Love the Unexpected

Ah, the dreaded gestational diabetes test. Everyone has their story with it.

First comes the initial screening. You go in unfasted, they take your blood. You drink a gross sugary drink, wait an hour, they take your blood again. Voila. You’re done. No big deal.

Most of the time, it comes back negative and you carry on with your life. But alas, a couple days later, you get the call that your sugars came back a bit high.

Gulp.. but don’t worry, it was only the screening. Nothing has been confirmed yet. You still have the second test. So, you start researching about gestational diabetes and you realize all carbs get turned into sugar as their digested?!

Probably shouldn’t have dropped out of high school biology. Still, this newly acquired knowledge is power. You realize you had a big breakfast before that screening. Of course two English muffins created a false positive! Why wouldn’t they?

You go into the second test fasted, prepared this time. It’s not the nonchalant, que sera sera experience that it was the first time. Now it’s personal. They’ve upped the ante on you – the gross drink has a higher glucose concentration. They test your blood before, one hour and two hours after. The minutes wear on but finally, it’s over.

You walk out feeling confident, feeling good. Then you get the second call. You’re one of the lucky 3-20% of women who has gestational diabetes.

Alright, so this might be a very specific example. This was my experience of receiving a gestational diabetes diagnosis. If you haven’t had a chance to read about our reaction to finding out we were expecting twins or our cleft lip and palate diagnosis, you might not realize that at this point in my pregnancy, I was starting to feel like I was hitting just about every “1 in x” statistic that I could.

This made the news about my gestational diabetes pretty discouraging. I had no idea where to begin finding information about what I should be doing to manage it and more importantly, I was concerned about whether it would cause any harm to my babies.

Thankfully, in Alberta, you are immediately referred to a registered dietitian and endocrinologist upon receiving a diagnosis of gestational diabetes. Within a couple days of getting the final test results, I was booked into an information session with other women who had tested positive, to go over the risks and methods of treatment. In addition, I met with my dietitian weekly to review my sugars, my diet and work together to get my numbers in check. Here are the dos and don’ts I learned in managing gestational diabetes

Don’t blame yourself

You didn’t cause your gestational diabetes. It’s true that there are factors that may put you at higher risk, like twin pregnancy, but they are largely outside of your control. According to the Mayo Clinic, researchers still aren’t sure why some women get it and others don’t.

The US National Institute of Diabetes and Digestive and Kidney Diseases, defines gestational diabetes as high blood sugar during pregnancy that results from your body being unable to create the necessary amount of insulin required to regulate it.

While pregnant, your body develops insulin resistance, which means that your body isn’t using the insulin as well as it should. Most women are able to produce enough insulin to compensate for the resistance – those that can’t, develop gestational diabetes.

So if you’ve received a diagnosis of gestational diabetes, don’t beat yourself up about it. It’s something that is outside of your control but can be managed.

Do work with your registered dietitian and endocrinologist

There’s lots of great general information out there about how to manage your gestational diabetes, some of which I’ll cover in this article. But every woman is different and what drastically spikes one woman’s sugars might have a negligible effect on another’s.

Your dietitian can help you work through the trends in your specific blood sugar numbers and diet to identify what changes might help. If changes to diet and exercise aren’t delivering results, your endocrinologist may recommend an alternative treatment like insulin or other medication to help manage it. It’s really important to work with your health care team to figure out what’s best for you and baby (or babies!)

Don’t obsess over your numbers

I’m talking to myself here, because this was something that I found very difficult. Gestational diabetes has a way of sucking the joy out of eating – having to test your sugars two hours after every meal is one of those ways.

My husband and I went all in on the recommendations we were given for diet and exercise. We eliminated all “white” foods. Rice, bread, potatoes – gone and swapped for their high-fibre counterparts. Sweeteners like maple syrup, honey, sugar – I said a sorrowful goodbye for now. We paired protein with my carbs every meal and snack – I ate an egg every morning at breakfast. I hate eggs for breakfast. I did my best to heft myself out the door for a short walk after each meal.

