Week 2: Back to Square One

The end of a year and the beginning of another is typically a time for contemplation and new beginnings. Two years ago, I wrote a long and heartfelt post about gestational diabetes being a wake up call for me, and resolved to make some positive changes in my life in 2015. And indeed, 2015 was a year of hard work and many lifestyle changes. I put many new habits into place and gratifyingly, becoming lighter, fitter, stronger as the months went by.

And then, things changed again. By the end of 2015, I was pregnant with my second baby and the first trimester fatigue was overwhelming. I had to take life one day at a time. My history of gestational diabetes flagged me for an early screening test, the one-hour glucose tolerance test. I failed the test by a small margin, with my blood glucose measuring at 144 mg/dL when the cut-off is 140 mg/dL. This meant that I had to go in for the three hour 100 gram glucose tolerance test. My glucose measured perfectly within-range for the longer test, so my OBs and I collectively breathed a sigh of relief and they advised me to keep doing what I was doing in terms of being active and moderating my carb intake.

Around 25 weeks is when most pregnant women in the US are tested for gestational diabetes, and when this time rolled around for me, it was recommended that I go in for yet another three hour glucose tolerance test. And I did something that I rarely do in the face of medical advice- I refused to take the test. Why? Because (a) I am "borderline" on these tests, either narrowly passing them or narrowly failing them more or less depending on the day, (b) I find this test to be extremely unpleasant what with drinking 100 grams pure glucose on a fasting stomach and then sitting around the lab for 4 hours for 4 separate needle sticks, and (c) most importantly, if I failed the test, the next step would simply be that I would be testing myself 4 times a day with finger-sticks and a glucose meter and controlling my blood glucose with diet and exercise.

So I chose to skip the test, and go straight to the self-monitoring. I had my glucose meter from 5 years ago; I bought fresh test strips and new batteries, re-calibrated the meter and was good to go- testing 4 times a day (fasting + an hour after breakfast, lunch and dinner) and meticulously recording the numbers. Interestingly, two of my OBs thought my approach was perfectly reasonable. The third OB was not happy- her argument was that without the test, I don't have a diagnosis of being either positive or negative for gestational diabetes- having the diagnosis flags a woman for further tests. I saw her point and worked out a negotiation- I would continue self-monitoring and let them know if the numbers were trending high (but still skip the darn glucose tolerance test). And she would send me for a late-term ultrasound, which they recommend for GD+ women to make sure the baby wasn't getting too big (etc.)

I find glucose self-monitoring is the most amazing tool for me. You get instant feedback on how you are doing and how different types, amounts and combinations of foods affect your blood glucose. For instance, my numbers would always run high after eating Chinese take-out, even when I skipped the rice. They would run high when I ate take-out pizza, even if I ate only 2 small slices and a big salad on the side. The finger-pricks honestly are not painful, especially once you learn how to do them right, but I still find them unpleasant to do. There are a few non-invasive glucose monitors being developed- skin patches, earlobe clips- and I hope they are commercially available soon because I want to buy and use one of these. Regular glucose monitoring is the best way to prevent and self-manage diabetes.

Anyway, I managed to keep the glucose numbers within range during the pregnancy. After a few weeks of within-range numbers, one of the OBs said I could calm the heck down and test only 1 day or so per week. Even though last spring and summer was a hectic time for our family and there was no time for carefully calibrating diet and exercise, I believe that the reason it went better this time was because I was in better health at baseline and knew what works for my body. I will be eternally grateful that the baby was born uneventfully and with an average birthweight.

With a new baby, all kinds of routines and habits go down the tubes. We have been in maintenance mode. Now with a nearly 6 month old baby, I feel as though I am back to square one in some ways. And that is OK. I just have to work out a new normal in terms of eating and exercising. In life, the only constant is change and you just keep adapting and tweaking the routine to keep up.

So when this past weekend, a dear friend brought up the idea of doing a sugar-free month, I jumped up and said I would do it with her. She was inspired by this NYTimes article. The sugar-free month is intended to reset taste buds that have been over-indulging in sweets over the holiday season. It is a way to become more aware of how much sugar we consume on a day to day basis without even realizing it.

We're trying to get some of our friends and co-workers to join in on the "fun". The whole month of February will be our sugar-free month so we have a couple of weeks to prepare for it. When I say sugar-free, it is more of a "free of added sugars", meaning that sugars naturally occurring in fruits, vegetables and dairy are fine. But really, each person doing the challenge gets to make their own rules about what foods they want to cut out and what habits they want to change.

Do you have any interest in joining our Sugar-Free February challenge? Let me know and I will post updates on the blog so we can all do it together.