My daughter arrived a little early. About a month early, actually. But she is healthy and doing just fine. She weighed 5 lbs 11 oz at birth and my OB estimated that had I gone to full term, she would have been around 8 lbs. A good size, but not as big as you might expect for having gestational diabetes.
As the pregnancy went on, I found it easier to control my blood sugar. The glyburide definitely helped. Towards the end, I was skipping my morning walk since I was able to keep my post-breakfast glucose under 130 without it. I was tired in the mornings and it was getting warm, even at 8am. I continued with my evening walks with my husband and son, and that has continued to be a night time routine, even when I wasn't able to go after our daughter was born, my husband still took our son out.
The other thing that I found really helpful was a protein shake I could eat for lunch when I was too nauseated for other sources or protein or just too tired or hungry to make something requiring more effort. I used a shake called Spiru-Tein that I have had before. In fact, I drank it during the first trimester of both pregnancies when I was nauseous but needed to eat. I was worried it would raise my glucose levels too much, so I hesitated to try it until I felt like I had my blood sugar pretty well under control. Although it only has 11 grams of carbs, I mix it with milk and it tastes pretty sweet. I found the best way to make it is to mix one scoop in the blender with 1 cup of milk, about 8 ice cubes. The vanilla one almost tastes like a milk shake.
There were some days when I felt nauseous and didn't want to eat any protein, not even peanut butter or cheese (the two forms of protein I could tolerate best when I had no appetite). I would feel depressed because I didn't want to eat anything, but I needed to eat something for the baby, something with protein. Once I found I could make this shake, feel full, and have a post-lunch glucose level of around 95, I felt a lot better. I didn't have to stress about whether or not I had an appetite because I had a backup meal I knew I could tolerate.
Once my daughter was born, my OB told the nurses they didn't need to test my blood sugar any more (they were testing it every few hours at first) and that I could resume a normal diet. I tried to continue to eat well from the hospital menu, but I did indulge in chocolate pudding the first night and loved every spoonful.
Since coming home from the hospital, I try to follow the basics of the diet I had been on. I try to eat snacks between meals and have protein any time I eat. And I try to still drink about 3 glasses of milk per day. But I've gone back to having my morning coffee with milk and I've been indulging in a little chocolate every night. But I don't eat cereal for breakfast - I have something with protein, usually a PB&J sandwich on whole grain bread. And I still try to limit my carbs at meals and eat brown rice instead of white, etc.
It's been weird sitting down to eat and not having to remember to set a timer for 1 hour. And I still mentally go over what I'm eating, even if I don't actually write it down in a log anymore. I also find that after I eat, I feel like I'm forgetting to do something (test my blood sugar).
In about a month, I'll start testing my blood sugar again so I can take the results to my OB on November 6. Hopefully everything returns to normal. I asked him if I was likely to get GD again if I have another baby. He said chances were good, but if I get my weight down and change my eating habits and continue to exercise regularly, he has seen women who don't develop GD on a subsequent pregnancy.
Monday, September 21, 2009
Friday, September 4, 2009
Good news
I saw my OB today. I only gained 1 pound in the 3 1/2 weeks since my last visit. Although I started this pregnancy 10 pounds heavier than my first, I may actually not go over my all time high weight from last pregnancy. We'll see - I'm about 3 pounds under what I weighed at my last prenatal visit during my last pregnancy and I only have 4 weeks to go.
I confirmed with my doctor that I will take the glyburide up until the night before my scheduled C-Section (unrelated to the gestational diabetes). But the good news is that once the baby is born, I don't need to test my blood and I can eat whatever I want. He specifically mentioned cake and ice cream. I'm excited. I thought I'd have to test my blood even in the hospital and order off the diabetic hospital menu.
A week or so before my follow-up exam 6 weeks post-partum, he said I should start testing my blood here and there - both fasting and after meals, but not the 4 times a day I do now. And then I should bring those results with me. If all looks OK, I'm good. I won't even have to do another glucose tolerance test that I was dreading (I read online that they usually do one 6 weeks after you deliver to be sure the diabetes is gone). He said since we have such good glucose monitors these days, it makes more sense to test your blood with how you eat normally. He also said hopefully I would make lasting changes based on what I've learned. And certainly I will since I think it will help ward off Type II diabetes. But at least I'll be able to have more than 15 g of carbs at breakfast and I can indulge in chocolate mousse once in a while.
