All the Sugar

Before the fertility clinic would proceed with our first cycle, they sent me for a one-hour glucose tolerance test to screen for prediabetes, due to my bloodwork having shown that my blood sugar levels are slightly elevated. I passed the test and all was well. When I had to take the same test around 29 weeks gestation, I did not pass and was referred for the three-hour test. I had read that many people who fail the one-hour pass the three-hour because many people’s bodies just need that little extra time to handle the sugar. Many people in my personal life confirmed this, telling me that they’d failed the one-hour also but then had been fine. So I went in pretty optimistic. I drank the nasty, syrupy drink and then, ravenous, sat and read a book while getting blood drawn every hour. The phlebotomist asked with each blood draw if I was feeling okay, and since I was, that also made me optimistic.

I was a little anxious anyway, just because I know I’m genetically predisposed to diabetes and have already had signs of insulin resistance since high school (rough, scaly dark patches of skin in my armpits and under my belly; some skin tags; cellulitis at 20 years old which took doctors forever to diagnose because it’s usually only seen in elderly, obese diabetics), but after hearing even my own mother and sister say they passed the three-hour, I kept talking myself down and convincing myself that I really probably didn’t have it. Then I got the call from my OB’s office saying my results were “abnormal” and I needed to call an endocrinologist RIGHT AWAY to schedule an appointment.

Heart in my mouth, I called the one they recommended who took my insurance and set up an appointment for the following day. The doctor was very warm and friendly. He showed me my results from the three-hour test, showing what levels are normal at each hour and how high mine stayed throughout. He asked me about various symptoms (excessive hunger and thirst, how many times I pee in a night, etc.), family history, etc. He explained why this can happen in pregnancy, and that since the placenta is the source of the issue, it will go away as soon as the placenta is delivered, but for now may worsen as the placenta grows. He said the baby is not harmed, but that the baby is overmaking its own insulin to counteract the high blood sugar flowing into it, and that high insulin can lead to too much growth and complicate delivery if the baby gets too big. Having the baby’s pancreas on overdrive throughout gestation can also increase baby’s risk of developing diabetes and childhood obesity later in life, so it’s important to regulate my own blood sugar so the baby doesn’t have to overcompensate for me.

Then he talked to me about diet change and handed me a whole packet with recommendations for meals and snacks, what I can have in unlimited quantities, what I can have in moderation, and what I can NEVER EVER have. Some of the never evers really surprised me – I mean bananas, really?? The “bad” things that I craved and had been indulging in freely were on that list, as well as some things I thought were really healthy for me (like watermelon and grapes).

He showed me my target range and what numbers should worry me. He told me to stick to this diet and test my blood sugar fasting and then an hour after every meal, fax in the results every few days, and then come back in a week to evaluate. If the numbers were concerning in that first couple of days, like my blood sugar was out of normal range even with diet changes, then I would need insulin and have to come back in immediately for that. He offered to show me how to do it then and send me home with some supplies so that I wouldn’t have to come back in so soon if that happened, but said it was my choice. I said, “No thank you, I’m feeling utterly overwhelmed as it is and would rather not have to learn injections on top of it when I may not even need them. I’ll come back in if I have to.” He told me to keep fat in my diet because now is not the time to be losing weight. Then a nurse came in to show me how to use the glucose monitor, which looked intimidatingly complicated at first use.

I didn’t even make it to the car before tears were streaming down my face. I felt utterly overwhelmed at all that was in front of me – having to plan every meal and snack, having to avoid so many things I love and just am not sure how to replace at meals, figuring out the glucose monitor and remembering to take my blood and log my food choices after every meal. And I felt overwhelming guilt at my poor diet up to that point and how my baby had been having to work its poor little pancreas to death to try to make up for it. It didn’t matter that this was coming for me no matter what, and that people get it no matter how they were eating before and during pregnancy. It didn’t matter that baby was fine and not being harmed right now. I couldn’t stop blaming myself for not doing enough to protect my baby and keep it as safe and healthy as possible. I’ve struggled with willpower when it comes to food my whole life, and all I could think was that even my baby hadn’t been enough for me to change that, and how shameful that feels. I felt anxious and overwhelmed by the path ahead of me, the major diet overhaul and monitoring, and then ashamed that it felt so difficult. I called my mom to get it all out of my system, and then faced the challenge of figuring out where to go for lunch that wouldn’t make my first blood sugar check be elevated. (I chose Chipotle: brown rice, grilled chicken, tomatoes, guacamole – all approved items.)

