Monday, September 19, 2022

Life with Gestational Diabetes (Part 1)

I've now had my gestational diabetes ("GD") diagnosis for almost three weeks. It's been a bit of an adventure, and definitely not an especially fun one. The good news is that - at least for now, and hopefully also for the next few weeks or longer - it seems likely I can manage the condition fairly easily with relatively small diet and lifestyle changes. The bad news is I'm finding that the standard of care for gestational diabetics at my OB-GYN practice and the specialists they refer to is not especially high, so there's been little support from my medical professionals. This isn't an insurmountable problem at present because my condition is luckily uncomplicated for now, but it doesn't feel great to navigate it mostly by myself.

Because today's topic is completely about a potentially serious medical condition and the management thereof, an important and necessary disclaimer: I am not a medical professional, so for all things to do with GD, please consult with your doctor first and foremost. Sadly, it does seem like my experience with feeling somewhat left in the lurch by one's medical team is not that uncommon with GD, so I think many people end up finding lots of guidance and help from other people who have been there. (In the past few weeks, I've been on the r/GestationalDiabetes subreddit for much of my education about how to manage the condition.) 

The Emotional Side

As I mentioned last week, I probably wasn't as shocked or upset about my diagnosis as many might be. I have huge genetic risk factors for Type 2 diabetes in my family, and already had a right-on-the-edge of prediabetic blood sugar reading at a physical last year, which means that many of the scary implications of GD for the pregnant patient were things I already knew to be true for me long before my diagnosis. 

That being said, once I finally got in for my specialist consult and officially received medical counseling about the potential very bad side effects of poorly managed GD for both baby and pregnant person, I did feel emotionally distraught for a few hours while I processed that. (This first appointment happened nearly 10 days after my diagnosis, a not uncommon time gap.) My understanding is that much of the severity of GD - particularly around weeks 32 to 36 of pregnancy - is basically not in the patient's direct control because it's mostly driven by the placenta and hormones. Thus, the medical advice can sound a bit like "hey, all these super-bad things can happen, but you really can't control if it happens." Which, yikes...

It didn't help that this consult was also the appointment where I learned there's a communication gap between my OB-GYN practice and the specialist's office about who will actually be supervising my GD care and scrutinizing my blood sugar results on an ongoing basis. This isn't a huge problem for now, after I finally figured out finger-stick test (on my own, with help from some r/GestationalDiabetes comment threads). Almost all my readings have been consistently normal, with only one or two spikes with obvious causes that are relatively easy for me to avoid going forward, which somewhat reduces the urgency of getting more follow-up care right at this moment. I'll get to the bottom of figuring out who's actually supervising my care within the next week or so, no doubt, but it's definitely been frustrating!

Diet Changes and Monitoring Blood Glucose Levels

Throughout the pregnancy, I've been fortunate enough to not have had any major problems with nausea, food, aversions, and the like. I've even been eating somewhat less candy and sweets than I usually do, since those flavors don't strongly appeal to me most of the time. I've also never eaten an especially high-carbohydrate diet because the foods I like best are more on the savory and higher fat and/or protein side of things. Thus, the diet changes that help many people manage their GD - at least until week 32 when hormones often go haywire - have not been too challenging for me thus far. 

For the first week after my diagnosis, I hadn't yet figured out finger-stick tests and using a home blood glucose meter - I swear I jabbed myself nearly 20 times over a few days on and off and barely got two or three valid test results - so I was almost scared to eat carbs. That definitely wasn't sustainable, to try and navigate the diet changes without any real monitoring of blood sugar levels. 

I don't know if GD affects the body's ability to get by on very low carbs, because for the first time in my life I sometimes seemed to experience some brain fog if I got too aggressive about avoiding carbs while still eating enough otherwise? That's a question I should bring my doctor, or the dietitian or nurse they refer me to for GD supervision... 

