Gestational diabetes is a type of diabetes that develops during pregnancy, which means your blood glucose levels go high. It can cause problems for the mother and the baby during pregnancy, childbirth and after childbirth. That’s the reason they test your blood sugar levels at various stages of pregnancy. As per the latest NICE guidelines, your midwife will determine your risk for gestational diabetes at the time of your first antenatal appointment. She/He will check your risk factors:
- If your BMI is above 30 kg/(m x m)
- If you had a previous large baby weighing 4.5kg or above
- If you had gestational diabetes during a previous pregnancy
- If you have a family history of diabetes (first-degree relatives – parents or siblings)
- If you are a minority ethnic family origin with a high prevalence of diabetes (This includes people of South Asian, Chinese, black African and African-Caribbean family origin. In these populations, the risk of type 2 diabetes increases at an earlier age and at a lower BMI level.)
Any pregnant woman with any one of these risk factors will be offered a gestational diabetes test. I am a south Asian, so I have one risk factor, however, during my first appointment, I was offered only a dipstick urine test and a blood test, that includes HbA1c.
Dipstick urine test was done by my midwife where she dips a testing strip in the urine sample and tells you if you have protein, nitrites, white cells or sugar in your urine. She found ketones in my urine sample but that was considered very common and due to poor diet. During my first trimester, my diet was definitely poor, if not non-existent. First-trimester is challenging for most first-time pregnant women. My midwife did a dipstick urine test thereafter at every antenatal appointment, but everything was reported normal. If your midwife finds glucose in urine they offer you glucose test ( most probably Oral Glucose Tolerance Test) for confirmation.
For the first blood test, I had to visit a phlebotomist to give a sample. My phlebotomist suggested I call my GP after a week and they will let me know if my blood test report was ok. When I called they told me that “everything is ok and no action required”. I was not satisfied with this one sentence answer so I probed a bit and asked how is my Iron and HbA1c, and everything was in the normal range.
Offer women with risk factors for gestational diabetes a 75g 2-hr Oral Glucose Tolerance test at 24-28 weeks.
NICE guidelines
NICE guidelines suggest that offer women with any of the risk factors (mentioned above) a 75g 2-hr oral Glucose tolerance test at 24 to 28 weeks. Hence, at the 27th week, my midwife prescribed me a Glucose tolerance test. In this test, they check your fasting glucose level. Then they’ll ask you to drink 8 ounces of a syrupy glucose solution that contains 75 grams of sugar and after 2 hours they will draw your blood again for sugar test. They will diagnose gestational diabetes if the woman has either:
a fasting plasma glucose level of 5.6 mmol/litre or above
or a 2-hour plasma glucose level of 7.8 mmol/litre or above.
NICE Guidelines
Once a woman gets diagnosed with gestational diabetes, it is considered as a high-risk pregnancy and their diabetes and the antenatal clinic will offer you an appointment within a week.
Oral Glucose tolerance test day
It is a difficult test. You can’t drink or eat anything for 8 to 10 hours. I was supposed to reach the hospital empty stomach at 8:30 am. Around 9:00 am the phlebotomist called my name to draw a blood-sample for fasting blood glucose. I had a snack around 9:00 pm the night before and until 9:00 am it was almost 12 hours. A pregnant woman can’t stay hungry for 12 hours in her late second trimester, it’s a torture.
Anyway, I followed the phlebotomist to the blood test room. She directed me to sit on a chair and confirmed my name, date of birth and address before taking the blood sample. Then she gave me an orange-flavored sugary drink that I had to finish within 5 minutes. I was starving so much that even that off-putting drink was acceptable at that stage. I was instructed to wait for 2 hours (until 11:30 am). I was not allowed to eat anything, leave the hospital or walk around except washroom break. She asked me just to sit in the waiting room. I was allowed to drink up to 2-3 cups of water and that’s all. Trust me that sugary drink doesn’t cut it, you need real food to feel comfortable. Those two hours in the hospital room was another punishment. I took a magazine, book, and music with me to kill the time.
Anyway, She called me in again for another blood sample at 11:30 am and then finally I was allowed to go home and eat. The phlebotomist told us that in case I fail the test, I will receive a call from the hospital diabetes team the next morning. Otherwise, consider everything is OK. Well, I was not concerned, because
- I am not overweight, my BMI was 22 when I got pregnant, and even now I have not gained more than the recommended weight.
- I eat healthy all the time (except occasional chocolate bites)
- I am a very active person ( swimming, hiking, long walks, yoga, etc.)
- Never had diabetes before
- I don’t have any family history of diabetes
So we headed back home. I couldn’t wait and starve anymore so we decided to stop by on the way and eat something nice. Little did I know it will be my last nice meal in a long while.
