Gestational Diabetes Chatter #6

[~mamaspice~]

Hi belfie, yeah I tried having a dairy snack just before bed as someone had said it might help with my fasting BSL's but it didn't really make any difference.

sorry to hear you got a 9.7. Did you have to go on insulin with your last pregnancy?

[belfie]

sorry to hear you got a 9.7. Did you have to go on insulin with your last pregnancy?

Yup, but was only up to 18 units by the end, which I didn't think was TOO bad. But really don't want to be induced this time (can't afford to be IYKWIM) so will be doing my utmost to avoid insulin - as that typically does result in induction. Last time the DE wasn't much help with the diet (she just said "oh you know your diet better than me!"), so that's why this time I've asked to see the dietician. I've just been re-reading the NSW diabetes GD meal plan... it has 4 serves of fruit!! Morning tea, lunch, dinner and supper! That seems heaps of fruit to me, and I can normally only tolerate 1 serve a day anyway due to my other dietary restrictions. But really, would you eat that much fruit?

[~mamaspice~]

Yup, but was only up to 18 units by the end, which I didn't think was TOO bad. But really don't want to be induced this time (can't afford to be IYKWIM) so will be doing my utmost to avoid insulin - as that typically does result in induction. Last time the DE wasn't much help with the diet (she just said "oh you know your diet better than me!"), so that's why this time I've asked to see the dietician. I've just been re-reading the NSW diabetes GD meal plan... it has 4 serves of fruit!! Morning tea, lunch, dinner and supper! That seems heaps of fruit to me, and I can normally only tolerate 1 serve a day anyway due to my other dietary restrictions. But really, would you eat that much fruit?

I'm not a big fruit eater TBH so no I definately wouldn't eat 4 serves per day. Was Xander a big bub? At what gestation were you induced? And are they just more keen to induce if you're on insulin because they think baby is likely to be bigger? Sorry for all the Q's, I'm just interrested because I cannot be induced, well, apart from them breaking my waters to see if that starts labour.
I am only on 4 units of insulin ATM but the endo said if I get a fasting reading over 5.5 to increase to 6 units and see how I go. Well this morning my fasting reading was 5.7 So it looks like I'll be doing 6 units tonight.

[belfie]

Good questions MamaSpice, and I'm more than happy to answer them. My first thought was "oh why can't you be induced" but then I've seen your sig - vbac :fingerscrossed: so I'm wishing you the best of luck.

Re my birth, Xander was induced at 39 weeks. It was meant to be about 38+5 but the hossie was busy and then I sat around for a few days with gels, so in the end he was born at 39+1. He was 7lb 7oz, so not big at all.
Regarding induction, have a read of SeaChange's thread as that explains it really well. In a nutshell, while some drs will suggest induction due to potential size issues (macrosomia), IMO the most crucial issue is around placenta health and the impact of insulin. My endo basically said that GD's can be at higher risk of stillbirth once over 40 weeks in particular - this is why most ppl on insulin are induced. My obs and I negotiated around induction dates. His opinion was that he'd want to induce at 38 weeks if I'd been on high insulin (60-70 units +) but given mine was lower, he was happy to wait. I also had CTG monitoring in the interim. I was happy that they were keeping a good eye on bub. The other issue can be higher risk of breathing problems, and as my endo explained it, if your bubba has had some extra blood sugar and is "big" it's not so much about the size of squeezin' 'em out (not his words ) but the risk around the body being too large for the organ maturity IYKWIM... i.e. immature heart/lungs supporting a big fat boofer body.

Given your insulin is currently low, you might be able to get away with it. So saying (and I hope this doesn't upset you) given you're 32 weeks, I don't like your chances of staying low and I agree that t his could impact your vbac attempt But on the bright side, maybe they'd just break your waters and if that gets you going (b4 40 weeks) well then that's ok. Plus it's your second which also supports an earlier labour. I tried EVERYTHING to start my labour naturally, but at 38-39 weeks, my body was TOTALLY uninterested.

Like you, I really can't be induced either this time, so that's my incentive to TRY avoid insulin (pelvic floor nerve damage & prolapse means I can risk suction/forceps - both of which I had last time, which means no epi... which means avoid induction like the plague really). Otherwise it may well be a c-s for me (plus I have a low placenta atm so it also depends on that moving).

And I'm totally happy to answer any questions you have or we can just chat about it - it's good to think through it all now . Are you also aware that many hossies have a policy to put GD bubs into special care nursery for the first 24 hours to monitor their blood sugars? (they can be low at birth) X went in, but "roomed" with me... i.e. he was in my room a lot, but we were back in the nursery for feeding - so it was less traumatic than I expected. Then he spent 60 hours under lights for jaundice lol so it was good I was mentally prepared to deal with him being in SCN.

I'm sorry to hear you'll have to go up to 6 units of insulin . FYI, I started on 8 units and ended up on 18. I was also told that at certain times, due to hormone surges & stuff, your BSL's can just creep up & up regardless of what you're eating. It's difficult when you know the impact it can have tho.

[~mamaspice~]

Wow, thanks for all the info Belfie, I didn't realise that insulin dependant GDM accelerates the maturation of the placenta. A very valid reason for keeping an eye on things. I've also read that because I've had a CS I already have a slightly increased risk of stillbirth post 39 weeks. I think that personally 39 weeks is the limit that I'm comfortable with. If bub decides to come before then, well all and good but I am seriously considering booking a CS for 39 weeks at the latest.

