Gestational Diabetes: Now what?



hi my name is Alison early and I am 31 years old and I'm currently 25 weeks pregnant with my second baby the reason that I'm making this video is to just discuss the experience that I have had in both of my pregnancies so far with gestational diabetes so as just kind of a disclaimer upfront I am a physician I am NOT your physician I'm not an obstetrician gynecologist I don't have medical expertise per se in this area this is not intended to treat or diagnose any medical conditions so basically just as an overview kind of what gestational diabetes is it is a condition of increased insulin resistance that can affect up to 18 percent of pregnancies according to some data so all pregnant women have a degree of insulin resistance and insulin is a hormone that your pancreas releases every time you eat to transport glucose into your cells and glucose front comes from carbohydrates so in simple terms the normal pregnant state is that you have somewhat increased insulin resistance which allows more of your body's glucose to go to the developing baby this happens because of some of the hormones that are produced by the placenta and it kind of increases through the pregnancy so generally speaking women are tested for gestational diabetes in a normal scenario at about 24 to 28 weeks that would be different if you had other predisposing factors my dog is right here sniffing around which is coming at you live from the basement so why does it matter number one is in some patients it can be a sign that they may have had a pre-diabetic or insulin resistant state prior to pregnancy that was undiagnosed so many you know young healthy people don't go to the doctor and have screening labs all the time so it could be something that was just pre-existing but undiagnosed there is a higher likelihood of something like type-2 diabetes later in life and they say that up to 70% of women with gestational diabetes will be diagnosed as type 2 diabetics within five years so that statistic is upsetting to be quite frank with you in more of the short term babies who are exposed to high levels of glucose in utero are more at risk for what's called fetal macrosomia or large baby this can lead to birth complications like difficulty giving the shoulders out which is called shoulder dystocia also because the baby could be having to compensate for elevated glucose levels their pancreas can be making more insulin than a typical baby and then once they're born and then not exposed to the mother's high glucose levels the elevated insulin that's being produced by the baby can actually cause decreased blood sugar or hypoglycemia in a neonate which can also be very dangerous and then even a potential for future metabolic issues such as type 2 diabetes metabolic syndrome obesity in the baby so for all these reasons it was very upsetting for me to receive this diagnosis which was unexpected in my last pregnancy and it took a long time for me to really process it in a number of ways I think first I had it was almost like going through the stages of grief um I immediately was crying when I got off the phone with the person who called and told me my test results I was in denial about it I thought it must be because I eat really healthy and I never eat 50 grams of or a hundred grams of glucose all at once so I thought it must be that my body's just not used to that kind of a load and I don't really have gestational diabetes and then there was kind of a period of seeking any information that I could find I think that was for a couple reasons one of which being that I do have some medical knowledge so I was trying to brush up on what I did know about it which I mean honestly wasn't that much but um I wanted to read like the medical literature about this and find out exactly what I was dealing with the other reason is that unfortunately in my last pregnancy when I got the diagnosis it was a Friday um I just kind of was dropped on me like a bomb and they said we're gonna refer you to a specialist and we'll fax that over on Monday and then you should be hearing from them so that was like all I knew time so I remember last time it was in November it was like right after Thanksgiving and they were like well we want you to see the specialist but you know the holidays are coming up and we've got busy schedules and days off and stuff so they gave me an appointment in mid-january that was like six weeks later I was really actually very upset because um I was coming from a place of it I was a resident and in our residency we if patients needed to be seen we just had to see them and you had to stay late and you had to squeeze more people in and we didn't just say sorry it's the holidays so you're just gonna have to like deal with it until we have time to see you I didn't have any information about anything and I just felt like they really left me hanging so that's not the situation this time and I'm not trying to blame anybody but I'm explaining sort of why I emotionally had a hard time dealing with the diagnosis at first so anyway I spent that whole weekend reading as much as I could thinking I will never ever eat another carbohydrate again in my entire life and just trying to start with the coping process like what did I do wrong how could I have prevented this what does this mean for my future child I had ideas prior to that that I might have wanted to have a fully natural birth with no epidural or anything and everything I was reading was kind of saying that the odds of that were getting smaller so anyway that's just kind of framing my emotional state so then you begin the process of they will prescribe you a glucose meter and you have