Tuesday, February 16, 2016

Dealing with Dissapointment

So last week, I shut down the blog for the week.  And by now, you might be wondering why.

Basically, the short of it is - I found out I have gestational diabetes.

To you, this could mean a range of things.  Maybe you think it's no big deal.  Maybe you're shocked to hear that someone as healthy and active as me is struggling with this diagnosis.  For me ... well, the first few days after finding out about this, I was extremely upset and disappointed. 

Knowing I've spent the last 5+ years of my life trying to improve my health and beat my genetics, and trying to stay as fit and active as I could during this entire pregnancy, hearing a nurse matter-of-factly telling me over the phone last Monday that I failed my second round of glucose testing made me break into tears. 

And looking into the statistics of what this meant for me, I got even more upset.  Because although almost all women, after giving birth, have no lasting effects requiring ongoing diabetic management at that time ... as many as 40-60% of women with gestational diabetes in pregnancy end up developing type 2 diabetes 10-15 years later in life.

After learning this, I was absolutely crushed.

How could I have tried so hard to be so healthy, and yet have failed? 

All I could do is wonder is what I had done wrong.

After a lot of processing, and meeting with another group of pregnancy gurus, I've learned - nothing.  Or rather, that I did nothing wrong.  Unfortunately, I just drew the "lucky" straw that dumped me into the gestational diabetic bucket, and there's no amount of proper diet or exercise, pre or during pregnancy, that could get me out of it. 

It took me a long time to cope with that concept.  Eventually, even after my husband repeated it a few times, something started to sink into my disappointed brain...

To quote my diabetic councilor: "I've seen women who's definition of pregnancy is to get home from work and glue themselves to the couch all night, eating ice cream, and they have not a single problem.  And then I see women who are fit and active, running marathons and eating the best diet they can, and unfortunately, they still become diabetic when pregnant."


So, how did I get here?

Well for those of you unfamiliar, at around week 28 of your pregnancy, women are subjected to a standard glucose test.  Essentially, an hour before your standard appointment you drink a small bottle of "special drink" (mine was an orange flavored, 50g sugar slam beverage).  Then, you go into your doctor's office and get a finger prick to test your blood sugars.

A normal result one hour after drinking for this initial test is a blood sugar of 140 or less. 

I rang in at 156.

To me, that didn't seem so bad.  And even my doctor said at the time that it was very possible I'd pass the second round of screening.  So ... a few days later, off I went.

Round two of the glucose test involves drinking another sugary drink (this time mine was lemon lime flavored and had 100g of sugar in it - and yes, it was as disgusting as you're imagining), but this time there are more restrictions.  You have to come in right away in the AM to your doctor's office, and you can't leave until you're done.  You have to be fasting, so no eating after you wake up.  And you have to get 4 blood draws - this time all from the arm. 

Since this test is more complicated, here's a chart of normal ranges and my results:

            Time                   Normal Ranges                   My Results
            Fasting               Less than 95                        85 - Pass!
            1 hour                Less than 180                       198 - fail
            2 hour                Less than 155                       174 - fail
            3 hour                Less than 140                       146 - fail

Yeah, it wasn't good.  I failed all three measurements after I drank the sugary beverage. 

This meant that although my body did well overnight with getting the fasting sugars down, it wasn't responding fast enough during the day with insulin to break down whatever was in my system when I ate. 

And by definition, that makes me a gestational diabetic.


After discovering I had failed the test, and lots of tears later, I ended up in a diabetic nutritionist's office.  There I went over:

     - what my current diet was
     - how to use a blood sugar meter
     - what keytones are, and how to test for them in your urine

Lucky for me, I had a fairly good understanding of meal planning and how to do standard blood sugar tests, so that part was easy.  Well ... except for the fact that I learned I wasn't eating nearly enough carbs.  D'oh!

