I first truly learned the importance of advocating for yourself (or having someone advocate on your behalf) when I was in Rwanda experiencing the cancer diagnostic process there. That situation never leaves me. Since then, I’ve always been a proponent of listening to your body, seeking medical consultation when in doubt, and pursuing treatment early on. Timing of diagnosis and treatment, in many injuries and illnesses, can have a huge impact on the treatment process and/or outcome. And if it turns out to be nothing? Well then you have peace of mind and can move on.
This mindset has already helped me during pregnancy and it’s a clear example of how it’s beneficial for us to be an active participant in our own healthcare journey – whatever that may mean to you.
In early pregnancy, I was quite scared of all the what ifs. What if this isn’t a viable pregnancy? What if we have a miscarriage? What if the genetic testing shows an abnormality? I didn’t let it consume me, but it certainly hindered my excitement a bit as I felt more fear – definitely related to my cancer trauma. As the weeks went on though, appointment by appointment, I started to feel better. Each time we were told things were going well and our baby appeared healthy, I breathed a sigh of relief. Luckily, our baby is still healthy, as far as we know, and that’s all we hope for.
However, sometime nearing the end of the first trimester I was on my hospital system’s online portal looking at test results and I found something that caught my eye. It was a blood test result from a year ago, pre-pregnancy, that I had never seen before. I switched primary care providers because I didn’t care for the one I had, and somewhere in the transition, this result must have gotten lost in the mix. I had a high glucose reading – 189 mg/dL. Now, I didn’t even know I had a glucose test done so it was not a fasting test, and it very well could have been that I had some chocolate or something right before the blood test. I do love chocolate, after all. So I didn’t jump to conclusions.
The result just piqued my interest and made me wonder – could I have pre-diabetes and not know it? I have a family history of type II diabetes and while it can be lifestyle-related, genetics play a large role. Well, now I’m pregnant and I know about gestational diabetes so I wondered if this could be of concern here too. Although this test was from a year ago, I wanted to reach out to my doctor.
So, I messaged my primary care provider, my current one and not the one that performed the original test. He said that my OB would do a gestational diabetes test later in pregnancy and I shouldn’t worry about it. Well, I didn’t think that was a good enough answer so I reached out to my OB. He also wasn’t concerned, but said we could do a finger prick glucose test at my next visit.
That, to me, was a start. A finger prick glucose test isn’t a gestational diabetes test. It’s simply a measurement of your glucose level at a moment in time, without fasting or changing your diet in any way. So at my 15-week appointment, we did the finger prick test. He had a nurse or tech do the test at the end of the visit, because he said again that he wasn’t concerned at all. Well, the reading was higher than we’d like – 149 mg/dL – 1.5-2 hours after I last ate. My doctor came back into the room, surprised, and said we’d push up my gestational diabetes test to our next appointment at 19 weeks, rather than wait until the 28-week appointment.
The process for a gestational diabetes test is that you first take the 1-hour glucose tolerance test where you fast for 2 hours prior, drink a gatorade-type drink at the office and do the finger prick glucose test exactly one hour after you finished the drink. Depending on the reading, you either pass the test or they move you on to a 3-hour test with different guidelines.
In the meantime, my doctor told me to eat a low carb, high protein diet. I didn’t think that would be much of an issue but I found it extremely difficult once I realized how many carbs are in many vegetarian sources of protein. It felt impossible to get enough protein while also reducing my carb intake. I eliminated as many simple carbs as possible, leaving in complex carbs to be able to get my protein in. I still felt like it was high carb but I did what I could. It was mentally taxing though, as I generally eat a nutritious diet as is and I follow a ‘no food is bad food’ mindset with everything in moderation. Restriction, to me, feels awful and usually doesn’t bode well for me mentally.
I did what I could though over the next month and I tried not to let it consume me. Fast forward to our 19-week appointment. This was the big one – our anatomy scan! We were incredibly excited about this scan but I was also aware that I’d be learning more about the possibility of gestational diabetes through the 1-hour test.
