Sunday, January 15, 2017

Holiday Treats and a Failed Glucose Test

I'll be the first to admit, I did not eat well over the holidays and have no one to blame for that but myself. Since my in-laws arrived, around a week prior to Thanksgiving, all the way up through the end of the year, I indulged. Eschewing my normal diet, I indulged on bagels, donuts, waffles and pancakes, maple syrup, chips, chocolates, pie, ice cream, and mocktails...which let's face it without the alcohol are just pure sugar. Oh was it all delicious! My rationale for this indulgence was that my weight was still progressing nicely right on course (I was still exercising and watching portions). I started pregnancy #2 the same weight as pregnancy #1 (BMI 21). I gained 35 pounds during my first pregnancy and am still on track to gain only 30 pounds this pregnancy. I'm very happy with that! At my appointments, my blood pressure was a steady and consistent 100/60. So, although I knew I was consuming a lot of simple sugars, I figured my body was handling them fine.

Fast forward to the first week of the year. I had delayed my 1-hour glucose tolerance test from 28 to 29 weeks due to plans at the end of the year. Plus I thought it would be nice to pay for the testing on my 2017 insurance deductible instead of throwing away more money into my 2016 deductible. Although I'm not crazy about chugging so much sugar and artificial color, my clinic requires the testing.

A few facts...

Pregnancy hormones result in higher insulin resistance to ensure enough glucose is available to nourish the baby. Usually this is not a problem, your body secretes enough insulin to handle the amount of glucose in your blood. 

Gestational diabetes is when your body does not produce enough insulin to counteract the glucose in your blood, resulting in dangerously high blood sugar levels. 

Risk factors include: Over age 25, Overweight (BMI >30), Family history of diabetes, Polycystic Ovarian Syndrome (PCOS), History of Gestational Diabetes, History of delivery of a large baby

A Glucose Tolerance Test involves drinking a large amount of sugar and then having your blood tested to see how your body responds to the sugar. If your insulin response is not significant enough to lower your blood sugar you will "fail" the test. The test is also used for Type II Diabetes testing. 

A few notes on Glucose Tolerance Testing...
Every clinic has their own policies. Some clinics even give the drink for you to take home at your previous appointment! 
The drink has artificial color. Why the company feels the need to add color to a medicinal drink given to adults is beyond me, it's not as if we need it to look pretty. 
The 1-hour test is 50 grams of Dextrose (sugar), approximately 14 oz of soda.
The 3-hour test is 100 grams of Dextrose, approximately 28 oz of soda.
If you occasionally drink regular soda it's very similar to what you consume for the test.

This was my experience...

I had my test on a Wednesday. I went in fasting and gulped down the drink. My office gives Glucocrush Orange flavor 50 grams of Dextrose (sugar) which to me tastes like flat Orange Fanta. I had done the exact same thing with pregnancy #1. I sat in the office for an hour, during which time I had my appointment, before having my blood drawn. I felt a little jittery but it's a lot of sugar. On Friday I received a call that my level was high. The maximum allowed level was 140 and I was at 155. This didn't seem so bad to me until I found my lab results from my previous pregnancy and saw my glucose test was only 103. I was scheduled for the 3-hour Glucose Tolerance Test for the following Wednesday. My clinic said if I didn't want to do the 3-hour test I would be automatically referred to the Diabetic center.

As a nurse, one of the most upsetting parts of this for me (other than knowing I hadn't been processing my increased sugar stellar which was not good for baby) was the idea of having a diagnosis of gestational diabetes. I normally work pretty hard to stay healthy, so the idea of having a diagnosis on my medical record which says I am more likely to develop type II diabetes later in life (that's one of the things the diagnosis means) was very upsetting to me.

I immediately changed my diet. I read a lot of advice to not do that because you want the 3-hour test to be accurate, but I wasn't willing to not make changes just to wait for further testing. My only risk factor for gestational diabetes is my age (37). With my weight being on target and my risk factors low, my diet appeared the most likely culprit. Knowing my body wasn't metabolizing the sugar as efficiently as it should, I didn't want to subject my baby to all that sugar for even one more day!

I also asked a coworker about her glucose test. She had one baby in her late 20's but gained around 80 pounds during her pregnancy, so I wondered how she had done. She informed me she failed the first test and that she had been drinking 3 large sweet teas per day at that point. (If you're not from the South, you may be unaware of this wonderful thing called sweet tea. It's basically iced tea with as much added sugar as a soda. You can get huge cups of it from pretty much every fast food place in Charlotte and restaurants serve it as well.) The only thing she did was stop the sweet tea and she passed her 3-hour test a few days later.

I was further reassured when reading indicated to me that only 15% of women who fail the 1-hour glucose test also fail the 3-hour glucose test.

(***There is literature contradicting the necessity and accuracy of glucose tolerance testing in pregnancy. The big concern with gestational diabetes is that it can be a precursor to high blood pressure and preeclampsia which can be life threatening. Other concerns are that the baby could be larger than average or could have difficulty controlling their blood sugar after delivery. Testing for gestational diabetes should be discussed between you and your medical care provider. If you are adamant about not drinking the dextrose solution, there may be other options available to you.)

