I had a feeling over the summer that I would have gestational diabetes with this pregnancy. I didn't even know what gestational diabetes really meant, what caused it, or what it entailed, but I just knew that I would fail the glucose test. Fast forward to the last week of November when I failed the glucose test. Sadly, I found out right after I had just finished a huge shopping trip at Trader Joe's to buy their delicious holiday treats. I immediately texted my friend Juliana who had gestational diabetes with her most recent baby. I needed to find out what to do! Not eat any of those treats was the answer.
Gestational diabetes is caused by the placenta releasing a hormone (insulin-like growth hormone) that causes your body to resist the actions of insulin, so that the insulin your body makes does not adequately get rid of the sugar in your blood. Normally, your body produces more insulin to overcome the effects of these pregnancy hormones, but sometimes it does not. That is when you end up with gestational diabetes and higher than normal blood sugar levels. Gestational diabetes isn't as much of a problem until the baby starts growing rather than forming, in the late second and early third trimester. For example, after two rounds of testing, I was already 30 weeks pregnant when I was diagnosed. The problem with gestational diabetes is that it leads to complications with the baby. The baby might be bigger than it otherwise would be, and this leads to increased risk for c-sections or other complications with delivery. In addition, after birth the baby might have blood sugar that is too low because it has too much insulin produced by the mother and still circulating in its body, but not the blood sugar from the mother. Finally, the baby is producing it's own insulin to combat the high blood sugar in it's body. This is problematic because insulin is linked to being overweight. That is the most troubling complication for me. The OB can induce labor early to avoid complications due to size, and the pediatrician can give the baby sugar water in a bottle if their blood sugar is too low after birth. But producing too much insulin in utero sets your baby's body up for insulin resistance later in life and a subsequent tendency to obesity. Yikes. Who knew? It turns out that insulin is this evil genius hormone in your body. Insulin is the Dr Doofenshmirtz of hormones because it is evil, but vitally important. (Although I happen to think that Dr D is not actually as evil as he would like to think he is.)
My first appointment for the diabetes was with a nutritionist. She told me that I could not gain any more weight for the rest of the pregnancy. That seemed impossible for someone who usually gains the most weight in the last few months of pregnancy. She also said that I could eat 205 grams of carbs a day, divided into 3 meals and 3 snacks. 30, 50, 50 for meals, and 25 for each snack. My friend Juliana was told 15 for breakfast and 30-45 for lunch and dinner, and 30 for each snack. I actually stuck with Juliana's numbers rather than my nutritionist's recommendations.
My next appt was meeting with the nurse practitioner for a class on how to test my blood sugar. I do not have a good history with needles. I passed out every time I had to have blood drawn until I was sixteen. And when I was in the hospital with Audrey, I nearly passed out every time they stuck me. Neil was there putting the oxygen mask on me each time. I did think I was going to pass out when I had to practice pricking my finger that day. It turns out that it is better to prick the side of your finger rather than your finger tip because there are less nerves there. Sometimes your fingers don't bleed easily, and then you have to squeeze your fingers pretty hard to make yourself bleed enough to trigger the monitor. Sometimes I would have to ask Neil to squeeze my finger while I pricked it. Dry skin makes it harder to draw any blood, so you have to turn the dial on the monitor and make the needle go deeper. I generally rotate sticking my thumbs, index, and middle fingers. For the first few weeks I only pricked my left hand so that I could use my dominant hand to use do the needle. Once I got the hang of it, I could use either hand, I rarely had to squeeze my finger, and it stopped hurting. Another important thing to remember is to actually wash your hands before pricking your finger every time. Right before Christmas, we were helping the kids ice sugar cookies. I didn't think I had any icing on my hands, so I didn't wash my hands before checking my blood sugar (bs). My blood sugar was 500-something. Obviously, I had a sugar coating on my fingers. After washing my hands, I tested again, and the number was fine. There have also been a few times when I have gotten readings that I knew were either too high or too low, so I would test again. As for the blood sugar montioring kit, I carry it with me wherever I go. If I know I won't actually need it, I will leave it in my car. You just have to be careful with the temperature because the monitor won't work if it's too cold. The testing strips are light and temperature sensitive. They have to be kept in these specially lined old-school film canisters. When I finish a pack of testing strips, I use that container as a sharps container on the go. Each evening, I empty the trash into a container that held some delish TJ candy that I didn't get to eat-basically it is a plastic food container with a lid. That way I am never just throwing the used lancets or testing strips into the trash. This also allows me to check my blood wherever I am. I check my blood sugar in the car all the time. I check it at church.
