Support and help with Gestational Diabetes?

[Crapweasel]

Failed the "Lucozade test" last week, I've now been told that my GTT has also come back high and have therefore been diagnosed with Gestational Diabetes.

Having failed the Lucozade test but passed GTT during my last pregancy I was really hoping to dodge that particular bullet again. Oh well....

Did some searching in the archives and found this fab old thread with lots of support and tips on diet etc. Any current sufferers (or experienced old timers) fancy joining a similar thread for 2010?

I have a diabetic clinic appt on Tues (where I understand I'll get a finger prick testing kit and see a dietician) so I'll report back then.

I'm 29 weeks by the way.

I had it; was life-changing for me. Will be back later to tell you more as I'm about to take baby up to bed.

Right, I'm back.

I was diagnosed earlier than you, as I was tested early due to PCOS and other risk factors. My GTT was borderline.

I followed a very strict diet but was unable to control my blood sugar through diet alone so after a few weeks went onto insulin. Frankly, the diabetes nurse was OBSESSED with insulin and I think I should have tried diet for a while longer. The diabetes nurse was pretty useless so mumsnet and the internet became my chief source of information.

I soon found that my diabetes was worse in the morning so I had to be very careful with my breakfast. Porridge, cereal etc were no good as they raised my bloods too much so I ate a lot of bacon and egg, which were perfect. As the day progressed I could be less strict.

I started exercising to help control my blood sugar and did Davina's pre-natal DVD nearly every day, and went for lots of walks with my toddler. Exercise is a great way to help lower blood sugar.

I was very strict with my diet although with insulin the nurse told me I didn't need to be; another example of the poor advice she gave me.

Anyway, as a result of the diet control and the exercise I lost a lot of weight. I was a size 20 and now a year later I am a size 12 as I have continued with the exercise and diet. 2 weeks post-natal I was back in jeans I last wore in 2006, 3 years and 2 babies ago! It is the best thing that could have happened to me.

DS2 was born on the 50th centile so wasn't too big, so it proves that good GD control can work. I had to fight the hospital to keep DS2 out of special care as they had a policy of automatically putting all babies born to diabetic mothers in special care. This was probably the most stressful part and I had to get a letter from the Head of Midwifery put in my notes supporting my wishes. The hospital's policy is contrary to NICE guidelines, and has since changed.

My DS's blood sugars were monitored for 24 hours after birth as there is a risk of low blood sugar, but he was fine. Breastfeeding helps address that, so do it if you can.

Hope that helps! I was so upset when I was diagnosed (perhaps irrationally) but it turned out to be life-changing due to the weight loss and lifestyle changes I have made.

If I have another baby I would probably look to challenge the way in which they insisted on monitoring me throughout labour which meant I ended up being pretty immobile. I was also induced at 38 weeks which in my hospital is standard. I'm not sure how I feel about that now.

Good luck with your pregnancy!

I've had a nightmare with the diabetes nurses, too!

I controlled my daily levels with diet and exercise - but my obsessed diabetes midwife insisted on Insulatard at night. The thing is, that took my aggregate levels down during the day. As a result, I was checked in with a hypoglycemic incident - which was horrible. Then I was told to eat every two hours, which brought my levels up! Grrrrr. As a result, my baby's stomach is 40 week's old; her head is 36. I'm probably going to be induced in the next week.

My issue with it all is that my diabetes midwife would pull out the "dead baby card" - insinuating that unless I complied with instructions with no question, my daughter's life was absolutely at risk. There has been no effort to meet me halfway or acknowledge the latest research. To be fair, everyone else has been great.

Being assertive has helped a lot - reading up, knowing the latest guidelines, knowing that continual monitoring isn't written in stone, and neither is anything else!

One lovely side effect is that you get more scans, more chances to ask questions and meet the people who will care for you. Continuity of care is much more likely.

Good luck - you'll be just fine and your DC will be, too.

I made a complaint against my diabetes nurse. She really was appalling and I had a similar hypo incident. She seemed to take great pleasure in telling me about my diagnosis, and pronounced gleely that she made all the pregnant ones cry.

But yes, you do get more scans.

