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12/02/2005
Prediabooties
The last time I saw a doctor for anything non-vagina-related was more than five years ago. I could argue that even that visit had pelvic origins; my primary care doctor was certain that the burning gastric pain I frequently experienced was the result of my monthly menstrual abuse of ibuprofen. She refused point-blank to remove my gallbladder, prescribed a cocktail of Maalox and novocaine, and sent me off to make do with two chump-ass extra-strength Tylenol.
From this, I concluded that she was obviously a dangerous quack and resolved never to darken her doorstep again. And in the succeeding five years, I never felt I needed to. I am either very healthy, very stoic, or very stupid.
I had a battery of bloodwork run when we consulted the maternal/fetal medicine specialist, which uncovered Factor V Leiden. In reviewing those results, my garden variety OB/GYN — the least specialized of my worldwide cadre of coochie doctors — noticed that I'd never had a followup glucose tolerance test postpartum.
You know where this is going, right? Right? C'mon, this is me.
Three more days of carb loading. Ten more ounces of syrupy orange swill. Two more hours of rolling my eyes, looking at my watch, and staring pointedly at the large-bellied woman sitting across from me knitting booties. (I swear to God she was knitting booties. Hey. Lady. Yeah. You're pregnant. We get it.) And one more call from my gynecologist saying I'd flunked.
My fasting level was fine, but my final number was high — 140 is top end of normal, and I skidded in at a jaw-clenching, teeth-chattering, Jesus-gay-but-that-stuff-is-sweet 151.
That's not high enough to qualify as full-blown diabetes, but it's high enough to reveal that I have what's called impaired glucose tolerance, colloquially called prediabetes. It's not a troublesome condition in and of itself, but rather a big flashing neon warning sign that I'm much more likely to develop Type 2 diabetes later in life, and am at elevated risk for heart disease and stroke.
Now, I already knew that based solely on family history. (Parent with diabetes? Check. Parent with heart disease? Check. Parent with hereditary coagulopathy? Check, please.) But now my doctors know it, too, including my primary care doctor.
My OB/GYN is a rotten goddamn tattletale, is what she is.
So now what's going to happen is that my primary care doctor, whom I couldn't pick out of a police lineup if she had "I am the real killer. Please catch me before I kill again" tattooed on her forehead, will tell me I need to exercise more and watch my diet. That's it. To delay or perhaps even prevent the eventual onset of diabetes, the sole prescription is to lose weight — which I don't need to do, thanks to a cool 20 I recently lost — exercise more, and eat plenty of baconless leafy greens and colon-scouring fiber...which we all should be doing, anyway.
Hey! Thanks for the help.
In other words, no surprises. The most disturbing thing about this revelation is the fact that I'll be expected to do a glucose tolerance test every year. That's an awful lot of bootie-knitters to glare at, you know.
Comments (51)
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Oh, poor sweetie. I HATE diagnoses that just say "Now you REALLY can't eat anything that makes you happy."
Shit.
Big hugs.
Mmmhmm, I feel your pain. Been there, done that. Had gestational d. with my 2nd child (I measured 43 cm at 37 weeks) and was warned to keep the weight in check post partum. My weakness is carbs in any form, especially cereal. Good luck!
I'd talk to an endocrinologist. You might really benefit from a low dose of an insulin sensitizer medication to turn things around so this doesn't progress to Type 2 diabetes, which is essentially a burning out of pancreatic cells. The firstline medication for it might be Glucophage/metformin. Talk to your PCOS friends, who know the ins and out of these things. Glucophage works on the liver. Avandia is a newer drug; it works on the muscle tissue. Each drug tells the pancreas not to store so much sugar as glycogen. These are the only two tissues in the body that can store glycogen. If you can get this back in balance, your pancreas won't have to work as hard. I had to be on both medications in order to get it right so I could conceive. The two drugs make each other work better; not long ago they even came out with a combo pill, AvandaMet. I really do think you would do best to talk to an endocrinologist about all this, though. Metabolic issues are really outside the realm of ob-gyns and most family doctors won't go there either. Just as well.
