Update on My Struggles with GD

My struggle with GD continues, an epic battle of time, diet, contrasting advice from doctors and nutritionists and just trying to manage it all within the realistic timeframes of a busy life.  I met with an endocrinologist after I returned from London to get a second opinion on my GD numbers and at the recommendation of my GP.  Then while there, I met with a nutritionist who walked with me through my daily diet to try to help me figure out if I was getting enough of the right nutrients.

My numbers had been really good, but she thought maybe it was because I had not been eating enough carbs, which I need in order to grow two babies.  They recommend a 2000 kcal diet for a pregnant woman with twins, and especially because I was "lean" pre-pregnancy.  She seemed particularly concerned whether I was getting enough and if the babies were growing on track.  I was pretty surprised by this because I had never gotten any indication of issues from my doctor and I always eat until I'm full.

At her advice, I started trying to include more carbs in my meals, which I was previously avoiding (not entirely, but definitely taking in moderation), like pasta, rice, bread, crackers.  I also tried to include more dairy, like soy milk or milk, to get more carbohydrates and calcium. 

It's worrying because for the last three weeks I have had to test myself a lot more often to check what foods "trigger" me, and my numbers have been all over the place. 

I scheduled another follow up appointment to see if I'm just doing the meal planning and testing wrong, or if these numbers aren't as bad as they look, or whether it's time to throw in the towel and get insulin.  This is when things get frustrating, because I am getting a lot of conflicting and backtracking advice which makes me wonder if anyone in the medical establishment actually knows what they are doing.

Since I've been diagnosed, I've gotten the following zig-zagging and often mis-matching advice:

The private endocrinologist recommended a fasting number of no more than 5.5 mmol/L and a 2 hour post-meal number of no more than 7.5 mmol/L.  The public hospital recommends a pre-meal number of no more than 6 mmol/L and a 2 hour post meal number of no more than 7.0 mmol/L.  My private OB thought for my fasting number I should really be around 5.0 mmol/L, which I have never been at.  I don't really know whose guidance to go with here...

My private OB had told me to cut down on carbs so as not to spike my numbers.

The public hospital dietician told me carbs were still important for the baby's growth.


I was told by the private nutritionist that I should significantly increase my carb intake because she thought I should be gaining more weight, even though others had never focused on my weight.  Then after my second meeting she told me I could cut back on my carb intake and eat less than the recommended number of "exchanges".  She even told me to seek out Greek yogurt instead of regular yogurt, which is exactly the opposite of what she told me the first time I met her!  Grrrr.

Last week, I had a very unpleasant meeting with the OB at the public hospital, who basically frowned at all of my numbers and diagnosed it as "poor diet control" which, I know she meant nothing personally by it, but had me bristling at the implication that it was my poor management of my diet.  They wanted to check me in to the hospital for a couple of days to test my numbers and see if I needed to get insulin, which sounded absolutely insane to me.  Perhaps it's a cultural and social difference, but in the US you do not just voluntarily check in to a hospital as an inpatient so that someone can monitor your glucose levels?!  Well here they practically insisted on it.  She was ready to check me in the next morning.  I was in disbelief.

After much consideration, I actually did reluctantly check into the hospital earlier this week, to establish this "baseline" to see if I needed insulin.  I thought, better safe than sorry, and maybe it's worth a loss of 2 beautiful days (weather wise, not political wise) and my regular life to be shunted into a hospital room to gain certainty over this condition.  Well, I cannot say that I have been impressed with the system.  I would argue that the stress alone of dealing with the hospital has been enough to give me a severe setback on my GD.

Infuriatingly, they missed my urine check for the first day, then served me bland soda crackers as a snack (the only option available), then (a LOT) of white rice with a small side of vegetables and meat.  I pretty much lost my shit when I saw these meals.  Breakfast was congee made with white rice paired with an egg.  Lunch and dinner were both white rice with a side of vegetables and meat.  My numbers were pretty high after my lunches and dinners.

