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...

Hey,

No I haven't had a 36 week scan, I was only diagnosed last week following a scan the week before that showed baby has a big tummy. I'm just being completely rubbish with biscuits etc. Fasting readings are generally not too bad. Feel a bit like I'm running out of time! 37 weeks on Saturday.

What's the first port of call with medication? The idea of injecting insulin terrifies me...which I suppose should really motivate me to be strict with my diet.

Coaster first they tried me just with metformin tablets... but as you are more advanced not sure if you will go straight to insulin... it's not that bad, the finger prick test hurts more...

Coaster, in the most gentle way possible, try to cut back on the sweets and biscuits. I know how hard it is, we all do because we're all going through it. But as the doctor kindly pointed out to me originally that while he understands its hard for me, the baby doesn't care about that and that spikes for her are bad.

I have never been good at diets, but knowing that this is important for the baby is making it a little bit easier. At the very least, swap to plain digestives or similar rather than cookies/chocolate biscuits etc.

Coaster - Also look at low GI and whether you can swap things for lower GI foods that have less impact on blood sugar such as sweet potato for normal potato, dark chocolate instead of white/milk/chocolate bars with caramel etc. Certain fruits are better than others so avoid tropical fruits like pineapple and mango and stick to berries and things like apples. I did low GI to try and get pg with my PCOS and I could really see the benefit on my skin and cycles by just swapping high GI for low GI foods

I have had slightly higher readings recently so not sure if the 32 week hormone surge is hitting as I am not feeling unwell although have had a blocked up nose for a week that didn't seem to hit my reading. My readings seem to be going up even though I am eating similar lunches and breakfasts to before. Got 7.2 for a breakfast that was giving me below 6 last week. I may have to cut down on my post dinner pudding as I usually have an ice cream but yesterday it was 7.8 even with a low GI dinner.

Thread dropped off my list so checking back in. Still only 20 weeks so a few more weeks until my GTT.

LIG - same Russian roulette as you; now 36 + 2 but managed to keep it reasonably under control recently. Do you know if snacks during labour have to be low GI or by then is everyone beyond caring? I'm asking because stocking up this weekend on stuff and wondering whether I can do haribo!

Sorry but I think blood sugar levels have to be really tight during labour so that the baby isnt born with too much insulin in its system.
I wasn't allowed to eat during labour at all (just had IV glucose and insulin) so it's worth checking with the hospital if you'll need snacks.

Once the placenta's out though...

..ferrera rocha?

may have a secret stash in hospital bag already...

During labour I had no food between 5pm Wednesday and after my DD was born 2ish in the afternoon on Thursday... also on the IV glucose and insulin as well...

Coaster, i'm afraid I agree with WorkingBling. It's for such a short period of time that if you possibly can just totally cut out biscuits, cake, sweets, chocolate etc then it's worth it. I am on week 3 now of diagnosis and although I do struggle at times the cravings have mostly gone and now if I have the odd yoghurt or sugar free jelly I do feel like I've had something really sweet, which just goes to show how much sugary stuff I was obviously having pre-diagnosis!

My diabetic MW has shattered my dreams informed me that I will be monitored for 24 hours after the birth and my bloods have to remain within a target range, albeit slightly higher than it is now. I had planned on packing a snickers for post-birth gorging but that is out the window now! I was under the impression that I will have to continuously monitor my bloods throughout my induction period, and then when on delivery ward they will take over and there is a possibility that I may be put on an insulin/glucose drip despite the fact that I am only diet controlled. I find the thought of that quite scary and depressing. But I presume it's the best thing for the baby?

Has anyone started thinking about expressing colostrum pre-birth? I haven't tried yet, when would be a good time to have a go? I presume a bit nearer to the finish line than 34w?

YY to cutting out sweet stuff, and bread/pastry. The less you have the less you want (IME anyway).

I'm lucky though in that I've always preferred savoury stuff anyway - my treats are usually cheese and salami rather than cakes and biscuits - luckily they are great from a GI point of view

Rusty I thought it was the baby's blood sugar that was monitored for 24h after birth, not ours? Did the mw explain why they need to monitor our blood sugar after birth?

