Well we’re back to this again. I apologize to those of you who are sick of hearing about this…I’m honestly sick of talking about it…but I think it’s important that I share what I’m learning so that the information is out there for people who may be in a similar situation.
I am, at this point, 98% sure I’ve been misdiagnosed.
There are quite a few reasons, but the biggest one is this:
So wait a minute…if I don’t have gestational diabetes, what’s going on? Why was I getting some high blood sugar readings?
Here’s where it gets complicated.
…if this isn’t something you find interesting, skip this post. The important stuff is the information above. If you’re pregnant and eat a low carb diet you need to know that you need to “carb up” before the glucose tolerance test, or you will get a false positive. If you’ve already been there, taken that test and feel like you’re in the same boat I am…or if you just find all of this interesting, read on. It’s about to get weird.
I’m going to do my best to explain what I’ve learned in layman’s terms. I’ve said it in the past, but I want to say it again: I am not a doctor. I may be misunderstanding some of this information and as such I may misrepresent exactly how things work, but I’ve done my best to read as much as possible while only looking at information that is coming from reputable sources, and have been balancing that against my personal results using my home glucose monitor.
My understanding is that, to ridiculously simplify it, diabetes is a disease that occurs when the cells in your body become saturated with sugar. Insulin tells your cells that they need to store sugars from your blood so that in the future, if you are in need of energy/sugar, it can be released and used. When your cells are already filled to the brim with sugar however, they stop listening to your insulin, because, “hey Joe, we ‘aven’t anywhere to PUT any more sugar!”, and that tissue becomes what is called “insulin resistant”. The more insulin resistant tissue you have in your body the higher your blood sugar levels become.
In pregnancy, your body naturally becomes slightly insulin resistant. Bodies are, in general, rather clever creatures when we let them be. They’re very good at recognizing their priorities and making sure those are taken care of. Think of your body as being a bit like a medieval kingdom. Your brain is the most important resource your body has, so it’s royalty. Gets the best cuts of meat, even when everybody else is starving. Muscles and other flesh tissues are more like the serfs in this analogy. Crops are good and there’s plenty of food to go around? They may eat nearly as well as the king…but as soon as things get scarce, poor old bicep cell gets gruel and nothing better. That’s your body normally. Get
pregnant and that growing baby even trumps your brain. (Which is probably a big part of why
I fainted).
So, normal, non-pregnant body with “normal” (over 150g a day, but not excessive) carbs: King Brain eats carbs/sugars, peasant muscles eat carbs/sugars, everybody is more or less happy. Maybe a little chubby if the number of carbs is on the high end, but not diabetic.
Normal, pregnant body with “normal” (over 150 g a day, but not excessive) carbs: King Brain shares a feast of carbs/sugars with Emperor Fetus. Peasant muscles still eat carbs/sugars, but somewhat less than normal (depending on how MANY more carbs than 150 g you take in) since they’re sending a portion of their “crop” to the castle to celebrate their distinguished guest, Emperor Fetus (the mild insulin resistance that appears in every pregnancy). Everybody is more or less happy.
Diabetic, pregnant or non-pregnant body with excessive carbs: King Brain eats carbs/sugars, Emperor Fetus (if he’s in town) eats carbs/sugars, peasant muscles eat carbs/sugars…there are a ton of sugars left that nobody needs/wants (diabetic insulin resistance) and there are sugar beets rotting in the streets (your blood stream). NOT everybody is happy.
Normal, non-pregnant body with low carbs: King Brain eats carbs/sugars, peasant muscles eat very few sugars/carbs, learn that fat is
DELICIOUS and eat that instead (this is mild insulin resistance of another kind). So long as you are either losing weight (which means that your cells have some extra sugar stored that they can use in a pinch) or eating enough carbs that you avoid King Brain getting hungry (
hypoglycemia), everybody is happy. Including your waistline.
Normal, pregnant body with low carbs (this is me): King Brain and Emperor Fetus share their carb/sugar feast. If there aren’t enough carbs around to make a decent feast, King Brain sends out an edict that peasant muscles must send in any extra carbs/sugars they have stored and ARE NOT ALLOWED to eat any new carbs/sugars they see and must make do on fats alone (more serious insulin resistance, from the combined pregnancy insulin resistance and resistance from a low carb diet). Peasant muscles totally give up on the idea of seeing carbs/sugars again for a while (they aren’t allowed to eat them anyhow) and come up with awesome recipes for fats. You’re unlikely to put on excess weight. If you don’t eat a high enough level of carbs to make an impressive enough feast, King Brain hands over his share to Emperor Fetus and goes to bed (you faint). However, so long as you keep your carb level in a healthy range (for your body), everyone is happy.
…until you take the glucose tolerance test.
So what happens then? If you’re healthy on a low carb diet and don’t have gestational diabetes, why do you fail the glucose tolerance test?
Remember how in the analogy the peasant muscles have come to the conclusion they may as well toss out their recipes for eating carbs and have developed a fondness for eating fats? The glucose tolerance test is about to throw a monkey wrench in the works. Suddenly, out of nowhere, your body/kingdom has HUGE amounts of carbs/sugars…Emperor Fetus is impressed, King Brain eats til he’s more than full and temporarily rescinds the restriction against the peasants having carbs/sugars. Problem is, not everybody gets the message…so some of the peasants still think they’re not allowed to eat the carbs that are now overflowing the land…and those who DO get the message, well, they may remember that, back in the day, Grandma used to make this incredible carb pie, but the recipe is lost, none of them have ever made it…and so they understandably do a shoddy job of it. They mostly keep eating fats and the sugars get left in the streets/blood.