It will be interresting to see how quickly my insulin requirements ramp up. Hopefully not too quickly How many weeks were you when you were started on 8 units? Were you on Protaphane?

I have a scan this Friday. I'll be 33+1 weeks so it will be interresting to see what size bub is and what the fluid levels are like etc.

I'll have to check out what the Hossie's policy is re: bub in SCN etc. Thing is I not 100% certain which hospital I will be having bub. See I'm doing shared care between our local public hospital and a private OB (who is also a senior OB at the public hospital) and the plan was that if I were going to VBAC I'd birth at the public hospital but if I had an elective CS then the Ob would do that for me at the private hospital.
One of my friends who had GD recently had bub at the private Hossie and bub roomed in with her straight away. She wasn't insulin dependant tho and bub's BSL's were fine. I'm not sure what the public hospitals policy is though. I think they only take them to SCN if they have hypoglycaemia or another complication.

[belfie]

yeah it's interesting isn't it. I think the big issue is that insulin doesn't necessarily accelerate the maturation of the placenta but there is an unknown role in the impact on the placenta (maybe that's a nitpicky distinction - but it just intrigued me ). I didn't know that about the increased stillbirth risk from a previous CS either. I'm pretty sure i'll end up being a CS at 38-39 weeks.

Re my insulin, good question - I had to look it up. I started at 32+5 days.

Have fun at the scan, great to have another peek at bubba. Just bear in mind all the conflicting literature about baby size, don't let 'em freak you out. I know soooo many ppl who were told bubba was big/small etc and turned out to be quite wrong. I've got a scan at 31.5 weeks for placenta, I can't wait for another peek!!

Re your hossie, aah that makes it a little tricky to check re SCN policy. Most ppl I seem to remember in this thread, the policy was pretty standard, but of course I don't know how many were public or private. I get the impression that it's very much if you were on insulin. If you're not on insulin they don't seem as fussy, maybe that's why your friend's bub wasn't admitted? I was told that my bub would be admitted regardless of his BSL's (which were fine, first a shade low but still technically "normal"). So saying, I kinda found out that it would happen quite accidentally and then I asked them (hossie and obs) all about it. I don't think I would have been told (grrr) if I hadn't gone asking! Plus I think it also depends on the paed, as a GD bub (insulin-dependant) seems to always get checked (at my hossie) by a paed, so I imagine it's at the paed's discretion a bit too.

AFM... 9.9 tonight . really way too high, so I'm glad I'm seeing the dietician tomorrow. I actually thought I had an ok dinner too, so clearly I have to tighten up. In general my levels are sitting way too high, with only a few 6's and nearly all 7's. I think my endo thought I'd have a few weeks before it really kicked in... but I think not. So I'll be eating like a saint asap otherwise I think they'll be whacking me on insulin quick smart - eep! I actually found a place that does gluten free fish & chips! I was soooo excited. I had fish, one potato cake, TWO chips, a salad and a gluten free/onion free dim sim (I was soooo excited, I haven't been able to have a dim sim for 8 years!). So ok not very healthy at all, but I really thought the carb load woulda been ok... but the batter probably kicked me over. Plus I had a small oj with my iron in it. So I need to find another way to have my iron (it's a liquid form) and the oj helps absorption, but I think too much sugar! Ah well

Btw, you know my profile above where it says collecting acronyms... the BBG is the fun bit... that's for Beautiful Baby Girl tehehe just to keep me positive

[~mamaspice~]

Lol, I was wondering what the BBG was!

It sounds to me that unfortunately your placental hormones are going to make you insulin resistant regardless of how good you eat, so please don't beat yourself up about it. It sounds like it's outta your control really. It's good that you're onto it though. And just remember that if you DO need insulin it is best for you and Bub. I was doing some research yesterday and in order to effectively limit the effects of macrosomia I read that fastings need to be under 5.5 (preferably under 5.3) and one hour post meal BSL should be less than 8 and 2 hours post meal BSL should be less than 7. SO of course I was *****ing my finger 1 AND 2 hours after breakky and lunch yesterday just to see and 1 hour post meal my readings were 7.6 and 2 hours post they were under 6 so I'm happy with that. I did 6 units of insulin last night and my fasting BSL this morning was 5.2, so under the 5.5 which I'm happy about. I do suspect though that I'm going to havre to keep upping the insulin like you said. HOpefulyl I wont get past about 20 units.

I will definately have a chat to the OB's about both hospitals policies RE: SCN admission for insulin dependant GDM. You have a point, my friend at the private Hossy wasn't insulin dependant and nor was my friend at the public hossy and they both had their bubs rooming in straight away.

I must say I AM looking forward to my scan on friday Although I am half expecting them to tell me bub is on the larger side as I'm just feeling really ucomfortable all of a sudden. I cant remember feeling this uncommfortable with my last pregnancy. Plus Charli was born at 38 weeks weighing a healthy 7lb 8oz and I didn't have GD with her, so considering this is a GD pregnancy AND I'm having a boy, which are generally bigger anyway, I thing baby B might be a 9 pounder by 38 weeks.

Good luck with your upcomming scan. Hopefully the placenta has moved away for you.