I had gestational diabetes with DS and I'm now 17 weeks pregnant with number 2 and it's back again. The whole thing came as a surprise the first time round because although my Mum has type 2 diabetes I was really fit and slim and it didn't cross my mind that I could still pick it up. I try to be positive about the fact that this has given me a warning that I obviously have a genetic tendancy towards diabetes and therefore I can be more aware of managing my lifestyle as I get older.

I managed to control my diabetes entirely with diet last time following a low-carb regime similar to llarggub. I had DS at 37 weeks weighing a tiny 4lbs 6oz, so GD definitely doesn't always mean a big baby! The low birth weight was never explained, but i'm pretty convinced that it's unrelated to the diet I followed as I already had a tiny bump at 28 weeks when I was diagnosed last time.

My tips for managing the diet are to make sure you understand how different foods affect you, bearing in mind that this is likely to change as your pregnancy progresses as the insulin resistance is progressive. For example I can manage porridge for breakfast at the moment (but any cereal, or even worse, toast is a disaster), but last time porridge caused a reading of over 8, even when made with water, so I'm making the most of it now!

Last time I was having a breakfast of 1 slice of Vogel Soya & Linseed bread (lowest carb I have been able to find) toast and greek yoghurt. Lunch would normally be some kind of salad and dinner would focus on the protein and the veg. I snacked on nuts, cheese, olives... Eggs are good too.

Sorry for the mammoth post, it's a subject close to my heart at the moment!

Hello Chocolatecalculator, may I just ask you a question about your post?

I too have a type 2 diabetic mother. I too have started both my pregnancies fit and slim. I am now 30 weeks with no.2.

How was your diabetes initially spotted? Was it through the regulation urine testing or the full on GTT?

The reason I ask is that, in my first pregnancy, despite never having an abnormal urine test I was sent for a GTT because of my mother's history. The test was negative. The diabetes nurse actually told me off for wasting her time (as my urine/blood tests had not shown any diabetes indicators)! This time round I've declined the GTT even though my obstetrician and midwife both want me to have it and aren't terribly happy with me. Once again I've had completely normal urine tests so far. Now I'm wondering whether it's possible to have gestational diabetes but for some reason this is sometimes only picked up by GTT and not standard urine testing? The rest of my pregnancy has been healthy and there's no indication that baby is anything other than normal weight for 30 weeks.

Thanks to you in advance and to anyone else who might have experience of this.

Bagofrefreshers, I was completely the other way round. In my first pregnancy I declined the GTT as it seemed so unlikely to me that I would have GD and I wasn't prepared to take a morning off work for it. It was then picked up in a routine urine test at 28 weeks. (Incidentally the only midwife appointment I had after lunch, so may have been a problem earlier, but I was always doing my samples first thing). There was a question of whether it was just an abnormal reading, so they gave me a blood tester kit to test after meals and I was told if I had 3 high readings over a fortnight I had GD- I managed my 3 high readings in just over 24 hours! I got told off by the midwife for cancelling my GTT so seems like you just can't win!

It sounds to me like you're just one of the lucky ones, my sister was pregnant at the same time as me first time round and went for her GTT given my experiences and was fine- obviously just me who inherited the dodgy gene.

ChocolateCalculator, thanks for your reply, you've given me food for thought there. 3 high readings over a fortnight is quite a low threshold by the sounds of it. Perhaps my negative tests are just down to the randomness of appointment times/what I might have eaten on any given day, and rather than being complacent, I should just do the test. One of my two sisters did get GD with her pregnancies, but she was quite overweight to begin with and I've always put it down to that. Your experience just goes to show that it's not just about weight (well it's shown me at any rate!).

It definitely isn't just about weight; the super-slim GP at my surgery had it!

Everyone involved in my 2nd pregnancy agreed that I probably had undiagnosed GD in my first pregnancy. I had all of the urine testing and it wasn't picked up, yet I had excess amniotic fluid, a baby weighing 9 pounds at 37 weeks and several other things which I don't really remember now.

Bagofrefreshers, that pretty much used to be my feelings on the subject which was why I cancelled my GTT, but before I got pregnant with DS I was size 8-10 and running 30+ miles a week- I wish I had time to do that these days!

