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ooashooo

Are my numbers really that bad?

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ooashooo

I was diagnosed 2 weeks ago at 26 weeks.  I saw my doctor today and she said that I need to get my numbers under control.  Right now the goals for my numbers are: 70-95 before eating AM, 70-120 2 hrs after breakfast, 2 hrs after lunch and 2 hrs after dinner.  

 

I just did the math and only 25% of my numbers are outside of the parameters, the highest numbers being 163, 141, 139, & 138 2 hours after meals and 113, 105, 102 & 101 before eating in the morning.  The dr. acted as though my numbers were way off and need to be controlled better.  I told her that for the most part I'm getting numbers within the desired range and I'm no longer eating the foods that caused the higher numbers to occur.

 

My main question is this, will the occasional high number (1 out of 4) really be detrimental to the baby?  When I see a high number I am walking for 10-15 minutes (when I can) and it drops it down within range immediately.

 

The reason I am asking this rather than just trusting my dr. is that when I gave her my chart she asked me what range the dietitian wanted me to be in and I showed it to her on the chart.  She seemed to get all flustered  and embarrassed that she didn't know it was on there.  I just got the impression that she didn't know exactly what she was talking about.

 

Any guidance on this would be GREATLY appreciated!  This is my first baby and I've never even been close to diabetic so it's new for me all around.  Any meal suggestions that have helped you all keep your numbers under control?.  Also, any absolute no no foods (other than cereal, candy, sweets & pizza, which I already know about) would help a lot too!

 

Thanks so much!

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davef

I don't know anything about gestional diabetes. If it was just you involved, then having the odd reading over 140 I'd consider to be fine, it happens. Most of us T2 diabetics aim to be below 140 two hours after a meal and as you say, you're doing that 75% of the time.

 

As for foods, carbs are what are most likely to spike your numbers, many of us avoid things like white bread, potatoes, rice & pasta. Often people find keeping carbs per meal below 30g works well. If you have a meter, then the best way to find what works for you is to test before each meal, two hours after and you then know how that meal worked for you.

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samuraiguy

It's hard to say how damaging the numbers are without an A1C because if you have a reading over 160 mg/dl, but it's down below 100 mg/dl in less than 15 minutes then that's not as damaging as it taking more than an hour to come back down. You might want to check at 1 hour to make sure you aren't getting even higher readings then that don't come back down until more than 2 hours PP.

 

I personally don't consider any food verboten, it depends on portion size, so as mentioned above use your meter to guide you in what and how much you can eat.

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fjordscape

Walk for 15 min and you see the BG drop, wow! Another testimonial to the power of walking against higher bg. 

 

There are two points to make in answer to your question. 

 

(1) You need to know how the 2 h value relates to the whole glucose response curve. You need denser postprandial (pp) readings: add at least the 1 hour value. Consider a study which included some women with gestational diabetes and some without: http://ajpregu.physiology.org/content/300/4/R941, 2011. Figure 1 shows there are several possible overall glucose response curves. (1 mmol glucose/l = 18 mg glucose/dl. 5 mmol/l = 90 mg/dl) Your glucose response curve could be the bad A or closer to the harmless D. But each of the curve categories has wide individual variation. For example, C and D on average peaked kind of low, around 140, but at least one subject exceeded 180. Notice also how A differs from B, C, and D in that it peaks at 1 h instead of at 1/2 h. Let's focus on the 2 h values. With response curves B, C, D, the average 2 h values are between about 100-110, quite below your readings. But as the graphs show (dashed lines), individual women in the groups had 2 h values close to 140. 

 

If only you can get a continuous glucose monitor for at least a couple of weeks. 

 

Synthesize this study with study of 1282 normoglycemic people (http://care.diabetesjournals.org/content/29/7/1613.full, 2006) that showed that 98% of normoglycemic people surge to between 120 and 140 (140 mg/dl ~ 7.9 mmol/l) after eating, And 2/3 of them take about 3 h to regain fasting level. The 2/3 had a pp curve like D in the first study. The average fasting level of the 89% was 84. Again, in this 2006 study, peaking at 140 was the metabolism of 89% of totally normal people. Check out the graphs. You'll see that only 2% of the subjects had no pp rise at all. 

 

The subjects were administered the OGTT, which I suppose is meant to challenge one's metabolism more forcefully than a typical meal would. 

 

(2) Hyperglycemia is partly due to one's genes. However, there is intriguing evidence from animal studies where complications were induced in animals with normal bg by injecting them with extracts from the cells of diabetic animals. Diabetic complications are not all about the glucose! There is apparently little research on all this, so there is no solid answer to your question yet. I'd be interested to hear of evidence that hyperglycemia during actual pregnancy is harmful to the fetus. Due to the placental barrier, I would expect any impact to be indirect. Like, a baby born to a mother who scraped her knee is not going to have a scraped knee. On the other hand, fetuses of smoking mothers have worse health in childhood. Again, your hyperglycemia, as you have reported it, consists mostly of mild IFG. The 113 fasting value and the 2-hour value of 163 are genuine causes for concern, I think. I got 164 at 30 min by guzzling juice, but by 2 h I was back to 107. But you are finding out how to bring those levels down. 

