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Dr. Hive, gestational diabetes + hypertension late pregnancy


eternalsummer
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So this is my 6th baby and I feel like crap.  Doctor and RN (mostly I see the RN) are no help.  Here is what is going on:

 

I am 37+ weeks.  I have GD; none of the risk factors (am 31, not overweight, etc.).  When diagnosed with GD I started eating low carb as recommended; since then (it was at 32 weeks) I haven't gained a pound, but the baby is growing more or less normally I think, as no one has mentioned anything.  My last baby was 9.5 lb (I am a small person) and I think I probably had undiagnosed GD with that pregnancy (I took the glucose test super early with that pregnancy and only barely passed).  Normally I have 8.5lb babies.

 

Starting also 2-3 weeks ago I have been occasionally super tired.  It has gotten worse as the pregnancy has progressed; once I was at the store picking up a prescription and felt really quite terrible - sort of confused, very strong urge to lie down, cloudy of head.  So while waiting for the prescription I took my blood pressure, twice - 140/100.

 

I called the doctor's on-call number and they said to come in to the hospital to have my blood checked.  They said I had slightly elevated liver enzymes and should rest as much as possible until the baby is born.

 

Okay, I said.

 

Then the next week at the Dr's office, my blood pressure was normal - I knew it would be as I can sort of feel when it is good and bad, and my appointments are generally at a good time of day (around noon).  They also said the hospital doc had misread my labs and that my liver enzymes were fine and my BP was fine.  I told them about the exhaustion and the sort of puffy feeling in the morning and the inability to remember the right words for things, etc. and they said that was normal.

 

I have checked my BP a few other times when at the store and sure enough, if I am feeling good it is 130/90 and if I am feeling bad it is 145-150/100.

 

Anyway, I have devolved to a point where I am clear headed and good of energy for about 4 hours a day, from 2 hours after waking until 6 hours after waking.  The rest of the time, and especially through the middle of the night, I am quite swollen, I feel very compelled to lie down or sleep (I sleep probably 14 hours a day, which is a *lot* for me), and I can't remember the right words for things.  

 

I had pre-e in my first pregnancy a decade ago but haven't had it since.  

 

My blood sugar levels are great; I do that loathsome finger pricking thing and my fasting is always around 60-65 and 2 hours after food is never more than 85.  The chart they gave me said the two numbers should be below 90 and 120 so I think I am fine there.

 

 

Any ideas as to why my blood pressure is so variable and whether it matters?  I have 5 kids and a business so it's not really practical to do bedrest unless I really need to, and my normal OB indicates I am fine and don't need to (but she hasn't seen elevated BP readings from me either - I think they suspect I am making up the ones not at her office or something).

 

Is there any way to get more energy or do I just wait it out?  I normally deliver at term or maybe a week late, so I've got weeks of this left and I am just so tired of being so tired.

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Did they not do a urine test for protein when you went in to have your blood checked? With my third last fall, they did an initial urine test that looks for one level of protein that's different from the usual one in the office. Depending on the results of the first test, they decide to do a 24 urine catch to determine if it's preeclampsia for sure. I'd push for additional testing because you know that you are feeling worse than you normally do with your pregnancies.

 

Put yourself on bedrest as much as you can. Lay on your left side as much as possible, take Epsom salt baths, and drink lots of water.

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They said my urine only had the trace proteins (I think).

That's good. PIH can be miserable on its own without turning into pre-e. It can also get very bad very quickly, which I'm sure you know. I'd be vigilant and not hesitate to call and advocate for yourself if your pressure starts spiking again.

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Are you hydrated?

 

I felt terrible with #4. I was completely out of sorts and I couldn't pinpoint the problem. I would wake up and my heart would race, but my blood pressure would test within normal ranges. I didn't have gestational diabetes, but my children were always large for their gestational age. Finally, my doctor recommended pushing fluids as a last ditch, let's-see-if-it-helps remedy.

 

It took three bags of fluids for me to feel normal. I still struggled through my final week of pregnancy, but I wish I had spoken up sooner and made sure I was drinking enough water. I felt so much better.

