Wednesday, August 1, 2012

OB appointment 27 weeks 4 days: It's official


As expected, I have now been officially diagnosed as having gestational diabetes. I saw my OB this morning and despite the news, she was very upbeat (as always). She came bounding in to the room, calling out "Sugar girl!" Overall, she was very reassuring and encouraging, giving two hugs and several high fives. Lots of "OMG, you'll be 28 weeks on Saturday! You're basically in the third trimester!! Look at you! Everything is going to be fine!" I really don't know where she gets her energy from.

Interestingly, I have gained no weight in the past month. Don't know if that could be diabetes-related or not, but given my worry about getting huge, or Magpie being huge, I don't see it as a bad thing. I've certainly not been restricting my food intake. I was in the normal range for BMI before getting pregnant, and I've gained 18 pounds so far this pregnancy, which is an appropriate amount according to the calculators I have found online.

We listened to the baby on the doppler - her heart rate was in the 140s. And the OB measured my fundal height, but didn't tell me the measurement (and I didn't ask).

In terms of the gestational diabetes, the plan is for me to see a nutritionist for now. They also drew an A1C level to see how my glucose levels have been over the past three months. She wants me to monitor my blood levels fasting and 1 or 2 hours after each meal. If my diet is consistent and my levels are consistently low, she may drop some of the finger sticks. I am also supposed to see a nutritionist, pronto, to get advice on how to manage my diet. Once the OB heard what my blood levels have been at home, though, she said she was very reassured and that she suspects I will do quite well and be able to control things by watching my food choices.

She also said we will begin non-stress tests at 32 weeks to keep a close eye on the baby. She said that between the gestational diabetes and my coagulation issues, she will not let me go past dates, preferring to induce me if I get to 40 weeks with no baby in sight. Not what I will be hoping for, but I'm not really interested in going past dates either.

Here are the actual numbers from the 3 hour oral glucose challenge test (far right column). Interestingly, all of the lab values are lower than what my finger sticks were showing. Still really elevated, mind you (except for the fasting level), but lower. So that's good to take into account when I'm drawing my bloods and trying to make sense of the numbers going forward.

TIME OF SAMPLE COLLECTION
AMERICAN CONGRESS OF OBSTETRICIANS AND GYNECOLOGISTS (ACOG)
TARGET LEVELs
MO’S LEVELS ACCORDING TO HER GLUCOMETER


MO’S LEVELS
ACCORDING TO
venipuncture lab values
Glucose load: Samples drawn after 100-gram glucose drink

Fasting (prior to glucose load)
< 95 mg/dL (5.3 mmol/L)
95-102 mg/dL
 88 mg/dL
1 hour after glucose load
< 180 mg/dL (10.0 mmol/L)
233 mg/dL
 219 mg/dL
2 hours after glucose load
< 155 mg/dL (8.6 mmol/L)
225 mg/dL
 199 mg/dL
3 hours after glucose load
< 140 mg/dL (7.8 mmol/L)
176-184 mg/dL
 145 mg/dL
Results interpretation
If TWO or more values meet or exceed the target level, gestational diabetes is diagnosed. 



So that's it for now. Still processing this new reality, but it seems like a very manageable one. It's a little bit of an ego blow - I'm usually such a good test taker! But I have to remember this isn't a test I could study for and pass. It's not up to me. It's my body and Magpie's placenta calling the shots here.

Thank you again for all of your comments and stories about your own situations - it's been an invaluable help and made me feel so much better about this!

Mo

One reason why we'll be keeping a close eye on things!


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25 comments:

aryanhwy said...

Is it just me, or is that picture really creepy?

Marcia (123 blog) said...

Oh no! But I'm still very encouraged by your low levels at home! And yes, nearly 28 weeks :)

gwinne said...

Ack. Sorry to hear about the GD.

I did NSTs for both my kids' pregnancies. Be sure you eat something beforehand or they give you juice during (I know, the GD might interfere with this) as it can be stressful for YOU if Magpie doesn't cooperate and sleeps through the tests. And bring something to read for that 30-60 min :)

Anne said...

my gf got GD with her 2nd son, she followed the diabetes diet. The nurses in the hospital can teach you. She ended up gaining less weight than with her first son, and losing the weight faster. But more importantly- her son was perfectly fine and her diabetes went away after the birth. so it is super manageable with diet! you can do it!

Becky said...

I am normally a good test taker, so it is quite frustrating when you don't test well because of something completely out of your control ;) Baby girl is going to be fine! Because her mama is taking awesome care of her!!

Sprogblogger said...

Ugh. Bummer because it's one more thing you have to think about, but yay since it's something you have control over. And hurrah for your attitude and for your doc's. Sounds healthy.

Good heavens, Mo, you really ARE in the 3rd trimester. Wowza!

Dora said...

Been reading, but crazy this week. Also, I don't have any info on GD. (I think my mother expected me to get it, since there's lots of diabetes on both sides of my family, and I LOVE sugar.) But you've gotten lots of great comments, and terrific reassurance from your wonderful OB. You are an awesome mommy. Magpie is a lucky girl.

Hopefully you will go into labor on your own by your due date and won't need to be induced, but ya know, the internets are all waiting for Magpie's arrival. I think we would all crash your site if you went past due! xoxo

Anonymous said...

You are displaying a BRILLIANT attitude, are getting expert advice. Ask if stillbirth is a bigger issue FOR YOU from this issue. I bet it is Uncontrolled GD that raises risks. Diet and exercise are good for all of us pg or not. Avoid sweet drinks (fruit juices), see what what various foods do to blood sugars and listen to your experts.
Post birth: be aware of what still blows your sugars and avoid type 2 later. Moderation is easier.
Magpie's safe arrival is being watched all around the world!

Anonymous said...