My first instinct was to not only cut out all the sugary treats, but to go mostly low carb with meat, eggs, cheese, vegetables, and a little fruit. It was Saturday so we made eggs and chicken sausage for breakfast. I did not add any sweetener or milk to my decaf tea. The result of this was that I just couldn't seem to get full. I felt a little nauseated and had difficulty getting hydrated up for the day on plain water. (My normal breakfast is 1/2 cup orange juice diluted in a big glass of water, tea with milk and maple syrup, yogurt, granola, and half of a banana - very carb heavy.) I had plain yogurt (the kind I buy for my son) as a morning snack and a large salad with chicken and oil and vinegar dressing for lunch. I had bell pepper slices and hummus for an afternoon snack. I was still hungry. Then I did some more reading...

The recommended diet for gestational diabetes is not low carb, it's low simple-carb (simple-sugar). The recommendation is to consume some protein, fat, and a complex carb with each meal and snack. The complex carb releases more slowly than a simple sugar and combining it with fat and protein also further slows absorption which prevents a high spike in blood sugar. By cutting out too many carbs, I was actually doing myself a disservice. If you are not used to processing carbs at all, you can have a greater spike/response to the glucose test which can make the results even worse.

So I made a big pot of quinoa with some lime zest to eat with my chili for dinner. Between the quinoa and the beans, I finally did not feel hungry. For my bedtime snack, I had a clementine (mandarin orange) and a small handful of cashew nuts.

The next day, I moderated things. I cooked up a big pot of steel cut oatmeal and combined 1/2 cup with 2 scrambled eggs and some shredded cheese for breakfast. I felt so much better than the previous day. I drank my tea and plain water no problem and was well hydrated. This breakfast kept me feeling full though the morning, I even exercised during my son's 10:30 nap. After working out, I had a yogurt. Then for lunch another big salad with chicken. For dinner I had quinoa and leftover tofu and ground pork stir fry from Friday night along with some sauted green cabbage.

I kept up my diet changes in preparation for my 3-hour Glucose Tolerance Test on Wednesday. I also increased my exercise from 3-4 times per week to every day. Exercise improves insulin sensitivity and decreases insulin resistance.

I arrived for my 3-hour test fasting. At my clinic, it is just a lab appointment starting at 8 a.m. The lab tech drew my blood then gave me the usual drink, but this time it had 100 g of Dextrose. It tasted worse than the 50 g dose, more like cough syrup than anything else. I took the full five minutes to drink it under her watchful gaze. When I was done, she gave me a paper with the 1-hour, 2-hour, and 3-hour times to come back for my blood draws. The clinic has a hospitality room with a television, some computers, bathrooms, etc on the same floor and she told me I could go sit there and that I could also go out to my car if I needed something or wanted to, but not to leave the property. 

I went to the hospitality room, but was feeling pretty nauseated. Not wanting to throw up and have to do the test again another day, I stepped outside where it was much cooler. I strolled around for nearly the whole hour, chatting with a coworker on the phone. I tried to go back to the room twice, but both times I felt nauseated upon sitting in the warm room. (Although I wasn't thinking of it at the time, I suspect this walking around helped lower my 1-hour result. It's been found that people with Type II Diabetes who get even 10-minutes of non-strenuous exercise after eating have improved blood sugar control.)

My husband joined me for hour two and we did sit in the hospitality room and played card games for most of the hour. I was feeling much less nauseated by then which the lab tech told me was normal. She said if you make it though the first hour you are normally good to go on feeling sick.

Hour three I watched part of a movie on my iPad. The last 30 minutes I was constantly checking the clock and I was very hungry. I drank the most water during this hour since I was no longer nauseated.

I got my test results back the next day as follows. The ( ) indicate the reference/allowed range for the test according to my clinic.

Fasting: 76 (60-105)
1st Hour: 144 (60-179)
2nd Hour: 120 (60-154)
3rd Hour: 43 (60-139)
Result = Passed!

My blood sugar was very low at the end of the test. I had taken a homemade muffin from my freezer that morning and left it in my car. I ate it before driving home, and good thing because you shouldn't drive with a blood sugar of 43!

In conclusion...

This process was stressful. It's embarrassing that I knew I wasn't eating well for those weeks leading up to the test. If I had just watched my diet better it all could have possibly been avoided. 

With only 15% of women failing the 3-hour test, it seems there are quite a few false positives on the 1-hour test. However, I am choosing to see the experience not as the result of an unpredictable 1-hour test, but as a wake up to recent dietary indiscretions. 

I have put away all my treats and baked goods. The nurse who gave me my results also said, in addition to the junk food, I should try to limit bread, potatoes, rice, and juice. I'll keep up my healthier substitutions and also try to ensure I am consistently including protein with my carbohydrates.

A side effect of my diet changes is that I have started weeks 29, 30, and 31 of pregnancy at the same weight. Normally putting on that pound per week (or more) happens without my even trying. I'll talk to my doctor about it at my appointment next week.

Some useful resources...
American Diabetes Association
Baby Center - Overview Gestational Diabetes
Baby Center - Diet tips for Gestational Diabetes
Live Strong - Foods to Avoid

Best of luck to all the pregnant moms out there! If you'd like, please share your story in a comment!

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