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I do drink pretty much constantly - but I am living in a much drier climate than with previous pregnancies (we just moved to CO from MO) so maybe that is part of it.  I wake up every 2 hours at night, sometimes more often, and drink 8-10 oz. of water.  I'll try pushing more water through for a few days to see if that helps :)  Can't hurt!

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During my last pgcy at about 37 weeks I spent an entire day feeling absolutely terrible. I suspected it was due to BP so I had it checked 2 or 3 times that day and all day it was at that borderline level, like 140/93. I finally checked myself into the l&d triage. They ran a whole bunch of labs, my BP came down on its own and none of the tests they ran came back with anything abnormal. So they let me go home after a few hours when I felt better. It was really weird. I have no ides what caused the high bp. DS was born a few days later.

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You need to go back to the ER, if not now, then the next time it is up. The new guidelines for Pre-E include liver enzyme elevation as one of the symptoms, along with high blood pressure. Protein in the urine is NOT required. I'd be very concerned. Especially as you have a history of Pre-E. And hello, it is your 6th baby, you KNOW what is normal and what is not in pregnancy. 

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The on-call doctor at the hospital diagnosed me with pre-eclampsia when I went in, I assume based on the liver enzymes and the high blood pressure both at the hospital and at the pharmacy.  But when I went to my regular OB my blood pressure was down and they said that the elevated enzyme reading the hospital doctor had given me was a mis-read of the labs, so I don't have pre-eclampsia after all.

 

However, my blood pressure is still high (140/100+) on a daily basis (at least, every time I take it at a pharmacy it is like that and then I feel the same amount of bad in the same way at home for about 1/3 of my waking hours).  

 

I don't have the symptoms of eclampsia itself, or if I do they fade away pretty fast as soon as I lie down (spots, nausea, headache, etc.)

 

I would feel weird going back to the hospital as my OB and her RN have been pretty clear that there is nothing wrong with me in that way - when I mention the symptoms they say they are normal and they said the labs were normal as well, just misread by the on-call doctor.  So what would I say - "hey, I'm here because I feel weird and my BP is persistently high but my OB already said nothing was actually wrong with me"?

 

Ugh, I am so ready to have the baby.

 

Also I am ready to eat a #$@%$# cookie.

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Any ideas as to why my blood pressure is so variable and whether it matters?  I have 5 kids and a business so it's not really practical to do bedrest unless I really need to, and my normal OB indicates I am fine and don't need to (but she hasn't seen elevated BP readings from me either - I think they suspect I am making up the ones not at her office or something).

 

Is there any way to get more energy or do I just wait it out?  I normally deliver at term or maybe a week late, so I've got weeks of this left and I am just so tired of being so tired.

 

Take a picture with your phone of the results panel when you're doing the store tests. Then you'll have proof of readings combined with handy date/time stamp. 

 

I'd go and check your pressure daily or more than daily. Sure push liquids because maybe it is 'just' dehydration but I'd watch this very carefully. 

 

did you get a copy of the lab results from the hospital? I'd try to get a copy and see what the reported liver values were & what the lab normal range is. 

 

You should also be keeping an eye on that protein in the urine. You can buy home test strips ... 

 

But I'm sort of concerned that your physician (or midwife? Or did you just see a nurse?) is being so casual about this. It doesn't sound right to me, fwiw. 

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Take a picture with your phone of the results panel when you're doing the store tests. Then you'll have proof of readings combined with handy date/time stamp. 

 

I'd go and check your pressure daily or more than daily. Sure push liquids because maybe it is 'just' dehydration but I'd watch this very carefully. 

 

did you get a copy of the lab results from the hospital? I'd try to get a copy and see what the reported liver values were & what the lab normal range is. 

 

You should also be keeping an eye on that protein in the urine. You can buy home test strips ... 

 

But I'm sort of concerned that your physician (or midwife? Or did you just see a nurse?) is being so casual about this. It doesn't sound right to me, fwiw. 