I did not think that there would be a huge co-pay for my diabetes supplies because they are required, so I just took the Rx to CVS. Unfortunately, I had neglected to check whether this specific monitor was on Tricare's formulary; it wasn't. Seventy-five dollars later, I knew that I would have to change monitors once my supplies ran out. The new monitor that my insurance will pay for is just as good, but it is more difficult to get the used lancet out. You have to pinch something to release the lancet, but my finger nails are too short. I have actually pricked myself again trying to get the lancet out, and, one time, the lancet went flying. So I have to actually use a set of pliers to pull the lancet out every time. They are retractable, so I just carry those around with me now, too.
My third appointment was with the endocrinologist who just wanted to see my vital signs and a listing of my bs numbers. It turns out that my fasting bs was too high. This is the number that is not affected by diet, but might be lowered by exercise. Unfortunately, I cannot go out and exercise at 9 PM every night. It's just not feasible. The dr wanted my fasting bs to be lower, so I was put on nightly insulin injections. The added insulin while I am fasting displaces the pregnancy hormone (insulin-like growth factor) when it's time to bind to an insulin receptor. The insulin then is able to do its job rather than having the pregnancy hormone thwarting things. (Thanks, Neil, for the explanation.) I sat down with the nurse practitioner again in order to learn about these injections. When she helped me do my first shot, I again thought I would pass out, but I managed to hold it together. Amazingly, the shot did not hurt at all. There are insulin pens that hold the medicine and the shot all together, and there are the traditional syringes and vials of insulin. Of course my insurance pays for the old-school vial and syringe. The NP kept telling me to store all my sharps in empty coffee cans, so I was glad that my insurance would pay for two legit sharps containers.
The first night that I had to give myself an injection, I had forgotten about buying rubbing alcohol pads for wiping my leg and the vial. The next night, I had the rubbing alcohol, but could not make myself do it. I waited until the third night, when Neil was home from a work trip to have him do it. I was surprised when it hurt! We started on the outside of my thighs because I happen to have gross baby-induced varicose veins on my inner thigh. (TMI, I know.) After a few nights of Neil giving me my injections, Neil happened to have had a long few days at work and fell asleep at 5PM. I had to give myself the shot, and I could not do it. I was sweating, and praying, and googling "how to give insulin injections without hurting." Finally I just did it, and I was surprised to find that it hurt less than when Neil did it for me. I think his reply the next morning was something to the effect of maybe now I'll give myself the injections. The injection sites really never bleed, and if they do, it is just one drop. The internet suggests wiping the blood with the alcohol swab, but that seems painful to me, so I would just swipe it with my finger and then wash my hands. It's a good thing blood does not make me pass out because I am looking at blood all the time.
I developed a good system over the next few nights and the shots weren't that bad. Unfortunately, the added insulin only helped for a few days before the dr would increase the amount of insulin that I needed. I started at 6 units/night and eventually worked my way up to 26. It turns out that there is a huge difference between how it feels at 6 units as compared to 26. One night, after I had reached 26 units, I hit the muscle while I was giving myself a shot. It really hurt. The next night, I really could not give myself a shot because I was so worried about the pain. I asked Neil to do it, and that night it killed! It brought tears to my eyes, and I'm pretty sure I accused him of jabbing me in impatience rather than being careful. It turns out that we hit a nerve, and that it sometimes just happens.