That dreaded call from the hospital
The next morning started as usual, relaxed and nice. Around 9:30 I checked my phone and there was a missed call, my heart skipped a beat, I called back quickly and indeed it was from the hospital. My diabetes midwife told me straight away that I am diagnosed with gestational diabetes. Land slid under my feet and I felt dizzy… all I could utter was, ” Oh shit, are you sure? She confirmed that my postprandial glucose levels should be under 7.8mmol/L, whereas mine is 9.8mmol/L. Tears rolled down my cheeks and I sank on the sofa next to me. When she didn’t get any response from me for a few seconds, she asked: “are you ok?” Hiding my tears, I replied, “yeah I am ok”. But I was not. She asked me if I could visit her at the hospital? I agreed to that and she gave me an appointment for the same day.
The first appointment with diabetes midwife
Our appointment was booked in the afternoon, I waited for it in the disbelief. Somewhere in my heart, I still hoped that when I reach the hospital, they will tell me it was a mistake. Against my all hopes, once we reached the hospital the diabetes midwife, was ready with an Agamatrix glucose monitor on her desk. Once again my heart shattered into pieces.
I handed her my hospital notes file to her. She put some notes in it and started explaining my Glucose tolerance test results. She said my fasting levels were ok, but postprandial glucose levels were above the range.
She started with what is gestational diabetes and how it can cause complications during my pregnancy. I tried hard, but couldn’t control my tears when she was explaining all that. My husband was with me, I looked at him, he looked back at me with confusion in his eyes and put his hand on my knee in support. However, my midwife was comfortable with all this, probably she sees it all day long and now she is immune to these emotions. She asked me if I would like to take a few minutes before we discuss the next part.
After a minute or so I collected my courage again and asked her to proceed. She reached for the Agamatrix glucose monitor sitting on her desk and started explaining What is a glucometer and how to use it. She showed me all the components inside and then explained the procedure. Now it was my turn to test my blood glucose. I have needle-phobia and now I had to prick myself. My hand was shaking due to anxiety. Before pricking my finger I asked her if it’s going to hurt, to that, she replied, “not really”. And she was right, it is just the fear of pricking yourself with a needle, otherwise, it doesn’t hurt that bad as you imagine. My results were in the range but this comfort was short-lived. She told me that I am supposed to test myself 4 times a day:
- Early morning – fasting
- One hour after breakfast
- One hour after lunch
- One hour after dinner
She also informed us that with controlled diet and exercises, women can maintain results in the normal range in the 7th month, however as the placenta grows, blood glucose levels spike in the 8th month, before it starts falling back in the normal range after 37 weeks. If I have uncontrolled blood sugar levels, it may affect my labor and baby, that’s the reason they will scan me every four weeks now onwards.
During the discussion, she also mentioned that about 30 percent of pregnant women get diagnosed with gestational diabetes. Usually, it’s a temporary condition. That means it goes away once the baby is born. But not for all. I will be offered follow-up fasting blood glucose tests 6-12weeks after the birth of my baby to rule out diabetes. And about 35-50 percent of women with gestational diabetes will develop Type 2 diabetes within the next 5 years. Finally, she handed me some booklets and leaflets to read at home.
Don’t take me wrong, my diabetes midwife was a lovely young lady, however, everything was very procedural. It was information overload and I was left very scared and agitated, with only one question in my mind – What did I do wrong?
Dealing with the disappointment
Pregnancy was already tough, physically as well as emotionally. I was reading a lot about positive birth stories and hypnobirthing books to stay positive. And I was getting there, and then this gestational-diabetes-bomb dropped on me and I felt back to the square one and every plan out the window.
We had a romantic Paris trip booked for that weekend. With a heavy heart, we decided to cancel it. I had to learn to control my blood sugar now. I was not feeling confident enough to test my blood four times a day and then I had this extra task of finding low-carb, low-salt, protein-rich vegetarian diets.
I was depressed with all these new developments and not able to get over the thought that “what did I do wrong?” Only risk factor I had was that I am over 25 years of age and I have South Asian background. None of my close friends or family members ever got diagnosed with gestational diabetes or diabetes, then why me? It took me a while to accept it and move on.
Like every other pregnant woman, I was also keen on controlling my blood sugar levels with diet and exercise, rather than taking medications or insulin. In terms of diet, things didn’t change much, except that no occasional chocolates or walnuts stuffed dates now on. My association with food has changed. Food is not a pleasure anymore, It became medicine. Physical activity was not a mindful choice, it became prescription. Things that I used to enjoy, became tasks because they are forced on me.