I started the appointment by drinking the gatorade-like sugary drink, which wasn’t as bad as I anticipated but wow was it sweet, even for me! While we waited an hour to do the finger prick test, it was scan time! We’re lucky enough that our friend’s mom is our ultrasound tech so she spent a lot of time explaining everything we were seeing as she went and everything looked great! Nothing seemed concerning and our baby was measuring perfectly so we were relieved and thrilled with this news. It was also truly incredible seeing the images and movements, since the only other scan we’ve had was when baby was a little bean at 7 weeks. It definitely helped this pregnancy feel more real and it’s wild what you can see in an ultrasound!
As we were waiting for baby to move a little so she could get the remaining images, we realized it was an hour since I drank the glucose drink and I needed to get the finger prick done. She told me to hop up, go down the hall to the lab, test and come back so we can get the remaining images. Easy enough!
They have an in-house lab so she did the finger prick and BOOM – 202 mg/dL. For those who aren’t familiar with glucose readings, they were looking for less than 134 mg/dL. My reading was quite high and she told me that I’d likely be considered to have gestational diabetes simply off of this reading. My heart sank. I didn’t want this at all (who does?) but because I advocated for this, I clearly had an inkling that this may be the result.
I went back and we finished the ultrasound with success and then it was time to meet with our doctor. When he walked in, his first words were, “When you fail a test, you fail hard!” and I laughed, and said, “Go big or go home!” I appreciate that I have this type of rapport with my doctor and we could laugh about the situation. He confirmed that we’re skipping the 3-hour test and he’s referring me directly to a diabetes clinic for next steps. Damn – it’s good that I advocated for myself but it sucks that my concerns were validated.
The rest of the appointment was smooth sailing with the normal Q&A and scheduling of our next appointment. As we left, I felt relief that we had answers and could take action but I also felt a little defeated. If the past month was any indication on how difficult managing my diet would be, I knew this would be a challenge for the rest of pregnancy. Let’s be honest, while I primarily try to eat nutritious foods, most of my favorite foods are carbs (especially when I’m not feeling well during pregnancy)! My doctor gave the green light to indulge a little over the next week as the diabetes clinic is very strict – so I did just that! One last hurrah during pregnancy with some of my favorite foods. I should have taken some photos but alas, I was too busy enjoying every bite.
As I continue to reflect on the situation, I remain grateful that I didn’t take my primary doctor’s nonchalance as a final answer to do nothing. Instead, I stuck with my gut and I reached out to my OB, who also wasn’t worried but at least took my concerns seriously and moved forward with testing.
Why did my doctors not feel that the original test warranted being looked into? Maybe it’s because I’m not considered high-risk from a weight perspective, maybe it’s because they know my history and that I prioritize my health as best I can, or maybe it’s simply because of my age? Gestational diabetes can happen to anyone who is pregnant, despite family history and lifestyle factors, though. There could be a number of reasons that they weren’t concerned but I’ve learned from my past that despite the odds, you can always be the exception so go with your gut and ignore the rest.
The most important part of this to me is that not only did I advocate for myself but I advocated for our baby. Gestational diabetes, if left unmanaged, can stress the baby’s pancreas during pregnancy and cause a high birth weight which is risky for baby and mama. It can also increase baby’s risk of having weight issues and/or diabetes in the future. If I hadn’t pushed a little, I could have been unintentionally putting our baby at risk over the next two months before getting diagnosed at the 28-week appointment. I would have felt beyond guilty if that happened.
Lesson reinforced! Be your biggest advocate and don’t take no for an answer if you feel like something may be wrong. Doctors are people too, and I’d like to give them the benefit of the doubt that they’re working based on their knowledge and experience, but sometimes that’s just not enough. You know your body best. When you advocate for yourself and find a doctor who listens and takes action, even if they aren’t concerned themselves, I call that a win. Stay healthy, friends!