Confused (and a little pissed off by) gestational diabetes. Any experts?

[weebigmamma]

My blood sugar has been fine since the start of the pregnancy but because the baby was measuring big for dates a couple of weeks ago they sent me for a glucose tolerance test. It came back saying that I had GD so last week, at 35 weeks, I had my first appointment. I went back today and they were pleased with my blood levels- all week long they have been consistently well within the range. But the baby is still measuring too big so they've said they're going to put me on insulin anyway. It's this that I don't understand. Would insulin not lower my blood sugar? If that happened it would often be too low. And could it not be the case that I'm simply having a big baby?! He is about 7lb now they think and I have 3 weeks to go because I'm having a section at 39 weeks. The insulin would start next week. What difference would 2 weeks of insulin make? I feel quite confused and fed up. Would love somebody to explain all this to me.

[BEEwitched]

My midwife just left, and she did say that they'd gotten much stricter about things recently - I think there are new NICE guidelines coming out in the summer so they might well be tightening things up everywhere!

I feel better now that I feel I have a bit of control back, and I've only 10 weeks to go, anyway.

[weebigmamma]

Beewitched, it's weird isn't it? I had to cause a whole big hoo haa over ELCS when it looked like they were not going to discuss it with me until really late on. Their guidelines are apparently nothing like the NICE ones on that issue either. One thing I can say in their favour, if you keep asking about stuff they do respond and everything I've had a problem with so far has been sorted out really well. I think they're just hyper busy.

[BEEwitched]

Tarka thanks for that number, I hadn't been able to find the 'official' guideline number! Not that it helps, the same hospital also put me on bp medication even though my bp is below the NICE guideline threshold for meds...

Also, from my own research the numbers given for the need for insulin therapy in the case of GD are between 5% - 10% of women, I was told, oh, it's about 50/50 whether you'll need insulin or not.

Like weebigmama I just wish they gave us accurate, up-to-date information based on NICE guidelines instead of internal policy...

[TarkaTheOtter]

Don't worry about the 5.6, NICE recommend fasting below 5.9 anyway.

[weebigmamma]

The latest is.... I just got an email from the head honcho who says that no, I won't be put on insulin. LOL!

And of course today is the first day when I have a reading that is above the limit (5.6 this morning). We'll see what they say next week, but at least it seems like they're not going to put me on insulin for no good reason.

[hubbahubster]

I'm amazed that you're being treated as if you have GD with your readings, weebig – fingers crossed you get an clear explanation of why this is happening soon. And I find my left hand gives up its blood more easily than the right, for some reason… I do use the highest setting though. Give your arm a shake first and then rub downwards on your forearm, that helps blood flow too.

sister my community midwife is really supportive but they're less so at the hospital. I have a placenta scan (to check position as it's low) in a couple of weeks and then a meeting with the consultant I saw in my last pregnancy, so I'm sure the GD convo will come up… watch this space!

[weebigmamma]

I will try that too, thank you! Yes, I find the pricking quite painful and having to do it repeatedly is awful. Glad to hear that insulin isn't as bad. No, I'm not using the highest setting but I will have to if this continues :-(

[TarkaTheOtter]

Because of the hypoglycemia I had to test ds once he was born and the nurse showed me a much better way of doing it than I had been doing on myself. She pricked, then squeezed, then wiped away the blood, then squeezed again and then tested.
Are you on the largest setting on the lancet thingy? I hated testing, the insulin injections were so much less painful.

[weebigmamma]

Beewitched- lol! It's not just me with the rubbish watery blood then! I can only ever get blood out of my thumbs and today I'm having no luck at all. I must have used about 10 sticks already. My appointments are on a Tuesday. I wouldn't like to be coming the whole way from Derry or whatever every week- it's amazing that it's the only clinic!

Tarka- I will try drinking more water, thanks for the tip! Also- I will ultimately do what I'm told with the insulin thing. I do trust doctors on the whole I just wish they'd explain things better sometimes, but I'm sure it's just about business and having to see 300 people one after the other or whatever! :-)

[BEEwitched]

I think the lancets they gave us must be crap, I attend the same clinic as you and I've had to prick myself SO often, and then to add insult to (literally) injury I get an error message from the daft machine saying my blood isn't bloody enough... I actually ran out of test strips yesterday because I wasted so many!

Ah well, we might cross paths on a Wednesday at some point, it's like a cattle call at that clinic...

[TarkaTheOtter]

Are you drinking enough water? I always found it harder to get blood when dehydrated.
I've dug out the NICE guidelines and they suggest insulin if you can't diet control OR the baby has an abdominal circumference above the 70th centile at diagnosis. So presuming the latter is the case then they are following correct procedure.
My dc2 was hypoglycemic at birth (I believe they screwed up my medication during labour because I had a reading of 22 just after he was born) and it was horrible. The midwives and I practically had to force feed him. I was lucky that his sugars came up quickly because he nearly went to SCBU to be tube fed. He wasn't even that low either. If they think insulin will lower the risk then I'd take it.

