Is my Gestational Diabetes back? **UPDATED**

Type 1 and LADA
1

Hello,

My name is Angela. I am 35 years old (today’s my Birthday actually).
I have been blessed with a Handsome 18 month old Son and a Beautiful 16 year old Daughter.

With my Son, I developed Gestational Diabetes. Which I was able to control with a very strict diet. So strict I gained only 13 pounds through my entire Pregnancy. My Son was born healthy thankfully, but at a relatively small 6 lbs.11oz for 40 weeks. I ate very little, mostly because I would feel absolutely terrible with sugars in the 140-170+ range (heart pounding, thirst, dizziness/lightheaded, tiredness etc.)

The last 18 months health wise has been quite the roller coaster. I’ve always had frequent headaches I attributed to working in front of a PC, living with aged glasses, not enough water intake etc. However, 10 months ago I experienced my first Migraine with Aura, then had another 6 weeks later. I sought treatment, started on Topamax with an abortive medication Imitrex PRN. Also started B12 injections (I am also a post weight loss surgery patient- 8 years post Sleeve)

After giving the medication its ample time and still experiencing frequent headaches and full blown Migraines (without blinding Aura) I started evaluating my food choices even closer than I was already. Reduced artificial sugars, stopped all alcohol intake for 2 months and still experienced daily pain and fatigue.

Then about 4-5 months ago I started noticing a familiar feeling after I ate. Extreme tiredness, frequent urination, difficulties breathing (at times) thirst and my heart racing. Additionally, I have been getting numbness/tingling in my hands, feet and lips which I first attributed to Migraine symptoms. I have lost quite a bit of weight recently, a total of 30 pounds as of now.The light bulb turned on about a 2 months ago. I started watching what I ate even more. And as I feared with sugars and carbs I felt even worse.

I decided to go to a Endocrinologist first. She did a full CMP with A1c and gave me a Blood sugar monitor. Told me to monitor myself when I felt these “feelings” and try to do my fasting BS when able. Come back in a few weeks and we can go over results and my readings. I am concerned because my blood work “seems” okay to normal, or at least within reason (?) especially my A1c. (see below)

Hgb A1c: 5.5%
HDL: 49
LDL: 109
Triglycerides: 56
Cholesterol: 169
Bilirubin: 0.2
Fasting Glucose: 83
BUN: 14
eGFR: 113
Chloride 111
CO2: 21 (I know this is LOW unsure why)

Other health related info: Post weight loss surgery, Family history of Thalassemia with associated Anemia.

My fasting blood sugars have been anywhere from 85-116. The higher they are in the mornings are usually when I actually ate the night before, nothing crazy (1 chicken taco with a flour (eeek I know) tortilla and 4 bites of refried beans- no sodas etc. EVER. My 2-2.5 hours post meal sugars have been 90-161. With the high one being when I ate approximately 1.5 cups of rice, black beans and steak with sour cream and some guacamole (taco bowl without the taco) again, I eat small to small medium portions due to my weight loss surgery and now also with the fear of high blood sugars crashing me out for the day or giving me a headache.

My fear is, with a normal A1c, and somewhat normal BS I will be viewed as “normal”. I do not want a Diabetes diagnosis- as many of you didn’t. However I do not “feel” normal at all! My quality of life is dwindling and the inability to eat is taking it’s toll. I am happy to have lost weight but I am very weak. I feel as though things are getting more and more sensitive even with “acceptable” food items at accelerated pace.

Any insight would be greatly appreciated or any suggestions on further testing (if any) so I could try to ask for when I go back to see the Endo if she deems me normal would be greatly appreciated. I am sorry if I sound desperate, but I kind of am.

Thank you in advance,

Angela

2

First off let me say, I’m sorry you having these issues. I may be off base when you say you can’t eat…is that because you don’t feel well with them or because you worry that your sugars will spike.

If it is because you don’t feel well have you been checked for gastroparesis, which is slow emptying of the stomach and not un-common after weightloss surgery.

You may also want to have your iron checked as you have PA already (from the B12 shots) and Iron usually strolls in there. Also, be sure to push your proteins and water…

3

Mskdka,

Thank you for reply and kind words. Your suggestion for looking into Gastroparesis is something I never thought of. I thank you.
The original reasoning behind my B12 shots was for Migraines actually- I read that they can help. I went to a local lab that gives them for $30 (for weight loss) and well it helped then- my PCP felt it was good enough to give me a Rx especially since I was post weight loss anyways.

My Anemia is most likely due to Thalassemia which my Mother, Grandmother and Great-grandmother all had/have. But I have not had a recent CBC either- wonder why the Endo did not run that.