We were doing everything “right”, which made it incredibly frustrating when at each sugar test, I was coming out just slightly over the threshold. It became very stressful and made me second guess everything I was putting in my mouth. I needed a perspective change.

Do treat your numbers as data

The great thing about working with medical professionals in this specific case, is that they don’t have the same emotional attachment to your numbers. They have the ability to look at what you submit and see them purely as data points. I wasn’t completely successful, but I did eventually get better at taking on this perspective.

One of the turning points was when I came to terms with the fact that while modifications to diet and exercise are enough to manage gestational diabetes for many women, I once again was not destined to be one of the majority.

In spite of my best efforts, my numbers were consistently high. My endocrinologist recommended that I start insulin to help manage it.

Although I was disappointed, I agreed that this was the best course of action. In the end, I felt a huge sense of relief when I started insulin because it gave me hope that we’d be able to get this thing under control. Until then, I had felt like I was failing my babies by not being able to get my sugars in check. We still had work ahead of us to identify the right doses but at least there was something tangible I could do if my sugars came back high.

Over time, in combination with the insulin, I did start to identify certain foods that seemed to spike my sugars more than others. I couldn’t eliminate them entirely but I did learn to pair the right portion size with the right insulin dose to balance things out.

Don’t let fear stop you from eating

This one is closely linked to the number-obsessing. Before starting insulin, when my dietitian asked me how I was feeling about how things were going, I admitted that I was starting to feel like I needed to restrict myself in order to get my numbers in check. I believe her words were, “that’s not good”. This, along with my squeaky clean diet, was a big reason for why she referred me to the endocrinologist for insulin.

It’s true that there are risks associated with gestational diabetes if it’s not well maintained. The Mayo Clinic lays out these risks: things like an excessive birth weight for baby, preterm birth, serious breathing difficulties, higher risks of obesity and type 2 diabetes in baby later in life.

It’s important to get gestational diabetes under control – but it’s also important to make sure you’re getting the necessary nutrients to grow your baby. It was tempting for me to cut out complex carbohydrates altogether when I found them to be the main culprit in my blood sugar spikes – yet a pregnant mother is recommended to eat nine to eleven servings of complex carbs every day. Those are the guidelines for a singleton, which meant my needs as a twin mom were even higher and I needed to continue to hit my daily target calorie intake (If you’d like more information on nutrition in twin pregnancy, check out my article.)

There needed to be a balance between these two things – for me, that meant introducing insulin.

Do heed the gestational diabetes diet tips

Diabetes Canada provides lots of great resources on how to eat to manage your blood sugars. This guide for basic meal planning offers some great tips, such as:

• Choosing low glycemic carbs like legumes, whole grains, fruit & vegetables and learning to count your carbs
• Preparing most of your foods at home, to avoid the excess sodium, sugar and saturated fat in processed foods
• Limiting (or omitting) sugars and sweets
• Eating consistently throughout the day – I was recommended to eat three meals and three snacks at regular intervals to avoid spikes in sugar

Though I wasn’t able to control my diabetes completely by following these diet recommendations, I came really close. My sugars were never excessively high and were usually within a few points of my target. This created a good baseline, so that I didn’t need too much insulin to get me in the necessary range.

Reflection

I’d be lying if I said that managing my gestational diabetes didn’t require some significant lifestyle changes. I consider myself a healthy eater, but it still tested my limits.

Poking yourself four times a day to test your sugars isn’t fun. Injecting insulin into your belly – also not fun. But it is in many cases, thankfully, temporary. For most women, gestational diabetes goes away soon after delivery, and I was incredibly thankful to be included in that number.

My risk of type 2 diabetes is significantly higher now than it was pre-pregnancy but that knowledge gives me incentive to continue eating a well-balanced diet and returning to my fitness regimen.

I’m incredibly thankful for my husband, who was an indispensable support. He dove into the challenge to switch to whole grains, avoided sugar in solidarity and helped me with every injection he could.

I’m also thankful to the medical professionals who walked me through the journey. Though I would have preferred not to need their help, they did provide significant support.

All-in-all, it’s not something I would wish on anyone but for those who find themselves joining me in the minority, I hope you find yourself feeling a little less alone.