question about gestational diabetes

[Connie&Andrew]

Hi,

I had a question about anyone being diagnosed with gestational diabetes, how the diagnosis was made, and what kind of diet they were put on.

First, a little bit of history. When I was pregnant with my last baby, my 1 hour glucose test came back elevated. They then had me take a 3 hour glucose test and that one came back within normal limits. So I never went on any special diet and I don't think I made a special effort to watch my sugar intake at all. Well, when my baby was born 10 days early at 10 lb. 9 oz. (And he was injured at birth), I wondered if maybe there was something going on and the 3 hour test just didn't show it. (I also have had a 9 lb 1 oz baby and a 9 lb 8 oz. baby)

Now I am about 28 weeks pregnant and just had my 1 hour glucose test. It came back elevated. They want me to go in next week for the 3 hour test. I'm thinking I should just go on the diet to be on the safe side. I'm not exactly sure what kind of diet I should be on, though. I do have a date for a planned c-section for this baby.

My sister just had a baby in February and her 1 hour glucose test came back elevated. They didn't do any further testing, they just put her on a 2000 calorie diet, with a certain number of "exchanges". The basic diabetic diet, I think. Then she had to have her blood tested every 2 or 3 weeks. Everything came back normal after that.

I think it's interesting how different doctors have different protocols. I was just wondering what other people's experiences were.

Thanks for any comments or experiences.

Connie

[jennyinsandiego]

Hi!
I have had six babies and had GD with the 2nd, 3rd that just required diet modification. The fourth I started to need insulin. After the 5th I never was able to go off the insulin and it is here to stay. My sugars were the most controlled with #6 (my bpi baby) and she was the largest at 11# ( the others weighed 9.6, 9.3, 10, 8.15, 8.1). So while birth weight can correlate with diet/control, diabetics have macrosomic babies as a rule not just because of poor control.
I would buy a blood glucose meter (they are usually free when you buy the strips or get a script from your dr) and start testing yourself. Then avoid foods that elevate your sugar (start by eliminating white foods, starches). The limits are now lower than what a dr who has been around awhile will tell you They should be under 120 one hour after a meal). I was hospitalized during my 5th because my sugars were over 150 consistantly ,which is within ok range for some doctors. Tight control is so important when you are pregnant. The first thing I would do is to RESEARCH! The ada diet is outdated and when you are pregnant, hormones and other factors make sugar control really hard. Plus when your sugars are high it can cause damage to your baby, not just big baby. As an example, when my sugars were really high for the beginning of my last pregnancy, her heart was enlarged and leaking. It went away as a result of better control. My diet is this, lean protein was unrestricted. No fruit in any form. Non-starchy vegetables are my only carbs and real fats, ie butter, olive oil. oh and a 20 minute walk after each meal.
All that said some people feel insulin resistance is a natural thing in pregnancy and you may do fine just cutting back on your sugars. But I would ask lots of questions. What was your level for the one hour? What was your fasting level? Like with anything, Get the facts. Not just "elevated". It won't hurt you to follow the diet even if you aren't diabetic. Re-reading this, I see I am all over the map (need more caffeine!) So please don't hesitate to email me if you have any questions. Oh, one more thing, if the 3 hour does come back with high numbers, you should be having more ultrasounds, non-stress tests and afi's done as you get closer to due date. Mine usually start at 32 weeks. Hope I don't sound too alarmist, but This disease has become a ruling factor in my entire family's life.
Good luck, let us know about your test results-
Jenny

[admin]

Hi Connie,
I had GB with my second child (11years ago). He was 9 lbs. My third preg. was fine. My 4th preg. , I was tested for GB early. 1 hour came out elevated. 3 hour came out "normal" so Dr. never advised to control with diet. however, baby was 10lbs. and ROBPI . I've also wondered if maybe the 3 hour was misdiagnosed and if I have a legitimate "legal" issue. I don't really know the steps to take (can anyone help out here?) Anyway, with my GB baby, the diet was basically no sugar, several small meals every 2 -3 hours with a specific combinations of foods. Dr. should refer you to a dietitian to specifically discuss the combinations as well as self testing for blood sugar levels.

[m&mmom]

The biggest problem with diabetes not being diagnosed in my opinion is a lot of doctors I have questioned are not using the Carpenter Coustan conversion which the American Diabetes Association recommended they do in 1999.