Then they had the gall to point out that I was a likely candidate for insulin given how high my numbers were.  When I said it was because of the type of food they were serving me, a nurse had the gall to respond, "but usually patients don't spike like you do when eating our food" and another asked, "Well do you think you can bring your own food?"  That does not even begin to make sense.  Clearly if I am already on a GD diet and having trouble with my numbers, I will spike when eating an even more inappropriate diet.  And if I am eating my own food, what is the point of being in a hospital to do it?

A dietician came to review my meal and told me nothing new - try to walk more after eating and don't feel the need to force down carbs if you don't feel like it, and try to space out your snacks better.  Gee, really?

A very young endocrinologist came to see me the first day literally to take a photocopy of my numbers and to come back with a plan the next day.  That was it.

On the second day he came back with a half baked diagnosis that I could likely continue on a diet controlled plan but that it would also be highly likely I would need insulin in about 2-3 weeks time.  Then he saw the spike in my numbers from the lunch I had and said he needed to revise his thinking and speak to his superiors and come back to me the next day.  Then he said that I needed to stay at least another day because they needed a urine sample to test my ketones, and then maybe 2-3 days after that so they can make sure my insulin is at the right dosage.

I also could not get a straight answer on just how bad my numbers are, how I actually get started on insulin, why I had to be physically checked into the hospital to get this done (I am almost positive in no other country in the world is this a requirement) and why they couldn't have just used my nearly 2 months' of finger-pricking records to decide whether or not I needed insulin.  I could not understand how forcing me to be in the hospital, eating their inappropriately highly refined carbohydrate diet, could possibly help.

I mean, is this like something out of a Catch 22 novel or what?  It'd be comical if I weren't so freaking upset and frustrated.

The only good thing that has come out of the hospital stay is that I finally got to watch Center Stage (I know, how could I have missed it), started watching Riverdale, and read three books, one of which was the very interesting (but not perfect) book "The Farm" by Joanne Ramos.  I recommend it.

I have also spent some time thinking about why I am so resistant to the idea of insulin.  I think whether people mean to or not, it's kind of treated as a "taboo" thing - for example, a lot of GD moms will report proudly that they were "entirely diet controlled" and, while not shaming anyone on insulin, inherently assumes that being on insulin is a bad or negative thing.  I think most of my own resistance came from the idea of having to inject myself, as I really hate needles, and the thought of having to do that every day, maybe multiple times a day, was cringe-worthy and shudder-inducing.  I think there is also a fear that having to use insulin with GD would somehow lead to my having to use insulin post pregnancy, like I didn't "pass" or do it "right" or somehow be deemed to have a more "severe" case of GD, and would be at a higher risk to have this ailment for the rest of my life.

Also, finger pricking doesn't sound like a difficult task, but it's really proven impossible for me to do it at exactly 2 hours after I've eaten.  My weekdays are full of calls followed by meetings followed by drafting or working or trying to get documents done asap -  I have tried to set alarms but it's frankly a lot of alarms to keep track of.  I inevitably lift my head and realize it's been a full half hour or hour too late.  I sometimes also can't control my hunger - if I don't have time to fully plan out a big meal at lunch, or get hungry too quickly after breakfast and then need to snack, either before the two hour window or else too late/close to my next meal, I mess up my numbers.  And I never quite manage to squeeze in the 20 or 30 minutes of time to walk after I eat, which is also something that is supposed to help.  And so I wonder if my guilt and turmoil over the GD/insulin debate also stems from the fact that I feel like I haven't been as vigilant as I could have been with a diet controlled plan.

I've been reading up on insulin more, and I was heartened to see that many women who did go on insulin found it to be such a relief.  While that doesn't make me any more excited about potentially packing needles, it certainly made me feel a little bit better.

I keep telling myself that, ultimately, if I do need to take insulin, it's not because I failed to eat properly or manage this right - it's simply that my hormones are completely out of whack and cannot be fixed without medication.  But that doesn't fully address my anger at my body for failing me for the time being.  I feel really betrayed somehow, even though it's not my body's fault and my body has been more than kind and tolerant of the abuses I've heaped on it thus far.  But I'm still struggling to come to terms with it.