Ever since becoming pregnant, I would read about all the different “pregnancy milestones” — things I’d have to do at the different marks (How many weeks can I tell people? When do I find out the sex of my child? When to shop for maternity clothes?) My husband hated it, but I went on a Googling spree. And I was fine with it! I’m someone who likes to know what’s generally coming rather than find out through my OB or 1-2 anecdotal experiences.
Of course, one of the dreaded pieces of this journey was “When do I get tested for Gestational Diabetes?” — I had learned that I may have an increased risk due to a few conditions out of my control: genetics. My mother is a diabetic, and overall there is a diabetic trend among those of South Asian origin, plus I couldn’t help but feel that I was a tad past normal BMI reqs pre-pregnancy. And what would it mean? Anything from a large baby due to getting too much glucose, a baby with complications after birth (jaundice, low blood sugar, or being born too early), and potential early induction (which may prevent you from giving birth naturally).
All of these truths had me a bit nervous before my 1 hour glucose test — which I failed — followed by the 3 hour glucose test, which I also failed.
THE GLUCOSE TEST
The 1 hour glucose test consists of drinking this sweet AF 50mg sugary drink (no fasting required) within 3-5 minutes, and they wanted my number to be below 135 after an hour. Mine was 145.
“Maybe it was the banana bread I had that morning.”
I thought, “It’s fine, I’ll pass the 3 hour test.”
This required 3 days of 10 carb servings per day (they want to make sure you don’t cheat the test), fasting overnight, coming in to get blood drawn, then drinking that same nastiness — except it’s 100mg this time, in the same time span of 3-5 minutes. Then they’d draw my blood 1 hour after, 2 hours after, and 3 hours after (no water or anything in between these blood draws).
In general the cut offs for the test differ slightly among OBs and institutions. If you fail 2 out of the 4, you’re diagnosed with GD. Here were my numbers (right) compared to the cut offs (left):
Fasting: 95mg/dl - 94mg/dl (passed)
1 hour: 180mg/dl - 176mg/dl (passed)
2 hour: 155mg/dl - 169mg/dl (failed)
3 hour: 140mg/dl - 144mg/dl (failed)
You can imagine my frustration, thinking to myself maybe there were ways I could have wriggled out of this diagnosis. But of course, you never want to cheat the test. It is what it is, and always important to know and treat effectively so that your baby is safe and doesn’t get too big. Of course I had no knowledge of my numbers on the day of and had to wait the next day for the results.
The minute I got the GD diagnosis via voicemail after my dentist appointment, I was immediately wracked with sadness, fear, and guilt. Because I just came out of my cleaning feeling relieved, unscathed and cavity free! But that changed within 5 minutes of checking my voicemail. I sat in my car crying before driving to work.
I couldn’t help but wonder — was this my fault? Did I cause this during my first trimester where nausea took over and I latched onto bagels and cream cheese for comfort? When the only thing I was in the mood to eat at 9 weeks was macaroni and cheese? Was my addiction to simple carbs the culprit? And of course, the other side of my brain said, “OK, time for research!”
I immediately started reading even more after being diagnosed, wondering how many people were diet-controlled; what types of diets they were on, and what the ramifications were if one was unable to control one’s diet. The scariest part: I now have a 50% chance of developing this in my next pregnancy and a higher chance of developing Type 2 later in life.
First step - meet with a nutritionist. This was slightly more informative than I thought. Largely because she described how pregnant women’s placentas produce all these hormones which at times prevents our insulin receptors from working, thereby increasing our blood glucose levels. The nutritionist gave me some guidelines (in short - it’s carb control), which were then altered slightly by the gestational-diabetes nurse. Here’s what it looked like:
All XXg represent carbs:
Breakfast: 30g (test blood sugar 2 hours after first bite)
AM snack: 15g
Lunch: 45g (test blood sugar 2 hours after first bite)
PM snack: 15g
Dinner: 45g (test blood sugar 2 hours after first bite)
Bedtime snack: 15-30g
(Test blood sugar when you wake up next day - fasting level)
Note: getting these carbs from high fiber, 100% whole wheat, low sugar items is way better than useless non-nutritional simple carbs — which I’ve always known but damn is it hard while pregnant!
Next - I had to get a blood glucose measuring kit (my OBs prescribed one to my pharmacy). This is to test my blood sugar 4 times per day by pricking my fingers with a lancet. I use Accucheck (I’ve heard some negative things re: OneTouch from forums and other mamas, but see if you can request a brand that others have reviewed well).
Some doctors say to test after the first bite, or last bite of your meals — some do 1 hour after meals, with targets under 140mg/dl, while others say 2 hours under 120; fasting targets are generally below 95 or 90. I know — super confusing! And based on your doc or OB, you may have a different set of rules. I had to test 2 hours from the first bite, with a target under 120; my fasting target was under 95.
Breakfast meals that have worked for me:
Whole wheat waffle (1) with peanut butter and 4 to 5 dark-chocolate chips
Any amount of eggs scrambled with veggies and cheese
Whole wheat toast with peanut butter and thin layer of low-sugar jam
I’ve coupled the above with half cup of unsweetened almond milk + half a cup of Stok iced black coffee (no sugar of course) on the way to work.
I’ve stayed away from cereals, milk and fruit because the carb count is just too high for me to risk spiking.
Lunch meals that have worked for me:
Whole wheat wraps or sandwiches with cheese/veggies/protein inside
(only get the carbs from the wrap or bread and make sure they’re under 45g)
Small soup (clear soups without noodles are less fatty/carb-y) and half sandwich similar to above and/or small salad with cheese, veggies + protein
I steer clear of too many beans/bean-based items since beans have a lot of carbs although they’re a good protein source. I just get my protein elsewhere.