My lack of eating is due to fear of spikes and tiredness. Which I know not consuming is a vicious cycle that leads to more tiredness. Of course when I make wise choices, in which I feel I mostly do- I do still at times feel tired but without the palpitations, and all the other symptoms. I feel even worse with any carbs or sugars and now that I am monitoring again, I see that carbs and any sugars probably do not mix well. With weight loss surgery I’ve limited my breads and rice already due to just lack of room reasons, now I’m just in awe of the sensitivity of carbs and sugars (even with fresh fruit) I’ve gained since my GD and Pregnancy. Protein is what keeps me alive, and of course water!

Again, I am thankful for the recommendation on the testing for Gastroparesis. I am now armed with that request.

4

Hi Angela,

Definitely something going on.

Can you try eating more at least to support the information collection… And record what you eat so that the Dr can see.

Many women have gd before a diagnosis.

The endo should ideally do a complete workup looking for type 1, including antibodies, cpeptide, insulin levels, and maybe a glucose tolerance test.

Eating low carb or even ketogenic may help symptoms and enable you to eat more.

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5

Hi Your A1C looks great. I believe over 100 fasting is considered pre-diabetic. It was for me. I had gestational diabetes with my twins at age 38 and they went full term but I was on bed rest for 5 months. For me the diabetes never went away. It has progressively worsened over the past 18 years. I had to start insulin last October. For years I managed with diet and exercise.

you are doing the right thing keeping a close eye and seeing a specialist.

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6

Hello all,

Just followed up with my Endo- and she told me “There is definitely something wrong, but I am unsure of what it is at this point- and I am not going to act like I know” and advised me to go to Baylor. I appreciate the honesty, but I feel very defeated at this point. She is a very young Physician and very sweet and quite Beautiful and all but I feel terrible everyday when I eat. I feel like if I ate like garbage for 3 months then my A1c would definitely reflect something but I just cannot live my life that way and old down a full time job and be a productive Mother of a Toddler and a Teen. The headaches and lethargy would surely be my demise.

I kindly asked her twice about further blood work, she declined. I asked her about a glucose tolerance test, she seemed puzzled and said, “I don’t know who (lab) would do those”. Really?

I am going to look into Baylor. Anyone with any suggestions on Physicians at Baylor or within the maze of the Houston Medical Center would be greatly appreciated. I live 45 miles from the Med Center and taking time off work is ALWAYS a problem so this will be FUN.

Thank you in advance.

8

Justlookin,

Thank you, I agree with everything you said. I will most likely go to my PCP whom is very understanding and will listen to me and usually any suggestions or questions I have, I will ask her if she could write an order for this blood work.

Thank you.

10

I am going to ask my PCP. It seems like at least in my general area, unless your Pregnant it’s extremely difficult to get a GTT? I would think if someone had GD and is experiencing the same symptoms and almost exactly the same BS spikes as when I was Pregnant- it wouldn’t be difficult to do. But here I am.

My fasting BS at the highest was 116. Usually it’s pretty “normal” around 80-90’s. However, I do not eat a “normal” amount of food since I am post weight loss. The 116 am was the morning after 1 chicken taco with pico, lettuce, sour cream and 4 bites of refried beans at 11:00 pm (I was driving back from out of town).

I understand these levels are not extreme, however at 120 I can see my heartbeat in my vision and when I am above 140 I feel terrible. 160 I felt as if I was walking through wet sand having with palpitations and weak arms. I know it would be much higher if I ate a big mac, drank a coke and ate fries. But I can’t physically do that- I could eat probably half, but I am afraid of the wipe out and hangover later on.

I called my OBGYN regarding my 2 hour GTT that was done 6 weeks after birth (12/17/2015) my results were:

60 min BS was 154
120 min BS was 98

Those values seem borderline- please correct me if I am wrong. I was also exclusively Breastfeeding at this time as well. I feel like if that was done today, it would not be 98 at 2 hours. Frustrating.

11

Well, you wanted opinions, and I’ll give you three :slight_smile:

  1. Migraines with Aura were my very first symptom of high blood sugars, and came about 6 months prior to my diagnosis last May. I blew them off as stress-related after my doctor ruled out brain lesions/tumors (at great and unnecessary financial cost to myself). Not sure how common they are as an actual symptom of high blood sugar, but mine have reduced in frequency to near zero since normalizing my blood glucose.

My fasting blood sugars have been anywhere from 85-116

  1. 116 mg/dL is high, even if you ate a ton of carbs the previous night. It’s not high for a diabetic, but it’s definitely higher than a non-diabetic would normally experience. If this isn’t a freak reading (i.e., it has happened more than once), I’d be concerned with that regardless of what your A1c is. I try to keep mine under 100 mg/dL, and am usually successful (although not this morning).

My 2-2.5 hours post meal sugars have been 90-161

  1. A 161 mg/dL 2 hours postprandial blood glucose reading is also very likely not something a non-diabetic is going to experience. A reading of 90 is perfectly normal. If I had more than one 161 two hours after eating over a couple of weeks, I’d be concerned as well.

