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I am on my third pregnancy with gestational diabetes. While I would not say I am an expert, I do have a lot of information. I am going to share my information, which may help a few of you.

Gestational Diabetes Test
Gestational diabetes is generally tested between the 24 and 28th week. You drink glucola and an hour later they draw blood and test your blood sugar level. Blood sugar levels are just numbers and there are limits. For this test your blood sugar has to be 139 or lower. Anything higher usually triggers another longer test. In this test you get a lot more glucola and you come back every hour for 3-4 hours to have blood drawn. This gives Drs a better idea of how you process sugars (carbs). Glucola affects everyone differently. It is a orange drink that is really sugary but tastes like flat orange soda. Some get sick off it, like me, and some do just fine.

Now some doctors decide to do this earlier than 24 weeks. In my first pregnancy I was tested at 14 weeks. Being so new, I could not even tell you my test results.

Here is where it can get a little cloudy on information. When I took my test, I was told to fast - not eat or drink before the test. This way the test was accurate on the glucose reading of what they gave me. Since my first pregnancy I have heard women get all kinds of different information. Some are told to eat normally, some have a modified diet the day of the test, some fast. This is my personal opinion. You should fast before the test so they can get an accurate reading on how your body processes the sugars they give you. To me, by adding a meal or food, they don't know how much sugar you ingested before the test. Then they load you up with the glucola, thus in my mind, setting you up to fail the test. Again this is my opinion and not a medical one at that, just common sense.

You Have Gestational Diabetes - Glucometers
This can go several ways. My first pregnancy they wanted me to go in daily at first for blood tests. Well, before that happened, he decided to get me a glucometer. A glucometer is a personal diabetes reader you can perform blood sugar tests at home. You probably have seen a lot of commercials for them.

Most doctors recommend glucometers to start out with and a visit with a nutritionalist. If they don't then they are not arming you with the knowledge you need to provide the best care for your child. My hospital has training on how to use a glucometer, but really it is not that hard. At that meeting they gave me prescription the first time for a glucometer. This last time they just gave me one when I was there. There are also a lot of websites where you can get a glucometer free, you just have to do the research. The pharmaceutical companies make their money from the testing strips, so getting a cheap monitor isn't the problem. Strips can run anywhere from 50 cents to over a $1 a strip, so do the research on which glucometer your insurance company will cover and which one fits your needs.

Glucometer Testing
You now have a glucometer. Each doctor has their own reason and timing for testing. My first doctor had me test 4 times a day. My current doctor (2nd child) had me test all fastings (will get to what this is) and sometimes after meals. With my third child I told the doctor I wanted to check 4 times a day for my peace of mind. This way there is no cheating by not checking because you ate something you weren't allowed too.

Fasting sugars - this is the test you do first thing in the morning before you eat or drink anything with sugar/carbs. This reading has to be 105 or lower. Doctors prefer 95 or lower, but 105 is the absolute cut off.
2 hours after meals - note the time you stopped eating and then test 2 hours later. This number should be below 120.
1 hour after meals - This number should be below 140.

I won't go into how to test since it is pretty easy. Most meters come with instructions and most hospitals have staff to teach you how to use it.

Eating - what foods
The key to this is carbohydrates or carbs as I call them.

  • 15 grams of carbs equals 1 exchange of carbs.
  • 3 exchanges of carbs per meal - 3 meals a day
  • 2 exchanges of carbs per snack - 3 snacks a day
You alternate meal, snack, meal, snack, meal, snack for the day. About 2 to 2 1/2 hours apart. This keeps your sugar levels from spiking to high or going to low. Low is just as bad (never should go below 70).

So what kinds of things can you eat? Nothing sugary for sure. Meats don't contain carbs unless you load them up seasonings that have sugar in them. Fats do not have carbs, but you don't want to increase your fats only to have other problems.