I was making two big mistakes when I initially couldn't get the finger-stick tests to work with my blood glucose meter:

  • (1) I wasn't applying blood to the test strips correctly, so I just couldn't get enough most of the time no matter how hard I tried. With the Contour Next strips I use - with the Contour Next One monitor - one sort of scrapes the middle of the tip of the strip against the blood drop, and it should flow right on without needing much blood. (Only a small drop is necessary, somewhat less than the diameter of a slightly written-with non-mechanical pencil tip...) 
  • (2) I was probably flinching my finger away from the lancing device - I use the Accucheck Fastclix - and thus couldn't get jabs with a neat drop of blood that was easily applied to the test strip. I fixed that by sort of holding my finger down with the tip of the lancing device, say against the surface of my desk. With that tip - and some other common tricks like washing my hands with warm water right before testing, rubbing my finger while holding it low to my side beforehand, and working mostly with my pinky and sometimes my ring finger - I was able to set the lancing device to a lower depth setting and still consistently get enough blood on the first jab. It doesn't really even hurt, though it was initially extremely stressful before I figured it out. 

For me, the most important readings I currently take each day are my fasting result first thing in the morning - if that number starts going up to abnormal levels by itself, it's a potential sign of needing medication or insulin because the hormones have started to go haywire - and then an hour after my first bite of each meal. Based on my three-hour glucose test results and my occasional readings at two hours after some meals, I don't seem to show any signs of spiking at two hours rather than one hour. 

Now that I've been logging my blood glucose results faithfully for a few days, it seems like there are a few things I can't do with GD, all of which are somewhat common with many other patients:

  • (1) Eating particularly many carbs early in the morning, even things like a small slice of wheat bread - something I can handle perfectly even two hours later in the same day - with eggs and some coffee with milk for breakfast could get me close to a less normal reading, even if it wouldn't be a problem for lunch or dinner. 
  • (2) Drinking heavily sweetened drinks, as those can cause me to feel slight sugar crash symptoms. I made a mistake once with a Starbucks chai latte which, in hindsight, obviously probably would contain very high added sugar in an amount that's simply not advisable for any GD patient (~35 g added sugar in a tall). (I foolishly didn't check before drinking because I'd recently had a much less sweetened chai at an independent coffee shop and it wasn't a problem.) 
  • (3) It seems this is different for many patients, in that it can be unpredictable which types of carbs each patient can eat without causing blood glucose to spike. But corn tortillas, and maybe corn in general, may be a blood sugar spike-causing carb for me that I should avoid. I had my only abnormal fasting number so far the morning after a taco dinner made with corn tortillas. (Other taco meals with whole wheat or whole wheat + white flour tortillas have since been fine.)

There are certain other things that would probably also be too difficult or impractical to regularly incorporate into my diet for now: Delivery pizza night for K and I is no more until after pregnancy, as I would have too hard a time limiting myself to a small enough portion of pizza with the right side dishes for it to be workable. Many patients report that GD control is almost more about pairing controlled quantities of carbs with protein, fat, fiber at each meal than about exactly which carb or sugar-containing foods are eaten.

The Cost of Diabetes Care

I know I probably ain't seen nothing yet when it comes to the cost of diabetes care, because I'm not currently on any medication or insulin, but dang, even the price of some of the associated tools add up! The first time I went to the drugstore to pick up the basic tools - the blood glucose monitor, some testing strips, the lancing device, and extra lancet refills - the bill was right around $72.00. And that only included a week's worth of testing strips!

The monitors and lancing devices themselves generally aren't too expensive, I paid maybe ~$21 for the monitor and only ~$12 for the lancing device. But kind of like with inkjet printers, it's the refills that will really get you, or price-gouge you. Testing around four times'/day like I currently do may be on the lower side of average frequency for a GD patient, and I've calculated out the cost of my Contour Next testing strips for that at ~$2.28/day if I buy in bulk! Lancets are a bit cheaper, and I know not everyone uses a fresh lancet at every jab, but if I do that's going to be another ~$0.88/day

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