If you get the instructions to “carb up” in advance, basically it gives your “peasants” a chance to dig out their old recipes and start practicing them so when the flood of carb-crop comes rushing in, they remember what to do with it.
So what if you’re in my boat, and your dumb ol’ peasants left the sugars in the streets so it looks like you’re diabetic? Well, here’s what’s happened in my case:
Not really…not really, really, but a little bit.
About the same time those posts were being published I had several appointments. Everything I wrote about those appointments was true…I did get told my levels were perfectly healthy and I wasn’t high risk, ect, ect, ect…but I also heard “ooh, there are a couple of scores that are close to the cut off numbers. Not many…and that’s okay, it’s not a problem…but *hiss*”.
So, in my head, I’m now thinking “ok, so now not only am I not allowed to go over those numbers, if I don’t want to be given a hard time, I can’t even get close to them”. Over-achiever Erin, activate.
If you’ve never monitored your blood sugar you probably don’t have any clue of how
difficult it is to predict how your body will respond to a meal. I talked about it a little bit in my post on
what I’m eating, but there are HUGE amounts of information you need to determine if a food is going to spike your blood sugars or not. Glycemic load, glycemic index, slow carb vs fast carb, ect.
I did lots and lots of research on how to eat for diabetes, but basically, it was a lot easier to just eat even lower carb than usual than to try and figure it all out. I thought that it was a less stressful approach, since I didn’t have to worry about the scores if I wasn’t taking in the carbs.
Wrong.
You see, one of the scores I had to record was my fasting blood sugar levels. With my usual diet, my body/kingdom was getting enough carbs/sugars that my “peasants” didn’t really see carbs often enough that they did a great job with them, but King Brain hadn’t put out an edict entirely banning them from using them yet. That changed as I started eating fewer and fewer carbs to make certain I didn’t have to “worry” about my meal scores.
Stupid me, following the idea that I might have gestational diabetes, I went and upped my insulin resistance by eating too few carbs. My “peasants” left every tiny bit of sugar in the streets for King Brain and Emperor Fetus and so, even though I was essentially not eating any sugar or carbs, my fasting blood sugar levels were slowly climbing.
On the 14th of this month I had my (now) bi-monthly appointment with my doctor and went over my blood sugar numbers with her. She was happy enough with them that she authorized my going down from four tests to only testing twice a day: my fasting score and either my lunch or dinner score. For the next 3 days I didn’t change anything, continued to eat extremely low carb and my fasting blood sugar numbers continued their slow rise.
Honestly, I got a little angry.
I started researching new terms. Things like “can a low carb diet make diabetes worse?”, which is when I started coming across the information above. Information that told me that, whoops, I almost certainly don’t have gestational diabetes, I just screwed up the test by not eating enough carbs before it…and was sending my body into a state of insulin resistant panic because I was starving it of carbohydrates.
*Sigh*
So, I decided to try an experiment. (I know, *gasp!* when I’m pregnant?!? How irresponsible, right? But at this point the medical community has messed with my diet 10 ways til Tuesday, I can’t feel that bad doing a little of it myself) For the next week, I slowly added carbs back into my diet. It wasn’t nearly as scary now, because I could do it at meals I wasn’t required to report, take the blood test and see what was going on without worrying about the possibility of getting chastised if I got “too close” to my cut off numbers.
The more my carb intake headed back towards my original diet the lower my fasting blood sugars dropped.
So now here’s where things stand: I’m taking my blood sugar levels twice a day. My diet is more or less back to what it was prior to this whole mess. I’m eating a purposely low carb diet for the meal I have to test, because, well, I don’t want to have to stress about it AND I’ve found some
crazy delicious low carb recipes, but I am continuing to very slowly increase my carb intake. My fasting
blood sugars are consistently in a healthy range (not too close to the high end
or the low end…don’t want to faint again either!) and, because my body is calming down about thinking it’s going into starvation mode, even my meal blood sugar scores are dropping.
Before I discovered this further information, I wrote a letter to the head offices of the group that runs all of the staff I’ve been dealing with expressing my concerns about how my case has been handled. I now honestly feel that most of the staff has been unable to help me simply due to ignorance of the impact of a low carb diet on the glucose tolerance test, but entirely aside from that there are policies and procedures that need to be reassessed within the office in regards to unusual cases. Ignorance is bad, but rudeness, dismissiveness and a general attitude of “I know better than you, so shut up” towards patients is utterly unacceptable. I was contacted by the company’s VP of Human Resources the other night and she assures me that she and the office manager of the branch of the practice I’m a patient in will be taking a hard look at things that can be improved.
I have printed out the information I’ve found regarding necessary preparations for the glucose tolerance test and will be taking it with me to my next appointment to give to my doctor.
I’m tired. Tired of dealing with this. Tired of things not adding up. Tired of talking about it. Really tired of researching it and tired of thinking about it. On top of being tired from being 34 weeks pregnant and carrying the weight of a whole second person with me all day.
I hope to God this can be the end of it.
I hope that my talking about all of this here can save at least one other woman in my situation from all the stress and aggravation I’ve been through.
…at least I’ve gotten some
good recipes out of the bargain, right?
You guys know by now that if anything more comes up I’ll be telling you about it. If you have any questions, don’t hesitate to ask. Obviously, I can’t give you medical advice, but I can, and happily will tell you what has happened with me.
Especially Creative Broad 