Gestational diabetes support thread

[NoRoomForALittleOne]

I thought I'd start a support thread for those of us being tested, just diagnosed or being treated for GDM.

So collapse on a sofa, grab a low carb snack and come and chat about blood tests, finger pricks, diet changes, medication and birth plans...

Mumtobe you will start by monitoring your blood sugars (probably four times a day) and being told how to modify your diet. Read up on a low GI diet and start that now. Depending on what your results are with a low GI diet, you may need some treatment to bring your blood sugars down if they are outside of your target range (you'll be told your target by the MW, we have variable targets on here). Blood sugar control gets increasingly hard throughout the third trimester so even if you start off being totally fine without medication, you may end up needing something towards the end of your pregnancy. You will be monitored more closely and should be given growth scans at 28, 32 and 36 weeks (according to the NICE guidelines).

As for any danger to the baby, pre-existing diabetes is more of an issue and can cause birth defects (mainly heart issues, I believe). As for gestational diabetes, if treated well then risks are minimised. The chances of having a macrosomic baby (very large with extra fat around shoulders, chest and abdomen) are increased with poor control of blood sugars. The main risk with a macrosomic baby is a shoulder dystocia at birth. There is also a risk that the baby will end up with very low blood sugars after birth or very jaundiced. Some babies need a short stay on the neonatal unit. There is an increased risk of preterm birth. Also respiratory distress is more common in babies of diabetic mothers. Having said all of that, most babies are fine and just monitored for 24 hours after birth. Being diagnosed and treated is the best thing that can happen as this minimises the risks.

There are implications for labour and delivery but these vary depending on the hospital and what treatment you need. It's probably way to early to start thinking about that.

Does that help?

Hello

I had PLG test done due to family history and my results after 2 hrs were 7.6. My midwife said the cut off for diabetes is 7.8. So Im still in the normal range but in the high borderline site.

Should I be concerned? I have always loved sweet but during first and second trimester I was doing good, however now at 30 weeks I am having huge sugar cravings, I cant help it. And also cravings for pasta and white baguettes, all bad stuff.

So I saw the diabetic team, a supervisor of midwives and consultant on Monday. I had my overnight insulin increased to see if that would help my post-breakfast number and my fasting number was creeping up a bit too. It seemed to do the job to begin with but my post breakfast number this morning was back up to 8.6. They said that I would probably need some rapid acting insulin to deal with the breakfast highs. At the moment my other post meal numbers are within target but tending to creep up a bit so I may or may not need insulin for them too by the end of pregnancy.

I was relieved to be told that a request for ELCS would be granted based on a previous shoulder dystocia. I now need to decide if I want one or not. I've got my next growth scan on 2nd March and another four weeks after that. I want to see what is happening with this baby's abdominal circumference now that I'm on insulin. I have been told that I could have a pool birth and be continuously monitored in there. I will also have a senior midwife if I choose to be induced with a consultant obstetrician available and aware of my history. At least that is progress.

Zahrah what was your fasting number?

I dont know they only made me drink the drink and took blood after. They didnt take fasting blood.

I'd insist on a fasting blood being taken. My post load number was in range on my GTT but my fasting was too high. I'm now on insulin. The test only provides a snap-shot of what is going on so when I started monitoring it became clear how my blood glucose control wasn't particularly good.

hi all

Zahrah what's a plg test, is that the same as a GTT where they make you drink a sugary drink then the test 2 hours later?

noroom I'd not realised you had a shoulder dystocia before. How scary, hope your DC is ok now. Interesting that a pool birth was ok'd - does that means you will be allowed in the midwife led unit or does your hospital have pools in the labour ward? I didn't know they could do continuous monitoring in a pool...

mumtobe, welcome. good advice above - I'd say avoid sugary foods and high GI starchy foods (bread, pastry, mash, baked potato, breakfast cereal are the worst for GI) for now and then when you get your kit you can do some experimenting and see what gives spikes. Risks to your baby are much much less if you have been diagnosed and keep blood sugar controlled so try not to worry...

My hospital is small and only has a labour ward. I believe that there may be an 'active birth suite'. Only one or two rooms are ensure and I think that there's only six delivery rooms. the obstetricians only get told about the women who are 'theirs' on the delivery suite. The option of a water birth is s good one for trying to prevent another shoulder dystocia in terms of slowing down labour a bit and allowing me to move with ease.

Oh and most cordless continuous monitors are submersible.

PLG = Post-load glucose. It should not be done for the diagnosis of diabetes at all as it gives an incomplete picture. If they can only be bothered to do one test then it should be the fasting one...

Today I seriously want some cake...

Hello all, hi Tiny!

