Gestational Diabetes?

[Wondercat]

I am seriously confused right now about whether or not I am at serious risk for having gestational diabetes. My doctor's office is not being particularly communicative, so sadly I'm hoping somebody here will know more about it. This is going to be long - sorry!

Because of allergies I can't take the regular glucose tests with the corn syrup drink so they did a fasting blood draw and a blood draw 2 hours after eating that same day. First I got a message saying my numbers were fine and I don't have to worry about anything. Shortly after that she called back to leave a message that my number on the fasting blood draw was actually "3 points high" so the doctor wanted me to see a nutritionist. Later that day the nutritionist called to make an appointment for next Thursday but she refused to tell me anything if my doctor had not already made a diagnosis. So I called the doctor's office and the assistant told me that my fasting level was 98 mg and they don't like to see anything over 95 mg. She also didn't give me much information on what that means, or tell me what my other number was. I did some research on the American Diabetes Association website, and their cutoff number is 100 mg fasting, 140 mg 2 hours after eating. When I called back I spoke to a different doctor from the one who recommended a nutritionist and she said that based on that one number she didn't think I needed a nutritionist until we "had more data," preferably from me doing home testing with my own meter but she didn't think that based on my results that my insurance would cover it. She then said that my number for 2 hours after eating was 80 mg! That doesn't make sense to me to have a fasting number higher than my number after eating a HUGE meal of 2 fried eggs, 4 slices of bacon, a pint of milk, and a slice of applesauce cake. But maybe it makes sense to somebody who understands more about diabetes??

So I happened to already have a meter that my sister gave me from when she didn't develop gestational diabetes during her first pregnancy. Here's my other question - what is the margin of error on these things? I tested before breakfast for the first time this morning, and since I was nervous that I was doing it wrong I did it 3 times approximately 10 minutes apart to see if I would get the same/similar results indicating that I was doing it somewhat right. Everything seemed to go exactly as the instructions indicated it should each time, but my results (in order) were 95, 90, 103. So in the same morning I first got a result my doctor's office wouldn't like but the ADA wouldn't mind, then a result both would think is fine, and then a result both would think was not good. Is that really just user error, or is +-13 what can be expected for blood sugar test results? Or is there some reason why my blood sugar would fluctuate up and down like that without eating?

Basically any information would be really helpful because I don't seem to be able to get a lot out of my doctors.

Thanks!

[summerbaby]

Hi Wondercat,
I have been recently diagnosed with a borderline case of GD --- My numbers sound similar to yours. I hope I can be of some help. I've been seeing a doctor who specializes in diabetes, and have talked to a nutritionist.

You probably already know that this is likely a temporary condition that will more than likely disappear once the baby is born, but you will get monitored after the baby arrives, and at least for the first year to make sure it doesn't end up turning into TypeII.

First of all, the numbers that are normal for regular people with diabetes (the ones you found on the ADA website), are actually too high if you are pregnant (according to my doctor). You have to look specifically for information on GD... Anyway, that said, your fasting number should be below 90 and one hour later, after you eat, it should be under 140. Regular diabetics measure after 2 hours, we have to measure after 1 hour...It gives a better indication of how well your body has processed the sugar.

It is true that the home devices are not perfect -- I have also measured my levels more than once in the morning and there is a range -- but, they do give a good estimate.
I would just stick to the first measurement and go from there, or you'll drive yourself crazy...
It is also typical that your fasting # is high -- That has to do with not only how your body is processing sugar in the night, but also your hormones. Your body is looking for the right balance and doesn't find it -- thus causing the high number in the morning and the fluxuations. That is very simply put. It also might have to do with what you ate the day or days before and at what time.

I am sure the nutritionist will give you a good idea of what to eat and when. A lot of it has to do with how you combine foods and how often you should be eating. There are some foods that you should avoid as well for the time being...Also make sure you are drinking at least 2 liters of water/day and getting at least 30 minutes of exercise in 3-5 times/week, which also helps to process the sugar better.
You'll probably be told to eat 5 small meals/day or 3 meals + 2 snacks - which is important to keep the sugar levels even throughout the day. Some foods are better when eaten between meals. Some foods that change quickly into sugars are best combined with fats to slow the process down...

The elevated fasting number is also my problem, but I have been able to get it under control with changes to my diet.

If after a week of dietary changes, the numbers don't come down to the normal range, then you might have to take Insulin. Again, this is something that would only be temporary...

At first, I had to measure my levels 6x/day...before and after each main meal. Now, I am down to 2x/day.

