Super Sweet

Sleep more appealing than cookies?

I finally have my new OB appointment scheduled for August 7...by then I'll be over 13 weeks.  My first trimester screening is this coming Wednesday, though.  I'm hoping the MFM will let me do the Materniti21 test, both for reassurance that Chimi is trisomy free, as well as for the added benefit of knowing the gender a few weeks early.

The entire OB/Gyn group that delivered Finn stopped the OB part of their practice about a year ago.  There are only two other groups in town, and thanks to my health insurance, I'm stuck going to either one of those groups.  The group I decided on was basically by exclusion - I really dislike several of the doctors in the other group, and only mildly dislike a few of the doctors in the one I went with.  Now I dislike the group I decided on even more, thanks to the jerks they were around scheduling my first appointment.

I see a lot of patients from both groups (mostly with diabetes in pregnancy) and I know how they do things.  So I know that despite the fact that I had some high sugars after meals while pregnant with Finn (even after passing the glucose tolerance test with flying colors) and the fact that I had a baby who weighed 9lb13oz, they would not have had me checked for gestational diabetes yet.

Nevertheless, I've been monitoring my sugars since I got my first positive pregnancy test.  They started off fine.  But then about 3 weeks ago, the fasting sugars started to increase about the goal of less than 90.  So I started myself on metformin, and then increased the dose up to the max dose of 2000mg a day.  But still my fastings were high, in fact, Friday morning my fasting was 104 - WAY too high in my opinion.  Surprisingly, my post-meal sugars are excellent; even eating things like mac and cheese and giant baked potatoes, my post-meal sugars are all well within the normal range.

So I started myself on insulin on Friday night - 12 units of NPH.  And this morning my blood sugar was perfect.  Finally.  Thank goodness.

I'm so annoyed to be on insulin - my pregnancy is now officially high risk (though I guess it already was based on my age).  I'll have a lot more monitoring later in pregnancy, which is going to be a hassle with my work schedule.

But more than that, I'm relieved.  Sometime in the past week or so, the baby's pancreas has started making insulin, which means that the baby is going to be affected by my high sugars (my sugar passes into the baby's bloodstream, and the baby's pancreas has to work harder than it should to make more insulin - this increases the risk of low sugars after delivery, breathing problems, feeding problems, as well as increases the risk of obesity and type 2 diabetes for the baby later in life, among other things).  So I'm relieved that I caught it very early and was able to treat it on my own.

Like I mentioned, it's unlikely my OB would have tested me this early, even if I'd already been seen.  What's even scarier is that it's unlikely that my elevated sugars would have even been found with the current testing my OB (and a LOT of other OBs) do, as my sugar would have probably been fine on the one hour screen.  Several years ago the ADA recommended that the current two step testing for gestational diabetes (the one hour post drink test followed by a 3 hour test if that's abnormal) be changed to a standard, two hour test for everyone, that starts with a fasting blood sugar and is followed by a 1 hour and 2 hour check.  If any of those are out of target, you have GDM.  This recommendation was based on the International Diabetes in Pregnancy Study Group paper based on a lot of clinical trials, but primarily the HAPO study, and I was at the IDPSG meeting in 2008 that those recommendations come from.  The argument against this recommendation is that it increases the number of women diagnosed, but if you were one of those women (like myself) who would be missed with a standard screen, wouldn't you want to know? Wouldn't you want the chance to do everything possible to have a healthy child?

Ultimately, I will do anything I can to make sure this baby is healthy.  I'm very thankful that my postmeal sugars are fine right now, as I doubt I could follow the diet.  I am still so sick most days, and am still surviving on carbs with as much protein as I can tolerate (which isn't much).  But as soon as my nausea resolves, I'm following the GDM diet (though if my sugars stay good, I will allow myself cheats here and there!)  The less weight I gain now, the less likely I am to have high sugars later in pregnancy.  I hadn't really planned on watching my calories, and I guess I won't now, but the very act of rationing my carbs will end up limiting my calories somewhat.  And while I'm doing this all for Chimichanga, wouldn't it be lovely if I ended up weighing less after delivery than I did before?