I think for those with a genetic predisposition to diabetes there's nothing you can do to stop GD. However, I do think lifestyle factors can have a big impact on when/if Type 2 eventually strikes later on, which my GP told me at my 6 week post-natal check is pretty much inevitable. I am determined to hold it off as long as I can, so I am now very careful about my weight and ensuring I stay active. I want to hold it off as long as possible and in many ways feel I've been lucky to have this predisposition picked up through having GD. Doesn't mean I still don't get more than a little frustrated by having to be so strict with my diet when most people use pregnancy as an excuse to relax their eating habits!

The diabetes consultant told me that I probably would get Type II but with lifestyle changes I could possibly delay it indefinitely. I was envious of others when I was pregnant due to my restricted diet but was glad 2 weeks after when I was back in pre-pregnancy clothes!

llareggub- so true! I was so jealous of other pregnant women just being able to eat what they wanted, but then I suspect a fair few were jealous of me when I left the hospital 5 days after giving birth wearing my pre-pregnancy jeans! (Although having a tiny baby did help hugely with that!).

It's good to have someone remind me of the positives, it's easy to get a bit fed up when I think of how many weeks of very restricted eating I have stretching in front of me right now...

Hello Ladies . It's reassuring to hear from others who are/were in the same boat.

Llareggub, thanks so much for such a detailed post. So helpful.

The stuff about birth/post birth protocol is really interesting and I'm sure I'll have loads more questions as we see how things develop for me. For instance, with DD I had a very fast labour and the only pain relief was the pool which was fantastic. The idea of continuous monitoring is really getting to me. I'd also banked on being able to discharge myself fairly quickly this time (DH had already squashed my idea of a homebirth but it looks as though that wouldn't have been possible anyway).

Congrats on making such a positive lifestyle change out of your situation. I'm very impressed. I'm really going to struggle I think as I don't eat meat and am aware that my preferred diet is very carb heavy. I LOVE breakfast cereals and pasta etc. Hopefully I'll pick up some good tricks to reduce carbs and may be able to make at least some of them longterm changes. I suspect I'm going to learn to love eggs!

I'm not expecting a small baby - DD was 9lb 2oz. Possibly there was undiagnosed GD there but who knows, as I say the GTT was fine last time and I have friends who had similar sized babies with no GD indications either.

Oh, and ref the urine/blood result piece. My urine test was normal at the same point that my blood showed a 12.1 reading 1 hr after the Lucozade so it would seem that urine tests are by no means 100% reliable.

Another thing I'm picking up on this thread is to be very wary of diabetic nurses

Hi ladies. I was diagnosed with GD on Friday. 30 weeks on the nose and I am very concerned. My community midwife is dreadful; she's so flaky it's untrue. I took the GTT on Wednesday and she rang me on Friday and left a message to say that I shouldn't worry as everything is fine. Then she rings back to leave another message (two minutes later) to say "oops, read your results wrong, you've got GD. See you in a month." I then get a call from the diabetes nurse to say that I am to be put on insulin on Monday and that my chances of a normal birth are "greatly reduced". I asked about controlling it with diet etc but she sort of sighed on the phone and said no. I don't know what my levels are and she didn't have them in front of her. She said that the consultant wouldn't "let me" go to term. This is all on the phone btw; no one has met me let alone examined me! I am also very concerned as I am due to have the baby at the Simpson's in Edinburgh; a hospital with a less than great reputation for consultant led care... I had hopes of a waterbirth and minimal intervention and now it looks as though that's out the window. I also feel like I have let the baby down somehow. Feeling a bit lost to be honest. That and I am sitting an exam on 13 May which I am freaking out about... I don't half make things difficult for myself...!

Hi Ruby, keep meaning to come back to this thread.....

Have to go to bed now as DD (3) has started a phase of waking at 4am and then my pregnancy insomnia kicks in. Great timing for that phase DD!

I'll come back in the morning and let you know how I've got on and what I've learned over the last few weeks. Hopefully I (and any of the other really helpful previous posters on this thread) can help to fill in the gaps.

Sounds like you've had rubbish communication so far. I sat an exam at about the same stage of pregnancy with DD so you have my sympathies for that too.

