Feeling overwhelmed

Women's Health Gestational
1

So I finished my week of finger pricks and submitted them to the Gestational Diabetes clinic here. Once I got rid of a wonky meter, my fasting numbers were around 93-95 and all my post-prandials were under 120, so I thought this was fine according to the cutoffs I had for my last pregnancy. (<100 fasting, less than 140 pp)

However, now they’re saying the fasting cutoff is <94 and that a fasting glucose of 95 puts me 2 std-deviations away from the norm of 81. They want me to test for another week and they say the data are suggestive of gestational diabetes. I know it sounds nuts, but I am tempted to just quit testing at this point.

Based on one, big observational study, data suggests the risks of gestational diabetes increase linearly with increasing blood sugar, so a person with, say a fasting BG of 90 has perhaps 20% higher chance of preeclampsia, while a person with a fasting BG of 95 has a 40% higher chance of all pre-eclampsia, after controlling for other risk factors. Given my underlying odds of various negative outcomes, you would need to treat about 50 women with my profile to prevent one case of preeclampsia, which is the complication I’m most worried about.

On the other hand, my finger-prick BG numbers this time around are pretty much identical to those during my last pregnancy around the same time, if not lower, and my babies were both well under 7 lbs, and my blood pressure throughout both of those pregnancies were on the very low end of normal (90/60). Even at 30 weeks I do not classify as overweight according to BMI so I don’t think that elevates my risk either. And, when I actually did go in for the fasting tests run by a clinical lab, my BG was actually between 72 and 85 on those tests, even though the meter always showed a higher number when I first woke up. So some part of me wonders whether, if I just go in for the OGTT, would I even have been flagged?

And from what I can tell, there are no large studies showing that these more stringent guidelines, that capture lower-risk women (the new cutoffs flag about 20 percent of all women as having GDM), actually improve the outcomes I’m most concerned about. And once you get tracked into the gestational diabetes group, the odds that you will be induced early, the odds of your child being put in the NICU and the odds of winding up having a c-section when you didn’t have a large baby go up. So being diagnosed is not entirely benign.

So I’m debating whether to just stop with the testing at this point and just leave it alone. My husband thinks it’s nuts to do that, but he also isn’t living my life day-to-day and feeling viscerally how overwhelming it will be to meticulously plan my diet, find healthy exercise routines, check blood sugar an hour after eating, and go to about a dozen additional appointments over the next 10 weeks. Basically, I hate to think I’d be “noncompliant” but I realistically cannot imagine any way I could do all the things necessary to get my fasting blood sugar levels in line. On the other hand, I’d certainly feel guilty if I did have an adverse outcome even if there was no way to tie it to my care.

Honestly, I just don’t have the mental space to be doing all the monitoring they want, on top of monitoring Samson. They want me to eat 6 small meals a day – getting in 3 is a challenge. They require you to go to multiple “nutrition education sessions” – and every time I have an appointment, that’s an hour when Samson is not being closely monitoring. The diagnosis slots you in for more frequent prenatal appointments and weekly “antenatal testing” – basically where you do a 30-minute stress test for your baby, with an EKG, every single week. It puts you on track for additional ultrasounds to measure growth.

And from what I’ve read, manipulating post-prandial numbers with diet and exercise is easy, but fasting numbers are the most recalcitrant to change using those approaches. Which means I’ll spend a few frustrating weeks trying to control numbers which won’t budge, and will then be put on metformin or insulin anyways – for numbers that would not classify me as diabetic in any other universe.

It all just seems so overwhelming with managing my son’s T1D + being pregnant and generally feeling really lethargic and not 100%. I already have so many doctors appts, appts for Samson, etc. etc. eating into my work day and into the time I monitor Samson remotely, and because my husband doesn’t do it, he’s not very good at the remote monitoring. So I just feel like it will be this intervention designed to help but that will actually make my life more chaotic and that I won’t be able to do the things necessary to keep the numbers in line anyways.

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For me that would be the issue in a nutshell.

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Yeah. On the other hand, I’d also feel guilty if I spent all this time on my care during this pregnancy and my walking/talking children suffered – for instance if my son wound up having a dangerous low because I was at an appointment. Basically it feels like being a mom nowadays means feeling guilty for everything whether you have control over it or not.

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It is obviously a personal choice.

For me, the potential for long term impacts on the unborn baby would outweigh short term (non-critical) impacts to the family.

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the main increased complications associated only with fasting elevations are actually short-term for the baby or ones that occur to me during birth.