Now, on a slightly unrelated note. Many diabetics who can control their BG through diet find that meal macronutrient composition is far more important than meal size. I’m a diabetic, but if I were to eat

1.5 cups of rice, black beans and steak with sour cream and some guacamole

I’d have some serious blood glucose issues afterwards. The rice and black beans part of that just doesn’t work for me: too much digestible carbohydrate. I can eat all the steak (well, within reason) and sour cream I like without raising my BG too high, but I’d also be wary of guacamole: while avocados are high in fiber and good fats, they also have significant digestible carbs; and lots of places add all kinds of carbs to prepared dips like guac.

So, if you’re testing at 2.5 hours after eating and have elevated BG (I personally expect to see my 2.0 hour postprandials back to pre-meal levels as a well-controlled diabetic), I’d be concerned. I’d be concerned at multiple fasting BGs above 110 mg/dL. Those both sound like early stage Type 2 (or, possibly, LADA Type 1) to me when taken together with a slightly elevated but normal(ish) A1c. Regardless of what your endo says, you might consider a true low-carb diet (weed out the rice, flour tortillas, and other common carriers of digestible carbs) and see how you feel (and how your BG responds).

All that being said, your described BG ranges fall pretty squarely into what the ADA calls “risk of Type 2” or “pre-diabetes.” You can see their diagnostic criteria at http://www.ndei.org/ADA-diabetes-management-guidelines-diagnosis-A1C-testing.aspx.html. Your endocrinologist will very likely diagnose you as “Pre-diabetic,” which is generally considered to be early stage Type 2 diabetes. They will likely prescribe Metformin and increasing frequency and duration of exercise. And you may find that very effective.

13

I have seen that some people with type 1 feel terrible even with ‘mildly’ elevated blood glucose levels. I don’t think a glucose tolerance test is the answer (and it will make you fell terrible). I think that proper testing for type 1 may be the next step.

Have you read Bernstein? You can use his methods to help normalize blood glucose levels.

Hope you can get a doctor to properly test you.

Thyroid and / or adrenal issues could also complicate things… so a good endocrinologist may help, to look further at these aspects…

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14

CHello all,

Well my PCP seemed to get perturbed at the thought of me “thinking” I have Diabetes still. She was very adamant about my normal A1c, and that I just need to eat brown rice and eluded that everyone’s BS spikes to 160 after they eat. Even 2 hours after. I hit a wall again. I’m shocked at how Physicians get very threatened if you imply a disease based on Symptoms even after actually having the said disease.

She then digressed a bit and actually started formulating the possibility that BS could be high due to Anemia and since Thalassemia does run on my entire Maternal side of my Family- and the Endocrinologist failed to run a CBC 2 weeks ago, she ordered a full work up of my blood including a test to differentiate my blood cells. Thus hopefully get a actual diagnosis not just a “your anemic, take Iron” which I’ve gotten all my life. And iron is the last thing Thalassemia patients need.

Saturday I went in for an eye exam for the first time since 2014 this was pre-baby thus pre GD. SO apparently I have signs of spots or “Drusen” on my retina and my retinal vein is “swollen”. She stated that these can all be Diabetes related. So I will have to return in 1 month for a full medical eye exam for Macular Drusen and/or Glaucoma.
I think I can safely say I know where some of my ocular migraines and this strange new phenomenon of seeing my pulse in my vision is coming from.

I’m floored. Can all of this possible damage be simply from a few months of Gestational Diabetes that was well controlled with diet and required no medication?

Opinions please.

16

My PCP thought I was depressed when my twins were one year old and I was very tired. He totally missed diabetes. I would make an appointment with a different doctor as Tim said above. Doctors vary all over the board and there are good, mediocre and bad. I have had dozens over the years.

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17

Hba1c of 5.5 gives you an average blood sugar of just under 120. Not quite normal…

18

Really? 5.5 thought that was below diabetic threshold. 120 average means lower numbers much of the time and after eating going a bit higher than 120. I will ask my endo, other people can comment but I thought 5.5 was not diabetic

19

5.5 will not get you diagnosed as diabetic.
5.6 or 5.7 is typically the cutoff for prediabetic.
6.5 or so will get you diagnosed as diabetic.

Truly normal is likely < 5.0, So currently you’re stuck between a rock and a hard space.

20

Hello all,

I am back. I have had a roller coaster of a few months. I was formally diagnosed with Microcytic and low Iron anemia, however they could not tell if I had the Family Beta Thalassemia trait because of my low iron levels? I’ve lost about 8 more pounds, but I was able to eat a bit more for a little while! I started to think maybe the Endo was maybe onto something? Maybe?