Interestingly, I too have thyroid issues (underactive) and have done for 14 years, so well controlled. I had been seeing a thyroid consultant throughout my pregnancy and had told MW at booking in that my dad is diabetic, yet I had to ask for the GTT at my 28w appointment! I am somewhat reassured that as no glucose showed up in my urine tests at 28w and prior to that that the GD can only have set in post-28w, sometime before I had the GTT at nearly 31w. But still!

Had first growth scan a week ago and sonographer said all is in proportion and baby is estimated at 4lb 12oz, so statistically just above average nationally, and med-high weight for me personally. When I checked the stats after baby has longer than average legs (my DH is 6ft) and pretty average head measurements. Tummy was just over 50th centile. So I presume that is all fairly average? Diabetic MW was pleased with my readings and baby's size and I don't have to see her again unless my readings suddenly spike repeatedly. So I now I await the next scan and consultant obs appt in mid-March when I will be nearly 37w to find out when I will be induced!

Am not impressed with the lack of active labour now to be imposed on me, and quite anxious at the thought of shoulder dystocia, forceps and epidurals. I was quite chilled out about labour pre-GD diagnosis!

Snack ideas I have been okay with: muller light yoghurts, a few slices of tinned peaches in juice, SF jelly, quavers, mini cheddars, cheese and nuts, apple slices and peanut butter, houmous and crudités, krakawheat and cheese, those frankfurter hot dog sausages that come in a jar or vacuum packed, mullerice (only if eaten after a low carb meal). Cereals seem to be awful for me, oatibix and shredded wheat have both given me high readings!

Evening all. I think I have discovered a food that causes my blood sugar to spike - pizza. I had one a few weeks back when I was ill and it was very high. This time it was 8.6 which is alot higher than I have had except for when I was ill when I first started testing. So I guess it is no pizza till ds is born. (I didn't even enjoy the pizza much but it was a group decision to have takeaway pizza and I didn't want to be awkward!)

Does anyone have their 32 week scan results to hand? My ac was 82% and yet the overall weight estimate was 50% and most other measurements were in their 50s. So was a little confused how he could be average weight and other dimensions but with a big tummy. I looked up tummy measurement and they all say that 283 mm is 50% and he was 283 mm. So I am a little confused as to why my scan said 82%.

Zahara - I never had a fasting blood test either as apparently they no longer do this where I am. I also got told that my fasting should be less than 6 which is alot higher than the cut off for gd.

Noroom - interesting you can still have a waterbirth. I really want to speak to someone to discuss birth options but still got another week or so to wait. Still adamant I don't want to stay after the birth for 24 hours. Wondering if I can test ds at home and come in if needed? I am less than 5 mins drive to the hospital.

I wouldn't want to do the heel pricks on DC5 myself. I found it hard watching DC1 have them done as she was so distressed/grumpy and I almost passed out. I used to work as a nurse in theatres so I don't do passing out at the sight of blood etc. But I totally empathise with the desire to escape the postnatal ward. I was planning a home birth partly for that reason.

I'm intrigued by your scan results as well because the same thing happened to me at 28 week scan. Baby's measurements were about 50th centiles for femur length, 60th for head circumference and 75th for abdominal circumference but I was still told that baby was on the 50th-ish centile for weight I'm paying most attention to the abdominal circumference as this seems to be the most important measurement when you have GD.

LIG I guess it's not surprising that pizza gives you a spike, all that bread. Pizza is definitely on my list of post birth foods though! I can't eat cereal either Rusty. I even had a slight spike (7.9) after seeded toast and peanut butter for breakfast the other day, seems like my options are getting even more restricted .

I didn't have a 32 week scan so can't help on that sorry! Got 36 week scan next week though (at 35+3) so will share that. Bump was measuring about 1.5 weeks ahead by the tape measure so let's see what the scan says.

Noroom thanks for the info about heartbeat monitors. I had continuous monitoring with DD (as she was prem) and I had to stay flat on my back as every time I moved they lost the heartbeat. I'm hoping the same doesn't happen this time as would love to be able to move around. Getting in a pool would be ideal but depends on twisting arms to let me into the MLU fat chance as that's where the pools are.

LIG I missed your bit about testing DS yourself post birth. If you suggest that then please let me know what they say! I too would love to get out earlier, assuming birth goes ok.

I suggested getting a local GP to do tests so as to get home earlier, but midwife says it has to be every 4 hours incl overnight, so GP is not an option. Hadn't thought of doing them myself. I remember the heel pricks being done on DD in NICU, she did hate it poor thing but I imagine any baby would hate it just as much whether I do it or a nurse does it... and we'd all be much more comfortable at home in every other way.

