Friends, Romans, Countrymen! Lend me your ears!
A dramatic start? Perhaps. But for me this is drama worthy, game changing stuff. This is a story about my personal health journey, but at it’s heart, this is a story about taking action to manifest positive change in your life. Anyone can change their life, you just have to take the first step.
For those who have read my earlier blog “Low carb living – it’s not just a fad diet!” you will know a bit about my journey through my diagnosis of gestational diabetes mellitus (GDM) with my first child, which failed to resolve as expected in the post-natal period, resulting in a diagnosis of pre-diabetes. If you haven’t read that one yet I encourage you to, as it puts this blog into context.
What is GDM?
Diabetes is a progressive condition in which the body becomes resistant to the effects of insulin. Insulin is the hormone that converts glucose in your blood into energy and allows your body to store this energy for later use. Resistance to insulin means that over time, chronically high levels of blood glucose can damage blood vessels and cause the build-up of plaque inside them. This results in poor blood flow to tissues, commonly the extremities (eg. the toes and lower limbs) and the small blood vessels that supply your nerves (diabetic neuropathy) and eyes (diabetic retinopathy).
During pregnancy, your placenta produces hormones that help your baby to develop and grow. These hormones interfere with mother’s insulin (causing insulin resistance), so mother has to produce higher and higher levels of insulin to maintain normal blood glucose levels (two to three times higher in later pregnancy). If the demand is not met, blood glucose levels rise and GDM develops. If the mother’s blood glucose levels remain high, the baby may grow too large, too quickly which can lead to problems both during and after birth. Most obstetricians will be keen to induce labour early or no later than your estimated due date to reduce any labour related risks, which can be a problem for women who wish to go into labour naturally (like me).
For most women, their GDM resolves after birth as the hormones produced by your placenta are no longer an issue. However, the risk of developing Type 2 Diabetes later in life is significantly higher.
I was diagnosed with GDM with my first child. After Oliver was born I pretty much returned to my high carb pre-pregnancy diet, expecting that the GDM would have resolved. However, to my genuine surprise, my post-natal Glucose Tolerance Tests (GTT) at eight then sixteen weeks (the second one was at my request as I couldn’t quite believe the results…) showed blood glucose levels indicative of impaired glucose tolerance or pre-diabetes. This meant that even without the additional hormonal strain of pregnancy, my system was not adequately managing my blood sugars and I was at high risk of going on to develop Type 2 Diabetes and heart disease.
These results were such a shock to me, as someone who prided themselves on being fit and healthy. At the time the second GTT was done I weighed in at just under 50kgs (BMI: 19 – the combined result of the dietary changes I made after the first GTT results, post-natal anxiety and breastfeeding), so the only ‘risk-factor’ my doctor could identify was my Polynesian heritage which irked me as my father (Maori) does not suffer from diabetes or any glucose related issues, and my mother is Caucasian Australian.
For those not familiar with the GTT, basically it involves fasting for a minimum of eight hours prior, then attending a pathology clinic for a fasting blood test. You then have to drink (in one quick go!) a horrible, sickly sweet glucose solution which contains 75g of sugar. One teaspoon contains about four grams of sugar so that is 19 TEASPOONS OF SUGAR IN ONE NASTY DRINK!! I can’t tell you how nauseous I always feel after these drinks! So bad. Not only because I’ve just dumped 19 teaspoons of sugar into an empty stomach which would make anyone queasy. But also psychologically, for someone who has completely overhauled their diet to avoid refined sugar and carbohydrate, doing this to myself feels like a physical, mental and emotional violation of everything I believe in.
You then have to sit around the clinic for 2 hours getting another blood test at precisely 1 hour post drink, and again at precisely 2 hours post drink. Fun times huh? Bring a good book.
Here are the GTT 2 hour ranges so you know what normal and abnormal looks like:
3.6 – 7.7 mmol/L Normal
7.8 – 11 mmol/L Impaired glucose tolerance, or pre-diabetes
11.1 mmol/L or > Likely Type 2 Diabetes
Type 2 Diabetes is then usually formally diagnosed using the Glycated Heamoglobin (HbA1C) test. This measures your average blood sugar levels over the previous three months, so is a much more accurate reflection of how well (or not) controlled your blood sugars are. For the record, my HbA1c has always been within normal ranges which to me basically meant that I was doing an effective job of maintaining healthy blood sugars via my diet and lifestyle choices.
The table below shows my 2 hour GTT test results progressing from my first pregnancy, through to my diagnosis of pre-diabetes.
|Timeline||2 hour GTT Result||Outcome|
|~27 weeks pregnant with first child||8.5 mmol/L||Diagnosed with Gestational Diabetes.|
|8 weeks post-natal||10.2 mmol/L||Diagnosed with pre-diabetes|
|16 weeks post-natal||9.9 mmol/L||*Re-test at my request: no change in pre-diabetic status|
I was prescribed Metformin 500mg BD and advised this was a chronic, progressive condition unlikely to resolve, highly likely to progress to Type 2 Diabetes sooner rather than later.
What it all meant.
