Gestational Diabetes/NST's/Inductions? (kind of long, but please read)

[psychelle]

I have a few questions here (obviously, if you read my title of the post, lol! :)).

I have gestational diabetes. It was diagnosed in June, and in July I became insulin-dependent. I have been trying my best to follow the diet, but it sure isn't easy! The doc has had to increase my insulin doses several times (I am currently on 12 Regular + 26 NPH 1/2 hr before breakfast, 20 R 1/2 hour before dinner, and 18 NPH with my bedtime snack). Is this common to have to have the insulin increased so much? Does this mean that I am more likely to continue having diabetes after I deliver?

I am doing NST's twice a week, and they usually come out fine (reactive). The last two, though, the monitor placed at the top of my uterus showed that I have what the nurse called "uterine irritability." Basically, the print-out lines were very wavy, and she said that it is nothing to worry about, that it can be caused by lots of different things. Has anyone heard of this and can offer a fuller explanation?

My doc has said that if the baby gets "too big" he will schedule an amnio and an induction. I am currently either almost 36 or 38 weeks, depending upon what due date you go by (36 weeks by my LMP date, 38 weeks by the results of my first ultrasound). I had an induction with my first son, and I am scared that it will turn out badly--with my first, I don't think my body was ready at all, my bones didn't separate and his head came out really squashed, so he had to spend time in the special care nursery. Plus, I have a pre-existing hip/tailbone problem which couldn't be resolved with physical therapy (I will have to get x-rays after I deliver). My doc won't consider a c-section, not that I really want one, but I am scared! Any advice or words of wisdom you can give me? I have mentioned my concerns to my doc, but he doesn't seem too worried and, frankly, he seems like he is just dismissing my concerns as frivoulous. It is too late to find another doc or anything like that.

Please, if you have any advice, please share it!

[Gwen]

I haven't had any of the things you have mentioned. I was borderline diabetic with my daughter.
Now as far as I know your diabetes should clear up after the pregnancy. But I do know that woman who have gestational diabetes are more likely to have diabetes later on in their life sometime. So talk to your health care provider about signs to watch for and maybe get a yearly test for it.

I was induced 2 weeks late with my daughter and I also was not ready. The labor went fine for us though I pushed for an hour and a half. Maybe it will be easier with this one since you have already had a baby passed through the birth canal.

Sorry I couldn't help more.

[J&H Mom]

I think it is quite normal to have to adjust insulin up and down. I did not have to take insulin but was able to control it with diet.

I know a lady at church who had to take insulin with her last dd and she does not have any problems with it now.

It does however give you (if I have my facts correct) a 50 percent chance of developing type 2 diabetes within the next 10 years.

Hope this gives you some assurance.

[Lizbaby4]

I can certainly relate to all the things you mentioned in your post. I am now insulin dependant GD. This is my 4th time! The diabetes does clear up after the pg, most of the time...
You should have an annual blood test called a hemoglobin A1C, which will indicate blood sugar control for the last 60-90 days, also one about a month or 2 after you deliver.

My doctor increases my insulin weekly, based on my blood sugar numbers. He really freaks if it goes above 120 an hour after a meal! I am on 50u of Regular and 20u of NPH in the morning, 22u Regular at dinner, and 46u NPH at bedtime (so far, that will increase on Thursday when I see him!)

I am not sure what to tell you about the NSTs. If they say not to worry, then don't. As long as the baby's heartrate does not decrease with movement, it should be ok. You should also be having a BPP or u/s every week or 2 also, to more closely monitor growth and development.

As far as delivery...a good doctor will not let an insulin dependant diabetic patient reach the due date. There are so many things that can go wrong in the last month, including fetal death, that it is just not worth the risk. I was induced at 38 weeks, after an anmio to check for lung maturity, with my first. It gets harder to control the blood sugar later in pg, which has a lot of complications. Of course, I never progressed with the induction, the baby was stuck, and had a C section. He was 8 lbs 5 oz, which is small in my family! (My mother had 8-10 pounders and no diabetes).

I had a scheduled C section with my second (the last u/s I had estimated his weight at almost 10 lbs!) but he decided to come early and the C section was done about a week ahead of the planned date. He was also 8 lbs 5 oz!

The third was a scheduled C section, but I went into preterm labor at 30 weeks (not uncommon with GD), and he came at 37w1d, 8 lbs 2 oz. It was my choice to repeat the C sections.

If your doctor wants you to deliver vaginally, then it should be no problem. I would request an ultra sound to check for size beforehand though, just to be on the safe side.

Good luck, and if there is anything I can help you with, or any other questions you need answered, just send me an e mail!