Susan Semaan

This post follows on from yesterday’s, in which I share the details of my own stressful reaction to failing a glucose challenge test for gestational diabetes in my second trimester of pregnancy. (I took this test twice, in week 24 and in week 28, and I did not pass either time).

After scouring the internet for information, I began scouring for testimony. It seemed the medical establishment was quite in agreement that gestational diabetes is real, affects mothers and babies, and can befall women of all backgrounds and body types. While there are risk factors for gestational diabetes, like high BMI and a family history of diabetes, many women without any of these risk factors were still diagnosed.

I began finding these women on the internet, and I was immediately gratified that they were as anxious and as pissed off as I was. They were runners, nutrition counselors, people who follow the paleo diet … many of whom failed the glucose challenge test and some of whom subsequently were diagnosed with gestational diabetes. What were these women upset about? Well, everything about this test and its aftermath. Here are the common themes:

How could this happen to me when I am so healthy?
Why should a body’s fitness to process food during pregnancy be assessed on the basis of its ability to process something that is nothing like a food? Writers and commenters who carefully watched their diets were horrified at their reactions to the drink (some vomited, some felt like vomiting, some were grossed out) and peeved that they were expected to consume something so sugary, in the name of health, that they avoided so scrupulously in all its forms.
Why should they be forced to carry out such intensive monitoring when their real diets were completely fine? Some writers and commenters received a gestational diabetes diagnosis and were instructed to monitor their blood sugar using a glucose monitor four times a day (fasted in the morning before breakfast, and either 1 or 2 hours after meals). These women often found they processed their actual diets completely fine, and never had alarming results. Alternatively, they found that they processed their normal diets fine and had alarming results when they did eat carbs—which in some cases they claimed not to eat for exactly this reason.
Had they somehow failed their children by having gestational diabetes, and was it their fault? This was not the same righteous anger as the other two, animated by convictions about what was and was not healthy. These women felt terrible and worried about their babies. One blogger, a nutritionist specialising in gestational diabetes, chronicles her thought process on failing the test and openly admits to equating failing this test with actual, upsetting failure, her extensive knowledge on gestational diabetes notwithstanding. Her language? 'How could I not feel that way? The official medical terminology was passing or failing.’

Ultimately many women made peace with their experience, either of failing the first test and passing the second or weathering a third trimester full of screening. They dispensed advice on how to move on, how to make the best of a gestational diabetes diagnosis and learn more about health and nutrition, how to put oneself aside and put the baby first. They waxed philosophical. The fact remained, though, that they were uncomfortable with the conditions under which they were tested, stressed about the results, and unhappy with the monitoring regime that followed. One nutritionist blogger, Lily Nichols, applied her training as a certified diabetes educator to understanding her own experience in a way that could help others; hers was the only voice I found on the internet that was relatable AND knowledgeable. Most of what I read was one or the other.

I noticed a lot of things in this internet deep-dive. Many women were struggling or had struggled with this process just as I was doing, and they didn’t seem crazy or ill-informed. This was a painful process. Noting their pain, though, didn’t resolve much for me. I still had to answer the question of (1) how did I want to take care of myself and my baby given the fact that I had failed the glucose challenge test and (2) how did I want to work with my doctor on this?

Having tried, and failed, to prove to myself that gestational diabetes was a fabricated disease, I arrived at the conclusion that I did need more information about my body and that I did need outside input to get that information. I talked it over with my husband and decided to buy a glucose monitor to track my blood sugar levels; I could use this information to decide how I wanted to proceed. I began the four-times-daily process of puncturing a finger, squeezing a drop of blood onto a test strip, and writing down the number that resulted. I kept a log of what I ate alongside the number, to see if anything in particular spiked my blood sugar. After five days I was ready to cry every time I had to prick myself. (You may notice a theme here of me crying). The routine was not easy, pricking one’s own finger is a bit painful and even more painful when you are not very accustomed to taking these readings yourself and make frequent mistakes! I averaged 2 to 3 pricks per successful reading.

Monitoring myself so closely is also deeply uncomfortable for me. The constant feedback from the monitor about whether I was in desired ranges or outside them made me stressed about everything. I spent a lot of time mulling over whether I was allowed to have a snack or whether I was allowed to have a drink outside the mealtimes after which I would test my blood sugar. This was despite all my levels being normal, every time I used the glucose meter, whether or not I ate carbohydrates. This kind of monitoring drove me crazy; the fact that it involved deliberately making myself bleed did not make it more charming. Despite promising myself that I would eat normally during the test period (which I left up to my own discretion about when to stop) I felt frightened of sugar. I also drank water and took walks with more commitment than I had at any point in my pregnancy.

On day 5, I sent the results to my doctor, apologising for taking on board her suggestion without consulting her first. She laughed and confirmed that she had recommended this route, and then confirmed my levels were normal. The hospital protocols in this case were fasting levels below 90 and 2 hour postprandial (post-meal) levels below 120; my levels had been well within this range and usually quite a bit below. ‘Eat normally,’ she said. ‘And you can stop monitoring.’

I did stop monitoring, and I did continue eating normally, plus the freedom that I felt from knowing I would not be punished for what I ate. Despite the number of exhortations I read to look at the glucose monitor as simply a feedback mechanism on my diet, I was not able to be so appreciative of its insights; all I could think about was being forced to have an early induction. I had avoided a gestational diabetes diagnosis, but my new knowledge of gestational diabetes actually had shown me that this was not necessarily the good news I had been hoping for. My research empowered me to make choices about how I wanted to go through the testing process, but it made me careful of the dangers of sugar to the point of being slightly paranoid.

Knowledge, in this case, was the only thing that I could draw on and it felt like the thing to trust, but ultimately it was less decisive and less reassuring than I wanted it to be. Intuition, as well, had been slightly off: my ‘feeling’ that gestational diabetes was a fake disease was not entirely reliable. It was a humbling experience, to be sure.