 

Gestational diabetes does predispose the mother to diabetes decades later. 

 

Check out another article from 2006: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2628694/ Although this study was not about gestational diabetes, you could play around with it. Assume you fall into group D, has IFG+IGT. Assume you also have 1 h OGTT < 155 and are negative for the metabolic syndrome. According to Figure 1, in this study, the risk of progressing to diabetes within 8 years among people in this group was zero. Assuming a statistical fluke, obviously the real world risk is still around 1%. 

 

The metabolic syndrome (it's always "the") is a concept proposed around the year 2000. It was originally called "syndrome X" and it has also been called "insulin resistance syndrome", which is not synonymous with insulin resistance because IR is one of about 6 elements of IRS. You can look up the MS. Again referring to Figure 1, if you do have the MS, the 8 year risk was still only 5%. By adopting lifestyle changes to reverse your IFG, you can reduce that risk. 

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jwags

The guidelines for GD are much lower thsn the guidlines for normal diabetics. this is because high bgs can affect the baby. Many time they will put pregnant women on insulin untilmthe baby is born if numbers are too high. My no-no foods are any tyoe of grain, especiallynwheat, fruit, rice, pasta , oatmeal and of course Sugar.

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fjordscape

gestational diabetes affect fetus

 

More Web surfing reveals that a pregnant mother's hyperglycemia is a concern. 

 

The American Diabetes Association spells out that although the mother's insulin does not pass through the placenta, the mother's glucose does. This can make the fetus hyperglycemic. After delivery the child may become hypoglycemic. These fetuses often are larger than normal at delivery. http://www.diabetes.org/diabetes-basics/gestational/what-is-gestational-diabetes.html 

 

Details on how GD can affect the fetus, labor, and delivery are provided by Mayo Clinic and the Natl Institute of Child Health and Development. 

 

To try to digest the 2011 article I mentioned in the previous post. It looked at women in their 30's who *had* been pregnant. In the discussion section, the authors think that it probably is valid to compare women with a history of GD to other women as regards glucose metabolism. This study found that a lot of normoglycemic (NGT) women (neither prediabetic nor diabetic) do have glucose responses that stay above 100 mg/dl (5.55 mmol/l) for 3 hours or more. But those higher levels are much lower than 140. At 2 hours, those women are in a range from 110 down to 97 (6.08 down to 5.37). And their fasting "basal" is 91 or less. 

 

I don't know if it's valid to to compare the response curve of a pregnant woman to the response curves of nonpregnant women. But if we do compare them, the 2 hour numbers 141, 139, 138 most closely match the subjects of curve A, who peaked much higher, at 190 (at the 1 hour mark). And half of this group (138/262) were NGT. And none of them presently had GD, of course. 

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bananabread

In my opinion, gestational diabetes needs to be taken seriously, so if you're even borderline/flirting with the cutoff points, your provider will want you to take the meal plan and exercise plan seriously.  This will prevent your numbers from going up any higher.  Keep in mind that you're not eating to keep the numbers down, you're eating to be healthy, so stick to the meal plan as much as possible.  I tried eating to keep the numbers down, which meant I ate a lot of burgers, tacos, meat, cheese, etc. so that I'd get a ton of protein and barely any carbs.  But that's not good either.  You really need to stick to the diet and exercise because your ultimate goal is a HEALTHY baby and HEALTHY mom.  

 

And it will be frustrating.  I cried after my first call from the nurses to whom I had to report my blood sugars.  She kept quizzing me about my meals and asking if I do yoga or walk and I did all that stuff, yet my numbers were still so high!  My partner would question why I even check my bs, because when it would be so high, I would get stressed out and cry, which cannot be good for the baby.  

One thing that comforted me the most (other than my partner and my mom) was this blog: http://birthwithoutfearblog.com/2013/06/24/the-truth-about-gestational-diabetes-and-why-its-not-your-fault/  And I highly suggest that you read it.  Essentially, it's nothing you did or didn't do.  It's your cells, your hormones, and you can't control that!  

 

Some women can get their numbers under control through following the diet and exercise.  And that's why, I think, your Dr. is making a big deal about it.  For other women, myself included, the diet and exercise were not enough.  My morning morning fasting bs levels were about as high as yours, and I didn't understand.  I walked at night, I ate only protein at night, etc.  But how can my blood sugars be so high if all I've been doing is sleeping!?  Well it turns out that the only way for those morning fasting bs to be normal was to take glyburide at night.  I'm on a low dose, 2.5 mg of glyburide, and my morning fasting bs are always within range.  Again, it's not anyone's fault, it's just what I need to get my blood sugars lower.

 

Ultimately, I think it comes down to this: stick to the meal plan, exercise, try not to stress out about it.  If you need to take the medication to get your bs under control, then just take the meds.  If you need insulin, then take the insulin.  You've got other things to do, so try not to let this be another thing to stress about.

 

Hope this helps!

 

hang in there!

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