life and puppies

I’m up early (for me) this morning because I failed – or, rather, had abnormal results from – the one-hour glucose test I did last week. This failure on my part has sent me to the lab for a three-hour glucose test to determine whether I have gestational diabetes. From what I have read, gestational diabetes is both common and uncommon. Risk factors include being over 25 or 35, having a family history of diabetes and being overweight or obese before beginning pregnancy. Other risk factors appear to be being pregnant. Hmm. So here I sit waiting for the next blood draw…

Let me pause here to weigh in on a topic of semi-interest to me. It seems every profession has its own lexicon and its way of communicating with lay people. I am a lawyer and, while my work is not very complicated, it does have its own terminology and sometimes those terms can be non-self-evident to non-lawyers and require some explanation. For example, when I use the word ‘moot’ to describe a case, I mean that the case is no longer in controversy. The judicial branch can decide only cases or controversies, so if there is no more controversy between the parties, the case is moot and will not be decided by a court. The most common example of this is when there has been some sort of pretrial resolution to the matter at hand. As much as you or I may have wished to see how a judge or jury would decide a case, if there is no longer an actual conflict between the parties, the case is moot and is over as far as the law is concerned. Imagine my surprise then when I looked up ‘moot’ in a regular old dictionary the other day and found its meaning described as ‘open for debate.’ Well! Although this definition is not exactly the opposite of the legal one, it comes close. Anyway, the medical profession, not surprisingly, seems to have an entirely different language from my own, such that I sometimes wonder if we can ever be friends. Dr. Heather is particularly skilled at explaining things, but I have found her to be more of the exception than the rule. I do take some responsibility, though, as I’m sure I often ask the wrong questions. Awhile ago, when I lived in Richmond, I asked my doctor to take a look at a large mole I had had forever on my left leg, but which I felt had grown a little in the last year or so. She scrutinized the mole, scrunched up her face and said, “Well, it’s not symmetrical.” I said, “What does that mean?” She said, “It’s not the same on one side as it is on the other. If you folded it in half, it wouldn’t match up.” Uh, thanks. I guess what I should have said is something more like, “Does that mean it’s more or less likely to be cancer?”

This sort of thing happened to me again this week when I spoke to the nurse who told me that I had failed the one-hour glucose test. I asked her if she had any statistics for me, such as the percentage of women who fail the one-hour who are then diagnosed with gestational diabetes. She answered, “A lot of women fail the one-hour but pass the three-hour.” Very scientific. She then proceeded to tell me what the three-hour test would entail. She said there would be four blood draws and if I fail two of the four, I have gestational diabetes; if I do not fail two of the four, I definitely do not have gestational diabetes. I don’t know about you, Dear Reader, but this explanation made about zero sense to me and sounded a wee too close to junk science for my taste. So, I quickly took action and scoured the omniscient World Wide Web for information on this three-hour test. I soon realized that the explanation the nurse gave me, while technically true, was overly simplistic and, consequently, head-scratching. I am sure she was trying to conform her vocabulary to something I could understand, but her explanation had me only baffled. What I have learned since then, and what my basic brain has come to understand, is the following: gestational diabetes occurs when hormones from the placenta interfere with the pancreas’ ability to produce enough insulin to combat the glucose a pregnant woman ingests. For whatever reason, the condition usually sets in between 24-28 weeks of pregnancy. Because there isn’t enough insulin, extra glucose passes through the placenta to the fetus and that glucose is stored as fat in the fetus. The fetus can then become too big, which can lead to labor problems. Although there appear to be other complications with gestational diabetes, the major one is babies that are too large, which increases risk to the mother and ups the likelihood of a c-section. So, the test. Passing the one-hour test means there’s no need to do the three-hour (I passed the one-hour test I took at around 12 weeks). The three-hour, on the other hand, is considered diagnostic (though I read a bit about how some docs think it’s not very reliable) and it goes like this: the preggers lady (me, in case you got lost) fasts for 12 hours and then comes into the lab to have some blood taken. The glucose level in the blood is tested. If this number is too high, the woman immediately *fails* the test because, obviously, there is a problem: her glucose level is too high when she hasn’t had glucose in 12 hours. Ok, so assuming that test comes back in the normal range (the nurse told me she had had only one person fail blood test #1 in her nine years of lab work), the woman is given The Orange Drink. The Orange Drink is about eight ounces of sickly sweet Gatorade-like fluid that must be consumed in three hours. Women complain about the orange drink they consume for the one-hour test, but let me tell you that it is nothing compared to The Orange Drink I just drank an hour and a half ago. The drink for the three-hour test is twice as sweet as the other one; it’s just loaded with sugar. Note the capital letters to emphasize the difference. Anyway, ok, so the drink is consumed, the time the woman finished it is noted and blood draw #2 comes one hour later. So, I had my second poke about 30 minutes ago. This blood is then tested. Another draw is done an hour after that and that blood is tested and then there is the final blood poke, #4, which comes yet another hour later. The results of the blood test are then examined and if the woman has acceptable levels of two of the three, she is considered to be in the clear. On the other hand, if her glucose levels are still too high in two or three of the tests, she is diagnosed with gestational diabetes and the fun diet begins. So, basically, the test just measures how the pregnant body deals over time with a lot of glucose. The “if you fail two, you’re done” explanation is, as I said, true, and also now makes sense to me. I assume the most likely blood test to fail, for women who still go on to pass the test, is the blood draw at the one-hour mark; perhaps her body deals well with the glucose, but it takes just a little longer.

So, here I sit waiting for two more draws. It’s not so bad. I have wireless, a new laptop (MacBook Pro! Hallelujah!), Baby Bargains, The Botany of Desire, and some water — thank goodness the lab tech gave me a little bottle of water because I am still trying to get the artificial orange taste out of my mouth. And Doc Heather just stepped away from her hospital patients to check in on me and chat for a bit before she had to go because some loud alarm on her hip went ballistic!

I’m incredibly nervous as I really do not want to have gestational diabetes. Gestational diabetes can be an indicator that the baby will develop diabetes at some point in her life.* I know lots of women have dealt with it, it’s not the end of the world, the chances are the baby will still be really healthy and fine and that soon this will be a distant memory. I know all of that, but I still don’t want it. I worry I’ve already put my baby at risk for all sorts of physical shortcomings and mental problems, just by virtue of her coming from my womb. I don’t want to her to have to start off with one more.

*Since writing this, and while waiting for Blood Poke Four: The Final Chapter (for today), I read gestational diabetes is not an indicator for a baby’s future in the land of diabetes. Obviously, I need to do more research.