EMOTIONAL DRAWBACKS - PART I
Meeting with the nutritionist and having a way to check my blood sugars was initially empowering. As an optimist, I decided to take this as a challenge that I could overcome. So when I faced what I deemed as failure, I broke down — frequently.
Think about it. Everyday you wake up - you test your blood sugar. You need to be under 95 and the only control you had over it (supposedly) was your bedtime snack. You switch it around every night to wake up the next morning either relieved or devastated. Repeat this feeling 3 times a day, after breakfast, after lunch, and after dinner. Not to mention half of those times are in between work meetings in the bathroom, thinking only about what you can do to improve or plan your next meal. Sometimes I was so tired from cooking and cleaning after dinner, that going for a walk was just out of the question. And days where I would fit in gym time would sometimes result in a bad number; and some low-exercise days I’d end up testing okay. This entire thing was EXHAUSTING.
I remember literally just crying inside our closet and my husband (a general hospital physician who at times can approach things very methodically versus sympathetically) was genuinely confused. He would ask me if this was because of GD, probably because he hadn’t seen me randomly break down like this before and was truly curious as to why it’s affecting me so negatively when we were blessed to be pregnant in the first place. According to him — with treatment and diligence, nothing would be a problem!
And that’s fair when you’re on the outside looking in. But I withdrew. I was sick and tired of my conversations revolving around my meals, snacks, carb gram limits, sugar levels, not a moment in the day felt like I could dedicate it anywhere else. I didn’t feel like calling my friends (not because they wouldn’t sympathize, but because I didn’t even know how to bring it up or how to just verbal diarrhea the misery; and of course, it’s not always easy to feel weak around your loved ones 24/7). Hanging out with people for dinner or meals felt out of the question.
I latched onto my parents (shout out to them and I am so lucky to have them); my mother would insist I could call her anytime I felt this way, which was a huge help. It was the most frustrating feeling, day after day, knowing I still had [X] number of days having to prick my finger 4x and hold my breath for the 5 seconds before a number was revealed on that dreaded screen.
GETTING ON INSULIN
After repeat frustrations and nights of elevated dinner numbers and fasting numbers, my NP mentioned that the high-risk OBs would have to put me on insulin. If 50% of your numbers are elevated, that’s the protocol. I said “well 50% of my numbers look good, right?” referencing my breakfast and lunch logs. But she chuckled kindly and said “50% of each column, otherwise we diagnose insulin for that particular time of day - whether short acting or long acting.” The most comforting thing was that she told me it was my placenta, and it’s only gonna get wonkier as the pregnancy progresses and more hormones are released.
I asked a ton of questions, about the injection method, the number of units I’d have to inject, and how and when those units would increase, if at all.
I was also told that now that I’m on insulin, I’ll have to come in for 2 ultrasounds per week (!) and will be induced at 39 weeks if I don’t give birth earlier. So in short, less control over having a CS or vaginal birth based on baby’s position & size at that time. They would put me on 12 units for both dinner and fasting; with a short-acting insulin 15 minutes before eating dinner and long-acting insulin before I go to bed (around the time I have my bedtime snack).
I initially only told my family and a friend or two; I had a wedding weekend coming up, and the stress with my diet and impending injections had me in an emotional state once again. I inject my thighs right now, (can’t bring myself to do the abdomen yet since I bruise easily). My husband sometimes helps draw the insulin sans air bubbles before I inject. The smell of alcohol swabs definitely takes me back to the days of my grandpa injecting himself and me watching him when I was little.
EMOTIONAL DRAWBACKS PART II:
As an optimist, I really do know that I am blessed. I’m sure others have had much worse complications and I myself may face greater adversities in this pregnancy, the next, or in my overall health. I’m not short of perspective.
But when you go through something like this and only you are carrying your child, the last thing you want to hear about is about someone else’s pregnancy, or how they also had GD, or how they were put on insulin, or how they were also induced, or how they also knew someone who knew someone who had a baby who weighed normal.
None of that really matters. That doesn’t get rid of the fact that I now prick myself 6-8x a day, 4-6 pricks to check (or recheck) my blood sugars and 2 shots for dinner and fasting. It doesn’t take away the fact that I’m tasked with figuring out what foods spike me daily for each meal and to avoid things like the plague - things that I’m naturally craving as a pregnant person.
I’m coming to terms with the diagnosis and dealing with it day by day, distracting myself with cupcake toppers for my baby shower, blankly staring at onesies and cribs, and feigning smiles and replies like “good, thanks!” whenever people ask me how the pregnancy is going.
I’m working hard to keep my breakfast and lunch numbers stable. I’m currently logging them into a Google Spreadsheet, a manual log on my fridge, as well as an app - overkill I know - but there are only so many times I have access to one of the 3 throughout the day! The great thing is that my blood sugar monitor has a memory and you can click left or right to remind yourself of your levels. I am still planning my dinner meals and bedtime snacks to be within the carb limits provided, and the insulin has reflected a majority of my numbers under the target, which is certainly relieving.
Only 52 more days of meal planning, blood sugar checking, and insulin injecting. But it’s important to look for the silver lining; starting a week from now, frequent hospital visits mean frequent ultrasounds where I get to see how my baby girl is growing. I am gaining peace in talking about this and being able to help / share my experience with other mamas-to-be or get insight from those who have gone through this. So please feel free to share your experience or ask me any questions!
I plan to update this post as things progress, as i’m currently 31w5d with an induction date set for 39 weeks.