I confirmed with my doctor that I will take the glyburide up until the night before my scheduled C-Section (unrelated to the gestational diabetes). But the good news is that once the baby is born, I don't need to test my blood and I can eat whatever I want. He specifically mentioned cake and ice cream. I'm excited. I thought I'd have to test my blood even in the hospital and order off the diabetic hospital menu.
A week or so before my follow-up exam 6 weeks post-partum, he said I should start testing my blood here and there - both fasting and after meals, but not the 4 times a day I do now. And then I should bring those results with me. If all looks OK, I'm good. I won't even have to do another glucose tolerance test that I was dreading (I read online that they usually do one 6 weeks after you deliver to be sure the diabetes is gone). He said since we have such good glucose monitors these days, it makes more sense to test your blood with how you eat normally. He also said hopefully I would make lasting changes based on what I've learned. And certainly I will since I think it will help ward off Type II diabetes. But at least I'll be able to have more than 15 g of carbs at breakfast and I can indulge in chocolate mousse once in a while.
Tuesday, August 25, 2009
Glyburide follow-up
The glyburide really seems to be working. I've been well under 95 every morning, except the morning after I forgot my glyburide and had a fasting blood glucose level of 104.
Despite the fact that my fasting number is so much lower, I quickly discovered that I still need to go for a walk after breakfast to keep my post-breakfast reading under 130, otherwise it ends up slightly elevated. But a 10-12 minute walk will generally keep it under 120.
The rest of my post-meal readings are consistently under 130 (with a few exceptions I have posted about previously), so I am able to keep them in check through diet and exercise. It really seems to be the mornings I have the most trouble with.
I want to ask my OB at my next visit (Sept 4) when I should stop taking the glyburide. The nurse indicated I would take it until I delivered, but not after since you can't take it while breastfeeding. But the information that came with the prescription says you should stop taking it 2 weeks before your anticipated due date so it won't show up in your breast milk. I might be taking a low enough dose that it's not a concern, but I do want to verify since I intend to breastfeed exclusively.
Despite the fact that my fasting number is so much lower, I quickly discovered that I still need to go for a walk after breakfast to keep my post-breakfast reading under 130, otherwise it ends up slightly elevated. But a 10-12 minute walk will generally keep it under 120.
The rest of my post-meal readings are consistently under 130 (with a few exceptions I have posted about previously), so I am able to keep them in check through diet and exercise. It really seems to be the mornings I have the most trouble with.
I want to ask my OB at my next visit (Sept 4) when I should stop taking the glyburide. The nurse indicated I would take it until I delivered, but not after since you can't take it while breastfeeding. But the information that came with the prescription says you should stop taking it 2 weeks before your anticipated due date so it won't show up in your breast milk. I might be taking a low enough dose that it's not a concern, but I do want to verify since I intend to breastfeed exclusively.
Thursday, August 20, 2009
Looking on the bright side
On the tough days, it is easy to think about the downside of having gestational diabetes. But this morning, during my morning walk, I was thinking about the upside.
For one thing, I'm eating better for the baby than I had been. The lack of appetite that persisted after the first trimester had me eating a lot of cereal and PB&J sandwiches. I'm eating a better variety of foods now.
I'm also learning healthy eating habits that I think will stay with me and help me ward off Type II diabetes, such as eating smaller meals and eating snacks in between, as well as combining proteins with carbs.
I'm gaining less weight than I would otherwise. I started this pregnancy 10 pounds heavier than my last pregnancy and was worried about ending up 10 pounds heavier at the end than at the end of my last pregnancy. But since I started the diet and exercise, my weight gain has slowed and I'm almost hopeful that I will plateau and end up right around where I did last time.
And the other thing I'm happy about is that we are talking to our neighbors more now that we are out walking every evening (and I'm out every morning). The evenings here have been unseasonably cool and pleasant and we often see neighbors out in their yards or walking their dogs and stop to chat. We've even met some new neighbors, including a couple that lives 2 houses away that we never manged to introduce ourselves to in the 4 years we've been here.
For one thing, I'm eating better for the baby than I had been. The lack of appetite that persisted after the first trimester had me eating a lot of cereal and PB&J sandwiches. I'm eating a better variety of foods now.