What I have found to be good things to fill up on are: nuts, peanut butter, eggs, vegetables, fruits (moderation), popcorn, cheese sticks, lean meats...
Things to stay away from: juice (full of sugar...never in the morning!), cereals, breads, potatoes, rice, corn, peas, cake, cookies, chips...
Freebies (only one serving): sugar free jello, pickles, celery, usually anything less than 2 grams of carbs per serving, WATER.

I will admit I have little to no carbs for my breakfast. It is an easy meal where I can keep my carbs down and feel full. Try an egg with a little shredded light cheese, turkey sausage and either milk or water. Ditch the toast. Each slice of bread is 1 exchange of carbs.

Breads, buns....these will get you fast. I have found some bread that two slices are 1 exchange vs the normal 1 slice equaling 1 exchange. You just have to read labels closely. That McDonald's hamburger? Already have 2 exchanges gone just in the bun, never mind the cheese, burger and fries you want with it.

Have a birthday you want to celebrate? Want that cake? Save it for a snack and then only a 2x2" square of it.

Milk...time to switch to skim milk. Depending on the kind you drink, it does have carbs. Skim milk generally has a 11 grams of carbs per cup. Want some cereal? Measure out both milk and cereal to make sure you don't go over.

And a big problem I have found is that fiber is in the carbs, not separate nor in any other part of the nutrition. If you have problems with constipation during  pregnancy like me, it is so hard to get in fiber when you have to watch every carb that passes your lips. Try some Fiber One granola bars as a snack (29 grams of carbs usually). Or some All Bran Buds cereal. But also DON'T FORGET THE WATER! Water and exercise also helps the fiber in your system. I will admit constipation killed me for my first two pregnancies. With this one I make sure I have my water and fiber since I cannot exercise and have seen a big difference.

One personal tip I want to give. Don't give up everything you like. Just learn to moderate it down to smaller sizes, have it infrequently like once a week, and work them into your carb counts. Try cheesecake over a regular cake. If done right, the cheese in the cake has less carbs than a normal cake. Love chips? Figure out how many make 1 exchange and count those chips out. Don't take the whole bag with you. Ice cream is my downfall. I can't stand the sugar free kinds so I get slow churned of something lower in carbs and then measure it out. I let myself have it once a week as a reward for being good, but also I keep it within my dietary guidelines. Going out to eat...stay away from the rolls you get on the table, they will be your downfall. Love salads with dressing? Get the dressing on the side and dip your fork into it for each bite. You will find you get enough in each bite but don't use near as much dressing as you would if you poured it onto the salad.

Diet Doesn't Cut It
I controlled my sugars through diet alone for my first two pregnancies but will admit towards the end of both of these pregnancies I was warned I would be on insulin if I could not control it. This third pregnancy, I could not control it at all with diet and by 12 weeks my doctor was weighing his options.

Insulin shots are the tried and true method. I can't give you much information about this since I have not done this.
Medication is another method but is very controversial on how it affects the baby. This is where you have to do some research and trust your doctor.

I am on Glyburide. The maximum daily dose you are allowed is 20 mg. I am currently on 7.5 mg a day but started at 2.5 mg a day. Glyburide is a pill you take. It doesn't work immediately, but basically tells your pancreas to release insulin at a future time to process the sugar  you ingest.

I started with 2.5 mg before bed because my fasting sugars were around 120. This brought my fastings down to an average 80. Then my suppers were causing number up around 130, so he started me on another 2.5 mg in the morning to help bring down my supper sugars. As I have gone along he has upped them as needed when he sees my numbers going up. I see my doctor every week and he reviews my numbers and we discuss high ones and what caused them.

What Diabetes Does the Baby
The biggest issue is that if you don't control it, you will have a big baby. Remember if you aren't creating the insulin to keep your sugars down, then they are getting just as much. They don't produce insulin at this point so they cannot process it themselves. When they are born they will usually require sugar water because their blood sugar will drop without you helping them to control it (Neonatal Hypoglycemia)

Shoulder dystocia - generally this is where the shoulders are bigger than the head and cause the baby to get stuck or wedged in the birth canal. This is very dangerous. Here is more information about it I had this with my second child. We were almost to the point of breaking her collar bones to get her out. Fortunately we did not have to, but her face was a dark purple color from the bruising. The pressure of her body pushing down on the head to get out caused her to bruise terribly. She is fine today.

