Ashley Janus 10/29/24 Ashley Janus 10/29/24

Navigating Gestational Diabetes

It all begins with an idea.

Welp, this is a post I never thought I’d be writing about! When I got the call that I had gestational diabetes, I was in shock. Surely there was a mixup, right?? I was at a healthy weight, I worked out, I ate generally healthy… it just didn’t make sense. When I was pregnant with Ari, I failed the first diabetes test at 24 weeks and had to come back for the 3 hour test (10/10 don’t recommend). I did not fast for the first test and had it in the evening after a full day of eating. The second test I did in the morning with fasting and passed with flying colors. I never thought twice about it. Ari was 9.4 pounds at birth, which should have been an indicator. Thinking back, my glucose numbers were probably higher at the tail end of my pregnancy, we just never knew it. Given Ari’s size, my doctor ordered me to take the glucose test at 12 weeks with this pregnancy. That seemed super early to me, but what do I know. I also did not fast for this one as it was not advised by my doctor (I know a lot of my friend’s doctors are very different, though). My number was 215, which was high enough that they did not order the 3 hour, but instead immediately informed me that I had GD and that we needed to start treatment.

So how did I get GD this time around? It could be several factors. First and foremost, once you have a baby at or above 9 pounds, you are automatically at risk for GD in future pregnancies (per my doctor). This is the biggest reason my care team believes I have it. Another cause could be lack of sleep. I have never been a great sleeper (as my mother loves to remind me) and insomnia is ALWAYS one of my pregnancy symptoms. I often wake up at 2AMish and just never fall back asleep. When pregnant with Ari, I was able to take a nap on my lunch break and give my body a rest. This time around, that is a mere fantasy. So I am essentially running on E at all times and not able to consume caffeine, which I love for me. Finally, my doctor mentioned that high stress could be a factor as well. I am definitely one to downplay my stress levels and tell myself I’m fine, suck it up, move on, etc. But, let’s be real. The past year of my life has been one of the most joyful, yet most stressful years. Ari is the absolute light of my life. I have an amazing husband who I love dearly, I have a great job, a beautiful home, a healthy/loving family, and the stability that at one point I questioned if I would ever have. I am SO blessed beyond words and incredibly grateful. HOWEVER- partpartum was no joke. I certainly had PPD after Ari. I cried EVERY. SINGLE. DAY. We had constant visitors after a rough delivery and the healing process was no joke. Let’s just say at my 6 week appointment, my doctor told me I still wasn’t 100% (I could have told her that). My husband went back to work immediately and helped as much as he could, but it was still a lot when I could barely walk. The only person in the world you want after giving birth (outside of your husband) is your own mother, and my mom works full time so her availability was limited. So, you get the picture- the first few months I was a broken and emotional mess. Then, I got pregnant again when Ari was 4 months old. It absolutely caught us by surprise and I was freaked out to have another baby when Ari was only going to be 13ish months old, but we were still so grateful and excited. Then, the bleeding started. This went on for 2 weeks with nothing we could do as we had to just wait for the 8 week appt to see what was going on. I went into that appointment in tears, expecting the worst. To my surprise, the ultrasound looked great with a strong heartbeat. They could not figure out why I was bleeding, but there was a perfectly healthy baby growing and I was brought to tears from relief. I texted everyone who knew to share the good news and was in the best mood that evening. Then, I miscarried THAT NIGHT…the week of Christmas. So, you get the picture- hormones have not been my friend this year. I gave birth, stopped nursing at 3 months, got pregnant again when Ari was 4 months, lost the baby when he was 6 months, had to go in for weekly blood draws to ensure my hormones were dropping appropriately after the miscarriage…it was a lot. To be completely honest, I still cry over that baby. I never understood miscarriages and assumed it was something that you just get over, but so far it seems I will think about that angel baby for the rest of my life. I was grateful to have work to fall back on and keep me busy, but that is always an added stressor for me as well (but I think that is for anyone). I have childcare 2 days per work, but otherwise am working full time with a baby at home with me 3 days per week. I have always figured it out and made everything work and will always tell myself that is how things will continue to be, but it is certainly something that could have added to the diagnosis.

So, how does one treat GD? First and foremost, my doctor put in an order for a glucometer. I was ordered to do 4 finger pricks per day, one first thing in the morning, and one after each meal. I was also referred over for “classes” at the hospital, one with a diabetes specialist and one with a dietician. They were able to give me a great deal of information regarding the foods to avoid and foods to eat. Based on my size, I was told I could eat 30g of carbs per meal, and 15g of carbs per snack. If my numbers did not respond well to that, we would drop those numbers. That seemed super fair to me but, when you actually start reading food labels, it really isn’t much. For example, I often have a can of soup for lunch when pregnant because it’s quick and easy to heat up and take back to my desk and helps with my nausea. Well, one can of soup exceeds my limit. Essentially, I was told to eat high protein/fiber foods and avoid sugars and carbs as much as possible. When I asked how many grams of sugar I could have, they told me 3g or under (lol, okay). This was NOT conducive to my pregnancy cravings at all. I also get pretty nauseous in my pregnancies, so I literally crave carbs to be able to settle my stomach. A nice piece of salmon and broccoli is NOT what I had in mind to keep me from throwing up. However, diet and exercise is the first step in trying to manage glucose numbers. The goal was to be able to control them through those methods so that we do not have to defer to medication. Unfortunately, that was not the case for me.