I'm also learning healthy eating habits that I think will stay with me and help me ward off Type II diabetes, such as eating smaller meals and eating snacks in between, as well as combining proteins with carbs.
I'm gaining less weight than I would otherwise. I started this pregnancy 10 pounds heavier than my last pregnancy and was worried about ending up 10 pounds heavier at the end than at the end of my last pregnancy. But since I started the diet and exercise, my weight gain has slowed and I'm almost hopeful that I will plateau and end up right around where I did last time.
And the other thing I'm happy about is that we are talking to our neighbors more now that we are out walking every evening (and I'm out every morning). The evenings here have been unseasonably cool and pleasant and we often see neighbors out in their yards or walking their dogs and stop to chat. We've even met some new neighbors, including a couple that lives 2 houses away that we never manged to introduce ourselves to in the 4 years we've been here.
Complications
Since starting the glyburide, I've been doing much better with my glucose levels. My fasting blood glucose has been 90 or below every day since I starting the glyburide, usually around 85. And the few times I've gone over 130 after a meal, it's never been over 135 (with one exception) and I could usually pinpoint something in my diet (or lack of exercise) that caused it.
The one exception was Monday night. That afternoon, I noticed a contraction just before 3pm. I thought it was a BH contraction at first, but realized it was a little painful. Only about a 3 on a scale of 1 to 10, but the BH contractions have never been painful. I was working at the computer and jotted down the time. Twelve minutes later, I had another one. And another 12 minutes after that. I knew that 6 contractions in an hour, even BH contractions, warranted a call to the OB, and if they continued at 12 minutes apart, that would be 6 within an hour. The next came 10 minutes later, but was milder. And another mild one came 10 minutes after that. By then, my son woke up and I couldn't keep track. But I called my husband to come home and called my OB's office. The nurse called back and said to go to triage.
I spent 2 1/2 hours at triage, being monitored. It was over the dinner hour and I asked if they had food since I was due for a meal and I had gestational diabetes. They brought me a turkey sandwich with an apple and some kind of sugar-free gel dessert. I ate the whole sandwich although I suspected it had more carbs than the bread I normally eat, but I only ate half the apple.
Immediately before I ate, they also gave me a shot of terbutaline to stop the contractions. One hour after I started eating, my blood sugar was 152. That was pretty high even for a higher carb bread. I also hadn't gone for a walk, obviously, but considering that my post-dinner blood sugar when I do take a walk is in the low 100s or even mid-90s, I suspect the terbutaline had something to do with it.
When they released me, they said no exercise or lifting until my OB cleared me. This worried me since the last time I skipped my post-meal walks, my blood sugar was too high. Fortunately, I got ahold of my OB on Tuesday and he cleared me to resume normal activities. The contractions hadn't opened or thinned my cervix and the fetal fibronectin test they did came back negative, meaning I was unlikely to deliver in the next 2 week. He said controlling the gestational diabetes was more important. So although I skipped my morning walk on Tuesday (and had a blood sugar of 131 after breakfast), I resumed my walks that night and have been doing OK ever since.
The one exception was Monday night. That afternoon, I noticed a contraction just before 3pm. I thought it was a BH contraction at first, but realized it was a little painful. Only about a 3 on a scale of 1 to 10, but the BH contractions have never been painful. I was working at the computer and jotted down the time. Twelve minutes later, I had another one. And another 12 minutes after that. I knew that 6 contractions in an hour, even BH contractions, warranted a call to the OB, and if they continued at 12 minutes apart, that would be 6 within an hour. The next came 10 minutes later, but was milder. And another mild one came 10 minutes after that. By then, my son woke up and I couldn't keep track. But I called my husband to come home and called my OB's office. The nurse called back and said to go to triage.
I spent 2 1/2 hours at triage, being monitored. It was over the dinner hour and I asked if they had food since I was due for a meal and I had gestational diabetes. They brought me a turkey sandwich with an apple and some kind of sugar-free gel dessert. I ate the whole sandwich although I suspected it had more carbs than the bread I normally eat, but I only ate half the apple.
Immediately before I ate, they also gave me a shot of terbutaline to stop the contractions. One hour after I started eating, my blood sugar was 152. That was pretty high even for a higher carb bread. I also hadn't gone for a walk, obviously, but considering that my post-dinner blood sugar when I do take a walk is in the low 100s or even mid-90s, I suspect the terbutaline had something to do with it.
