Gestational Diabetes Follow-up

I went to a class on managing gestational diabetes yesterday. It was really just 3 pregnant women in the office of a dietitian with my medical group, so it was very personalized. She showed us a power point presentation all about gestational diabetes, gave us some hand-outs on diet and answered all of our questions. It was definitely informative.

The first thing she assured us was that it wasn't our fault. We didn't get GD because we had a hot fudge sundae. I was feeling guilty about having too many sweets, so this was reassuring. Apparently, pregnancy hormones suppress the effectiveness of insulin and this causes GD. Although I'm not sure why it only happens to about 3-5% of pregnant women. Age plays a part, but I forget some of the other factors. Unfortunately, she said getting GD increases your risk of developing Type II diabetes by 50-60% in the next 5 years. I'm already at increased risk due to family history. But she covered ways to prevent or delay developing Type II diabetes, which basically involves eating healthy (which also means eating frequently) and exercising.

I need to eat 3 meals and 3 snacks a day, with prescribed amounts of carbs at each meal. No milk, yogurt or fruit before noon - because pregnancy hormones interfere with insulin the most in the morning which can lead to glucose spikes. I need to eat some protein with each meal and snack. And there is a list of things I can't have, including soda, fruit juice, cookies, ice cream, etc.

Once I had gotten the news from my OB last week, I had started to make adjustments. I didn't know exactly what the guidelines would be, but I stopped drinking juice and this blood orange soda we get at Trader Joe's (which was usually just a glass a day with a meal). I stopped putting sugar in my coffee and using cream instead of milk (no carbs in cream, lots of carbs from lactose in the milk). And I generally tried to eat fewer carbs and to eat snacks with protein. I had been feeling hungry more often, but not too bad. So I was surprised that when the dietitian weighed us, I was several pounds lighter than my last prenatal visit. It was a different scale, so I'm not sure if I really lost 4 pounds or not. She said she wants to keep track of our weight because people tend to drop weight on the GD diet and they don't really want you to do that. But it's a natural response to eating healthier.

I also got a glucose meter and need to test my blood sugar upon waking in the morning and 1 hour after breakfast, lunch and dinner. My fasting BS should be between 60 and 95. The post-meal readings should be under 130. Last night, I was 134 after dinner. It was tough because I hosted my book club and made dinner from the snacks I provided - which weren't too bad, but it might not have included enough protein. This morning, my BS was 80, right in range. After breakfast it was 131, so pretty close to target. And after lunch it was 118.

Finding things to eat will be a challenge, especially given my lack of appetite this pregnancy. For breakfast, I had a vegetarian sausage patty on a half sandwich (made with whole wheat toast), with one fried egg with some cheese and tomato. I was so hungry afterwards that I was counting down the minutes until my snack. Which was a handful of almonds and 3 crackers (only allowed 15 g of carbs at breakfast and snack time). I was so weak and hungry, I barely had energy to make lunch. I had a chicken sausage sandwich with avocado at noon, served with a pile of carrot and zucchini sticks and some dip. With a glass of milk. Oh, and 3 crackers to make my total carb count 45 g. Although I felt full afterwards, I still felt hungry, although I'm starting to not feel so bad. I'm looking forward to a snack of cottage cheese and 12 fresh cherries in another hour or so.

I think the diet will take some getting used to. Hopefully I won't continue to feel hungry all the time. It makes it hard to concentrate and I've had no motivation to get anything done today. Except prepare food. I'm also supposed to exercise (walk) 10-20 minutes after each meal. I didn't have the energy after breakfast and by lunchtime, it was in the low 90s. Maybe after dinner it will be cool enough.

Gregarious Aaron

We had two birthday parties this weekend. One for Gabe (turning 3) at the beach on Saturday and one for Grant and Oliver today (both turning 2). Aaron had a great time at both. But on Saturday, at some point, he latched onto Oliver's mom Jenny (pictured above). He wanted to sit in her lap and had fun while she buried his feet in the sand. Again and again. And later, if he couldn't see her, he wondered "Jenny go?"

He played with some of the kids, too, trying to give a toy to 1 year old Bridget who was more interested in eating at the time, which upset him. But another boy took the toy and he was happy. At one point, he was trying to get the attention of various adults (who were carrying on conversations with each other at the time) but going up to them and saying "Hi!" in his most charming (and loud) voice.

Thom and I were both shy as children, so I'm not sure where he gets this aspect of his personality. But I hope it lasts so that he makes friends easily when he is older.

Today's birthday party had a train theme and we got to take Aaron on a miniature train for the first time. (You can see pictures on Facebook, where many of you will probably recognize the location.) The picture above is from today, when Aaron wanted to sit on Jenny's lap again. Since it was her son Oliver's birthday and they were starting to open presents, we coaxed him over to our blanket in the shade so she could assist with gift opening. But later, I saw her carrying Aaron, presumably at his insistence. I think he's found a backup mama. Fortunately, Oliver was playing with his dad, Chris, and wasn't bothered by the fact Aaron was stealing his mama.

The only downside is that it was miserably hot. Well, in the low 90s, I would guess. Everyone was roasting, even in the shade. But there was a nice breeze during the train ride.

Helping with the Crossword

I used to do the Wall Street Journal crossword puzzle on a regular basis. But some time after Aaron was born, I didn't keep up with it. But I found an old puzzle in the magazine tote and took it with me to my 3 hour glucose test and made enough progress on it that I wanted to finish it. Aaron saw me working on it yesterday at the table, probably the first time he's seen someone doing a crossword puzzle. He of course wanted to help. I took these pictures today. He was having a snack and saw the puzzle sitting on the table and requested it. He looked so serious about it, I had to take pictures. It would look more impressive if he was working on the puzzle and not on the previous week's solution.