to start pricking your finger and checking your blood sugar fasting so first thing in the morning before you eat or drink anything and then within one to two hours after every meal and you'll get a meal plan that you're supposed to follow and you are supposed to record all of your blood sugar readings what you're eating and it becomes this whole experiment of like if I eat this what is my blood sugar do if I exercise what is my blood sugar do if I eat this as a bedtime snack what's my fasting blood sugar going to be so because I've always been interested in health and nutrition it was really not that difficult for me to figure out what to eat to keep my post-meal blood Sugar's within the target ranges that was pretty simple but I really struggled with my fasting blood sugar and so that was kind of the bane of my existence for the rest of my pregnancy so your fasting blood sugar can be difficult to control in some people because even if it's low blood sugar or normal range when you go to bed some people release glucose from their liver overnight and then you can have an elevated blood sugar in the morning so as I went on through pregnancy for a while I was kind of able to stave off having to go on medication I would started exercising after dinner and I started doing different things to try to keep my fasting blood sugar down and it was just kind of hovering like right on the borderline of where they wanted it so in the end I did end up having to go on metformin which is an oral medication before bed and then at the very end the metformin wasn't quite keeping me where they wanted it to so then I had to use insulin which is an injection before bed so all of this was a really strange experience for me in a lot of ways because I've been fortunate not to ever have really had any chronic medical conditions before I've had a ton of exposure to specifically type 2 diabetes and taking a walk in those shoes was very eye-opening for me as a physician in a lot of ways it's a real pain to check your blood sugar four times a day it gets very tiring to have to plan out all of your meals and snacks and never be caught without something to eat because there's literally nothing in a convenience store or a vending machine that's not just a package below sugar so there's a lot of like behind the scenes just planning your food all the time you know the pregnant aspect of it I feel like wasn't too bad for me because I didn't have a lot of like food cravings or anything through my pregnancy so adjusting my diet was just like kind of the easiest part of it to be honest I think that in a way just sort of making the decision one time that I wasn't going to eat certain foods I didn't have to make that decision every single day at every single meal I just didn't eat that stuff anymore so um the diet itself wasn't that big of a deal the emotional part was really difficult and as the week's went on it's like you can get used to anything so as the week's went on it became more of a routine but this time around it is very much more expected that I was gonna have gestational diabetes again I was kind of hopeful that I wouldn't but I did fail the one hour glucose test so that was a decision that my doctor and I made that I would just do the screening test and if it if I failed I'd there is no reason to go through the three hour test again because obviously that's just the way my body is during pregnancy if you have gestational diabetes I think it's number one the best thing you can do is educate yourself you may or may not agree with the conventional diet and advice that's given to you I am NOT here to advise on any specific diet or carb intake or anything but I would really encourage you to do your research there are some really good resources online I feel like there's not a ton which is a big reason that I am making this video because it would have really helped me with my diagnosis to hear from somebody who just you know is the odd one that has it unexpectedly it was really important to me to know that I was not diabetic before pregnancy I had had blood work done just as part of my job for my health insurance and I had a normal hemoglobin a1c before I was pregnant the first time after I delivered at my six-week checkup I did another glucose challenge so much fun and that time everything was normal so it was truly limited to just while I was pregnant this time around going into the pregnancy since I knew that that was probably gonna happen again we checked my hemoglobin a1c and my first trimester and it was 4.8 which is almost the whole point below the even pre-diabetic range so I am NOT diabetic or pre-diabetic or have any insulin problem outside of pregnancy so I think for me that's just a helpful thing to keep in mind that um you know hopefully I won't be one of the people who ends up with type-2 diabetes within five years I did a lot of rambling in that if you have any questions about gestational diabetes please feel free to comment or go to my Instagram I talked a little bit about it on Instagram because it helped me a lot to connect with other people who were dealing with this last time so I hope that's someone helpful to somebody even if it's just commiserating and saying that you felt the same way as I did so if that's you I totally understand where you're coming from you will get through it and you will do great so Beth I have to say for now

One Reply to “Gestational Diabetes: Now what?”

  1. Thanks for the quick review! So crazy that it took 6 weeks to be seen…I would have been so anxious during that time! I hope others find this educational and realize they’re not alone.

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