When they released me, they said no exercise or lifting until my OB cleared me. This worried me since the last time I skipped my post-meal walks, my blood sugar was too high. Fortunately, I got ahold of my OB on Tuesday and he cleared me to resume normal activities. The contractions hadn't opened or thinned my cervix and the fetal fibronectin test they did came back negative, meaning I was unlikely to deliver in the next 2 week. He said controlling the gestational diabetes was more important. So although I skipped my morning walk on Tuesday (and had a blood sugar of 131 after breakfast), I resumed my walks that night and have been doing OK ever since.
Thursday, August 13, 2009
First dose of glyburide
The glyburide prescription didn't get called in until Wednesday. On Tuesday, my fasting blood sugar was 93 and the rest of the day I was under the 130 post-meal limit. So I thought that if my fasting blood sugar on Wednesday was still under 95, maybe I could delay starting glyburide for another day and see how I did.
Tuesday night, my post-dinner blood sugar was 99. I had the same bed-time snack as the night before (peanut butter and a tsp of low sugar jam on a slice of wheat bread with a glass of milk) at the same time as the night before (9:35pm). Wednesday morning, I tested my blood sugar at 7am, the same time as I tested on Tuesday. My reading was 99. Quite a bit higher than the previous day and several points over the limit. I guess there really isn't anything I can do about it.
So Wednesday I picked up the glyburide. I was reading the info that came with it and noticed that it said to discontinue use 2 weeks prior to your expected due date if you plan to breastfeed. The nurse had told me I would take it up until I deliver, but not after I deliver since you can't take it if you are breastfeeding. Which makes me wonder how long it stays in your blood. I'll have to ask my OB at my next appointment since I definitely plan to breastfeed.
Last night with my night time snack, I took 2.5 mg of glyburide. I woke up several times last night to pee, but didn't notice any signs of hypoglycemia. Although it might be hard to tell when you are half asleep. My fasting blood sugar this morning was 84. After breakfast, it was 116. I had the same breakfast as yesterday (1 whole grain waffle (12.5 g of carbs) with peanut butter and a side of cottage cheese and coffee) and yesterday my blood sugar was 124. And that was after a nearly 20 minute walk! Today, I didn't get out for my walk, partly because I was tired and partly because Thom was working from home and I didn't have the energy to take Aaron with me. So having a lower baseline really helps in the morning.
Tuesday night, my post-dinner blood sugar was 99. I had the same bed-time snack as the night before (peanut butter and a tsp of low sugar jam on a slice of wheat bread with a glass of milk) at the same time as the night before (9:35pm). Wednesday morning, I tested my blood sugar at 7am, the same time as I tested on Tuesday. My reading was 99. Quite a bit higher than the previous day and several points over the limit. I guess there really isn't anything I can do about it.
So Wednesday I picked up the glyburide. I was reading the info that came with it and noticed that it said to discontinue use 2 weeks prior to your expected due date if you plan to breastfeed. The nurse had told me I would take it up until I deliver, but not after I deliver since you can't take it if you are breastfeeding. Which makes me wonder how long it stays in your blood. I'll have to ask my OB at my next appointment since I definitely plan to breastfeed.
Last night with my night time snack, I took 2.5 mg of glyburide. I woke up several times last night to pee, but didn't notice any signs of hypoglycemia. Although it might be hard to tell when you are half asleep. My fasting blood sugar this morning was 84. After breakfast, it was 116. I had the same breakfast as yesterday (1 whole grain waffle (12.5 g of carbs) with peanut butter and a side of cottage cheese and coffee) and yesterday my blood sugar was 124. And that was after a nearly 20 minute walk! Today, I didn't get out for my walk, partly because I was tired and partly because Thom was working from home and I didn't have the energy to take Aaron with me. So having a lower baseline really helps in the morning.
Tuesday, August 11, 2009
Glyburide
I saw the dietitian and the nurse this morning after having trouble controlling my blood sugar last week. The last 3 mornings my fasting levels have been 95 or under and my post-meal levels have mostly been OK the last two days. But looking back over the week, my averages were too high. And they pointed out that even when my fasting levels weren't high (prior to the triage incident and in the last 3 days) they are still hovering right around 95.