Until the day before yesterday. I had my first blinding Migraine with Aura in almost a year, nothing terrible, just unusual. Then that night I ate a bowl of Rice Chex (unsweetened) with whole milk, a late night snack while watching Netflix. About 30 minutes later I am on the floor, heart racing, stomach turning, arms heavy. After about 10 minutes I was able to crawl up and test my blood sugar, it was 185. I soon started vomiting, and later my lips started twitching uncontrollably, felt like there was a bag of bee-bees rolling inside my lips and my whole mouth was numb and tingling. It was twitching so forcefully my Husband could see it. My left hand went numb and tingling as well.

The next afternoon at work I remembered I had some Ketone strips and tested my urine. This was about 15 hours later. It was at the “Moderate” (lightest purple-40) level. I feel like I am right back where I was months ago. I can’t eat barely anything again. I tested my fasting sugar this am and it was 112. However, with my small blood cells- are these blood tests even reliable?

My question to you all is. Obviously with the history I have had with the Endo here, (see above) and the only other Endo in the immediate area has a 6 month + wait- what online blood tests would you suggest I have ASAP? I would like to be as budget friendly as possible, but do realize these are important and not the cheapest also. I would like to get these done and if they are what I think they are, I can then go to the Endo who said what she said in May, and she can test anything I didn’t do online or could not afford.

Thank you all for you time and help.

21

Your fasting BG from the lab is 83 and your A1c is 5.5. A FB of 83 is considered by Dr. Bernstein to be the perfect number for non-diabetics. However your A1c is too high to be the perfect non-diabetic. Clearly something is off.

I would suggest you put together a 24/7 BG profile. The easiest and cheapest way to do this is with the Abbott Libre. Its approve in the EU but if you are in the U.S. you can buy the sensors on ebay or other internet sites. They run about $80 per sensor and will last 2 weeks. You will probably want to get two sensors for a four week profile. There are several free apps to read the sensors which communicate with NFC - you touch the phone to the sensor. You should keep a log of what and when you are eating so you can correlate it to the sensor readings. Gary Scheiner has a free one here
"Printable Diabetes Logsheets | Integrated Diabetes Services

I suspect you are having non-diabetic periods and other periods where you are not producing enough insulin. This is pretty common in early stage diabetes. The 24/7 profile will provide the answer to this. Now, assuming I am correct you will need to do something but based on you lab results your endo may not want to do anything. So, you will need to take the correlated log with you to your endo.

The chances are your endo will want to put you on metformin. If you are seeing post meal spikes of 185+ metformin will do nothing for you to address this. The ADA’s BeyondA1c Forum was held a couple of weeks ago and Dr. Ralph DeFronzo from the University of Texas Health Science Center sums it up best “The most waste in type 2 diabetes is to continuously put people on metformin and sulfonylureas (glyburide, glimepiride, etc.). These drugs have no protective effect on the beta cell, and by the time you figure out what you’re doing, there are no beta cells left to save.” https://diatribe.org/the-diatribe-foundation-and-tcoyd-11th-annual-forum

If you need to go on insulin you may want to read this report which was just released on the insulin Dr. Edelman shared positive feedback on at the BeyondA1c conference. It is difficult to get hypoglycemia with it as it works in synergy with the liver. Since your numbers may sometimes be normal and other times not this insulin will make dosing so much easier and safer for you. The report is here seventhform.com/vdexdownloads/vdex-whitepaper-072817.pdf

22

I’m thinking you need to head to the ER for this preferably a teaching hospital’s ER, like Baylor. There are just so many things that COULD be driving this, sensitivity digestive etc, you could have them run the GAD panel for type 1, etc…and they would love the chance to Dx.

The A1C is an AVERAGE over three months … Mine is wonderful right now. HOWEVER it doesn’t show the lows that are driving the ‘good number’ and offsetting some bad highs.if you average 40 and 250 you have a respectable number but doesn’t mean you not diabetic…so I say a TEACHING HOSPITAL ER…

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Wow, you are so insightful! this is an amazing option! I am definitely looking into this! Can you be a/my Doctor? Thank you! Thank you!

25

Thank you Love. If this type of situation happens again, I will be going to the ER. At the time I did not realize I was in such potential trouble and my mind was not working well- All I wanted in life was to lay down and drink water simultaneously.
Hence why I want to get some blood work on my own and become informed and empowered on the next path as far as Physicians, Endo and PCP have given me the A1c is normal door in the face. I just want to know if for sure if Gastro, Endo, Neuro (again), Hema, or Psych (j/k-maybe Oo) is my next stop.

Taking time off of work is a tremendous feat to see multiple Physicians. Which is unfortunate since this does take a toll on my abilities to work efficiently. And without a formal diagnosis besides Anemia and Migraines- FLMA isn’t a card I cannot use at this time.