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.