Monday, March 10, 2008

But if they really are after you...

Funny story. At last week's OB appointment I asked Dr.Best to prescribe a glucometer for me. I had been borrowing a friend's, but she needed it back. Sure, he said, no problem, which pharmacy do you use? And then he stopped to ask "But you are not testing like a diabetic would, are you?" I assured him that no, I was not. Just testing when I felt funny, and that I did indeed catch a few rather impressive reactive lows*. I think they are getting worse, I said. I think I am loosing sensitivity in my receptors, I said. (Hm, as I type this, it occurs to me that this sounds like a pretty terrible pick up line. Don't try this at home, ok?) Dr.Best nodded, sagely, in what I interpreted to be agreement with my deductive reasoning, but also a statement of there is nothing we can do but watch, a sentiment with which I heartily agreed.

So where's the funny part, you ask? Here it comes. I failed four tests in five days now. The 1 or 2 hour postprandial (after eating) measurements on both my friend's glucometer, and my own new shiny freshly calibrated one. The first one was the night last week when I felt too puky to eat anything but carbs, so I thought that was it. But I started watching after that, and measuring, and had a few much more worrisome setups since. I am taking insulin-sensitizing drugs already, although my dose is not maxed out. In fact, one area of discussion we left open at the appointment was whether I am staying on the drugs for the duration as per experimental protocol in agreement with a paper that is supposed to come out soon in a very respected journal, or whether I am dropping the drugs as per current widely-accepted protocol. I called today and left the message for Nurse Kind, throwing myself at their mercy. A triage nurse called me back, but I asked for Nurse Kind, so they will try to have that happen today. And we'll see where it goes from there.

This is how this happens, by the way, the transition from insulin resistance to diabetes-- your insulin receptors become more resistant to the actions of insulin, requiring more insulin to accomplish the same work in each cell, making your beta cells work harder to make more insulin, resulting in more insulin in the circulating blood, resulting in more and more profound reactive lows. Until, one day, the beta cells just give up from the overload and make less insulin. And then it's the glucose that stays too long in your blood. A textbook case, really. My nerdy little self has to admit that it's actually kinda cool to watch it happen in real time. It's just what it means for me that isn't so cool.

I am not shocked. I have had documented insulin resistance for a while (and obviously since well before then since I had those pesky PCOS symptoms for years before someone was smart enough to diagnose me definitively), so it was always a toss up as to whether I would get through any given pregnancy without dipping into gestational diabetes. I got away with it twice, and that, I believe, was pretty impressive in its own right. I have been watching my carbs for so long that it's really second nature to me, or maybe even first one by now. So I am not shocked. I am mildly annoyed that it appears to be happening so early on in this pregnancy. I am resigned to whatever I have to do for the duration, though. I am resigned to it happening every time, and early, in any pregnancy subsequent to this one. I am not panicking or freaking out because this is sort of expected and should be manageable.

The scary thing, the unknown, is whether my beta cells are just on strike or whether they have severed their relationship with this particular employer forever. I can handle the strike. I was just hoping not to become a real diabetic, for life, before the age of 35. Little things, you know. But I am not going to think about this for now. Most likely it's just gestational, and I can't know one way or the other until I am done gestating. So I am going to focus on doing what needs to be done now instead. That's my plan and I am sticking to it. La-la-la-la-la-la. Now if only the nurse would call so I would know what it is they want me to be doing...



*going hypoglycemic relatively soon after a meal due to too much insulin ending up in the blood, and so clearing out too much glucose too fast.

22 comments:

Wabi said...

JUST what you need to make life that much more complicated, eh?
I'm really sorry this is happening at all, let alone when you are in a state where carbs are something you. must. HAVE. NOOOOOW! due to morning sickness and general cravings.

Are you already on a diabetic-friendly diet as part of the study?

kalakly said...

Crap. That sucks. I "hope", that seems like the wrong word to use here, but you know what I mean, I "hope" it is "just" GD and that it's managed and gone right after your done gestating.

Thanks for the support over at my spot, I hope we shooed away the anons fer good:)

Let us know what KN has to opine.

Bon said...

this was fascinating, and made me feel utterly dumb in the ways of hormones and glucose and such.

i was, back when i lived in Korea, diagnosed as insulin resistant and as having mild PCOS. for years, i watched carbs carefully. but then i got pregnant very easily, twice in a row, and had no GD symptoms in either pregnancy. i was told, here in Canada, without further testing of any kind, that i'd probably been misdiagnosed...and i resumed my happy diet of pizza and ice cream.

hmm. perhaps i ought to rethink.

Tash said...

Funny, (maybe not haha) but I always thought the silver lining of my IF was that I discovered I was IR and started watching my carb/sugar intake too, figuring I was doing my body a good thing *for life* not just for the duration of my pregnancies. But, as you know and said, these things are a bit more exacerbated when pregnant (more energy needed, obviously), and may very well drift back to the old normal when you're done. In fact, I don't even think it's unusual to see an uptick in subsequent pregnancies, is it?