Definitely heed the warnings that these medications can cause you to be at more risk of becoming pregnant if you are not using contraception. It turns out that the female reproductive hormones are incredibly affected by high insulin levels, and getting them back down to normal really enhances fertility in those that had an imbalance.
Ew. That's a lot of that nasty orange stuff to have to look forward to.
Longtime lurker...
Just wanted to make sure you saw this article on C. difficile: http://www.washingtonpost.com/wp-dyn/content/article/2005/12/01/AR2005120101478.html
That's the bug that Charlie has, right?
My Dad was diagnosed last year. Just barely in the diabetes category. He takes a little medication, walks 4 miles a day and watches his diet. I think it saved his life. He was headed for a stroke or something with that huge gut. Now 40 lbs later, the gut is gone.
The orange stuff, gross. Could they at least put it in a martini glass?
I agree with Celeste about meds, but you don't need an endocrinologist for it -- we stupid general internists also treat some patients who have impaired glucose tolerance with meds these days.
Although diet and exercise are way more fun!
P.S. We don't usually use the glucose tolerance test, though -- that's some old-fashioned medicine that the OBs cling to. Usually we monitor with a simple fasting glucose. At least one piece of good news?
Cool graphic, by the way.
Hey, I didn't say general internists were stupid! I said they're all quacks, and that I'm stupid!
The good times just keep on rollin', don't they Julie?
I actually have PCOS, of which the impaired glucose tolerance is a big part. Got pg with my first during my first full cycle on Metformin. Figured it would be easier the second time around, since we know what's wrong now, right?. Just finished my 6th full cycle on it and start my first Clomid pill today. Whee.
Hope that the exercise and fiber routine works well for you, and congrats on losing the 20!
Well crap.
That sucks! AND you've reminded me that my 6-month postpartum glucose screening is weeks away. Gest. diabetes with all three pregnancies means I'm a real candidate for getting a nice exercise and diet order, too.
I'll say it again: crap.
Hello there, just de-lurking to say I enjoy your site. I'm not IF (at least, not that I know of) but I've enjoyed your stories and am rooting for you. Sorry about the un-fun diagnosis.
Hi - A bit of assvice... if the glucola really grosses you out, you might want to ask your doc if you can use jelly beans instead. Here are the citations for two articles I've read for work on the subject lately:
Lamar ME, Kuehl TJ, Cooney AT, Gayle LJ, Holleman S, Allen SR.
Jelly beans as an alternative to a fifty-gram glucose beverage for gestational diabetes screening.
Am J Obstet Gynecol. 1999 Nov;181(5 Pt 1):1154-7.
PMID: 10561636
Boyd KL, Ross EK, Sherman SJ.
Jelly beans as an alternative to a cola beverage containing fifty grams of glucose.
Am J Obstet Gynecol. 1995 Dec;173(6):1889-92.
PMID: 8610782
Yeah, Metformin. How about an insulin level?
Mmmm syrupy orange swill. Jelly beans? ick.
hey I saw all your story in the magazine "selecciones Reader's Digest" it's so cool everything u've done...I wanna do a site like this...I'm from Venezuela and I've 15 years old...talk to ya...see ya
DoctorMama, I hope you didn't think I was calling internists stupid. I wasn't. My endo is also an internist. In my case I just had the most luck getting an endo to give me the prescription. I think that an internist certainly could take care of this, but it all depends on their belief system. I think this is the same with any type of doctor, though. The insulin sensitizer meds are fairly new, and while many doctors of several stripes are all for them, others aren't.
Julie, here's hoping you can find somebody to discuss this with who can help you figure out if this is something that might be good for you!
Cool 20! Sweet! Now quit hogging the damn floor cake.
