In March last year, quite early into my first pregnancy, I was diagnosed with Gestational Diabetes. I have quite a lot to say about this, because it was the worst thing about being pregnant and I think that’s mainly due to misinformation.
Most people aren’t tested for GD as early as I was, but because my BMI is high they checked me out early doors and diagnosed me in March 2018. This was done by taking a blood sample first thing in the morning, when I hadn’t eaten since the night before, and testing my blood glucose. It was 5.4, which is the top end of healthy for a non pregnant person (if that’s you, your fasting level should be between 4 and 5.4). If you’re up the duff in Scotland, they’re looking for it to be 5.1 or lower.
This discovery kick started a machine that irritated me for the rest of my pregnancy. I got booked in to an ‘education session’ with a nutritionist at the hospital, and had to begin checking my blood sugar 4 times a day and attending a series of fortnightly checkups with a different midwife, obstetrician, diabetes consultant and medical student pretty much every time. New mums with uncomplicated pregnancies get to see the same community midwife throughout, and I was fiercely jealous – not least because the community midwife, on the few occasions when I did get to see her, didn’t act as though the only way I could be overweight is by subsisting exclusively on jammy dodgers and sherbert.
NB, high BMI is by no means the only risk factor for GD, and very slim people get it too. However, as a perennially chubby person (according to the BMI I’m obese even when I’m a size 12, and keep in mind I’m 5’7″ so not petite), I had an awful lot of medical professionals insinuating I slept with the biscuit tin under my pillow. This in spite of the fact they know perfectly well the condition is caused by pregnancy hormones.
Basically my increased levels of oestrogen, progesterone and human placental lactogen made my body resistant to insulin, meaning I couldn’t break down sugar properly. It’s like being allergic to carbohydrate – one of the highest spikes I got in my blood sugar levels was from eating wholegrain rice, and another was porridge.
This is because in spite of being seemingly quite healthy, oats (carbohydrate) + milk (carbohydrate) + a banana (carbohydrate) break down to effectively be eating a bowl of sugar. In spite of this, the NHS advice to those dealing with GD is to ensure that about 45% of each meal consists of… starchy carbohydrate.
I understood the risks of GD pretty fast. It’s associated with macrosomia (baby growing too big because your body feeds all the unprocessed sugar to it like a massive Brutus), pre-eclampsia (which can straight up kill you), premature birth and stillbirth. Understandably the NHS want to keep an eye on you, hence the fortnightly clinic – at which I had questions.
Could the diagnosis be wrong? I didn’t get the glucose test, after all. This was mentioned in the NHS leaflet, which said I’d have to drink a cup o’ liquid sugar and get a blood test to see how my body coped, but I didn’t have that. The leaflet also said diagnosis would normally be at 24-28 weeks, but they told me in week 12. But for the first few weeks, in spite of the initial high reading, my sugar levels were usually under 5. Could that one fasting level not have been a fluke? If I had Type 1 or 2 diabetes, those early readings would be bloody amazing.
The response of the diabetes consultant to all this was to smile and say no. Literally, that was the full explanation I got from him, and then he reiterated the risks and told me to eat sensibly. Oh, and that I’d have to lose weight after having the baby or I might get Type 2 diabetes in later life. Cheers for that in-depth analysis, pal. Subsequent consultants kindly reminded me of this fact every couple of weeks, just in case I was in danger of being excited about my baby or some shiz.
Thank goodness then for the internet, which told me:
Healthy pregnant bodies deliberately work to keep blood sugar lower than normal – this is actually why they want your levels to be low. Think of it a bit like fetuses being allergic to sugar – so even a little bit extra thanks to your newly insulin-resistant bod is bad.
Most people end up on some form of medication because the condition is progressive and driven by hormonal changes. Even if you do manage to control it through diet and exercise to start with, as I did, your placenta hates you and does not want you to have treats. And even if you don’t have treats, it’ll still get worse for the majority of people. THIS IS NOT YOUR FAULT. But, some (most) consultants will kind of act like it is, making snide comments about resisting chocolate biscuits and how you’re going to have to diet as soon as the baby is born.
I guess this is because it costs them money to medicate you, and they’re hoping that if people can control it through diet it’ll save them cash? I’m not sure who told them the best way to get a (notoriously hormonal) pregnant person not to want cake is to imply that even considering it means you want your unborn kid to possibly die. It doesn’t seem like textbook bedside manner? It certainly belies no understanding of comfort eating.