The only one I’m actually concerned about is preeclampsia, which if severe can lead to prematurity. But prematurity was not actually associated with fasting BG in this study:

“Premature delivery, intensive neonatal care, and hyperbilirubinemia were significantly related to the 1-hour and 2-hour plasma glucose levels but not to the fasting plasma glucose level.”

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Would there be a down-side of just doing your own monitoring and keeping an eye on it instead of doing the monitoring they want you to do?

For example, you know what you are doing with Samson and you know all about diet, so you could skip the “nutrition education sessions”. But you could check your BG when you wake up and after meals, and watch your diet a little more closely, that’s relatively low impact and you would know how you are are doing.

And there is no negative to getting a little extra exercise, it’s beneficial for everyone. Samson could do something with you. Family walk, family swim.

If it gets worse, at least you would know it because you are testing. And if your condition changes you could follow up with more aggressive control steps and consult with your doctor. That seems better than flying blind.

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7

Those numbers are well within the margin of error of home bg testing from their targets, and even if they weren’t I still don’t find them concerning, but I do understand your concern… those are completely normal blood sugar levels though IMO… why not just do the one time OGGT they offered and be done with it?

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First, I would BREATHE! You are clearly very overwhelmed with everything you have on your plate, and thinking while being overwhelmed, or emotional in any way can fog up your rationalization. If it were me, I would prioritize what is most important. I would think the following things are most important…a) Your unborn baby (congratulation, btw! We are also pregnant with our 6th AND FINAL baby…week 10 atm.) b) Samson and c) Your mental, emotional and physical well-being.

Prioritize those and make the best decision you can. If it were me I would sacrifice my own well being temporarily to ensure my babies are OK. However, you can’t sacrifice your overall HEALTH, because that would, naturally, be detrimental to your baby in the belly. If it were me and I couldn’t meet all the strict standards that have been indicated for me (many appointments, many tests, scans, etc.,), I just wouldn’t do them…I’d do the best I could at home with the materials that I have on hand. You’re more than capable, intelligent and dedicated enough to take care of yourself in a good enough fashion to stay in good health during this pregnancy imho. It’s sometimes difficult to realize that “this too shall pass.” Your babies due date will come, your baby will be born, and you will look back on this time with even a more strong spirit due to this difficult period.

Naturally Samson’s health is at the top of the list since he can die if you and your husband don’t do the right thing…for me, I weigh things according to how damaging they can be to my family, if I don’t do things correctly. If we don’t monitor Liam’s sugars and treat him 24/7 the way we should, he could die…so, to me, this is #1 concern.

You’ll do the right thing, Tia. You’re so very intelligent and hard working and I know you will figure this out and do what’s best for you, your baby, and Samson.

Our thoughts are with you and I’m always here if you want to talk! Send me a PM if you ever want to talk about whatever and I’ll give you my phone number.

#1 - Breathe and get a clear head.

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yeah, that’s a good suggestion. I’ve basically just been checking my BG when I wake up and spot-checking after some meals that I figure are more carby or junky. I mean, I know my Greek salad is unlikely to cause a huge BG spike. But the numbers are pretty consistent. 95 fasting BG. 116 post prandial.

The negative for exercise is basically that I don’t have the time or physical ability to do it. I can’t walk right now and am still waiting to get in to see a physical therapist (they will see me on Thursday). So it would be a “healthy recommendation” that I feel guilty about because I am unable to do. Plus, it requires my husband giving me the time to do the exercise. It means he has to give the kids dinner and put them to bed.

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I’m thinking of just doing the fasting portion for now – if that’s normal then the other numbers I tested are normal and we’re done, and I can do that before Mitch goes to work.

I don’t want to do the full OGTT because a) I almost passed out last time from hypoglycemia and b) it takes 4 hours and I have to sit at the lab during that time. I’m honestly a little paranoid that something will happen at Samson’s daycare and I won’t be able to get to him quickly. Right now I work a 3-minute drive from daycare, so anything that happens on Dexcom I can instantly react to. There is literally no one on staff who is well trained (everybody is on vacation and there are a bunch of temps filling in for them). One day last week I came to daycare and he was 56 double arrows down and literally no one who was watching him even had an idea that he had diabetes or that they should be looking at his numbers :frowning: Mitch works either 35 minutes or 2 hours away, depending on the day, so it would mean he’d have to stay home from work that day to be able to respond to such situations. Our "system"at daycare right now is me frantically texting/and/or driving to school to treat lows :frowning:. The more capable teachers will be back this week so maybe after that I’ll feel more comfortable doing a 4-hour test, but until then that’s just too much time away. As it is all Samson’s had a number of lows at daycare while I was at checkups and I could have prevented them if I’d not been driving or talking to the doctors, etc…