I know that our blood sugar will be carefully monitored during birth though, and that the insulin and glucose drip is quite likely if it looks like it's going spikey - even if diet controlled up to that point. Apparently the stress of labour quite often creates spikes even if you were well controlled before . So you would need low GI snacks but even that may not be good enough. Bear in mind some women can't face food, throw up etc during labour anyway...

I was told it's best for the baby because if you have blood sugar spikes during labour that are transmitted to the baby, they could get withdrawal symptoms (i.e. a hypo) once they're out, because they've got used to high blood sugar and then it gets taken away. Especially since they often don't feed much in the first 24 hours.

I do slightly wonder though whether all women get blood sugar spikes during birth - even those without GD - it's just nobody ever knows because they don't get tested?

Question: what is everyone having to drink at the moment? Alcohol and caffeine are limited, sweet drinks are out... I'm bored of water and peppermint tea... What else is there?

Can I ask why you would express colostrum prior to the birth? Where would you store it? When would you give it to your dc? Also, as Rusty said when can you start doing it?

My last labour I didn't want to eat so only had a few sweets but it was a quick labour. Then when I was starving I was not allow to eat post birth because of the epidural to deliver the placenta. However, before the epidural they did check what I had eaten because if I had eaten a lot it could make me sick.

IV glucose/insulin sounds rubbish and I will do my best to avoid that. I am all ok with a GD diet as actually encourages you to avoid processed food and eat naturally and cook from scratch - but giving you glucose and insulin to work against each other sounds very un-natural and I think they will need to work hard to convince me that is a good idea - also if they get it wrong then it could result in too high/low blood glucose. (I think I am eating a lot better excluding my pizza/cake binge at the weekend as I am making the right decisions and making sauces etc. from scratch rather than being lazy and using a jar.)

The ironic thing last time when I was in hospital with dd, was the food was so processed and high GI with white bread, sugar filled jam etc. I imagine my blood sugar would go mad post birth if I ate their food. Another reason I don't want to stay in hospital.

I know I have to...I'm just struggling. I am being good today though, hoping I can at least show tomorrow that I can do it. I never craved sweet stuff before pregnancy, it was always savoury things or wine that I wanted. Throughout pregnancy though I've wanted ridiculous amounts of chocolate, and it's not helped by everyone around me saying "oh you're pregnant, eat whatever you want!"

I've really had enough of this whole pregnancy thing now. I've suffered with horrendous anxiety and depression throughout the whole thing, until recently when it's been better...and now this. I'll be 37 weeks on Saturday...I think at my appointment tomorrow I'm going to request an ELCS. It was already a possibility anyway, now with the added likelihood of induction and a large baby, it's tipping things in that direction.

mini my pg SIL got a higher reading than me post pizza and cake but then found out she passed her GTT. (She is 29 weeks.) I think that I had the same blood sugar issues last time and yet passed my GTT by being well and eating my low GI diet 80% of the time. So I imagine that my blood sugar was all over the place and not sure what happened to dd but we were both fine although never monitored. Who knows what would have happened if I was tested though....

Drinks, I have been drinking diet coke and caffeine free diet coke and then water, fizzy water sometimes with a bit of lime/lemon. Been trying to stay away from fruit juice now so a little limited. Also, not sure I should drink too much diet coke even without caffeine because of the artificial sweeteners but it is the only fun drink I can have.

The colostrum thing is a really good idea, as I understand it. It means if the baby has any suger lows, they can feed it with stored colostrum rather than waiting for you to produce more. Colostrum production is so low because usually babies don't need a lot so this way you can give it to the baby rather than formula. And I think whether you are a a big BF or FF person, it's clear that a baby a few hours old with blood sugar issues is probably going to do better on colostrum.

You store it in the freezer. I'm going to a training on this on Friday or Monday so will get more details then but I think you bring one syringe with you at induction and then get DH to bring the rest later if possible.

You basically hand express it out and use a very small syringe to capture it. I haven't started actually storing it yet but I have been practicing in the bath now and again and am pleasantly surprised how much you get (bearing in mind that the syringes are just 1ml big).