 

I also think you need to request a copy of those lab results. And test your urine. And do you go to a group practice? Can you see one of the other doctors? Otherwise, yeah, I'd go into the freaking hospital if your doctor is blowing you off. You have high blood pressure, you have a history of pre-E, and the ER diagnosed you with pre-E, and your doctor says there is nothing wrong?

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Have they done a BP test with you lying down then standing up? I don't know what the test is called ,but when I pushed my doctor, she listened and ordered the exam.

 

I laid down for ten minutes and I had a BP test.

 

I stood up and immediately a nurse took my BP.

 

The difference was significant enough that I ended up in the hospital hooked up to an IV. I had to repeat the test three more times, after each bag of fluids, before they let me go home.

 

I was also drinking a lot of water during this time, but I, too, was in a very dry area. My doctor said, "You're supporting two metabolic systems. It doesn't take much for you to feel terrible."

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Absolutely go to ER if you feel weird.  You described my symptoms and why my first was born 10 weeks early and my third 5 weeks early, both under emergencies.  It can change and be variable so quickly.  They should definitely be watching it more carefully.

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Having had GB I don't like your blood sugar levels.  I realize you aren't on insulin, but those numbers seem low.  How low carb are you?  

 

As far as your BP, your having signs of Pre-E, with a history, and no one is doing anything?  I'd be asking to see a different OB and taking your BP more often.  Make sure your journaling your blood sugar and your blood pressure.  If your OB isn't going to do anything then I would got the L&D the next time your BP is high, or that your symptomatic.

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Your carb levels seem really low to me. You still have to eat carbs with GD. Carbs with your meals! Carbs with your snacks! Just a controlled amount of carbs. You and your baby need the energy carbs provide. How is your GD being monitored? I had to meet meet with a nurse like every two weeks to go over my numbers and discuss my diet. Eating (just) enough carbs was a big part of the conversation.

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I eat what they say to eat, which is approx. 30 carbs per meal plus protein.  They have not asked to see the numbers or anything; they just told me to buy one of those kits with the little needles and strips and the machine thing and then record fasting and 2 hours after meals.

 

I don't go to a group, I just picked the OB with the best reviews on Google reviews when I looked (don't laugh, I thought it was a good idea!) and she is a lone practice.  I have only seen her twice this pregnancy, though.  FWIW, she has 4.6 stars with 30 reviews.  I've always had Medicaid or paid out of pocket before, so this was my first pregnancy actually choosing a practice. 

 

All they told me about the GD was that it should be below 90 fasting and below 120 2 hours after eating, so I figured there was no floor since they didn't mention one.  (Actually they said nothing, but the packet they sent home said those were the targets).

 

Now that I have googled it I see that maybe my sugars are pretty low a lot of the time, strangely enough.  Should I just eat more often?  I don't know how to fix the fasting as I'd have to eat in the middle of the night.  I will ask about this at the next appt.  I failed the 3 hour glucose pretty spectacularly (except for the fasting number which was fine) but of course I haven't come even remotely close to 100 carbs at a time since then.

 

 

That is a good idea to take a record of the BP measurements to show the OB at the next appointment.  We don't use cell phones but I have a digital camera.  I feel kind of weird about it though.  I really hate confrontation.  I am nervous even about asking for an induction at 39+ weeks with this baby (I have 1.5-2 hour labors start to finish, and right now I am 35 minutes from the hospital, so I am looking at definitely no epidural without an induction.  I have delivered 2 babies without an epidural and I have been scared of it since the moment I had the last baby.  I have an extremely low pain tolerance and am a chicken.)

 

I think I will try bed rest (as much as possible) and maybe more frequent eating to keep sugar levels stable and see if that helps.  If I have any of the serious signs (seeing spots, nausea, extreme puffiness, upper right abdomen pain) that don't abate as soon as I lie down I'll go into the L&D.  I would just feel so weird going in again for no other reason than same as before, which turned out to be nothing to worry about.

 

I haven't had any standing/lying BP tests but I have been drinking a lot more water today.  