After that I had a real mental block to giving myself the shot, but I knew that I would need to get over it. I would sit for 30 minutes, trying to give myself the shot. I found some water bottles that had frozen in our mini fridge and used those to numb the spot on my leg. That helped. Eventually, after a few weeks(!), I got over it, and am able to give myself the shot without any problems. It turns out that when you have a lot of insulin to inject, it is less painful to inject it a little at a time rather than all at once.
Another trick was to start using my inner thigh. As I lost weight, my outer thighs had less fat to pinch. This is always a good problem to have! Luckily, my inner thighs have plenty of fat for pinching. It hurts less when the spot is fatty. Some people with actual diabetes give their shots on their bellies, the fatty part of the palm of their hand, or have someone use the fat part of their tricep. I rotate spots each night so that it hurts less, but that is more important for people with actual diabetes. Injecting in the same spot over time results in the insulin creating a fatty deposit at the injection site. (Who knew that insulin makes us fat?)
For the most part, I checked my fasting bs every morning, checked one hour after I finished eating meals, and sent a bi-weekly email to the dr/np. Some mornings my bs was low enough to make me feel weird. My fasting bs has never been dangerously low enough to worry about going into a coma, but enough to make me feel dizzy or like I am going to pass out. Sometimes I just feel jittery. As I have gotten rid of all the sugary stuff in my house, it is hard to find something that will bring my blood sugar up quickly. I keep thinking that would be my chance to have a coca cola, but cannot bring myself to keep one in the house because I will want to drink it. I tried eating a gummy lifesaver, part of a snickers, a chocolate-covered mint jojo (I saved a few from xmas so that I could have them after the baby was born), and a croissant. It took two hours to feel less jittery, for my bs to go up, and I felt disgusting after eating all that. Now if my fasting bs is below 70, I just have a nice-size glass of chocolate milk and make myself breakfast. That usually makes it better.
The dr suggests having a spoonful of peanut butter five minutes before I give myself the injection because I think it is supposed to help with too low bs, but I have only done that once. It is hard to retrain myself to think that eating pb out of a jar is okay. The dr also said that peanut butter is good for bringing my bs up quickly, but I have not tried it.
Here is the technical aspect of all of this:
1. On food labels, you can subtract grams of fiber and sugar alcohols from the carbs for the net carbs. Also on food labels, a carb exchange is 15 g of carbs. I don't care about the other exchanges.
2. I generally stick to 15 grams of carbs for breakfast. (Sometimes I allow myself more, and sometimes I have no carbs at breakfast.)
3. I generally stick to 30 g of carbs for lunch, dinner, and all snacks. I usually only have two snacks. I rarely have three, but if I do, I have dessert after my kids are in bed when I can relax. Sometimes I have no carbs at all for a meal or for a snack, but that is not usually all in one day. It is very rare for me to have 40-50 grams of carbs like the nutritionist suggested. I usually have 15-25 g for each snack.
4. My fasting bs would not go down below 100 without insulin. I could not get my fasting bs to go down past 90 until my insulin was at 26 units. The target is 70-80 with an absolute max of 90.
5. My 1-hour bs target is 110-120s with an absolute max of 140. Sometimes I forget to take my bs one hour after eating, so I take it at two hours. At that point, my bs needs to be below 110. It always is.
6. As the baby grows, and the placenta grows, the placenta secretes more and more of the insulin-like growth hormone. That is why my insulin needs have increased every few days.
7. Conversely, 50% of women experience a decreased need for insulin as they come within a few weeks of delivery. I feel like something in this experience is finally going my way because I am one of those women! In the past week, I have decreased my insulin to 24 units, my fasting bs is in the 70-low 80s every am, and sometimes less than 70, and my bs is staying lower after meals.
8. I have to check my bs and take my insulin until I am in active labor.
I have a list of foods that I have asked Neil to provide for me in the hospital after I have the baby. I figure that I have never asked for a push present, so this is an ok trade, but Neil has nixed driving the 30 minutes to Sonic for a Coke with Sonic ice. My next blog post will be about what I eat and when, my weight loss, and what I'll do after the baby arrives. And how Chick-Fil-A was on my post-baby food honeymoon list, and how it's not anymore. (Another thing that is going my way!)
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