Interesting (you know, not really, but...). I just got diagnosed as "pre-diabetic" by my endocrinologist right before I got pregnant, but I had a totally normal glucose tolerance test. I just have a high fasting glucose.
I do wonder if this new diagnosis of "prediabetes" is mostly a scare tactic. Dunno.
Good luck with it all. Perhaps you can pick a different Primary Care doc?
Bummer.
primary care docs -- dispensing really expensive common sense since 1823! seriously, do they ever tell you anything you didn't know?
I was making fun of us internists -- I didn't think you guys were!
Quack, quack.
Welcome to the club. I can't remember how long ago you came of the birth control pill, but they can raise your blood sugar. Found that out the hard way. If you want to avoid the primary doc, try an endocrinologist (the regular kind, not the reproductive kind). They know this stuff better anyway.
{{sigh}}
Hahahahahaha, oh, God, poor DoctorMama.
This whole post scares me since my father recently told me I was fat and should worry about getting diabetes. (He's a dr too, as if that excuses him for being ever-so subtle.) My grandfather had it. My great-grandfather probably died from complications regarding it. I know I should do something, like get a test, but I almost don't want to know. But then I think, why hasn't anyone of the cadre of doctors we've seen recommended it? Should I get this test done before we embark on round two of IVF? Oh Julie, mostly I am sorry that you got this rather icky news.
Yeah, love the graphic. It's hi-larious!
Julie, it isn't often the comments left are funnier than your post. But I think it happened today.
I 2nd everything CELESTE said. I have PCOS, a clotting disorder and am type 2 pre-diabetic. I'm also on METFORMIN which works wonders. I also hate my primary care DR and found that going to a really good ENDOCRINOLOGIST was that best thing for me. That and having a top OB/Gyn. OH and Celeste is right about getting pregnant on Metformin, it does make it much easier to concieve so it's actually written on the package as a warning to those that want to avoid pregnancy! oh and I'm also supposed to watch what I eat and excersises more...lol
From here, the scariest part is having to sit with those pregnant women, year after year. Torture, to me.
I TRIPLE the recommendation for an endo/metformin. Especially for anyone with fertility issues- to not test/treat for that is, like, rediculous. Made me ovulate right up.
Having borderline bad blood sugar still can be really bad- you don't need "full blown" diabetes, which is just a relative cutoff number anyway, to suffer many of the inflamation-related effects from it.
ESPECIALLY since you just lost so much weight (that's a lot!) to still have the number so high- please consider seeing an endo and bringing up these issues. It can be a really big deal. Why not see a specialist when you're dealing with something they are trained better at? Noone ever, in my (low temperature, giant fatness) life ever thought to test me for hypothyroidism either until I saw an endo, also. Surprise!! Metformin and synthroid to go, thank you very much. -j
I've got Factor V Leiden too, heterozygous. I was told that it was imperative that I come off Ortho-Tri-Cyclen immediately, but come to find out, once I met with an expert clotting pathologist at Emory, that eight years on OTC and no history of blood clots in the family meant I was okay.
Just have to ask, did you ever figure out what your burning gastric pain was? I have the same thing. I've been to the dr. 4 times and have found out nothing.
Ugh. I had gestational diabetes as well, and I'm now 12 weeks post partum. The endocrinologist told me I need to have the glucose test 6 weeks after I stop breastfeeding (I'm exclusively pumping, but, same difference). My regular doctor had never heard of that and thinks I should have it done now (yay! Fasting while pumping around the clock!)
I had enough appointments and tests during my pregnancy for a lifetime. I think I'll just hide out for a while and enjoy my Oreos... ;)
Jumping on the Celeste is right bandwagon here. Boring I know, but...
I'm prediabetic too. I've been taking Metformin for about 6 months now, and haven't lost a frigging ouce, but my blood sugars are evening out and are usually under 110, despite the fact that I eat crap all the time. SOrry, but I'm not giving up chocolate and splenda, well, it's OK in baked goods but that diatetic candy is pretty horrible.