My morning numbers, which are “fasting” numbers, had been quite high while my numbers during the day had been within limit. my care team shifted their focus to my evenings to try to figure out what was essentially going wrong overnight. I was prescribed Metformin which I took before bed to try to manage the fasting numbers. This seemed to work for about 2 weeks and then my numbers spiked again. At this point, I was informed I needed to begin insulin, which I had hoped to avoid. I administered one shot per day in my stomach before bed. Then, based on my morning numbers, we could tweak the dosage to see if I needed more or less. To make things more fun, I was allergic to my insulin and my stomach was covered in hives. I was told it would take at least a month for insurance to approve a new insulin and that I was likely allergic to the preservative in the drug as opposed to the drug itself, so a new brand likely would not solve the problem. In short, suck it up and enjoy your hives for the next few months.

Even with the insulin, we struggled to maintain my morning numbers. They would get dangerously high and then dangerously low. For example, after a whole week of high numbers, my care team ordered me to up my insulin by 3 units. The first night I administered the new dosage, I woke up at 2AM covered in sweat with blurred vision, shaking hands, and dizziness. I could barely walk to get to my glucometer to prick my finger before seeing that my blood sugar was at 48 (which is severely low). I grabbed a candy bar and a sprite and tested my sugar every 20 mins again until it was normal again. I still see that event as an act of God- my husband rolled over onto the remote and the light of the tv turning on is what woke me. If I had not woken up, I don’t want to know what the outcome would have been. The second time I had an episode like this, my dog had a panic attack in the night and woke me. No doubt, there is a guardian angel watching over me.

Ultimately, we struggled to get my numbers under control my entire pregnancy. Even when I gave birth, my numbers dropped to 50 right when it was time to push. We would start to get it under control, then they would rise and fall again. It was a new tweak every week and felt like nobody knew what was going on. My team was convinced that I had to have had diabetes before I got pregnant and just didn’t know it, but everything tested all clear after the birth. I had to be very conscious of what I ate and how I moved my body my entire pregnancy in order to somewhat maintain my health and combat these crazy glucose numbers.

From an exercise perspective, I tried to move my body every time I had a high glucose number and after every meal. Sometimes that was throwing Ari in the stroller and going for a long walk, sometimes it was pacing the house and going up and down the stairs. I also turned to weightlifting as an easy way to move my body. I kept 10-15 pound dumbbells in our living room and would use them while playing with Ari or while I was on non-video work calls to get easy movement in. As simple as it sounds, it was quite the struggle when I felt exhausted in my pregnancy and just wanted to lay down. I think reminding myself that this was (hopefully) temporary is what helped. Essentially, suck it up and move your butt and this will all be over in a few months.

From a food perspective, I had to be pretty strict. Every dinner was a protein and veggie and minimal rice or potato for a carb. I’m talking 1/8 cup of brown rice. I still made it because my son and husband would eat it but I really needed to limit myself and just load my plate with broccoli to try to make it look fuller. Lunch was typically eggs, turkey and cheese roll-ups, or reheating dinner from the night before. Breakfast was challenging for me because I have never been a breakfast person. I have no desire to eat in the morning but you have to with GD to maintain numbers and test. I would typically just have sugar free oatmeal, fruit or protein yogurt for this meal. The evening snack was the most challenging. I often did not even want one but was encouraged to eat before bed to maintain the overnight numbers. I stuck with apples or celery with peanut butter, protein shakes, protein whip (protein powder with greek yogurt and a splash of milk), or nuts with a cheese stick.

My best advise it to add variety. I feel like you end up eating a lot of the same things when diabetic because you find what works for your body and have to stick with it. You better believe I got sick of seeing a chicken breast on my plate and had to find ways to make it more appealing. I turned to things like Thrive Market where you can search based on dietary needs and found sauces and snacks that were Keto, low carb, and sugar free. I loaded up on different flavors of my protein powders so that my shakes and protein whip would be different every night. I also recommend investing in a diabetic cookbook or making a board on Pinterest dedicated to those recipes. On the nights I felt burn out from the same foods, I was able to find other creative options there.

While I could look back on this experience as being absolutely miserable, I think it is better to focus on the positives that came out of having GD:

I had a MUCH healthier pregnancy than my first. Perhaps not from a blood sugar standpoint, but from a diet and exercise standpoint. I was eating clean foods and moving my body every day, which I certainly did not do with my first.
The baby weight came off easier. I breastfed both of my boys and know that played a part, but I was able to fit into my bigger sizes of pre-pregnancy jeans within a month of giving birth. Don’t get my wrong, it was a tight and uncomfortable fit, but the fact that I could even get a thigh into them had me in shock. I gained 32 pounds in this pregnancy, but gained 60 in my first pregnancy.
I learned a ton about healthy eating. I had certainly been a healthy eater before, but it was the same meals that our trainer had given us when we were working out consistently. I got creative with how to cook healthy foods and that was something that I was able to carry over postpartum.
It was good for my son. The healthy meals that I cooked were good for our entire family and I felt good about what Ari was eating. I was also very proud of how many stroller walks we went on or how many times we chased each other around the yard. If I did not have GD, I probably would have given in to the pregnancy exhaustion more and laid on the couch/been less active. This diagnosis forced me to be more engaged with my son and keep him active and healthy as well.

In short, GD is different for everybody and each story is unique. Mine was a bit of a whirlwind and we never really got it under control, but I still learned a lot and was able to make several lifestyle changes to accommodate the diagnosis. I know I am at a high risk to have it again, as well as an increased risk to have diabetes myself later in life. I try to remind myself of that constantly to continue living the healthiest life possible so that I can be my best self and show up for my family in the best way possible every day.