As I said in my last post on this subject, it doesn’t seem as if either my body or my mind likes being pregnant. I can certainly pinpoint the stage when things all started to go wrong the first time around, though: it was when, completely out of the blue, I was diagnosed with gestational diabetes at around 29 weeks. The whole situation was a bit of a mystery. I had no family history of diabetes. I was pretty active, and eating healthily. I hadn’t shown any of the usual symptoms, and indeed I had barely put on any weight at all. Nobody would have had any idea about my underperforming pancreas had it not been for the hospital’s policy of screening all pregnant women for diabetes, whether they were showing symptoms or not. I can’t say for sure whether or not it was a good thing that I was diagnosed. I have to hope that the whole rigmarole was worth it for the boys’ sake. And, who knows? Maybe I would have had the peri- and post-natal depression anyway. What I do know is that it was with the diabetes diagnosis that I started to lose control over my pregnancy, and, to a degree, my sanity.
I think much of the problem the first time around stemmed from the hospital’s “one size fits all” approach to treating the condition. I had gestational diabetes, which, obviously, I must have caused by being grotesquely overweight and persistently gorging myself on chocolates and cheeseburgers. When the diabetes got worse, week-by-week, to the point that I needed insulin to control my blood sugar, well, that meant I clearly wasn’t trying hard enough. The fact that I needed insulin during pregnancy was also clearly an indicator that I was well on the way to type 2 diabetes after the delivery. Why couldn’t I just put some more effort in? Didn’t I have any self-control? Did I actually want my baby to die? Oh, and, by the way, the consultant happened to be running a study of obese mothers with diabetes: did I want to talk to a social worker about my bad food choices and how they would affect my unborn child?
As you can imagine, this was not the most helpful approach for them to have taken.
What was in fact happening was that I started out eating a fairly normal, balanced diet (cutting out, of course, any obvious sugary items), but, in response to the constant criticism from the hospital, I began cutting more and more foods out entirely: not just starches, but all fruit and most vegetables too. By the end of the pregnancy, I was really only eating fish and leafy greens, and I was getting so fixated on my apparent failure to control the diabetes with diet that I was pretty much terrified of eating. As for the weight issue, well, this is me about a week after Eoin was born: you can judge for yourself. I’m afraid I have absolutely no idea who took the picture, and I do look a bit of a state: I was already getting fairly unwell at this point. I think it’s fair to say, though, that I was not obese.
Perhaps if I had been more blasé about the whole thing, it would have been better. However, I was far too determined to do the right thing, and was desperately trying to measure up to the consultant’s impossible standards. Instead of being supported, I was left feeling that everything I did was wrong. I didn’t realise at the time that gestational diabetes inevitably gets worse no matter how carefully you eat, or how much exercise you do: it is your placenta that makes you insulin-resistant, and the only sure way to ameliorate the condition is not to be pregnant any more.
Fast-forward three years, and, having moved cities and now pregnant with Ronan, I was again faced with the likelihood of diabetes. Thinking about how badly the diagnosis had affected me the previous time, I was, understandably, pretty worried about how I and the medical team in this hospital would deal with the situation. At first, things seemed to proceed along the same lines: I had no symptoms whatsoever, and all early tests were clear. Suddenly, around 28 or 29 weeks, I was again diabetic and bracing myself for the anticipated misery. I am incredibly grateful to be able to say that I couldn’t have been more mistaken: the entire medical team was supportive and understanding, and, more to the point, they actually listened to my story and took on board the details of the situation. When I described the meals I had eaten, they didn’t accuse me of lying. When I worried about the severe restrictions I was going to have to place on my diet, they kindly pointed out that this was a temporary condition, and if I needed to take insulin in order to be able to eat a balanced, healthy diet including the occasional piece of fruit, then so be it. When, as was inevitable, my blood sugar started to get harder to control, they didn’t immediately accuse me of illicitly eating chocolates and chips, but rather reviewed my diet and discussed insulin dosage in a measured, sensible manner. They were thorough and caring, but notably absent was the overwhelming sense of blame which had pervaded my first experience. With Eoin, starting insulin was seen as the final confirmation of my absolute failure. With Ronan, it was very definitely a necessary short-term measure, one which would enable me to go on leading a normal life. It might be interesting to note that, while my mental health was so much better during my second experience of diabetes, the physical impact on me was almost identical: again, I put on very little weight (about 2 kilos) up to the point of diagnosis. Again, I promptly lost it immediately I stopped eating any and all cake. Barring my blood glucose levels, I never showed any symptoms of diabetes, and my HbA1c, when I’m not pregnant, is totally normal. Ronan was, like Eoin, not the macrosomic monster-baby you might expect, but rather smack-dab in the centre of the size bell curve. Really, the only difference with my second pregnancy was that I didn’t spend my final trimester hovering between blind panic and a crushing sense of failure.
Again, I have to underline the fact that I am not that kind of doctor. This post is not intended to be a substitute for proper medical advice. What I do want to say, though, is this: if you’re reading this, and you’ve recently been diagnosed with gestational diabetes, please learn from my mistakes. Firstly, it’s honestly quite likely that there’s nothing you could have done about it. People do like to play the blame game when you’re pregnant (and get used to it, because it doesn’t stop when the baby’s born), but it’s entirely possible that you would have been diabetic whatever you had done. While it’s probably not a good idea to prepare for pregnancy by putting on a pile of extra weight, it’s important to note that being large doesn’t inevitably mean you’ll develop gestational diabetes. Other significant risk factors are your age, and whether or not you have a family history of diabetes: there’s really not a great deal you can do to change these. Don’t panic about food, like I did: once you cut out the obvious problem foods (sugars, processed stuff), there’s really nothing to be gained by starving yourself. A low-GI diet should work, but, for heaven’s sake, don’t try to eat a low-fat diet too: get plenty of nuts, avocados, full-fat yoghurt, eggs, cheese and oily fish into yourself. They’ll help to balance out the overall GI of your meals, provide valuable nutrients, and, crucially, keep things tasting good. If you need insulin, make your peace with that. Be grateful that you’re unlikely to need it forever. When you’re pricking your fingers to check your blood glucose, or looking for a new spot in which to inject, remember that there are an awful lot of people for whom this is daily life, not just a frustrating side-effect of a biological process. Understand that, while this may mean you are more likely to develop diabetes later in life, it is not a foregone conclusion. Be sensible, be cautious, but don’t be paralysed by fear, and don’t ever feel that you’ve failed. Take it from me: it isn’t worth losing your mind over.