Thursday, 14 September 2017

Silver Lining of the Grey GDM Cloud - Aarti Mehta





  

My GDM (Gestational DiabetesMellitus) experience started when I was 16 weeks pregnant. Since I had some obvious characteristics for a GDM suspect - overweight, age 30+ and diabetes in the family, my doctor advised to get a GCT (Glucose Challenge Test) done anytime between 16 to 18 weeks. I had this lingering regret that I wanted to shed a few kilos and become healthier before I conceived but life always has plans for you rather than the other way around!

Diagnosis
As anticipated the GCT result was disappointing. I was 3 points over the upper limit. GTT (Glucose Tolerance Test) was the next test to confirm GDM and here too, the result exceeded the upper limit.

I was asked to consult a General Physician who, within five minutes of our meeting, prescribed Insulin twice every day and casually told us how it was easy to administer, that we should buy it and the nurse can show how it has to be injected. There was no other precaution, no advice on checking blood sugar regularly or even room for us to question him. I was overwhelmed to say the least. The word “Diabetes” had checked into my life, Insulin was closely following and I felt I had no control of the situation. But the logical, practical, problem solving me, re-appeared! I spent that night reading loads and loads on GDM.

Next day, I met a renowned endocrinologist and came back feeling a hundred times better. I got a diet chart, instructions on how to check and monitor my blood glucose and advice on exercise. I was re-assured of my views about having a healthy pregnancy with GDM through controlled diet and exercise. I also found a dietician to help me with GDM diet who was an angel in disguise and provided the encouragement to conquer GDM with self-control and meal planning.

I immediately started morning and evening walks (something I had been procrastinating for a few weeks unnecessarily) and made changes to my diet.

GDM without Mobility

I was all charged up, consumed by the world of meal planning & timing, calorie counting, glucose monitoring, staying hydrated, etc.  Then, the unthinkable happened. I twisted my ankle and fractured foot meant no exercise. Thankfully, we found a physiotherapist who consulted for pregnancy. She taught me a range of upper body exercises that I could do while sitting on the bed. Life seemed sorted out, atleast for the moment.

IUGR Scare
My 20 week scan was normal. I monitored my sugar levels regularly and maintained a food journal that kept me on track. With drastic change in diet and exercise, I lost weight which worried my husband a lot. He kept raising this concern with the gynaecologist at our appointments but she took note of it only at the 28 week appointment. She asked me to focus on gaining weight. Her advice - stop exercising to conserve calories and work with dietician to increase my daily calorie intake. Post this, I did put on about a kilogram in two weeks. 

However, the 32 week scan showed that the growth velocity had de-accelerated and the fetal weight was in the 5th percentile. The doctor anticipated a premature delivery and I was prescribed a steroid to help develop baby’s lungs. The doctor also explained that taking these shots can cause a spike in blood glucose and advised me to get admitted to take these shots so that the blood sugar could be monitored and insulin be given as per requirement.

Welcome Weight Gain

We weren’t convinced and decided to take a second opinion. We found a GDM friendly gynaecologist who patiently answered all our queries and provided logical answers to all our GDM and IUGR related queries. She advised against taking the steroid at that point much to our relief.

I continued to rest after each meal, kept exercise to the minimum and increased my lean protein intake. My weight increased gradually and much to our relief, the 34th week scan showed improvement in the fetal weight. I still had to watch my blood sugar levels closely.

Insulin Scare

Over the next two weeks, as much as I was trying to achieve a steady weight gain without an increase in the blood sugar level, my glucometer disappointed me increasingly. At the 36th week appointment, my gynaecologist showed concern towards my blood sugar readings. I visited the endocrinologist again who prescribed a slight difference in my diet, suggested doing a light stroll after each meal (by now my plaster cast had come off) and asked me to visit her in a week’s time. 

After a week, I was prescribed insulin. However, since there was only a few weeks left for my due date, I wanted to try making it work without insulin. Yet, as a precaution we bought the insulin, learnt how to administer it and went back. I promised my husband that if at any time my two consecutive readings were high, I would start insulin. Since my weight gain was now on a steady rise, I started exercising again - ate only the meals that had worked well in the past and watched my glucose levels like a hawk. I was living on the edge from one meal to another.

Finish Line
The 37th week scan showed fetal weight as normal. From there on, I could see the finish line of my GDM race. We never went back to the endocrinologist and the insulin remained unused.

Most private hospitals follow a protocol to induce GDM moms at 38-39 weeks. That was my final problem to tackle. I wished to complete full term (or go into labor naturally before 40 weeks). At 38 weeks we consulted at another hospital for a back-up, in case my doctor insists on an induction. But my doctor, true to her word, did let me complete full term and beyond. After trying all tricks in the book for inducing labor naturally, I settled for induction of labor after 41 weeks. Induction too didn’t work and finally, I delivered a healthy baby through emergency c- section.

The Silver Lining
Now, you must be wondering where the silver lining is.  Let me show it to you:
  • Eating healthy and exercising is important during pregnancy and I don’t know if without GDM I would have been able to do it so well.
  • I have never eaten so much salad in my life! With a healthy diet that included salads, lean protein, omega-3 fatty acid rich food – it did wonders for my skin and hair. And I kept stayed away from common pregnancy complaints like swelled feet, backache, etc.
  • Good health helped me recover much faster after the c-section.
  • Diabetes runs in both of our families and GDM helped us to eat healthier and we hope to continue the same and keep diabetes away from our lives for as long as we can.
  • Since I did not put on much weight most of my pregnancy, I continued wearing my regular clothes till the final few weeks. 
  •  And finally, the entire experience brought us closer to each other. Parenting is a lot about teamwork and this experience was a reassurance that we can sail through stressful situations by having each other’s trust and support.

Editor’s Note
 * BBN maintains a service directory that provides you with a list of professional health services in Bangalore, including pre & post natal fitness. You can access the directory here.  

*To read more about GDM and how to manage it, click here. 

* Induction before 41 weeks should not be suggested if gestational diabetes is the only medical issue. Click here to know more about gestational diabetes and induction of labour.



2 comments:

  1. Thanks for sharing your journey. I am sure that this will help a lot of expecting parents who are challenged with GDM. Good work!

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  2. Awesome journey. Your journey needs standing ovation mainly for the below points :
    1. Choosing to alter the lifestyle instead of opting the insulin way.
    2. Stressing out the importance of workouts and good diet during pregnancy.
    3. For doing such an excellent homework and not believing anything on face value
    4. To have teamed up with your husband in all the plan.

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