Right I'm back. Here's how things have panned out for me since the GTT. (By the way, my GTT result wasn't too far out of range - went down to 8.5 after 2 hours against a target of 7.8. GD diagnosis is an all or nothing thing but if yours was higher that might explain why they're suggesting going straight to insulin)

For me, I went to the clinic and was set up with a finger prick monitoring machine. I had to test 4 times a day - before breakfast and then 1 hour after each meal. Target is to get fasting blood sugars within a range of around 4-5.5 and post meal to below 7.8. It honestly doesn't hurt that much, the worst bit is fitting in the testing around the rest of your life.

I also saw a dietician. As I'm sure you know controlling blood sugars is about limiting carbohydrates but they are very keen not to limit too far. Ie they don't say "don't eat bread", they say "switch to wholemeal". Equally pasta and rice are to be limited not cut out. They'll suddenly start to be very interested in what you weigh (nobody weighed me at all in my last pregnancy!) and tell you off if you start to lose weight. As said above, eggs are brilliant, cheese, nuts etc are all great to snack on.

I had a week of that diet and thought I was doing pretty well, I only had a few out of range reading mainly associated with bread so I thought I'd get a pat on the back and "avoid bread". Instead they put me on insulin. And to be honest, though I was very upset at the time (cried buckets in the appt ) they were probably right. My readings are climbing even with the insulin and I think I would have really struggled to manage on diet alone as your insulin resistence increses as pregnancy goes on. Again, the thought of injecting yourself is honestly worse than the reality.

With regards to "not a normal birth" -what a horrid thing to say to you! - I'm still exploring this and different people are telling me different things. Eventually it will be up to my obstetric (not diabetic) consultant to make the call but they often induce at around 38 weeks. Part of the reason is a risk of a big baby (though they will monitor this with lots of scans) but there is also a small risk of early placental failure because glucose can essentially age the placenta.

I'm still exploring what this means re continual monitoring during labour etc. As said above they will also monitor baby's blood sugars over 24 hours after birth and may look to "top up" if BF is not keeping them high enough. Exprssing before the birth was mentioned to me as a consideration to avoid formula top ups which I'm personally against.

Sorry, this is a mamouth post but hopefully some of this will help you. Let us know how you get on and feel free to ask any more questions.

Wow that's very useful! The midwife also said in her latter message that my results were borderline but I don't know the figures and neither did the nurse who called me. I'm not all that sure the midwife did as she did misread them She just told me that the treatment is insulin and that's it. She was a tad brusque! I have read that it is quite common to induce at 38 weeks. I was really hoping to avoid that as I have heard nothing but horror stories about induction; although to be fair, no one ever tells you the good stories do they?! Not nearly juicy enough. Care in Edinburgh is pretty desperate all round. I quite liked my midwife (DH has no idea why as she is very forgetful and scatty and doesn't seem very knowledgeable). I think I liked her as she didn't weigh me and my appointments were always really quick!

I do still feel like this is all my fault and that I have somehow brought it on myself. I have been thinking about my diet over the past few months and it really has been pretty good. I'm firmly in the hummus and tabbouleh camp for lunch and I eat lots of fruit (with the the exception of bananas which I am phobic of . Make of that what you will.) and vegetables. I dislike chocolate and always have - I used to save my easter eggs up and flog them to my brothers at vastly inflated rates - and sweet stuff as a rule leaves me cold. Pasta has always given me an upset stomach too. I am not sure how far I could really control it by diet. Dinner is generally chicken/fish and salad (unless DH is cooking!) One thing that I could cut out is milk I guess - I don't tend to drink it when not knocked up and I have been drinking quite a lot of it. Sometimes spiked with strawberry milkshake syrup I did read somewhere that the lactose is not great for GD.

I should stop speculating and googling and go back to the books! This blasted exam isn't going to pass itself (although, that would be great...)

Wish me luck for tomorrow.

Ruby, Try not to beat yourself up, it won't have been caused by anything you've done. Your diet sounds excellent already!

I think the worst thing about GD - worse than the needles and the restricted diet - is the constant feeling of failure. Someone in the MN pregnancy book describes "failing a test 4 times a day" which rang true with me (although I'm currently only failing 1-2, mainly the morning one ). If you're of the logical, test passing mentality like me, (and I'm assuming you are ) then the fact that whatever you do you can't always "win" is really hard. Sometimes I increase my insulin, eat the same thing and the damn reading goes up. It's easy to take each increase in dose as another failure. I think you have to get to the zen like state of accepting that for the next few weeks your body will just keep changing and your insulin resistence will keep going up. I'm not there yet but I'm working on it.

