Abu Dhabi, UAEMonday 19 August 2019

Forced walks and crying over pizza: dealing with gestational diabetes

Studies have shown up to one third of pregnant women in the UAE are diagnosed with temporary diabetes in pregnancy

Around 32 weeks heralds the start of the toughest time for those with gestational diabetes. Getty
Around 32 weeks heralds the start of the toughest time for those with gestational diabetes. Getty

I arrived for the gestational diabetes test well prepped for the three-hour wait, having loaded my bag with carefully chosen reading material. I needn’t have bothered. I had barely warmed the seat when I was told there was no need to continue. A doctor would be in touch, the lab technician said.

It didn’t take long to work out what that meant. I had failed the glucose tolerance test at the first hurdle – the fasting blood reading.

I called my husband and explained what had happened through the sobs. We arranged to meet at a cafe nearby, where I chose a fruit platter to eat – but quickly realised I probably couldn’t eat this, either. It may be natural sugar, but it is still loaded with the stuff. Cue even more tears.

Dealing with the diagnosis

After I finally stopped crying, I decided there was nothing else to do but get on with it. I went out and bought a home glucose monitor and hit the internet for tips to learn the rules of managing gestational diabetes. The strain of the disease develops during pregnancy, and like other types of diabetes, it affects how your cells use sugar, causing high blood sugar that can affect your pregnancy and your unborn child.

The strain of the disease develops during pregnancy, and like other types of diabetes, it affects how your cells use sugar, causing high blood sugar that can affect your pregnancy and your unborn child.

In case you’re interested, blood sugar is hardest to manage in the morning, but becomes easier as the day progresses; carbs have to be divided into strict doses and spread out; and both a walk after dinner and night-time snacks are a must. Pizza is a definite no, no – at any time of the day.

The night I learnt that was the only other time I cried during those 10 weeks following my diagnosis. After eating just two full slices and scraping the cheese and pineapple off another three, I headed out for my 30-minute brisk walk, as usual. When I got home my blood sugar was 178 an hour after eating – almost 30 points higher than it should be. I dread to think what it would have been if I hadn’t walked before I tested it. We headed out for yet another trot to bring it down and with a very heavy heart decided to park our weekly pizza night until after I gave birth.

In spite of all that, my daughter and I both emerged from my first experience of gestational diabetes unscathed. I didn’t need to go on medication and managed to control my numbers well with diet and my nightly walk.

My beautiful little girl, Molly, was born 10 weeks after my diagnosis, at 39 weeks and five days with perfect blood sugar – newborns of mothers with GD are often hypoglycemic, which means they have low blood sugar, from having to continually respond to high levels in the womb.

Molly also weighed a very average 3.59kg, lighter than many of my healthy friends’ newborns.

What I learned from my first experience

That was five years ago. I am now currently three quarters of the way through my second pregnancy. And lucky me, I have it again.

But I am by no means alone in the UAE. Studies have shown up to one third of pregnant women here are diagnosed with temporary diabetes in pregnancy – compared to one in seven births worldwide. The condition is caused when hormones made by the placenta lead to a buildup of glucose in a pregnant woman’s blood. Most women are able to simply make more insulin, which helps to transport the glucose into the cells, to compensate. People like me can’t.

There are a number of risk factors for gestational diabetes, including obesity, being older than 25, and having a family or personal health history. I have a big one – polycystic ovary syndrome (PCOS), which is characterised by insulin resistance, meaning I already struggle to produce enough insulin to transport glucose to my cells.

My wonderful gynaecologist and obstetrician, who diagnosed and treated me for PCOS before I got pregnant again, told me I was pretty much guaranteed to get it this time around. But having battled it and won the first time, I wasn’t scared.

Being proactive

Because of my history she booked me in for an early test at 21 weeks. I passed, and was genuinely shocked. My results were totally normal. In fact, they were better than good. That was because early in pregnancy hormones result in increased insulin secretion and decreased glucose production, improving the insulin resistance I suffer from. That starts to turn around 24 to 28 weeks, when gestational diabetes usually begins.

Knowing it wouldn’t last, I started testing my blood sugar so I could be on top of it early. It didn’t take long. And within two weeks, my fasting blood sugars started to rise. And by 23 weeks, I was officially a gestational diabetic.

I often wish I had the luxury of other mums-to-be, who can eat what they want and sit down and put their feet up if they choose to. But I’m doing okay.

As I was already doing all I could to control my sugars, walking each night and eating well, I knew I probably faced medication this time around. But in many ways, my experience has been different. Last time, my fasting blood sugar was good until I entered the dreaded 32 to 36 week window, which is the hardest time, for reasons I explain later. This time it was a problem from the onset. Last time my main issue was with post-meal spikes. This time they have hardly been a problem.

Despite that, it is worse. For one, I’m now on medication, metformin, a diabetes drug, as I was not able to bring my fasting blood sugars into range. Now almost 31 weeks pregnant, I’m four weeks into my treatment and my numbers are great – much to my relief, as the next step is insulin. But I may still not avoid it yet.

Insulin resistance increases as pregnancy progresses. Around 26 weeks is a key time, as three hormones reach their peak, increasing the effect. The next jump, which was very pronounced in my first pregnancy, is around 32 weeks, heralding the start of the toughest four weeks in terms of control. The effects of the placenta blocking hormones wear off after that, so it becomes a little easier.

I don’t always feel like heading out for my walk after dinner, particularly after a long day. I often wish I had the luxury of other mums-to-be, who can eat what they want and sit down and put their feet up if they choose to.

But I’m doing okay. I know now what I can and can’t eat, and understand, unfortunately, that harder times lie ahead before it improves.

But the prize at the end will be worth the pain.

Updated: April 3, 2019 12:53 PM

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