Also, they will never, ever ask you about what you’re actually eating (mostly chicken and spinach) or how much exercise you’re doing (walking 11,000 steps a day minimum and swimming twice a week right up until about week 34 for me).
Having said all that, my experience was that somewhere in the third trimester the string of consultants start to concede that actually it’s not your fault really. So if this is happening to you now, grit your teeth and hang on in there. I know it seems like forever, but it’s only a few months, and when you deliver that ratbag of a placenta you’re immediately cured.
Different bodies will tolerate different things, so you need to experiment with food a little bit to get the right balance for you. For instance some people with GD find that tomatoes send their levels sky high, but I was fine with them. Same with carrots, and multi-seeded bread. I would seriously suggest ignoring the advice to follow the Eatwell Guide, which is nutritionally simplistic and verging on nonsensical if you want to manage this. Take a look at gestationaldiabetes.co.uk for info and advice, and experiment with high protein, low carb recipes. But don’t cut out starchy carbohydrate altogether, because this can lead to ketoacidosis which is A Bad Thing.
As I mentioned, because of all the risks associated with this condition, the hospital want to keep a close eye on you. I wrote a description of the fortnightly clinic in the waiting room in June:
You get to clinic early, on time or a few minutes late – it doesn’t seem to make much odds which. You sit for a bit, and a nurse asks you to pee in a cup. You hand it over. You sit. A different nurse takes your blood pressure. You sit. A midwife listens to the baby’s heart and asks you how you’re getting on: have you had this form yet, how about that injection. You sit. And then you go into a room with three doctors (one student, one diabetes, one obstetrician) and they smile and patronise you.
You can only assume they do it this way round because if you saw the consultants before the midwife, they’d have serious concerns about your blood pressure.
Although I started out controlling my GD through diet and exercise, I ended up on Metformin tablets and latterly evening injections of Lantus insulin to control my morning sugar levels as they kept creeping over 5.5.
In the last few weeks they regularly suggested I was going to have to add in Novorapid insulin injections with main meals on top of that, although this didn’t actually happen – possibly because I restricted my carbohydrate intake even further by doing things like having broccoli or sweet potato with a protein component instead of couscous or rice. On a related note, I didn’t put on any weight until week 36 of my pregnancy…
Gestational Diabetes is a total pain in the hoop, not least because it ruins your birth plans. I had to go in early to be induced and was not allowed to come home again til the baby arrived because they wanted to monitor me every few hours. This meant I was 6 days in hospital overall – being offered almost exclusively foods that would spike my blood sugar, ironically enough. I did my best to choose vegetable and protein options over lashings of potatoes, white pasta and white bread (all of which spike you) but pickings were grim…
You had better believe that as soon as my baby was born I was straight on the school dinner style sponge pudding and custard though!
Because that’s the thing – the second that baby is born, your body goes back to normal. The hospital no longer give a toss what your blood sugar levels are like, and your body is able to process carbs properly again (unless you were pre-diabetic, which I was not).
Having GD is maddening. You obsess over food and feel guilty about your choices pretty much all the time – in spite of the fact you know logically it’s outside your control. You end up on medication regardless of how much salad you eat (or the majority of women do), and you feel like a failure – even though, again, it’s outside your control. At a time when you’re constantly knackered and highly emotional, when people blithely tell you to just do what you want because after all you’re eating for two, you’re told by the NHS you can’t even have an apple without worrying about what the sugar content might do to your unborn child.
But, having GD is also fleeting. At the time I felt like it was casting a shadow over my pregnancy, because of the mental work that went into it but also due to the endless bloody hospital appointments. (Seriously, couldn’t they make glucose monitors wifi compatible so you can upload your results every day and go in if they think there’s an actual problem? I spent so. much. time. hanging around waiting rooms to be told ‘your readings are pretty good, phone if you get anything out of the ordinary’)
Ten (nearly eleven) months later, all this feels like a distant memory. The end game, or baby as he is also known, has certainly drowned out my general irritation at the injustice of not being able to have porridge in the mornings.
I’ve been told that because I had GD once, it’s likely I’ll have it again in any future pregnancies. If that happens though, I’ll get through it again.