Stillbirth and birth defects also increase with gestational diabetes.

Weight Gain/Loss
I found with my first two pregnancies I actually lost weight because I had reduced my calorie and carb intake by so much that my baby was healthy and I was getting healthier. My first pregnancy I lost around 15 pounds  (and another 20 after I had her). Second child I lost around 10 pounds. Third one...well I am gaining, but I also cannot exercise to get my calories burning.

Well, I put a lot of info here but there is so much more out there. Gestational diabetes is not horrible, but it is a change of life and at times you feel like you are starving. You just have to know what to stay way from and what to go to to fill up. But most of all you need to control it or it could affect your baby and even their future with Type 2 diabetes.

What's Your Story? Tell us. / Hi, 36 weeks 3 days ... almost there
« on: May 18, 2009 at 01:14 PM »

I am Shari and new to the forums. Boy do I wish I had found this place when I was around 24 weeks pregnant. This is my third and final child. I had gestational diabetes with all three of my pregnancies. Because I am 37 (well, 38 today), I have been watched very closely. I usually don't have gestational diabetes start so early, but by week 12 I was put on Glyburide 2.5 mg at night before bed. By week 20 I was on Glyburide 2.5 twice a day, 12 hours apart and my blood pressure began to spike high. By high, I generally ran around 140/90.  At week 24 I was still running high on both glucose levels and blood pressure, which concerned the doctor, but not enough to but me on full bed rest. Instead he started weekly BPP. At 24 weeks I was also put on restricted activity. I was not allowed to go on walks or exercise, nor any house work. I went in weekly for BPPs until around week 32 when they started NST. Week 28 saw my blood pressure decrease to around 125/80. Around week 30 my Glyburide was increased again at bedtime to 5 mg and 2.5 mg in the morning. At week 33 they did a BPP again with a weight estimate. Baby boy was around 5 pounds which they said was in 53rd percentile. I will explain the weight issues a little later. Week 34, the doctor raised my Glyburide again, although this time for no apparent reason. I have since had some extremely low blood sugar levels as I am cooking supper. So low I have had to have my children feed me sugary products to stop the shaking. Very scary. The doctor on week 35 reduced my Glyburide back to what it was in week 34.

Then in week 35 and 5 days, I went in for my normal NST and had 4 contractions about 10 minutes apart. The doctor was going to send me to the hospital but decided to check me first. The baby had not engaged and I was not dilated nor effaced. So to be nice to me, he sent me home with strict orders to lay down and drink lots of fluids and if the contractions did not stop in 2 hours to go straight to the hospital. He planned to stop any labor. Well I had one more contraction in his office and then nothing for several hours. Off and on since then I have 4-5 a day, but nothing regular. I am still doing the resting thing, but still have to run my kids to school and such.

Today I am 36 weeks and 3 days and still holding on, but this morning was a little rough with some weird pains. I don't feel like I am in labor and the baby is kicking when I do my kick counts. So far the pains have not come back. I joke that this is my birthday gift.

About the weight problem. Gestational diabetes can produce large babies. My first was 7 lbs. 3oz. and my second was 8 lbs. 10 oz. My second child got her shoulders stuck on my pelvic bone in the birthing canal. The doctor was at the point of breaking her collar bone to get her out. It is a very dangerous situation. Basically her shoulders were wider than her head. Because of all the pressure, her face was purple from all the bruising. This isn't too bad considering how close we came to loosing her. So the doctor is being really cautious. 8 lbs is the cut off for a vaginal delivery for me this time. If he goes higher, then the doctor plans on a c-section.

So that is me right now. Nothing to extreme, but I have had to do a lot of resting with this pregnancy that I did not do with my first two.

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