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I don’t know anything about gestational diabetes per-say… but if you had any sort of other actual diabetes issue you’d be seeing inconsistent numbers all over the place, the numbers you cite are consistent and in a narrow spread that I know to be well within normal ranges of a perfectly healthy metabolism. To be honest, I’m more worried about your stress level than your blood sugar. If you start seeing fasting north of 130 and PPs north of 200 there might be s legitimate concern…
I’m really surprised your provider is causing you this undue stress… id take the numbers you have to someone else for a second opinion

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yeah the new definition of gestational diabetes, at least as defined by ADA and ACOG, is basically catching a whole bunch of women who would not even be diagnosed as prediabetic in normal circumstances, based on one (admittedly very large) observational study, plus a handful of randomized trials that are much smaller showing very equivocal benefits.

There was a huge debate about 3 or 4 years ago when the various obstetrics organizations updated their guidelines. Not everyone in the field is convinced that increased treatment results in better outcomes, and it’s hugely expensive (increases annual costs from $636 million to $2 billion). There still aren’t the data to support it, although presumably after a few years of these guidelines they should have more… But they justify it by saying that treating women with diet and exercise can’t be bad – even though they ignore that slapping that diagnostic label on people is enormously stressful, time consuming and expensive. Not to mention stigmatizing for many women. I can imagine quite a few women wind up with a case of post-natal depression after so much hyper-vigilance in later pregnancy. That on its own is known to adversely affect babies.

I suspect it will go the way of the urine screens I had to do at literally every.single.checkup last time I was pregnant. Lots of really robust observational trials showed that women who go into preterm labor have UTIs or protein in their urine. But after doing all these tests they realized that catching and treating women with UTIs didn’t necessarily improve that outcome, so they stopped. In general, pregnancy guidelines are an area where the data is really poor – because no one thinks it’s ethical to experiment on them.

We’ll see.

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I was diagnosed as a gestational diabetic with my first pregnancy and it created mental stress. In my opinion the 3 hour OGTT is a waste of time. No one eats like that in real life.

All the suggestions made earlier in the thread are helpful. If you’re comfortable checking your own BG and going for the A1C and watching your nutritional intake, that ought to cover it. My recollection was that my OB did not want to have to deliver an oversized baby. In the end, she scheduled me for induced labor using pitocin. When verifying the dates, she seemed to have calculated the delivery date to be a bit early, by at least about 3 weeks. My daughter was 6 pound 3 ounces. My weight gain was minimal for my size/height.

OB malpractice lawsuits are notoriously high- at least where I reside. Many of them are just trying to cover themselves by going through the protocol. I recall having to see a cardiologist because she detected some blip. 26 years later, I’m fine. With my second pregnancy, I took matters into my own hands in terms of diet, nutrtion and monitoring BG. Both children are healthy.

Do make sure that you trust your healthcare provider because while a normal baby delivery is fairly routine, as you may know, it could also become complex pretty fast.

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My first child was induced with pitocin, wow, that is some powerful &*$%. You have my respect.

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Oh…and no epidural.

I’ve been told that I have a high level of tolerance for pain. Funny story was that for my second pregnancy, I was in labor as I walked into the hospital, the security guard told me to walk it off, and that some times false labor occurs… I told him that I would not be there if i were not in great pain and that he better not try to slow me down. My son was born in less than 1 hour.

Truthfully, I’m more concerned with the ramifications of an epidural gone bad, or anesthesia reaction. My wisdom teeth extractions were by novacaine. The oral surgeon was good. Extracted four rather quickly. Then I looked like a chipmunk for about 4 days. :frowning:

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yeah our first was induced after my water broke early, and the incredibly strong contractions caused a partial placental abruption, which led to him being born not breathing (also a c-section). So I’m not crazy about getting a label that fast-tracks me into the induction group either.

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Your blood sugars aren’t unhealthy or dysfunctional, I don’t see any problems with self monitoring (occasionally) to ensure hat they don’t become unhealthy and just pursue it if anything changes…

When organizations lower thresholds like that it’s still not meaningful to people who don’t have diabetes… they probably lowered the threshold because countless women were out there pregnant with fasting levels of 150 and being told by their doctors that their bg was “borderline”

Your blood sugars are glorious-- celebrate them, eat healthy, exercise safely, and enjoy your child’s journey into the world.

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