After losing my composure a few times and passing through all 5 stages of grief, finally, I accepted the fact that I have gestational diabetes and I have to manage it for a healthy pregnancy and baby. Did that make it any easier? NO. I just got used to it.
Now I had to find happiness in new places. and one of them was pregnancy reflexology massages. Spending 55 quid on a massage was biting my pocket but it felt like a good investment. It gave me the motivation to think positively again and stop feeling like a victim. I started to focus my energy in the right direction. Another way to deal with my depression was to look good and feel good. I bought a few nice clothes and made a habit of getting ready and go out somewhere in nature to distract my mind. I also started looking for pregnancy yoga, pilate or meditation classes in my area,
The first-week managing gestational diabetes
The first week is hard when you come back home with your glucose monitoring kit and all the reading material on gestational diabetes. After reading through all that I was terrified, as elevated blood glucose levels during pregnancy pose many risks for mother and baby.
First-day of glucose testing was frightening as well. My heart would stop beating while glucometer monitor is processing my blood sample before showing the result. Every controlled reading would be a comfort and out of range reading would sink my heart. The second morning my reading was 7.8mmol/L after eating a thin multigrain seeded toast with almond butter. My blood glucose was high and I was starving.
No carbs for me anymore no matter what type – all bread, cereals, potato, almost all root vegetables, crackers, biscuits, etc. Even milk raised my blood sugar. Being a vegetarian, I am left with no options for breakfast. I was having just a few spoons of oats with milk, nuts, and seeds. For lunch only vegetables and legumes. I was starving all the time and my sugar levels were high. But, then I recalled some points from my master’s study –
- Exercises promote glucose uptake in the muscles.
- Drinking plenty of water can flush out excess blood sugar
- Stress raises blood sugar levels
- Add protein, fat and crude fibers, in your diet, to slow down the release of glucose in your blood.
Now I take 3 small high protein diabetes-friendly meals and 3 low-carb snacks a day. Learning to count carbs is helping. I eat a high protein meal with loads of salads. After 15 minutes of finishing my meal, I brisk walk for about 30 minutes and then do relaxation meditation for 15 minutes. And finally, test my blood sugar levels one hour after finishing my meal. My readings seem to fall under normal range now.
I also drink 2-3 liters of plain lukewarm water each day. These tricks seem to work for now and I am feeling better. But I know it going to get harder as I progress in my pregnancy. Particularly between 32 and 37 weeks. I will see it when it comes to it. I keep a journal, in which I track my diet, blood glucose, physical activity, weight, etc. It helps me analyze how am I doing, what is working for me and what is increasing my blood sugar levels. You can download my track sheets for free to create your own journal.
Stay healthy & happy
xx
Updates
Four weeks, living with GD (31-week pregnant)
Due to Covid-19, all my plans are out the window. No more pregnancy massages, no swimming or pilates classes, no NCT classes, no support groups for first-time mothers, fresh food availability is limited and to top it all outings are banned so the 30 minutes walk three times a day became a real challenge as we live in a small apartment. Pregnant women are in the high-risk category and it is advised to self-isolate.
My blood sugar levels have been mostly under the normal range. I had only 3 out-of-range readings:
- after eating a thin multigrain toast in lunch
- after eating a small chapati ( Indian bread) in lunch with dhal
- after a stressful day. If I am feeling sick, it fluctuates my blood glucose levels.
If I am eating carbs, even walking doesn’t help. Tracking is a time-consuming process but it is really helping me understand how my body reacts to different food items and my emotions.
10 weeks, living with GD ( 37 weeks pregnant)
My blood sugar levels are under controlled. Not a single after meal reading above 7.8 mmol/L. Fasting readings are hovering between 4.0 to 4.4 mmol/L. Just once I had 3.9 mmol/L. I have been on a strictly controlled diet and exercise regime. I am on very low carbs and salt diet. 37th week onwards I did some changes in my diet plan and exercise regime. To know the details, check my articles in labour and childbirth series.
I had two scans since the last update. At 34 weeks scan, all reports were normal. My final scan was during 37th week and the doctor told me that my baby is in 90th percentile. That means the baby is bigger or growing faster than 90% of babies at this particular gestational age. Therefore, They have to induce me on my due date and deliver the baby to avoid any childbirth complications. They could not explain why the baby is growing faster than usual despite maintaining perfect sugar control. As it is more common in women with gestational diabetes and uncontrolled sugar levels. Gestational baby measurements are known to be notoriously inaccurate. Nonetheless, they have to follow the standard procedure. I am a bit confused and concerned because my bump doesn’t look big at all and I have hardly gained 5 kgs in 37 weeks of pregnancy. I can blame nausea and gestational diabetes for less weight grain.
Cheers!