So I had pre-diabetes. Insulin resistance. Hormone issues. Fertility issues. Needed IVF to conceive. So many confused thoughts were swirling around in my head during the first year after the birth of my son. It all seemed to point back to hormone derangement as obviously insulin is a hormone….how and why did my hormones become so deranged? I wanted answers but unfortunately none of my specialists (fertility or obstetric) had any for me. My fertility diagnosis was “Primary amenorrhea” which is really just a fancy term for “no period, no specific cause identified” which raises more questions than it answers. Why did I stop getting my period? All of this resulted in a flurry of obsessive research, study, self-development and self-guided learning on anything I could get my hands on about insulin resistance, diabetes and the impact of diet and nutrition. I developed and sustained a healthy, nutritious and thoroughly enjoyable and sustainable diet that was based on loads of veggies, fruit, nuts & seeds and healthy protein. I completely abstained from bread, potatoes, white rice, pasta, noodles and any form of flour based products like cakes, cookies and pastries. I limited my sugar intake to that found in fruit and veggies, and the occasional raw (protein and fat heavy) treat. I started studying health and nutrition coaching with the Institute of Integrated Nutrition (IIN). I also started a daily meditation practice and had some transformative break throughs in terms of mind-set which I believe are all inter-related in the optimisation of my health over the past 3 years. Although I still don’t have solid answers to my hormone questions, I’m starting to realise that it all comes down to holistic health and well-being. And here is why I know I am on the right path.
When our son was about two and a half my husband and I decided we were ready to try again for a second child. For us this meant booking an appointment with my fertility specialist who advised going ahead with a frozen embryo transfer. This meant months of rattling around full of tablets. However, I was grateful that this time around all my hormone supplements could be taken orally rather than via injection as required for an egg harvest cycle. Our first embryo transfer did not stick. I was devastated. More devastated than I thought I would be to be honest. When I got the news I cried as though my heart was broken (in the carpark at work. Of course we always get bad news at work right?). As we had decided we would not go through another IVF and egg harvest cycle, this ‘failure’ felt very final, as we only had another two remaining frozen embryos, so literally only two more chances at conceiving this way. Fortunately, our second embryo transfer was a success and as I write this, I am 31 weeks into a healthy pregnancy!
As my pregnancy progressed I became conscious of the fact that my placenta was producing the hormones that would compound my pre-existing insulin resistance. I discussed this with my obstetrician who said it was extremely likely I would develop GDM this time around and to start monitoring by blood glucose levels again using my glucometer. I had, in fact, been monitoring them myself, irregularly prior, then much more regularly throughout my early pregnancy, for my own peace of mind. They were always within normal ranges and usually at the lower end of normal range, so I felt good that I was controlling them effectively. As the time for the GTT got closer I was filled with dread. I was filled with dread because I hated the damn test process, because I was sure I would have GDM again, and because if I had GDM again my risk of needing an induced labour were much higher and I was really, REALLY keen to avoid induction the second time around if at all possible.
My pregnancy GTT result at 28 weeks gesetation:
|Time||My Plasma Glucose||Normal Range|
|Fasting||4.0 mmol/L||(3.0 – 5.0)|
|1.0 Hour||9.3 mmol/L||(3.0 – 9.9)|
|2.0 Hour||7.3 mmol/L||(3.0 – 8.4)|
Interpretation: Consistent with normal glucose tolerance in pregnancy.
MIND OFFICIALLY BLOWN.
There is a strong chance some of you reading this may not appreciate the gravity of this result and think maybe I’m over-reacting a bit. But for me, this result blew my mind and is up there as some of the best news I’ve ever received in my life.
My Obstetric Clinic emailed these results through to me whilst I was at work (naturally), on my way to a physio home visit. I parked in my client’s driveway and anxiously opened the email. On re-reading the result several times I promptly burst into tears, which I then had to promptly rein in as my client had decided to come outside and greet me (why oh why couldn’t’ he just stay inside and wait for me to come in! I really wanted to savour those tears of happiness!!!)
When I returned to see my obstetrician for the follow up appointment, she expressed her genuine surprise at the result. She said she’d never actually known a patient of hers who had GDM with their first child to not have it with their second. She also advised me to continue to monitor my blood sugars regularly and randomly to ensure there was no belated onset. I have and continue to do this with results remaining well within normal range.
What the result means to me.
This means so much to me. I consumed 19 teaspoons of sugar within two minutes at 28 weeks pregnant (so highly vulnerable to insulin resistance) and my blood sugar levels remained within normal limits. There is no meal I could conceive of that would ever come CLOSE to having this much glucose (even my pasta and garlic bread dream meal!) so this really is the ultimate test of what my insulin is doing and how my body can manage blood sugars. For someone who was diagnosed with pre-diabetes, prescribed Metformin for the rest of my life and advised I just had to do my best to manage things as it would inevitably progress to Type 2 Diabetes (this last comment from a Endocrinologist), this result is life changing.
It means I do have control over my health and wellbeing.
It means that by making healthy diet and lifestyle choices we can manifest extraordinary change in our lives.
It means I just may have successfully reversed a serious medical condition.
It means that maybe anyone can do this!
There is lots of information and education out there about healthy choices for preventing and managing diabetes but I feel like my story needs to be shouted from the rafters! By making healthy lifestyle changes you have the potential to reverse impaired glucose tolerance! Diabetes is one of the fastest growing health conditions in the world! The implications are enormous!!
I can’t tell you how much this has done towards empowering me. I feel as though I can achieve anything with the right mindset, a healthy dose of commitment and most importantly by taking action and making changes. I completely changed my diet and lifestyle, and it paid off. I wouldn’t say it was easy exactly, but it also wasn’t hard as the goal was to avoid progressing to a disease process I was all too familiar with through my work on a Public Hospital Vascular Surgery Ward. I feel on top of the world!
PS – Only 12% of women develop GDM so I’m aware a lot of you may be thinking “how on earth is this relevant to me?” But I hope you see that the relevance to ALL lies in the journey, the action and the positive result as the result of positive change. What’s your thoughts?
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