It will all be fine. The extra monitoring is reall reassuring too. One thing to note that we were not very vigilant of in the exhausted post labor haze and the nurses missed is to make sure that they monitor Magpie's blood sugar levels very closely after her birth. Especially in the first 48 hrs. We didn't check to make sure that the nurses were monitoring our twins closely and their blood sugar levels became dangerously low. I still get the shudders when I think about it. It was clearly entered in the their charts by the perinatalogist. My piece of advice to all with GD. Xoxo Ocgal

MyTwoLines said...

I would make sure they check your anemia status too..recent research shows that sometimes HbA1c might not be as reliable in a pregnant woman with iron deficiency anemia because the hemoglobin molecule structure changes and it glycosylates differently...a glycosylated albumin would be more accurate if you are anemic. Just my two cents.

myfertilityjourney said...

What a great OB! Yes, you are 28 weeks now! Wow! So it looks like with the help of a nutritionist and watching what you eat, everything will continue to go well. YES! This is it, Mo. You will have your baby girl in your arms very very soon.

It Is What It Is said...

I know it is a PITA but seemingly one you will be able to manage without further medical intervention.

More importantly, you are 28 weeks PREGNANT, Mo! Yippee, jumping up and down for you right now!

Sunny said...

Sorry to hear that, Mo. But hooray for 28 weeks! You can totally do this.

Here is my post on following the GD diet, fwiw: http://sunnyinseattle-cadh.blogspot.com/2010/03/staying-thin-while-getting-fat-gd-diet.html

Hapa Hopes said...

I'm not happy to hear about your official diagnosis, but I am so happy to see that you have such an awesome outlook and game plan. You rock, Mo!

Alexicographer said...

Sounds good.

How delightfully magical to see you contemplating the possibility of being over term (or at least, avoiding that) after all you have been through. Here's hoping Magpie makes a voluntary, healthy, and uneventful appearance at, oh, 39w3d just to keep things simple :) .

Mina said...

You have to test and try what various carbs do to your readings. I, for eg, could eat potatoes and fruit with some 2-3 units more than advised by the doctor, and still get decent, below the scary line readings. But white pasta, white bread and croissants, a tiny bit of all white flour foods, would make me blood sugar soar to the sky. So I had to sort of avoid those and stick with what was better behaving. Curiously, three bits of chocolate were fine as a midmorning snack, but two bites of a white bread sandwich would give me a very high reading. Try to write down what you eat and the corresponding readings for a week or two and then you'll learn everything you need to do and it will be so much easier.
Treating food in carb units is not that bad of a habit, on the long term. And exercise is vital, especially since you have labour ahead of you and even if I was lucky to have short labours, I can so see why they call it "labour". You need to be fit to have a better experience. Induction is not that bad. It would be preferable to have a vaginal birth because afterwards you recover much quickly. But of course, if a c section is needed, than that is that and you do whatever it takes to get the baby here safe and sound. And don't say you can't think so far ahead, it is no longer all that far, third trimester lady! :-)

DM said...

Sorry to hear the GD result, and don't worry too much about the lack of weight - I put on 15lbs for the whole pregnancy and had a very healthy 6lb 7oz baby girl. Didn't even have to think about losing any weight afterwards as 10 days later I was back to my pre pregnancy weight (albeit a different shape!). I believe they tell you to put on too much, and its no wonder it takes people years to get off. My milk production was great and not affected and in by 4 days so you don't need excess weight for that either. Plus your third trimester will be MUCH easier with your carrying less weight. It may also be a good time for you to stop eating dairy which can affect baby's gentle stomach when they enter the world. Take care. DM

Pussy Parent said...

Sorry about the GD but yay for the 28 week marker!

Anonymous said...

You have such wonderful readers with such super commentary! THANK YOU FOR POSTING AND YOUR READERS FOR COMMENTING.
Am awaiting with eagerness your report on what the specialist tells you!

Her Royal Fabulousness said...

Seems like there have been several bloggers with GD lately. I'm sorry you have to deal with this but hopefully you'll quickly figure out how to manage it all. Big hugs girl.

Lisa said...

I know the GD is a bummer, but you've proven that you're willing to do whatever it takes to bring home this little miracle. It will be fine. All I'm thinking about is, HOLY SHIT, you're 28 weeks pregnant!!!!! :)

tireegal68 said...

Keep the faith and do what the nutritionist says and you should be fine. My GD baby was 5lbs 13 ounces at 38 weeks. That could have been related to the huge fibroid in my uterus though. I know with GD it's important not to go past term so the placenta does not deteriorate. I'm glad I went early and would do it again if it was necessary.

Brid said...

Hey, happy third trimester baby! I'm a few drinks in... long weekend here in BC... but waitin' for that third trimester photo and thinking of you guys. I'm so happy for you all... my friend, who is not a blog reader or writer, asked about you yesterday. She wanted to know if you had the baby... I thought it was interesting because I don't know you, even though I feel like I do... and I am, of course hoping above all hopes that everything is okay, and that your little magpie arrives exactly when she should, but then, so here is my friend wondering how you are and how things are progressing. That's like a couple of generations deep of people rooting for your little one. It's pretty weird actually. I've been reading your blog for quite some time now, and now here you are, so close. I love it.
All the best,
Brid

Brid said...

PS - my little guy was 9.5lbs (I didn't have gb), and he was totally good... so really, it's pretty arbitrary anyhow, right? They are how they are, and you just do what you can.
xo

Anonymous said...

I had gd starting at the first trimester..but thru controlled diet and help from nutritionist I never had to get insulin shots..which I was told is ok if needed and doesn't harm baby. anyway it is pain but manageable..watch portion size..I had to eat half sandwiches , half of a small potato..etc..overall I felt like I was on a pseudo atkins diet. best of luck to you !

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