Anyway, sorry you're dealing with it, but glad you're on top of it, and as you said, deep breaths, still within the management of current medical science. Should I traipse down this road again, I'll ask for your med protocol, as I was obviously on the old plan of which you speak, and the old drugs.

Magpie said...

Interesting - especially the "vicious circle" description...

Good luck.

meg said...

I know that you know all about how to deal with this, but I just wish you didn't have to.

Ahuva Batya said...

This was very interesting to read, as my husband's family are all diabetic and his sisters both had GD. Sometimes I wonder about the benefit of the internet; we can learn so much, but it gives us so much more to worry about. I wish you didn't have this extra complication to create more stress. Hopefully, it is just GD if anything.

My Reality said...

I like your explanations of how this all works.

I hope the GD won't rear it's head.

CLC said...

I have to say I was ignorant of gestational diabetes before I read this. I guess you do learn something new every day. I hope this doesn't cause you too much stress.

Aurelia said...

Oh I feel for you. After everything we've been through, it's so crappy to feel like we have to deal with even one more thing.

I know you can do this, but like Meg said, I wish you didn't have to.

charmedgirl said...

GD makes me want to puke. but i am happy that you are being so careful! i wish i would have been.

The Town Criers said...

Oy--the science geek part of me was reading with fascination but the emotional, caring side of me wanted to reach through the screen (oy--that actually sounds a little freaky science-fictiony) and give you a hug. I hope it doesn't go past gestation.

kate said...

well, that sounds sucky. But an interesting explanation as to how it all works!

niobe said...

I'm always amazed at how many people seem to develop GD. Obviously, I'm very much hoping that in your case, that it doesn't develop into full-fledged diabetes.

Julie Pippert said...

I have always been edge-hypoglycemic, and always failed my GTT in PG (managed through diet, still do now), but all this you are doing--how fascinating and how good you are tracking it. I hope it is just gestational.

Out of curiosity...have you ever heard of Holy Basil? Check it out. I wonder what you think.

Julie Pippert said...

Oh PS, hi, first time commenting. Long term IF person who learned all sorts of wonderful and horrible things during the journey, now parenting two girls, and spending too much time finding and reading fascinating blogs. :)

Amelie said...

I know how some scientifically interesting process becomes much less pleasant when it is actually happening to you. I'm sorry. What are the chances of it being gestational only (bad enough in itself)?

Mandy said...

Another cyster here.

I had troubles with failing tests in my pregnancy as well. My 1 hour GTT I barely failed, I passed the one and three hour portions of the next test but the two hour number failed. My biggest problems were my two hour post prandial numbers, and like you said, those times when I felt so awful only carbs seemed to work for my stomach.

What worked best, however, was to make a point to always pair a protein serving with a carb serving. Whether pg or not, my IR causes me much less trouble in those instances. Doing that and taking my full metformin dose had me back in good standing on my glucose readings.

Now that I'm not pg, my numbers are back to normal though I still test them occasionally to be sure.

wannabe mom said...

thanks for the detailed explanation. i have learned so much about pg and what moms have to go through and it makes me so sad. i read on another blog a while ago, the mom wrote, "i didn't want to become a doctor, i just wanted to be a mom." sigh.

Katya said...

Hi! I am not sure if this is helpful at all... but I love working with moms diagnosed with GD. They eat sensibly, don't have much edema (fluid retention and simple carb consumption are connected), and tend to birth easier because their tissues are more stretchy and flexible (once again, lack of edema).

Really, the only downside with GD diagnosis used to be the mandatory induction at due date, but nowdays with well controlled GD most practitioners lets moms go to 41 weeks if that is what they desire.

I tell my clients - "Our goal is to have controlled blood sugar. If we do that, let's see who knows you have GD? You know, your husband knows, your doctor knows, and even I know. Who does not know that you have GD? The baby, your blood vessels, and the placenta. Let's keep it that way, and then this pregnancy is no different from any other pregnancy. Just imagine you live on that special desert island where there are no white pastas, white breads, or sugary drinks."

christina(apronstrings) said...

thanks for the info. i have always wondered about the connections. i am (self-diagnosed mostly) hypoglycemic. my family is diabetic and i worry about gest. my brother and i were enormous babies (i weighed 10 lbs and my mom is onyl 4'11 and weighed 125 when she gave birth). so, of course, i am worried so about gest. diabetes.
i hope you end up getting all the info. you need.
yea. one more thing to worry about. blech!

Lori said...

You are so smart! I should probably know all of this, but don't.

If it helps at all... I have PCOS and never developed GD in any of my four pregnancies. So, it is possible.

I wish you didn't have this to deal with too.