Is he right-handed? Is he left-handed? I still can't tell. He switched hands several times working on the puzzle. And he eats with both hands. I think he's leaning towards being right-handed, but he hasn't started to show a definitive preference.

Gestational Diabetes

After failing my 1 hour glucose tolerance test last week, I had to do the 3 hour fasting test yesterday. I stuffed myself with chicken and some rice the night before hoping the protein would keep me from starving the next morning. I don't think anything can counter the ill effects of drinking 10 oz of glucola on an empty stomach, but I didn't feel overly hungry at least.

On the first blood draw, the woman jabbed me pretty hard and I flinched. I've had blood drawn lots of times and I don't flinch easily. Most times, I hardly feel the prick. But this woman made me flinch and to add insult to injury, when my arm moved she said "Don't move. I don't want to miss it."

The 3 hours passed fairly quickly considering I felt sick from the glucola. My appointment was at 7:15am so I was done by 10:30. My OB's nurse called me the day after the 1 hour test so I was expecting results today and was surprised when my OB called me himself yesterday just before 5pm. He said I have mild gestational diabetes. Three of the 4 tests were elevated. (2 abnormal test levels diagnose GD. With Aaron, just one of the tests was elevated.) Here were my results (and the levels that he told me were considered normal):

Fasting: 83 (under 100 is normal)
1 hour: 197 (under 190 is normal)
2 hour: 192 (under 165 is normal)
3 hour: 148 (under 145 is normal)

(In an article on BabyCenter, they list the cutoffs for fasting through 3 hour as slightly lower: 95, 180, 155, and 140 respectively. I think different labs have different standards, but I'm not sure why.)

He said it was mild and he wasn't worried, mostly because my fasting level was fine. But also because the 1 hour and 3 hour levels were only slightly elevated. He doesn't think I'll have any problem controlling it through diet. He is enrolling me in a program they have for gestational diabetes. Someone is going to call me by the end of the week with details. But he said there would be a class I need to attend where I will learn about GD as well as how to use a glucose monitor to test my blood sugar levels at home. When I asked if I'd have to test my blood on a daily basis, he said probably at first, but then it would probably just be a few times a week. I had read online that some women with GD had to check 4 times a day, so this was a relief.

He said the baby doesn't have diabetes and shouldn't suffer any problems. But he said he would probably do a few extra ultrasounds and that they would test the baby's blood sugar after birth. My glucose tolerance should return to normal within a few weeks after the baby is born.

I'm a little disappointed, but not overly worried. The hard part is that my appetite has never returned, even though I only occasionally get nauseated. But without an appetite, the things I tend to eat are high in carbs and sometimes sugar. So I think I might have to make some significant changes to the way I eat, including better meal planning.

Not Fast

Aaron surprised me yesterday. We were reading his Shapes book and he was pointing to the picture of a pillow (on the page with squares) that has a cat and dog on it. He usually says "pillow" (or at least his approximation of this word) and then says "animals". Then I say, yes, there are animals on the pillow, a cat and a dog. After that, he said "sew". I said "sew?", not understanding what he meant. So he said "SEW" - louder, the way he repeats a word when I don't understand and he's starting to get frustrated. We went back and forth a few times, with him getting more frustrated, but I had no clue what he was trying to communicate.

Now, usually if I don't understand what he's saying, he'll go find something to point to to make himself clear. Like last week when he said something that sounded like "quack" while I was singing a song about ducks. After failing to make himself understood, he got up, ran to the other room and pointed to a toy truck. "Truck" was what he was trying to say. And he had pronounced it the way he normally does, but it was so out of context at the time, I didn't understand.

But this time, he wasn't saying the name of something he could point to. So finally, he said, in a somewhat impatient and strained voice "not fast". Aha! He meant "slow", but wasn't pronouncing the 'l'. I still have no idea why the pillow with the dog and cat evoked the thought "slow", but I was impressed with how he figured out how to communicate with me.

Little Tyrant

Aaron likes to dictate what we can and cannot do. Which we generally ignore. Usually, he'll tell me "No talk" when I'm talking to someone instead of paying more attention to him. Sometimes it's "No sing" if I'm singing (or dancing or otherwise acknowledging music that is playing). Although sometimes he will request that I sing: "Mama sing."

But the other day we had a good laugh when Thom and I did something Aaron apparently didn't like. He was playing in the living room and we were sitting on the steps watching him and we rested our heads against each other. He got agitated and said "No Mama. No Gaga." and we lifted our heads to focus on him to figure out what the problem was. Since he didn't have words for what offended him, he came over to us, pushed my head against Thom's and said "No". As in, "No, don't put your heads together like that."

Real Gaga

In our office, we have a picture frame that holds 4 photos, 2 are of Aaron, and 2 are of Aaron and Thom. He'll point to Thom in the pictures and say "Gaga" (his version of Dada - which he can pronounce, but since he first called Thom Gaga, that sort of stuck). When Thom is in the office, he'll sometimes point to him and say "Gaga. Two Gagas!" As in there are two Dadas, one in the photo, one in the office. So I differentiated the real Thom from the Thom in the photo by saying, "That's your real Dada" since we are still helping him differentiate between real things and pictures of things (or statues of things). So lately he has been calling Thom "Real Gaga" about half the time.