It is important to get the numbers in the normal range for someone who is pregnant, as the risk could be that you end up with too much amniotic fluid, the baby could get very big, you could go into preterm labor or the baby could be stillborn --

When I first started the changes to my diet, I actually lost weight the first 2 weeks -- but once I got the hang of things, I was back to normal...

Hopefully, I've been able to answer some of your questions.
Good luck to you! If I can be of any more help, don't hesitate to write again or PM me.

xx summer

[lyly14]

Wondercat- I did not have GD with my pg but I am a pre-diabetic(borderline) and was prior to my recent pregnancy. I take medication for it and it successly prevented me from turing diabetic during pg. From what I know about diabetes having a high fasting blood sugar means that you most likely had high levels prior to bed. I have also heared it has something to do with the liver but I do not know exactly what. That stinks that you were unable to do the test because of allergies. Did they give any guidlines on what you should eat for your meal when you got tested? I would imagine that your level would be normal with the meal you ate even for a diabetic. It did not have an extreme amount of carbohydrates or sugar and would what you did have may be offset by the protein in the meal. Anyway I agree completely with the doctor who said you need more data. I think the recommendation of the nutritionist was a bit premature. Why don't they just send you to the lab for repeat testing? If your fasting is on the high side again then they can worry. The home meters are usually fairly accurate but numbers can vary a bit. I also have a meter that a friend gave me because they didn't prescribed one for only being pre-diabetic and have seen an increase in my sugar in the morning if I even only take my vitamins with water and no food. I hope you get the answers you are looking for and the doctors are more communicative with you, they are probably uncertain of how to go about diagnosing it since you can't really take the glucose tolerance test. I had periodically tested my sugars with my friends meter who is diabetic and had always had normal levels with the foods I ate. I had no clue I was pre-diabetic until I had taken the glucose tolerance test and the high amount of carbs and sugar in the drink made my levels go up to near diabetic levels! Good luck.

[Wondercat]

Thank you both for the replies. This is certainly much more information than my doctors have given me, which is my primary source of frustration. After I posted the first time a different receptionist called me to say that a different nurse wanted me to keep the appointment with the nutritionist. She knew nothing about any of my previous discussions with anybody else there. When I asked to have the doctor call me back the same receptionist called me back to say the doctor said to keep doing testing at home and bring my log in to the nutritionist.

Since Friday my morning number was 90 every day (at least I'm consistent), 2 hours after eating it varied between 82-101, before lunch and dinner 74-87, and 2 hours after dinner 109-115. Now everything I know about diabetes I have learned from the internet (which isn't the best place for information, but again... my doctors didn't tell me anything) but those numbers don't seem to be particularly high. The parameters I found over and over again specifically for GD were:

– fasting: 95 mg/dl
– 1 hour: 180 mg/dl
– 2 hours: 155 mg/dl
– 3 hours: 140 mg/dl

What you both mentioned about how it can be normal for the fasting levels to be higher in the morning is something to do with your hormones and your liver giving you a boost of blood sugar to prepare you to wake up and start your day - the "dawn phenomenon." Since my levels seem fairly low at night maybe that's what happened with my a.m. fasting test. I will be curious to see what the nutritionist has to say, if she really wants my numbers to get much lower than they are. I certainly don't want to lose weight. I started my pregnancy at 114 pounds, have gained exactly the appropriate amount since then, and had an ultrasound 2 weeks ago that showed my baby to be an active little bugger exactly the right size for his gestational age.

Thanks again. Whatever the diagnosis actually is I just want to get it soon so that I can stop worrying and know that I am doing the right thing for my baby.

[riogirl71]

Hi wondercat,
I had GD so feel free to PM me with any questions you have at any time. Like it was said, your level for pregnancy are lower than if you weren't pregnant. I had a problem with fasting numbers too. I changed my diet to:
breakfast - 15-30g carbs
lunch - 45 g carbs
dinner - 45 g carbs

snacks - 30 carbs

This helped me figure out what to eat, I also saw an endocrinologist so if you have more questions you should go see one, they treat Diabetes patients and people with GD. I would have about 3 to 4 snacks a day. What really helped my fasting numbers was having one serving of fruit with some light and fit yogurt at 11 pm, believe it or not having a snack late at night actually helped with my fasting numbers. I also ate a salad before dinner and it kept my numbers down. Also I found out that not all carbs reacted the same, if I ate the same amount of carbs in rice my numbers would skyrocket, if I ate pasta, they would go really low! So I would eat about 1 1/2 cups of pasta for dinner and a veggie burger and my numbers were great. Exercising moderatly also helps. The doc said even 10 min after a meal helps bring numbers down, and also drink lots of water after a meal, that helps bring numbers down too.

Anything else I can help you with please pm me! Good luck!