Monday, March 16, 2015

Gestational Diabetes (and why I have it)

Gestaional diabetes tends to effect women over 25yrs old who are overweight and have a family history of diabetes*. During my first pregnancy, meeting none of these criteria, I was very surprised to be informed that given my medical history I would likely get gestational diabetes. Funny, because my health history had never played a huge role in my life - it was my normal.
But suddenly the fact that my perfect functioning pancreas (for me) was about to be stretched to its limit.

I was born with something called Nesidioblastis. This is a rare condition (1 in 25,000 to 50,000 source) in which an overactive pancreas secretes too much insulin. In my case this meant I wasn't waking to eat as a newborn and couldn't maintain my temperature. However, because it is so rare, it took the doctors about 5 weeks to figure out what was happening as blood tests before that were inconclusive.
At 3months old, after trying various unsuccessful protocols and researching all the options, the doctors explained that the best option was to remove 95% of my overactive pancreas. The hope was that the remaining 5% would be sufficient to sustain my insulin needs. If it was still too overactive, another surgery would need to be done and I would likely be a brittle diabetic.
Fortunately the surgery was a success. Turns out, 5% of my pancreas is perfect. I would have periods of hypoglycemia as a kid, and in order to avoid seizures I needed to eat regularly. My mom explained to anyone who was curious that I was the opposite of a diabetic - I had to work to keep my sugar levels up instead of working to keep them down. If my routine was off or I was stressed (for example, on vacation or during a week of VBS), I would have a grand mal seizure. My mom remembers when I was young, the behaviors I would start showing that said a seizure was coming. I remember (obviously I was older) an aura - I would feel numb-ish and rainbow-y spots would come into my vision - and I'd say: "umm, I'm having a seizure" and then there would be a rush to get honey and I think there was puking and drooling involved but I would be fairly out of it by then. I'd wake up a few hours later with a headache. Seizures happened a few times a year. Again, this was normal for me - it never felt like I had a health "problem".
My last seizure was when I was nine and I haven't had one since.
The only other funny health thing (which has no bearing on gestational diabetes, but does seem like a bigger deal to me because I was older and more aware) was that I had severe stomach aches off and on from the time I was six years old that would last a couple of hours. I was brought to doctors. No one could figure it out and a few attributed it to stress/school - despite my mom's insistence that I didn't seem stressed. Finally at 14 years old, I had constant stomach pain for 3 days. By the third day I couldn't keep anything down - not even water. So my parents brought me to the doctor who was dumbfounded and in the end decided with my parents that I should be brought to the hospital. After several days, the doctors reluctantly but not knowing what else to do, decided to operate again, over my original scar. At that point they removed 6inches of my small intestines and scar tissue that had adhered to the small intestine. They warned us that this could happen again, but hopefully with me being older and now mobile, it would keep scar tissue from attaching to the small intestine.

Now, back to my surprise during my first appointment after finding out I was pregnant for the first time. When the midwife explained that I would likely get gestational diabetes, my first thought was: "she's confused! I have the opposite of diabetes!" At around 20 weeks gestation I happily sucked down glucola (people complain about the taste, but yum!) and was told I needed to do a three hour test (only 15% of women who test positive in the one hour test, are actually positive in the three hour test and thus diagnosed with gd - talk about unnecessary stress!). And I was surprised to learn my body wasn't working as well as it seemed to be on the outside. The three hour test confirmed that gestational diabetes was a definite. I met with a nutritionist. The whole thing was overwhelming. I had never had to worry about what I eat or didn't eat - and now suddenly all this label-reading and rules! In addition, the midwife was concerned at every appointment that I wasn't gaining enough weight. I politely informed her that my diet was very similar to this new-at-the-time-fad-atkins-diet that people were raving about because they were LOSING weight. You can't have it both ways - low blood sugar and low weight gain, or high blood sugar and more "normal" weight gain.
Insulin was discussed, I'm sure, but was never needed.
Baby number two - I declined the yummy glucola test and just asked for a prescription for a meter and the test strips as gd seemed inevitable. As it was a second pregnancy I was much more laxed about diet (frozen yogurt has fat and protein .... and some carbs ... so why not?!) ... and her birth weight and subsequent drop on the growth chart (she's been about 50% most of her life ... except at birth), I think reflects that less-than-ideal-gd-diet.

With this baby, I did the same thing. I just assume I have gd (and my numbers show me that I do).
The challenge with this baby is that I'm older and this is a third pregnancy - both factors make gd harder to manage with diet alone.
The thing hanging over my head is that our home birth midwife has made it clear that she is not comfortable attending our birth if I have to go on insulin. I have every confidence that she is knowledgeable and experienced and can handle any birth complication thrown at her. I'm also fairly certain that home birth in our state, while legal, is tenuous and she doesn't want to risk** anything - which I think is very fair and understandable.

Given the increased challenges on my body (age, third pregnancy), this round of gestational diabetes is definitely more challenging. At my last prenatal appointment the midwife suggested going off carbs entirely. This had the immediate effect of dropping my numbers impressively, which was very gratifying. But there's still a long way of pregnancy to go and hormones constantly challenging my body's ability to process food ....

*having researched gestational diabetes extensively I have strong feelings that the sugar number levels that pregnant women are expected to keep are not physiologically appropriate (the pancreas makes changes that leads to increased blood sugar to give the baby time to absorb what it needs - but the gd mom is expected to maintain lower sugar levels than the diabetic individual). I also don't see the sense in making a blanket rule that every pregnant women be tested for gestational diabetes (but I rarely think any medical protocol is appropriate across the board - humans are individuals and their medical care should reflect that). Also, if one does have the markers for getting gestational diabetes, there are alternative methods of testing versus drinking a glucola drink - if you think someone has diabetes, don't stress their body out with sugared-up orange soda! Many many of the gd concerns are based on concerns around diabetic women who are pregnant - and most of these issues are concerns in the first trimester; gd moms don't get diabetes until well out of the first trimester, so the concerns are irrelevant.

** the risks immediately at birth are a baby with macrosomnia (large baby) and a baby with low blood sugar having suddenly lost its access to the overabundance of sugar it has been processing for me (this happened with both of the older two, and generally immediate breastfeeding levels things out).

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