The dietician taught me that a carb is measured in grams on most nutritional labels (duh - I knew this), and that for every 11-20 grams of carbs there is one "exchange point", or what they call a "carbohydrate choice".  Here's a handy conversion chart that explains this in more detail:

After reviewing my eating from the previous day, the dietician showed me that my typical diet was including 0-1 "carbohydrate choices" per meal, and included insufficient snacks.  Then she showed me that my daily allotment should actually include 2-4 "carbohydrate choices" per meal, plus three snacks with an additional carb add of 1-2 each.  That ideal meal plan shook out like this:

Yeah.  So ... I wasn't even getting half the carbs I needed in a day to keep my diabetes in line.  Whoops.

To me, I didn't understand at first why this was an issue.  I mean, plenty of people live off a combination of carbohydrates and fat for energy.  What difference does it make if I burn more energy from fat versus carbs?

Well, apparently, a big one.  Especially in pregnancy.

What I learned is, when your body burns excessive fat stores for energy, or isn't getting enough energy period, your body releases something called a keytone.  For most people who are dieting or what not, this isn't usually a big deal.  But for diabetics, it is.  And for pregnant diabetics, it's a HUGE deal, since keytones can impact the baby's development, and especially their brain.

Yikes.  Ok.  More carbs it is! 

So with a modified diet plan, I left the office that day and started carb counting away.


At first, this whole process didn't seem like a huge deal.  Snack a little more, try to get in more carbs ... no problem.  Of course, immediately I was wrong.

Why?  Well ...

(1) I felt like I was eating so much food I was bursting at the seams
(2) My blood sugars were still way out of line after eating

To give you a feel for how my new diet shook out, here's an example of what I now eat in a normal day:

6-7am Breakfast
2 Carb Choices
  - 2 scrambled eggs with sautéed spinach and mushrooms and topped with a small amount of cheese, 1 cup blueberries, 1/2 of a whole wheat English muffin topped with avocado

10am Snack
1 Carb Choice
   - Small apple with natural peanut butter (yes, the kind that's made from only peanuts and salt - no sugar added)

12pm Lunch
3 Carb Choices
   - Romaine salad topped with cubed baked sweet potatoes and dressing, grapes and cottage cheese, mini whole wheat bagel, cashews

2-3pm Snack
1 Carb Choice
   - Chobani fruit yogurt cup, baby carrots

6-7pm Dinner
3 Carb Choices
   - Tomato and beef curry on brown rice, roasted asparagus

9pm Snack
2 Carb Choices
   - Whole grain crackers and hummus

As you can see - this is A LOT of food.  Not too much calorie wise, mind you.  But the volume of fiber alone is enough to  ... well ...


So yeah, after a couple of days of eating like this, it's getting harder to feel motivated to keep opening my mouth. 

This is all for you, kid.  Gah!  The things we have to do.

Oh - and going back to the blood sugars comment I made above, unfortunately with only two days under my belt of carb counting and following my new meal plan, I discovered I was going to have to go on a low dose pill (glyburide) to help my body better respond to insulin demands.

Of course, this made me a little nervous in regards to the impact on my baby.  But after some reading, I found that there hasn't been a significant difference found in babies born to mothers who use insulin versus pills to manage their diabetes - AS LONG AS THEY KEEP THEIR SUGARS IN CONTROL - and I'd sure as heck prefer not to stick myself with a second needle for insulin all day long. 

So, as much as I hated the idea, I hopped on the pill train and away I went.


Which leaves me at where I'm at today.  So far I'm about a week in on the new plan and all is going well. 

I'm trying to keep a positive attitude about all of this.  I'm still eating the proper amounts of food.  And I'm doing ... ok.  I'm not thrilled at what this might mean for my future, but with a baby on the way, I'm not trying to think about that right now and I'm just keeping my focus on the next few weeks.

Since I'm at 31 weeks Friday, and most gestational diabetics notice issues start to recede around week 36, I'm trying to hold in there for 5 more weeks.  (Or maybe more, if I don't level out at 36 and have to manage this until I'm full term).

In the meantime, I'm just hoping that everything keeps going as well as it is now!

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