June 7, 2021: I am using an injectable blocker device to inject insulin in my third trimester.
That was April 2021.
At 10 p.m. one night, I was holding a syringe of 6 units of insulin in my shaking hand and my pregnant belly in the other. I was desperately trying to guess what position might hurt the least, sting less, and work better. I’ve never given myself an injection, let alone in my third trimester belly, and never when my baby’s health was at stake. At that moment, I wished my medical team had better prepared me for my self-injection.
When I look back on my experience a year later, despite the fact that I have a top PPO policy with a major healthcare provider, I am overwhelmed by the gestational diabetes education offered after being diagnosed at 28 weeks. Continuity of care also leaves much to be desired.
I found out that I have gestational diabetes through a note in my patient portal. No one bothered to call the news. No one called to follow up. The notes read:
“Emma,
Your 3-hour blood sugar test is abnormal. You do have gestational diabetes. I would recommend you to Scripps Whittier Diabetes Clinic for gestational diabetes management. You will meet with a registered dietitian, registered nurse to check diet, exercise and blood sugar. You will have your blood sugar checked 4 times a day.Fasting should be less than 90, 1 hour after meals [she meant postprandial] Should be below 130.Make sure your diet is a mix of carbs, protein, fiber [sic] Do not eat sugary foods and beverages. Do not eat fruit for breakfast. Walk for at least 30-40 minutes after each meal. You will get more information at the SW clinic.
Uncontrolled blood sugar can be harmful to the developing fetus. We’ll discuss more on your next appointment.
We will notify you when your referral is approved. Please let me know if you have any questions. “
I have several. On the one hand, what does it mean to balance carbohydrates, protein, and fiber? Not everything has carbs, so how can I balance them with other items? If this is so dangerous to the fetus, why didn’t anyone explain it all for themselves right away? Also, she left out the most important piece of information: the amount of fat you need at each meal and snack. I didn’t find out until later.
At the same time, I have to follow up with myself before submitting the recommendation letter to Scripps Whittier Diabetes Institute. They never called and my doctor didn’t follow up with them.
When I finally got an appointment, I learned to prick my fingers on zoom with the guidance of a soft-spoken diabetes nurse. As humans, we don’t naturally touch anything that causes pain, let alone something that hurts enough to make us bleed. I cried so hard that the provider told me that if I couldn’t make it, I could have my husband pull the trigger for me that night. Eventually, I managed to pull the trigger and squeeze a drop of blood from my index finger.
Over the next few days, I quickly came up with a tip: If you press your finger against a hard surface (like a table or table) and inject from the side, it will do much less damage. My peri-obstetrician, who specializes in high-risk pregnancy care, was blown away by the idea when I told her about it on my next appointment. I pointed out that maybe it should have been included in the handout with information about checking sugar four times a day.
The next challenge is nutrition.
For the first few weeks of my diagnosis, my stomach was complaining. I mostly eat veggies because I know those are healthy and most don’t add to my sugar. I’m terrified of the high sugar content and don’t know what I can safely eat. Despite being in my third trimester, I initially lost weight.
I hope someone takes the time to explain what a balanced diet means. The dietitians I met said to balance items, but didn’t explain in a pragmatic way what that would mean for the variety of foods I could eat. The sample meals given in the handout are confusing because they don’t explain why certain combinations are good, making it nearly impossible for me to apply for meals beyond the few examples given.
For a few weeks, despite diet and exercise, my fasting blood sugar levels were outside the recommended range of control. I had to start insulin, which meant injecting insulin directly into my pregnant belly every night. My care team forced me to learn injections instead of zooms. I strive for a face-to-face meeting. They gave in, but reluctantly.
During the training, the diabetes provider only allowed me and my husband to practice filling the syringe with saline. We are not allowed to practice injecting it even if we ask for it. I pressure providers for tips to reduce injection pain. She had nothing but to say I’d get used to it.
I had a panic attack that night – my husband had to give me my first injection.
The next day, we met with a peri-obstetrician. She was shocked that we were not allowed to practice injecting saline or that the provider could not help us with our first injection. I asked if I could ice the area before the injection to reduce pain. She said I could. It helps a lot with pain.
If the goal of gestational diabetes is for the mother to adhere to protocols for managing blood sugar to minimize adverse health outcomes for the fetus, it makes sense that the healthcare system—OB and diabetes providers—should do a better job of keeping the mother in line.
Here’s what I want all providers to tell me:
- Prick one side of your finger, preferably the index or middle, while pressing your finger into a firm surface; doing so can minimize the pain of eating sugar, or, on some lucky days, eliminate it entirely.
- use one cap hand And/or ice the insulin injection area for 15 minutes before injection; it won’t make it painless, but it will reduce a lot.
- Inject yourself. It does help reduce pain, and you can minimize pain by preventing the needle from moving during the injection.
- Inject where you don’t think the baby will move – a baby that moves while injecting can hurt like Dickens.
- Eating a balanced diet means eating carbohydrates (think fruit, bread, potatoes, crackers), fat (avocado, heavy cream, butter, etc.) and protein (nuts, meat, cheese, eggs, etc.) at every meal and snack ), to quell the saying sugar spike.
Providers who treat gestational diabetes need to be more empathetic and offer practical advice to moms living with the condition, knowing the anxiety they experience as they experience a new condition that can have a huge impact on their unborn child . All those with children and battling this disease deserve better.
Photo: David Bardeen