Also, if you had problems bf previously, it's not a bad idea as it starts activating the ducts etc. I'm a bit annoyed that no one suggested this to me last time as in the notes I have received about it, it makes the point that women who have had breast surgery should definitely do this as it significantly increases their chances of being able to bf.

I'm going to try to express colostrum, starting from 38 weeks. Three reasons:

1. So that if baby can't BF well at the start and so gets blood sugar lows (quite likely as DD was tongue tied and it runs in families), they can give colostrum rather than formula to get her blood sugar up.

Colostrum is much easier than formula for a newborn to digest (prem DD threw up all the formula she was given) and also has all the antibodies etc.

2. Because hand expressing might help bring on natural labour and so avoid induction.

3. To help get breastmilk supply going, as otherwise it might not start quick enough especially if I'm induced before term (and if baby's latch is rubbish this could also mean BM supply is not kick started properly).

Because of 2) I will definitely not be trying to express anything before 37 weeks especially given my history of DD being prem. Midwives have said not before 37 weeks I think.

Colostrum is quite thick and very scarce, so you need to hand express the tiny droplets into very small syringes (available from hospital) and then store the syringes in the freezer and bring to hospital at time of birth.

LIG that's interesting about your SIL. Ties in with something I read which is that all pg women have GD to some extent in the third trimester, it's the body's way of ensuring the baby puts on fat. But for some of us it goes too far. I guess there must be hormonal ups and downs for everyone so perhaps for us "borderliners" it depends on whether we get tested during an up or a down?

I'm totally with you as regards being ok with the diet (it's a healthier way to eat anyway) but not so ok about the unnatural interventions such as glucose/insulin drip. I don't know if I'd refuse it - will have to have a think about that.

I had to hand express when DD was born as she was nil by mouth in nicu. If you do try to express don't get disheartened as you only get very small amounts of colostrum initially.

Also it might be worth checking if your hospital offers donor breast milk. We used this with DD as an alternative to formula before I was allowed to try latching her. So just another alternative that may take the pressure off if you are finding it hard to express much initially.

working can I suggest you ignore the advice and take all your colostrum in. They told me with ds tht I should just bring in a bit. Then, when it turned out he was hypoglycemic they wanted him on 40ml top ups. I only had 15ml with me so the rest was formula. Annoyingly I had loads at home but it wasn't any use there. It only took a couple of feeds then ds was back up to normal and I could just bf on demand.
I was a bf peer supporter so very keen to bf and was a bit upset at having to top up (probably irrationally) and kicked up a fuss. They got a paediatric consultant in to tell me it was formula in a bottle on the ward or a glucose IV in SCBU. Tbh he rolled his eyes at my expressed colostrum and said I could give that as well if I wanted. This was despite their own antenatal midwives encouraging me to pre-express.

I got better care when actually on the postnatal ward though. A lovely midwife found me a "hot cot" for ds to prevent him using up energy to keep himself warm and helped me cup feed the top-ups.

Thanks tarka. Will see about that. We live 5 minutes from the hospital so I have a broadly casual attitude to taking things there and back as its so convenient but you make a good point.

A lot depends on how much I can get out in the next two weeks!

mini that is what I had thought, that post-birth just baby's bloods would be monitored and I could merrily tuck into some sweet stuff! But no, I am told for 24 hours I have to watch my bloods too and only if both I and baby are doing well will we be released from hospital and I can then go back to normal with a fasting blood test at 6 weeks post-birth to check the GD has gone and I do not remain diabetic.

working - I will be interested to read what you learn about the colostrum expressing! I just had a go but got nothing, although am 34w and no idea if I'm doing it right. I just want to do all I can to improve baby's situation at birth and this makes a lot of sense to me.

Tarka interesting re hot cot, MW mentioned skin to skin and baby 'wearing a hat' but the explanation as to why i as a GD mum should do that was not great, I thought all mums were encouraged to do skin to skin? So it is to allow baby to regulate their body temperature and put less stress on their body?