Diet and exercise aren't the only answers. Go and see an endocrinologist and see what s/he says. You probably won't have to check your blood sugars every day unless you can't control them with medication. It's not that horrible.
So sorry aboutn the diagnosis. Am not diabetic but have a rather common thyroid problem (Graves' Disease) and found that even getting an endo who was not a thyroid specialist was useless, much less the GP, who knew absolutely nothing. Good luck with everything!
Come on ride that Metformin train (and ride it)!
That is all.
Yup, metformin. I got knocked up with a little surprise 6 months after I started taking it. Those pregnancy warnings on the package really DID apply to me! Who'd a thunk it?!
Just want to ditto everyone encouraging you to take Metformin. C'mon, everyone is doing it!!
I got hit with the "pre-diabetes" diagnosis/speech/truck in 2003. I was so bummed out because my doctor also really stressed the fact that my blood tests also showed a REALLY elevated risk of having a heart-attack before age 50. Since I was entering the last half of my 30s without even having a baby yet, it was very depressing. But I have to say, finding out I was IR was the best thing that EVER happened to me. I got put on Metformin, started "The Insulin Resistance Diet", and my body changed so quickly. I became healthier than I'd been probably since I started menstruating. I lost weight, my blood tests became very lovely, and a year later achieved my very first pregnancy.
It sucks, but believe me it's better to know than to walk around in ignorance slowly having your body poop out on you. Now that you know, you can get on Met and those insulin and glucose levels will be in the normal range fairly quickly, especially with the right diet mods. Once you do that, it's AMAZING all the other things that start working right.
You are cracking me up! That is so awful about the glucose test. As a non-knitter myself, I was forced to *gasp* read a book during mine:)
Factor V Leiden: I was diagnosed with one Gene of this, thank goodness I could not handle daily needles.
I love you Blog, you have a way were words.. 8)
I'm so sorry. Those tests are so horrible. I got my fasting blood sugar tested without that mess. Why are they putting you through that?
Julie, i'm sorry, that sucks. Particularly after taking off 20 pounds, you'd be thinking there'd be some reward, right? I've recently given up wheat, in the hopes of helping the endo (there's no hard and fast evidence, but I'm panicked enough at how fast it came back to try the anecdotal stuff as well) and it's nearly killing me not to be able to eat cakes and cookies etc, particularly since I love to bake. I feel your pain (not your precise pain, of course, because that would be very presumptious of me. Just a kind of related, minor pain).
Been there, lost 10% of body weight, been nagged to death about the amount of sugar I ate by my (type 1 diabetic) husband, done that, got the souvenir fridge magnet...
We are now very smug and I realise when my family comes to stay and moan that there's no sugar to put on their cereal, in their coffee, and to make endless cakes with, exactly WHERE I got the sweet tooth from.
There is light at the end of the tunnel, though - once you have a clear fasting glucose level, you shouldn't need to have any more of those really, really disgusting drinks. It took me 18 months, and it was partly the weight, yes, but I think also the cutting-out-sugar part.
Hello, fellow traveler. No fridge magnet for me, but lotsa Splenda in the house. :)
I have PCOS, so I had to go low carb about 6 years ago. That was a big part of what allowed me to ovulate and get pregnant.
But not to loose weight. Even on just a salad a day, I can't loose weight beyond a certain magic point. So I got mad, and got Metformin. Cause my knees couldn't take it anymore.
I have lost some now, but need to loose a lot more. All this is by way of saying I am jealous that you lost that cool 20. Gotta play catch up now...
Oh, one more thing. If they want me to ever drink that disgusting stuff again, they will have to physically restrain me and pour it down my throat. I hate it that much. Yes, I do.
Hey Julie,
I found your site a few months ago when we were in the thick of the "fertility journey". Am happily 16 weeks preggers after a successful IVF.
Have loved your site, I not only got tons of laughs and info about the whole fertility thing, but it's great to read about your adventures in new motherhood.