Anyway, good luck for tomorrow. And yes, back to your books to prepare for a test you can control. Lots of luck for that too. What are you studying BTW?

Thanks! I know I'm being daft but it's all very new still and I'm just feeling a bit lost. Easy to try and apportion blame! DH is away at the moment too so it's just me and my guilty thoughts (plus a couple of demented cats...). I'm just thinking too much and I'm a control freak at the best of times.

I'm studying to go to the bar. I passed my bar exams a few weeks ago but need a pass in another subject before they let me loose on the courts. Seemed like such a good idea at the time!!

Thanks again for your kind words - you've made me feel heaps better.

Ruby, how did you get on today?

Ruby, please try not to feel guilty. Your diet sounds pretty good to me, but even if it wasn't I am proof that it has nothing to go with what you eat while your pregnant as I cut out all refined sugar and cut right down on starchy carbs the day I got my BFP this time round in an effort to conserve insulin and at 20 weeks my GD is as bad as it was at term last time. You need to focus now on controlling your GD as best you can. Plus motherhood is riddled with things to feel guilty about, if you start with this you'll be overwhelmed in no time!

I don't know why they've said straight to insulin, sounds a bit odd, I would be asking lots of questions. For what it's worth I managed a pretty active birth last time, only on the monitor for 15 minutes after arriving at the hospital and then again at second stage. The problem with childbirth though is you can't really know beforehand how it's going to go, I think that's what makes people so nervous. It's such a short time in hindsight though try not to worry about it. Last time I really didn't want to stay in hospital overnight and was banking on a 6 hour discharge (no idea how I thought that would work with the GD!). Ended up spending 5 nights as DS was not well enough to go home. It wasnt the best time I've ever had, but I haven't really thought about it since!

I hope you're feeling a bit better now it's all sunk in. Let's get this thread going properly as it's so nice to have others who understand what it's like to have GD.

Hi Chocolate. Were you induced at 37 weeks with DS or did you go into labour naturally?

Hello there.

The guilt is abating now! It was a wee bit raw you see so I was wallowing in it a bit.

Today was fine. The dietician was lovely and said that my diet was ideal which was nice to hear. She didn't think that there was anything I could change and she didn't want me to change either.

The nurse gave me my monitor and I've had two gos on it now and it's not bad at all. Readings are a bit on the high side but it would be weird if they weren't I guess!

I have to take a week's worth of readings and then see the consultant and another doctor next Monday to discuss options. There was no mention of insulin today but she definitely told me that I would be put on it when I spoke to her on Friday. I asked and she said that I may be put on it next week depending on my readings which makes much more sense to me.

I asked her about delivery options etc as the websites etc that I have been trawling have all been pretty negative on that front. She said that they wouldn't let me go overdue but the doctors could talk through all that next week.

I am feeling much more positive now and I know it's nothing I've done. It's all a bit frightening I suppose and I've not really had much information from my midwife so it's easy to let your imagination run away with you! Still hoping that I won't have to be induced or have a section; fingers crossed the baby shows some restraint on the growth front!

Thanks for asking.

How are you guys?

With regard to induction and labour options - it isn't a case of the consultants etc letting you all do anything - you are the one in labour (or not ) and even with GD you still have the right to make your choices. Of course we all just want the best for our babies but don't let any (misplaced) guilt compel you in to having interventions you don't embrace at times you aren't ready for them.

The whole 'we induce at 38 weeks' thing - doesn't mean something bad will happen to your baby at 39 weeks nor does it mean you will be arrested and taken to hospital. It means that their preference is for induction at that point and doubtless if you ask they can tell you all about the subsequent rate of intervention and the outcomes they achieved. If taking all that into consideration your preference is something else - well that's a choice you can make. The same applies to monitoring in labour and care of the baby afterwards. Listen to all the evidence and ask what the alternative scenarios are - then whatevcer yo do you are acting with information and stand much more chance of feeling empowered about your birth choices - whatever they are.

Sorry if this all seems a bit obvious but i hate reading these threads where mums feel a bit browbeaten in to following a particular pathway. It doesn't have to be like that.