Just tentatively poking my nose in. I'm only coming up to 8 weeks and haven't even had booking in appointment yet, but I had GD (diet controlled) last time and was told I'd be highly likely to have it again. I had all the best intentions of eating healthily as soon as I found out, and cutting down on sugar. Than morning sickness came along and ruined those plans!

How early were you all tested, particularly those who had it previously? I was tested at 28 weeks last time and so on a restricted diet from about 30 weeks. I had a GTT last summer to check no underlying issue prior to TTC. Midwife last time said that if I got pregnant again I'd be tested at about 14 weeks, and then repeatedly until it came out positive or I got to the end of the pregnancy. Not looking forward to that! I may be at a different hospital this time though, and I know protocols can vary.

quesadillas I was tested at 16w but those were so borderline the midwife told me they were normal, but at 26 w my endocrinologist told me to start testing even before the other GTT and ta-da I had it again...

Pizza is ok for me, yesterday we had a regular margharita and then added tons of haggis on top (yum) and I had a good reading one hour after that...

sweet chilli or sweet & sour, on the other hand so give me bad readings...

i have been BAD today... free chocolates at work and i couldn't resist and had some... arse!

my last scan was just before 32w but i have my notes at home... i also had 50th on most and 95th for AC...

estimated weight 2.5kg give or take 25%

Thanks to everyone.

So now I am super confused about my situation.
Since I didnt make cut off I am still being considered low risk and no extra monitoring for baby.- last time mw didnt even measure the fundus hight.

Wondering whether I should insist to redo testing or whether to go to GP and ask him, however that would mean extra appts and there is long wait in the morning at the blood clinic.

My dad who is diabetic is coming to visit me and in abt 2-3 weeks, he can test my levels with his machine for couple of days while staying with me.

Or would it just be easier to purchase the testing machine? Is it overkill of paranoia?

I'd speak to your GP, Zahrah and express your concerns. You can always ask for a referral to the consultant and make it clear that the midwife isn't even monitoring fundal height (although that's about as accurate as a guesstimate IMHO).

Zahrah how many weeks were you when you were tested?

I wouldn't buy the machine yourself. The little testing strips are incredibly expensive without a prescription! But maybe press for test to be redone in a couple of weeks, this time with fasting bloods as well as post sugar bloods.

Only been diagnosed for a week and I am failing miserably at controlling my diet I never used to have a sweet tooth but throughout pregnancy I have just wanted chocolate all the time. My sugar readings haven't been great and I'm going to get told off at the clinic on Thursday! At what stage have people been told they will be induced/delivered? The only positive I can see in all this is not waiting quite as long for baby. I am so done with pregnancy! 36+3 today.

hi coaster what sort of things are you eating? And are your morning fasting results also high or is it just post meals?

I've been told 40 weeks induction if still well controlled with diet, 38 weeks if I can't control with diet and am put on medication. I'm keen to reach 40 weeks if I can so have been really strict (mostly) on the diet, but if you'd be happy with 38 weeks then maybe medication would be the better option for you all round anyway?

Have you had a 36 week scan as I think their views on timing (and definitely on induction vs c sec) are affected by that too. I have mine next week...

i will be induced at 38w, getting my date this thursday! (am 33+3 today)

I have been a bit useless recently, yesterday i went on a chocolate biscuit binge at work as i was having a bad day and someone brought some from a client... ahhhrgh, meant readings this morning were shite...

and then instead of waiting to do my post breakfast reading then have my coffee this morning, i realise when i had a 8.6 reading (!!!) that I was halfway through my frothy latte!!!

ahhhhrgh!!!

Coaster, the big problem with gd is that you have to entirely get on top of diet instantly. I read somewhere that for regular diabetics they expect it to take up to 6 months to get diet and medication right! We get a week. So don't beat yourself up. If you are more or less following the diet and you are still getting terrible readings I would say you will need medication.

I found that really stressful - like I was failing. But then someone pointed out its a disease. Diet can help, but that's why we have modern medicine. And my dr also told me that it gets harder and harder to control with just diet the closer to delivery you get. So hang in there.

I had my final scan today (36+3). Baby still growing in same 50 percentile track so I assume they will stick with an induction date of 39 weeks. I asked the midwife about monitoring and she said that as long as things are going ok they will not monitor me too much. I am going to ask about having it in my notes about converting to c section promptly if any issues on the basis that I simply cannot lie back for more than a few minutes. But in the meantime I am remaining optimistic that I can get through most of labour without excessive monitoring. I went quickly on induction last time so hoping it will be the same this time. (Although ds will be disappointed - he's excited about the childcare plans in place for him while I am at hospital!! ).

Meanwhile I am feeling a million times better since I started taking iron supplements and eating extra salt in an effort to get my blood pressure up. I was so miserable before!

Hang in there ladies!