Thanks,
Susan
Oh no! How snarky is that to hand down that verdict at this goody-laden time of year!
Will you have to take anticoagulants (Coumadin or Heparin)?
Hey, found your site through Erin--love what you have to say, the birthday pic complete with cheerios on the cake is a classic! Will be back for more.
OMG, and just LOL when I saw the status counter on the Lunchables because I bought three yesterday for my kids; of course, my daughter begged for the dang soccer ball chocolates right away, sucked down the capri sun and left the three mini hot dogs right in the box. wastamoney.
This is really a timely post for me. I received an email from someone who reads my blog who told me that she suspected that the symptoms I'm describing were actually insulin resistant. I have been losing massive amounts of hair for three years (since ttc). People would ask if I was PCOS and I said "No, because I chart and I know I ovulate". The only thing was I was an early recruiter -- always showed a follicle or cyst on day 2, which was always a teeth gnashing experience for getting your FSH test because of course, the E2 was elevated the results were unreliable. I went to scores of doctors for the hair issue and was told that losing 300 a day was 'normal' -- quacks. I have always struggled with my weight and thanks to ttc have gained 40+ pounds and nothing was working, not even running 3-4 miles, 3-4 times a week. So, I started South Beach. So the writer suggested I take a glucose tolerance test. I had spent enough money on tests and said, "Let's just assume she's right and the cure", so I went on South Beach. I've lost 12 pounds (but it's been slow, even with my running) but something remarkable happened -- I stopped losing my hair overnight. I went from 300 hairs a day to 15 -- and it's been consistent for over a month (ever since I've been on the diet). And I ovulate later now. And I get EWCM, which I never got. The good news is I discovered that my problem has been mild insulin resistance all along. The sad news is that I'm over 40 now and it's too late for my eggs. I suspect that this mild resistance is more common than people think but doctors really don't recognize it unless you test off the charts. If only they had listened to my symptoms which, in hindsight, really were classic insulin resistance symptoms, I might have had a chance with pregnancy with my own eggs. I'm not on metformin now, but if this weight don't budge, get thee a pill.
I'm sorry Julie, I know this is a suck thing. Once I realized what was my issue I realized that this isn't something I can do until I lose some weight, but rather, it is for the rest of my life or my hair will start coming out in clumps again. And it kind of sucks because I love my bread and sugar.
I second what Emily said, since she and I are leading parallel lives, what with the IR and the hair loss and all. I was just diagnosed last month with prediabetes.
I did not want to take Metformin, at least, not yet. I'm trying South Beach and exercise (with not great luck, I might add, but that's because I have no self discipline) but I also ran across something interesting in my internet searches. A study recently done at the University of Arizona by a researcher in the Nutrition Department has discovered that two tablespoons of apple cidar vinegar prior to meals stabilizes blood sugar with very nearly the same efficacy as Metformin does. So now I'm putting vinegar on everything from salad to chili beans.
Good luck my dear! The good news about prediabetes is that you can change its course.
I have PCOS and insulin resistance...I believe IR is the same thing you have. I take Metformin. In all your TTC reading,I'm sure you saw info. on Met. and fertility with blood sugar issues (if you are like me, you read EVERYTHING). I got pg. before I got on Met (with my 4th at the time), and I miscarried at 13 weeks. The dx. was b/c my placenta shut down from unregulated blood sugars...they were good, but somehow my insulin wasn't being controlled enough and it did something wacky. I started taking the Met. the day of my D&C, and I got pg. VERY easily on Met., in 2 cycles.
It regulated my periods, I ovulated much earlier and stronger (trippled my P4 levels!) and I stayed on it during my entire pregnancy and now have another (3rd boy) wonderful newborn son...who is healthy as can be! My point...oh yeah...is that getting on Metformin helps regulate the insulin your body uses, thereby not allowing your glucose levels to spike, and will in turn help your reproductive system out too! Might be something you want to check into!