Working - another one interested to hear about the colustrum. Please keep us posted.

Mini - I think the normal me will insist on being told by someone who can explain how it works and the benefits versus risks of it I.e. Most likely a doctor or good midwife rather than someone blindly following protocol. However, I know when I was in labour last time I sort of did what I was told and similarly when ill I did my gtt I took the midwife advice that illness will not affect my levels on the gtt. So I think I need to be as prepared as I can so hopefully my dh can fight any battles during labour. (Not his strength but he knows that fighting them is easier than me having a go later.)

Tarka - I am interested (but not keen to see) to know if I would get better care postnatally if I wasn't low risk like last time. Last time I was ignored pretty much which I sort of understand as other people had more need than i did so could not see the point of being there. Hence wanting to go straight home where I can sleep, rest and focus on my baby.

I didn't realise that they would monitor me too. Fairly sure the food they serve at my hospital would not help blood glucose levels at all. Would need to get my own food as not sure I would want to risk eating their food and then having to stay even longer. Jam (the cheap no fruit type) with cheap processed white bread is one of their staples with processed cheese slices or something they call chicken for a bit of variety! I think the best thing I ate last time was one of those school dinner chocolate puddings and not sure living on them is the best idea! !

Hopefully the doctor next week can put my mind at rest about it all as really not happy about all the monitoring. If it was just me I would just do what I wanted to do and walk out the hospital when I wanted to and refuse what I didn't want or feel was beneficial. But it is different as there is ds to think of.

After my blood glucose went up for similar foods, now it is back down to 5/6 after meals. Not sure I get why except that I was physically very busy yesterday but didn't do much formal exercise. (I still think activity may be more important than food to me.) Still been struggling to find any comparisons between normal and diabetic people but did find something saying that non-gd pg women would typically have levels of 6 +/- 0.7 1 hour after food. Will try and get a link on when on my laptop. It would be nice if non-gd people also monitored their blood sugar for a comparison to understand the differences.

I was diagnosed 4 weeks ago with a borderline result (5.3 fast / 6.0 post lucozade) and have been eating low gi every since.

I was worried about spikes over 5.5 in the morning and wasn't able to control it with strict diet and as much exercise as I can at 36 weeks.

My care to that point was completely uncoordinated with very little info shared. The morning readings prompted an app with a diabetic nurse and I had a bit of a breakdown outlining my experience and she was very apologetic and took a good hour to talk through everything.

She recommended merformin but referred me for a scan the next day and consultant app to reassure me and answer all my questions.

Yesterday I had a growth scan (totally average at 50th), heart beat monitoring etc and agreed to a pill in the evening as the best option. Even though I'm 36.4, no insulin was mentioned, that might be the next step.

Anyway, the good news is that if the meds control my morning readings and my diet the other ones, then there is no reason I still can't have a water birth / active birth, but with regular blood testing so I am over the moon with that.

Being on meds does mean that I'll have 3 apps per week for scans, consultant apps etc - it's apparently standard (Scotland) if someone is on meds, but I'm reassured that they are monitoring it and it's just not me worrying about negative outcomes for the baby.

It's quite a roller coaster, sorry for the essay.

guidelines.diabetes.ca/browse/Chapter36 Compares non-GD pregnant women with GD pregnant women.

Fruity I also don't seem to be getting any care and no one seems to be bothered by my GD. My midwife appointment was completely pointless as she cannot say much about birth plans etc. till I see the doctor next week.

I am also a bit in the dark about my fasting. Noone seems bothered by my fasting results and it was never measured during my GTT. Also, my target for fasting is 6.0 but from the sound of it that would be quite worrying for most other people. Do people have any guidance of when they should do their fasting? Is there a minimum time period and should it be done upon first waking or before breakfast? Mine seems to vary with how long I fast for and whether I do it straight away when waking up or before breakfast which can be up to 90 minutes late. Mine has gone as high as 5.3 but that has been after 6 hours fasting/disturbed sleep and can be around 4.0 if I get a good sleep and don't do it till I get to work around 8am after being up and busy since 6.30am.