[weebigmamma]

And I had to prick my fingers FIVE feckin times to get any blood out. I am a vampire.

[weebigmamma]

Had my first high reading this morning: 5.6. Just outside the target. I expect that will be enough to send them into an insulin-prescribing frenzy lol.

[OrangeMochaFrappucino]

Sorry, his head was 25th not 75th! Big in proportion to the rest of him and it grew faster as well so quickly went up to 75th and too big for all hats!

Anyway, OP, I have heard lots of stories about growth scans being completely wrong so I would question taking insulin just on the basis of scans - I'd want a really clear explanation first so I could understand why.

[OrangeMochaFrappucino]

Bee Witched although my baby was 6th centile for weight, he was 75th for head circumference! Newborn babygros swamped him but newborn hats pinged off his massive head! It wasn't a problem though, delivery was fine and he didn't look out of proportion - we still have trouble getting hats to fit though!

[sisterofcaleb]

Hey OP, I am v interested to read was tarka says. Although I still dont understand how insulin would help you...maybe you could test BEFORE you get up and eat in the night as an experiment to see how your levels are then. Maybe that is more relevant than after eating in your case? As I say I'm no expert though.

For those of you who failed the gtt with fasting readings below 5.5 and now fastings are ok...are you tempted to ask for the test again? I would be very interested in your positions.

Hubba nice to meet you! I just transferred hospital yday and had another mini battle to go under routine care not diabetic. Unless I get readings consistently over target I will not be labelled with GD this time. I am 27 weeks now so it may get worse for me. At my 28 week I will be asking for arrangements to be put in place for a home birth. I also have third degree tear and PPH to contend with!! Hope ur pregnancy remains healthy and well.

[weebigmamma]

PS I hope you eventually get some sleep!!

[weebigmamma]

Thanks Tarka. The clinic I attend is the only one in NI and it's really busy so I suppose that's why they don't bother explaining stuff properly but I've never been the sort to accept what I'm told without trying to understand it, so I really appreciate your and everyone's comments here! It has been really helpful. I am totally fascinated by the stories of people being told they're having a big baby and then it turns out to be smaller than they thought. Part of me thinks that because I am overweight and older I have been put on a track where the medical professionals are all assuming I will have problems at every step of the way. But that could just be my own personal hang up. I am glad the tests exist too but they don't half worry you about stuff!

[TarkaTheOtter]

Sorry lots of typos. Sleep deprived as neither my toddler nor newborn like sleeping.

[TarkaTheOtter]

Bizarrely weebigmamma eating in the night is probably keeping your morning fasting level low as it ill stop your liver from releasing sugar. That's why your reading was high when you had to fast 8hrs for the GTT.

They really need to explain all this stuff to you. Given your having a section the weight really doesn't matter (vb might carry a risk of shoulder dystocia which isn't relevant here) - it's the risk of hypoglycemia which is why the are being paranoid.

[BEEwitched]

shrugs I was over 4kg when I was born and my mom was slim, no GD, I was well-proportioned, just freakishly long. My husband is 6' 3''. This baby is not going to be small, I can tell you that, and he has inherited our big head so that'll be fun (head measured 30 weeks at 28+3).

Those fasting levels are similar to mine, if they're within range and all other results are within range they must be ultra paranoid...

[hubbahubster]

Sister, I'm also self-monitoring after a v borderline diagnosis of GD in my last pregnancy. So far I'm 30 weeks and can't see the point of the GTT as again, my sugars are all fine and even if I 'fail' it, they'll only ask me to do what I'm doing already.

None of the tests we have in pregnancy are compulsory, obviously we're very lucky to have all this available to us but in my case, I'm reluctant to put myself through the GD treadmill again when actually, my blood sugars are fine.

At 38 weeks a growth scan said that DS was already almost 8lb and I was asked what the hell I'd been eating. He was 6lb 13 when he was born a week later.

So while of course I understand that hospital staff are only following protocols, IME these growth scans are pretty sketchy!

[weebigmamma]

lol oh my goodness! Yes, they're basing everything on scans- last week 6lb, this week 7lb. At that rate he'll be 10lb by the birth. Or maybe not as the case night be! Feels like he weighs about 4 stone.... lol!

[hazeldawn]

They said ds was going to be small but no gd he was 9lb 7 had gd with dd she was 8know but I was on insulin from 28wks

[OrangeMochaFrappucino]

How do they know the baby is big? My first baby measured at the top of the chart for fundal height and a scan at 34 weeks indicated a big baby. They prepared me to expect a 8/9lbs+ baby though reassured me I wouldn't grow a baby too big to deliver. In labour we were all awaiting a big baby and I was terrified he would get stuck so pushed really, really hard.

Tiny little 6lb11oz baby shot out to everyone's surprise! He was sixth centile for weight and I noticed on my current maternity notes (2nd baby) that my first is recorded as SGA (Small for Gestational Age) - he was full term when he was born.

At 35 weeks, the bump is measuring top of the chart again but I have no idea if this time it will be a big baby or or I'll have another tiddler. It seems to me that their growth estimates are not particularly reliable!