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!

Click here to subscribe

3 hour glucose tolerance testing

I just completed my three-hour glucose tolerance testing. Things are not looking promising, I have to say.

The official bloods are being whisked to the lab at this moment, with results pending, but my husband Will recommended I start checking my blood sugars as soon as I failed the one hour test, and immediately provided me with a glucometer for that fun task. The values have been pretty ok the past week...sometimes a point or two over the ideal, but nothing too alarming.

But today. Today. Yikes.

According to my finger sticks, my fasting blood level today was between 95 and 102, the highest it has been all week (I tested twice - right when I got out of bed, and at the doctor's office. Weirdly, the higher level was at the doctor's office...I would have thought your glucose would continue to decline the longer you were fasting, but what do I know).

My one hour blood level after drinking the 100g of glucola (yuck!!) was 233. Seriously out of bounds, even if this meter isn't perfect.

My two hour blood level was 225.

And my three hour blood level was 176. I decided to wash my hands and do it again...resulting in an even more abysmal 184.

Here are the cutoffs to reach a diagnosis of GD...and my worrisome levels:

TIME OF SAMPLE COLLECTION	CURRENT American Congress of Obstetricians and gynecologists (ACOG)  TARGET LEVEL	Mo’s Levels according to her glucometer
	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
1 hour after glucose load	< 180 mg/dL (10.0 mmol/L)	233 mg/dL
2 hours after glucose load	< 155 mg/dL (8.6 mmol/L)	225 mg/dL
3 hours after glucose load	< 140 mg/dL (7.8 mmol/L)	176-184 mg/dL
Results interpretation	If TWO or more values meet or exceed the target level, gestational diabetes is diagnosed.

We will see how these values line up with the official venipuncture results, but you see what I mean about things not looking good?

I have only two risk factors for gestational diabetes: my age, and a family history of diabetes. I guess that is enough.

I'm thinking whether I meet formal diagnostic criteria or not, I should handle this aggressively. Honestly, I can't imagine passing the test with numbers like these showing up on my finger sticks (yes, we calibrated the machine correctly), but I suppose you never know. Maybe my glucometer is waaaay broken. I can only hope.

Needless to say, I am seriously, seriously bummed.

So I ask you folks: What would you recommend in terms of optimal maintenance of this situation going forward? Is a nutritionist/dietitian all I need, or could I benefit even more from a consult with an endocrinologist? Do any endocrinologists specialize in pregnancy-related diabetes/glucose tolerance issues? Or is just having my OB as the only MD enough? I want to take care of this as thoroughly as possible to reduce my and Magpie's risks now and after delivery.

One thing I'll have to ask my doctor....I was really sick last night - simultaneous vomiting and diarrhea (I'm guessing food poisoning). It was really not pretty. I thought I was going to die, but felt better enough by this morning to go in and do the screening. I wonder if being sick like that could have screwed up the test in any way?

I go in for my next OB appointment on Wednesday. I am hoping the test results will be in by then.

All thoughts in the meantime are most welcome.

Mo

Interesting graph of the difference in blood levels for diabetic versus nondiabetic.

Click here to subscribe

1st glucose tolerance test: FAIL

Last Thursday I took the one hour glucose test. My doctor said she would call the next day if there were any abnormality, so when I didn't hear from her, I figured all was well.

The hospital where my doctor works has an online records system so that you can see your lab results, medications, appointments, allergies, etc. I received a notice today that there was a new lab result in the system. So I checked.

Not only did I fail the one-hour test, but I failed by what I think is a lot. My value was 179. Yikes! (cut off, I think, is 140).

I was immediately worried, and also really disappointed that I hadn't heard from my physician's office. It reinforced the idea I sometimes already have that I have to be the one to be on top of all of my data myself, that I can't depend on others. And this is pretty disappointing because I love my doctor. It was significantly confidence-reducing to feel that if I hadn't caught this who knows how long it would be until I heard from them? And what if it had been something more urgent?

I called my OB's office and they said she wasn't in. That a nurse could return my call. Then they asked, Who had given me the initial results?

When I told them no one had contacted me, that I'd gotten the results myself online, they put me on hold.

A minute or two later, my OB was on the line. She's working in labor and delivery today and they had put my call through to her. She was deeply apologetic, said the results hadn't come in until Saturday and that the nurse was supposed to call me yesterday.

She also calmed me a lot about the test result. Said I need to do the three-hour test, but that it may be normal. And that just because I had a massive fail on the one-hour test does not mean I will fail the three-hour. I don't totally believe her, but it will be what it will be. She said if I have gestational diabetes, we will deal with it. That I won't have a 15-lb. baby. That it will be ok.

I just keep thinking I should have been much more careful about my diet up to this point. I don't think I've been terrible, but I haven't been monitoring every morsel I eat, and perhaps I should have been.

I hope that Ms. Magpie hasn't been adversely affected. I feel like I'm screwing up as a mother already and she's not even here yet!

I'm going in for the three hour test on Monday. I guess sometime next week I'll know the results.

Ugh. Count me as more than a little bit worried.

Mo

P.S. If interested, click here for a simply worded explanation of the risks of gestational diabetes to mom and baby.

More of this yummy (not!) stuff is in my future!

Click here to subscribe