 

 

You are all so reassuring in a strange way.  It is odd to feel more comfortable with people who have just had a lot of babies but are not doctors than with the doctors, but tbh I have now exchanged probably 20x more words with y'all about this pregnancy than with anyone/everyone at the doctor's office.

 

 

 

 

 

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Obviously I just have my own experience to go on, but I think seeing spots at all, combined with those pressures is enough reason to go in again. It's good that it goes away when you lay down, but I'm pretty sure my midwife would have induced me if I had been having visual issues too. I had high BP (spiking around 150/95-100, but usually 130s/85), and spilled protein eventually, but I never felt that bad like you are describing. That's why my midwife was more comfortable with watchful waiting. At 39 weeks, I chose to be induced rather than doing another 24 catch when I had some protein after my second afternoon in L&D.

How soon is your next appointment? Would you consider calling around to other practices to possibly switch doctors? I know it's really late, but if you don't feel like you have a good rapport with your doctor and can't comfortably talk about your concerns, it might be worth it. I don't want to add additional stress and worry to what you're already feeling, but this internet stranger is worried about you. Preeclampsia is scary stuff and doctors still don't understand it well. I'll be praying for you and your little one.

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Keep in mind, the ER didn't tell you it was nothing to worry about. They told you it was Pre-E. They thought you had a significant issue. 

 

Is there another ER you could go to if that made you feel better? That your doctor hasn't asked what your blood sugar numbers even are is amazing to me. I think you need another doctor. Does your hospital have a labor and delivery floor? If you go back, I'd ask to see a doctor there. If they still think you have pre-e I'd ask for a referral to another doctor as yours doesn't seem to think there is a problem. 

 

And were you seen by an ER doctor or by an OB in labor and delivery?

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I think you need to be examined by your OB. Preferably today. Why have you seen your OB only twice this pregnancy? Is baby moving okay? Especially since you are so far from the hospital, I really think you need examined by her ASAP so that she can reassure you on all of these issues, or admit you to L&D for observation.

 

 

 

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30 carbs per meal was my target too. But I also needed 15 carbs per snack, and snacks were mandatory. Between breakfast and lunch, between lunch and dinner and then again right before bed. Basically I was eating every two hours. My snacks were usually a small banana, or a Kind bar or one of those little fruit cups. I lived for my snacks. Otherwise I never felt like I had enough energy.

 

But you have GD. And a history of PE. And you've only seen the doctor twice? I don't like it. You deserve more attention than that. I would schedule a visit ASAP.

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In five weeks no one has asked to see your blood sugar levels?  Seriously!  I'm sorry, but that is not in any way acceptable.  I would suggest a day of checking your fasting am, then before each meal, after each meal (your 2 hour mark) and before bedtime to see where you really are.  You might very well be hypoglycemic between meals and that may be contributing to your symptoms.  To help with the am low you should be having a snack, with protein and carb, before bedtime.

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So to update, whoever said my blood sugar levels were kind of low was spot on.

 

I started eating an evening meal, upping carb intake slightly overall, and eating a very small amount (5-10 carbs +protein/fat) every hour or two all day.

 

The change has been remarkable.  My blood sugars are much less variable, and never as low as 65 fasting or 80 post-meal.  I have more energy (twice as many good hours a day, basically) and, strangely, my blood pressure went back to 120/80 and stayed there. The only time it gets out of whack is if I don't eat for 3 hours or don't eat the evening meal to tide me though the night.

 

It is weird, and I am not questioning it because it has made the last week or so bearable.  

 

I am being induced Monday.  I had my last appt. Thurs (I do usually see the NP, and saw her again Thurs.).  She said, oh, btw, how are your blood sugars?  I started on the saga but decided it was faster to just say they had been pretty low but were better now.  She just wanted to make sure they were below 90 fasting/120 2 hours post-meal. :)  I told her I never had had one that was close to 90 fasting or 120 post meal and at this point I wasn't waiting 2 hours after a meal to eat anyway - and still never close to 120.

 

Anyway, huge thanks to you all for advice; I would not have considered the possibility that blood sugar could be too low with GD!  And also I can't wait to have the baby :) 

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