This came from their website:
This can lead to macrosomia, or a "fat" baby. Babies with macrosomia face health problems of their own, including damage to their shoulders during birth. Because of the extra insulin made by the baby's pancreas, newborns may have very low blood glucose levels at birth and are also at higher risk for breathing problems. Babies with excess insulin become children who are at risk for obesity and adults who are at risk for type 2 diabetes.

Also if your 1 hour test was abnormal, then the first three hour result is abmormal which I think is 95(carpaneter coustan conversion) they you are to be diagnosed as diabetic. If two other results are abnormal and your first reading is normal you are supposed to be treated as diabetic. I found that a lot of docs in my area only go by the last number.
Cindy

[admin]

I had GB with my 2nd child. He was 9 lbs. (11 years ago) Diet was no sugar, small meals every 2 -3 hours and a specific combination of foods. Your dr. should refer you to a dietician for your special needs as well as info. on how to track your blood sugar levels. My 3rd preg. was ok but my 4th I was tested early. 1 hour test was elevated. 3 hour was "normal" however baby was 10lbs. 1 oz. and ROBPI. I often wondered if the 3hour was misdiagnosed and if I have any legal issues. (can anyone help me with that question?). Anyway, these are legitimate questions, Connie. and I wish you many blessings on your next child. B.V.

[Beloved Victory]

Hi Connie. Wow those are good questions. I had GB with my 2nd child (11 years ago) He was 9lbs. I controlled with diet. basically no sugar, small meals every 2-3 hours with certain combinations of food. and self -checking blood sugar 5-6X a day. Your dr. should refer you to a dietician who can help with your specific needs. During My 4th preg. I was tested early. 1 hour came out elevated. 3 hour was "normal" although baby was 10lbs. 1 oz. and ROBPI. I often wondered if the 3 hour was misdiagnosed and if I have any legal recourse. (can anyone help me with that question?) I wonder if that happens a lot (misdiagnosis) Anyway, Connie even though your having a c-section, I hope your clear if GD and your pregancy goes well!! B.V.

[Beloved Victory]

Sorry to answer twice! didn't think the first one went through.
=0

[m&mmom]

You should probably try to get the results of your three hour test for those pregnancies.
Cindy

[admin]

wow, the true experts speak
The two midwives I am priviledged to be working with both suggest the diet high in proteins low in processed sugar, whole grains and so forth, to all clients (we have clients...not patients!)~ Nutritional counseling is done in the first few visits, diet/nutrition is always a major focus for homebirth clients. When the first test comes back high the second is what they go by but IF a first comes back high we do alot of counseling and blood 'sticks' -If the second test comes back we have to transfer the mother out of care. There is a mother right now in our care that was high and then normal and she is growing a large baby but is very committed to birthing at home so the midwife has called her dailey at fiorst, to discuss sugar intake and finger sticks, and has done home visits.
I had never had an issue with sugar or large babies with my first 5 kids, all between 7.5 and 7.15...then Max came out at 9.9 (only 19 inches), My sugar test, in my opinion, was not done properly,
Also, I would like to add that the sonograms are over rated in my opinion they often do not interpret the weight of the baby/size correctly, Sizing a fetus is hugely subjective...so, it can almost be a bad thing to count on a sonogram...kwim? Non stress tests can be done at home, simply by counting the baby's movements and FHTs.That is something a mommy can do herself~
I think even if you are planning a cesarian birth its very important to watch your sugar intake as babies birthed in that maner are more prone to breathing issues and instabilities as they have not had the benefit of labor to get them ready for the outside, also, If your OB would let you experience labor before the cesarian- studies have been shown that that benefits the baby.

[admin]

I had Gestational Diabetes with my last four. The last one being the one with ROBPI. With all of mine I was diet controlled and faired pretty well. My first weighed 8#, 2nd 9# 5 ounces, 3rd 9#11 ounces 4 weeks early with all premature triats and my laast was 8 #10 ounces 3 weeks early. My second and third children I was sent to a dietary specialist. My fourth I was paranoid and began testing my blood sugar every 2-3 hours and after every meal. I watched my diet soooo carefully. I will say though that every pregnancy is way different. My 2nd daughter was so easy....my blood sugar was effected by nothing but sugar. My 3rd daughter...everything I ate elevated my bllod sugar...including veggies and salads..with no dressing...and my fourth was just careful, I was so scared. With my third I ate so little that I only gained 11 #. Have the doctor send you to a dietician. It is worth it, but watch out for those fruits they can raise sugars, over the line in a minute