelines.

Anyway, I am a difficult patient.

It is hard to be so monitored, but the main thing I took from my last pregnancy, and now again, as tarka says, is that impaired glucose tolerance is very very common in late pregnancy, and we are doing the best for our babies by being so careful about what we eat!

Sigh, 12 weeks. Long way to go for me!!

sister 12 weeks!! I feel for you, I'm finally feeling like I'm nearing the end,
I can't wait to not finger prick after every meal and get rid of that smelly insulin, it reminds me of old people's care homes. Luckily this is the first time iv had gd and this is my 5th and final pregnancy so won't be getting it again!

teri I keep thinking I've not taken my bedtime insulin either and its had no effect! Maybe it doesn't actually do anything? I do only have 4 units though as I was getting night time hypos.

I'd never be able to get fasting below 5! My readings are always at least 5.4+ during the day.

The injections I don't mind as much as the finger prick testing which I find really uncomfortable and hate doing.

tarka it's the same for me, iv moved the night time one to 24 as I'm still over and it's doin nothing at all (wondering if it's a bloody placebo) I'm on the levimir one for bed and novarapid for meals I'm on 12 for meals but that seems to work fine.