Going through gestational diabetes, twice!
When I was in medical school, one of our teachers used to say, “Pregnancy is the greatest pathology of human physiology.”
I found it hard to understand at the time, but when life brought me to that juncture I realised the truth of it.
My 1st pregnancy ended in intrauterine death (IUD) due to pre-eclampsia. With the next 2, I had pregnancy-induced hypertension (PIH). Overall though, these pregnancies were not very eventful, and I had my 1st and 2nd baby girls 3 years apart.
When I conceived the 4th time, however, I was obese. The initial 3 months of pregnancy went well, and I was taking my routine folic acid and following a normal diet. But when I had my routine labs at the start of the second trimester, my random blood glucose levels were detected to be very high – This was the first sign I had gestational diabetes.
I was almost in denial, thinking the result must have been caused by my heavy breakfast that morning. But my gynecologist advised me to closely monitor my fasting and post-prandial (after-meal) glucose levels and make a chart.
Confirming gestational diabetes
Charting my blood glucose levels over a week, I realised that while my post-prandial glucose levels were a little above normal each time (maybe because I was walking a bit after meals) my fasting glucose levels were always well above what they should have been. When I consulted my gynecologist about this, she persuaded me I had gestational diabetes and needed to start taking medication for it. The medication would limit how much glucose my liver released and help my body absorb more glucose from my bloodstream.
At first, I wasn’t sure about taking medicine during pregnancy; would it be safe? However, after an extensive internet search on the safety of the tablets my gynecologist had prescribed (specifically during pregnancy), I was reassured and started taking them.
As well as taking my new medication, I also switched my breakfast to food that contained complex carbohydrates (such as oats, whole wheat, bran, etc.). This was so that while I would still take a tablet at lunch and dinner, I wouldn’t need to take it in the morning. However, as we all know, pregnancy brings cravings with it. This meant I’d have the occasional sweet snack, ice cream or milkshake outside of my regular meals, and I’d have to take an extra tablet with it to keep my blood glucose levels in check.
As my pregnancy progressed my ultrasound scans kept coming back normal. However, being a doctor I was apprehensive, so I used to get frequent scans to check for macrosomia or polyhydramnios.
Reaching the third trimester
My 3rd trimester was difficult; I got hungry every so often and had to keep track of what I was eating and its effect on my blood glucose levels. However, I found a way around this by walking for 8-10 minutes after every snack – This kept my need for extra tablets in check, so I never had to take more than 3 tablets in a day.
When I got my ultrasound scan in the 28th week, the baby was 1 week ahead in terms of abdominal circumference (which meant the fetal weight was a bit high). This continued in future scans, till the 34th-week scan when the abdominal circumference was 2 weeks ahead. The fetal amniotic fluid was normal.
I’d already had C-sections (caesarean) for my earlier kids, and it was a certainty I was going to have one for my 3rd child too. Knowing this, and combining it with my inherent nature as a planner, meant I had a hospital bag prepped and ready well ahead of time.
One evening, in my 35th week, I began to feel a weird ache in my lower back that kept coming and going. My doctor advised me these were likely false pains and gave me spasmolytic tablets for them. I took these tablets 3 times over the next 24 hours.
However, the pain in my back didn’t go away. Instead, it grew more intense and lasted longer. I had no clue what was happening, but the next afternoon my husband and I decided to go to the hospital.
At the hospital, I found out I was actually 1cm dilated, in preterm labor, and having labor pains – At 35 weeks!
I’m sure I would have panicked if I’d had time to do so.
Instead, I was immediately prepped and rushed into an operating theatre. A C-section was performed and a healthy baby boy weighing 3kg was delivered. His vitals were stable, and I was fine too.
As soon as I was moved out of intensive care, my blood sugar level returned to normal. I checked my level for 1-2 days after, but they remained stable and I didn’t need to take my medication anymore.
Life moves on
Our life shifted to its new normal soon after the delivery. I now had 3 kids to look after, and that meant even less time for myself – No workout, less sleep, and a more stressful work-life balance.
I also couldn’t lose the weight I’d put on (almost 20kgs after 3 pregnancies), and had lactational amenorrhea (I wasn’t menstruating) which continued well after my 3rd baby’s 1st birthday. I never checked my blood glucose levels after his birth and had almost forgotten about the gestational diabetes I was so afraid of.
My next surprise
When my son had his 1st birthday, I thought about shedding some weight. Luckily, I found it very easy to skip meals – Most of the time I wasn’t hungry and didn’t feel like eating.
I lost 6kg in 4 months just by skipping meals and avoiding sugars, and was very happy.
Little did I know I’d conceived again!
Shocked, I realised the reason I wasn’t menstruating wasn’t lactational amenorrhea after all, and the thought of having to deal with gestational diabetes once again hit me hard. I was also very worried about having a fourth C-section. Since I wasn’t sure when I’d conceived, I decided to get an ultrasound.
This 1st scan had another surprise in store for me – I found out I was 17 weeks and 4 days into my pregnancy, and well into my 2nd trimester.
I immediately contacted my gynecologist and started checking my blood glucose levels. However, gestational diabetes hadn’t started yet.
As soon as my 3rd trimester neared though, so did the deranged blood sugar levels. This time I decided to take insulin instead of my previous medication (which I thought might have had something to do with my previous preterm labor). Insulin administration was more painful, tedious, and harder to adjust to. It took me a few weeks to work out the exact units I needed to take after every meal. Whenever I had to take an insulin shot, I missed my tablets (which I could just eat), but it was my decision and I stuck to it.
As my pregnancy progressed, my ultrasound scans showed the same pattern as last time – At 30 weeks, the baby was 2 weeks ahead in terms of abdominal circumference and fetal weight.
I was hoping to reach at least 37 weeks, but once again I started to get pain in my lower back – This time at just over 33 weeks!
My doctor prescribed tocolytics (an anti-contraction medication or labor suppressant) to try and stop the pains for at least a few days and let me reach 34 weeks, but nothing would stop them.
I’d already taken steroid shots at 30 and 32 weeks to improve the baby’s respiratory maturity, but I was still panicked. I was so scared that my baby would have respiratory distress.
I was still praying for my baby when they gave me the anaesthesia.
When I opened my eyes a few hours later, in the intensive care unit (ICU), I learned the baby’s vitals were stable and he was doing fine. Relieved, I closed my eyes again and slept a few more hours.
When I next woke up, I learned my blood sugar levels had dropped drastically during surgery and I’d needed dextrose (a simple sugar extracted from corn) to stabilise them. I was advised not to use insulin anymore.
I also realised that my belief my previous medication had caused my preterm labor was busted. It was probably caused by my gestational diabetes, stress, or both. I don’t know for sure.
Life moves on again
Life after the birth of my 4th baby (my 2nd son) was like a rollercoaster. Taking care of 4 kids, including a premature baby, was a herculean task that consumed all my time and strength.
And something was wrong – I didn’t feel well.
One day I randomly decided to check my glucose levels after an 8-hour fast and discovered they were very high. It turned out I was prediabetic – So my gestational diabetes hadn’t left this time.
I’m still struggling with my weight. I’m controlling my blood sugar levels with regular exercise, portion control, and the occasional use of medication.
I’m hopeful I can beat my diabetes though, if I lose more than 20% of my weight – Let’s see how soon I can do it!
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Rabia's sister developed gestational diabetes. But keeping a positive attitude, and setting targeted diet and exercise goals, helped her get through it.