As I sat at home and tried to remember all the steps for using the glucose monitor, stuck myself multiple times trying to figure out how to take the needle back out, and then tried to plan what I could eat the rest of the day and the next day at work, I let myself shed a few tears of frustration and then told myself that I would be a master in no time. This was all new and a lot to learn and figure out at once, but soon it would become routine. It just felt so unsettling to have everything in my daily life have to be looked at and managed differently, and to not be exactly sure how yet. Feeling incompetent is my quickest route to frustration and tears, and my instinct is to quit immediately (usually when it's something like assembling a product), but I couldn't with this. And I told myself, "You're going to feel this times a hundred when you're suddenly responsible for the care of a newborn, so you'd better humble yourself and get use to feeling this way and still functioning through it to get the job done."

My numbers were stable with the diet change so I didn’t need to come back in for insulin. This was and is my main motivator to sticking to the diet strictly, because I desperately want to avoid injections. I’m grateful that, while my body is clearly very sensitive to sugar (I’ve seen it spike just going from half to a whole wheat English muffin in the morning), limiting that has been enough to keep it under control. My fasting numbers are good, which they look at closely because blood sugar spikes overnight and is the highest in the morning, so some people wake up with high blood sugar no matter what they eat during the day and need at least nighttime insulin. Meeting with the dietician has been helpful, teaching me things like which foods equal how much of a serving of starch, how to pair a starch with a protein at every snack or meal (apple with string cheese, plain yogurt with blueberries) because the protein helps my body process the sugar, how to split up my breakfast (NO fruit in the morning when your blood sugar is most sensitive) into two small meals so that I stay satisfied without sending my sugar overboard, how to watch my patterns and what sets me off and what doesn’t so that I can find what works for me (“I hate telling a pregnant woman that any fruit is completely off limits – have a small banana and then check your sugar, it’s about what YOUR body can handle”).

I lost four pounds the first week. Actually, within the first four or five days. I was at a 13 pound total gain and went down to 9. I couldn’t eat enough butter, full-fat dairy, and nuts to keep my weight from going down. I called my OB’s office out of concern, and the nurse said that she was surprised the endocrinologist said not to lose weight because it’s impossible not to with such a diet overhaul, but that it’s only my own weight and I should just be focused on making sure I’m getting proper nutrition. She said as long as the baby’s weight is on target, they’re not worried about mine dropping. At our 32-week sonogram the next week, the OB confirmed that baby’s weight was perfect, exactly average, and that I didn’t need to be worried about my own. I stayed stable at this new weight for many days, and then slowly started gaining again, and I’m now up to 11 pounds total gain.

My wife has gone on this diet with me. I did not ask for that, and in fact told her just not to eat things I love right in front of me (cakes, ice cream) but that she could do it behind my back and not tell me, just so I’m not tortured. And she could eat anything she likes that DOESN’T torment me (chips, hard candies). But she insisted that this is how we both should be eating and that she knows she is predisposed to diabetes too, so why not use this as our wake-up call to being healthier? She doesn’t have to be as picky with planned out snacks or about having fruit in the morning, but she’s made her own diet overhaul. She measures her starches at dinner and has the same amount I do, and has cut down on how often she snacks and the portion size of her snacks. She’s been losing weight too!

At my second dietician counseling yesterday, we were going over my charts and she asked if she could keep the most recent week’s. I had an immediate reaction that made me want to say, “No, it’s mine!” and I had to figure out where that came from and how to explain it rationally to her. I said, “I’d like to keep the originals. I have all the rest of them and it just helps me look at my own patterns.” So she made a copy for herself and gave it back. She had told me earlier in the meeting to keep trying to fatten myself up, to make sure I’m getting enough nutritious calories in, and said I could make my breakfast more filling by having a whole light wheat English muffin instead of a half. I’d had to go back a few weeks to show her where I had tried that and my sugar had gone right over. Clearly I can’t do that! But that reference point is important to me. It’s important that I could look back at all the times whole wheat pasta has been fine for me, and try to figure out why the fresh whole wheat fettucini made me go over that one day, and then realize that I’d used store-made Bolognese sauce instead of our own homemade sauce, which the dietician pointed out usually has starch in it to thicken it. I’m not just tracking numbers for a doctor to look at and approve or disapprove. I’m learning my body and foods that are problems for me and foods that work for me and how much I can tolerate of different things. I want control over that, because this is for me.