I had really hoped to control my blood sugar through diet and exercise, in part because my OB thought I would be able to, but mostly because I feel that is best for me and the baby. So I was disappointed when they decided to start me on medication. I had hoped that since I was doing better since I started exercising again that we could modify my diet a little first. But the dietitian didn't see that I was eating a lot of carbs and she feels that the high levels are most likely due to pregnancy hormones. Plus the fasting level which seemed to be their highest concern, along with my post-breakfast levels, which could be high due to a higher fasting level, seems to be harder to control with exercise and diet. And she said she didn't want me to starve myself by cutting back my carbs even more. And some mornings, I was so hungry, I felt like I was starving myself.
The medication is Glyburide. The nurse explained that it makes the pancreas pump out a little more insulin and that it doesn't cross the placenta. I can't take it when I'm breast feeding, though, so I won't take it past the delivery. They are starting me on 2.5 mg, to be taken with my night time snack.
They started to talk about my high post-lunch readings, but when I pointed out that it seemed to be higher the times I had fruit, we decided I would avoid fruit at lunch time for now and see how it goes. The dietitian even suggested adding fruit to my dinner (as extra carbs) since my post-dinner readings are so good (usually 110 or less, often under 100 when I go for a walk). I do have fruit with cottage cheese every day for my afternoon snack, so I might just stick with that for now.
They warned me about hypoglycemia - low blood sugar - and that if I woke up at night with any of the symptoms, I should test my blood sugar. If it is below 60, I should have a fast-acting carbohydrate, like 1/2 cup of juice, then retest my blood after 20 minutes (I think that is right, but I have to double-check the time). If that happens 2 nights in a row or if my fasting blood sugar is under 60 2 mornings in a row, I should call and they could cut my dose back to 1.25 mg, but she didn't think I'd have a problem. 2.5 mg is a pretty low dose, apparently.
I'm not thrilled about it, but I want to do whatever is best for the baby. And maybe it will mean I have an easier time controlling my blood sugar after breakfast and after lunch. I'm just worried that I'll end up putting a little sugar in my coffee or skipping my morning walk if the glyburide is doing all the work.
I had really hoped to control my blood sugar through diet and exercise, in part because my OB thought I would be able to, but mostly because I feel that is best for me and the baby. So I was disappointed when they decided to start me on medication. I had hoped that since I was doing better since I started exercising again that we could modify my diet a little first. But the dietitian didn't see that I was eating a lot of carbs and she feels that the high levels are most likely due to pregnancy hormones. Plus the fasting level which seemed to be their highest concern, along with my post-breakfast levels, which could be high due to a higher fasting level, seems to be harder to control with exercise and diet. And she said she didn't want me to starve myself by cutting back my carbs even more. And some mornings, I was so hungry, I felt like I was starving myself.
The medication is Glyburide. The nurse explained that it makes the pancreas pump out a little more insulin and that it doesn't cross the placenta. I can't take it when I'm breast feeding, though, so I won't take it past the delivery. They are starting me on 2.5 mg, to be taken with my night time snack.
They started to talk about my high post-lunch readings, but when I pointed out that it seemed to be higher the times I had fruit, we decided I would avoid fruit at lunch time for now and see how it goes. The dietitian even suggested adding fruit to my dinner (as extra carbs) since my post-dinner readings are so good (usually 110 or less, often under 100 when I go for a walk). I do have fruit with cottage cheese every day for my afternoon snack, so I might just stick with that for now.
They warned me about hypoglycemia - low blood sugar - and that if I woke up at night with any of the symptoms, I should test my blood sugar. If it is below 60, I should have a fast-acting carbohydrate, like 1/2 cup of juice, then retest my blood after 20 minutes (I think that is right, but I have to double-check the time). If that happens 2 nights in a row or if my fasting blood sugar is under 60 2 mornings in a row, I should call and they could cut my dose back to 1.25 mg, but she didn't think I'd have a problem. 2.5 mg is a pretty low dose, apparently.
I'm not thrilled about it, but I want to do whatever is best for the baby. And maybe it will mean I have an easier time controlling my blood sugar after breakfast and after lunch. I'm just worried that I'll end up putting a little sugar in my coffee or skipping my morning walk if the glyburide is doing all the work.
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