Motherhood is all consuming.

Having babies, nursing, feeling the fear of loving someone that much, and there's this baby on your chest, and boom, your entire life has changed.

It's a privilege of being your child's safest space and watching your heart walk around outside of your body.

The truth is, I can be having the best time being a mom one minute.

And then the next, I'm questioning all my life choices.

I'm Lo Mansfield, your host of the Lo and Behold podcast, mama of four Littles, former labor and postpartum RN, CLC, and your new best friend in the messy middle space of all the choices you are making in pregnancy, birth, and motherhood.

If there is one thing I know after years of delivering babies at the bedside and then having, and now raising those four of my own, it is that there is no such thing as a best way to do any of this.

And we're leaning into that truth here with the mix of real life and what the textbook says, expert Insights and practical applications.

Each week we're making our way towards stories that we participate in, stories that we are honest about, and stories that are ours.

This is the lo and behold podcast.

Welcome back to another episode of Low and Behold, today's Conversation, gestational Diabetes in Your Pregnancy.

I brought on today's guest because I feel like gestational diabetes often referred to as GDM Gestational Diabetes Mellitus, that's the acronym for it, is something that often kinds of hits you really hard or unexpectedly in pregnancy, but you're still just left going.

I have no idea what to do after I get this diagnosis.

I'm freaked out, I'm anxious, I'm nervous.

Unfortunately, when this happens and when you're feeling that way, the hospital system, it just doesn't always come around you super well, yes, they're on top of results.

They're on top of numbers.

Making sure that, you know, we're all doing the best we can moving forward post-diagnosis, but I think that you're left feeling pretty alone sometimes with something that.

Kind of a lot to handle on top of just the regular burden and mental load that already exists when you're pregnant and you're expecting a baby.

Today's guest is Sarah Alayev.

She is a high risk OB and l and D nurse.

She has worked in two of New York City's busiest high-risk hospitals in a fast-paced maternal fetal medicine clinic as well.

After seeing too many moms around her with GDM just left really scared, confused, unprepared, like I was just talking about, right?

Sarah created the platform, GDM Nurse.

That is her place to change the story for you guys to flip all this anxiousness and the fear around.

So she is here now.

She's helping moms handle GDM, balance their blood sugars, of course, but she's also helping moms feel seen and heard so they can walk into their births like a boss.

Lots of clarity, less confusion.

That is the goal.

The conversation that we had today is really laid out as a very practical, what does this mean?

How will this impact me?

When does this come up in pregnancy?

If I'm positive, what does that mean for my birth?

What does that mean for me postpartum?

What does it mean for my baby?

And you'll also find that it's a really good blueprint for you not just to navigate GDM if you end up having GDM.

But also to do it really confidently to advocate for yourself inside of it, and then to make sure that the story that you have is not just the one that is specifically prescribed to you because you have GDM, but the one that feels good for you too.

Hey Sarah, thank you so much for being here with me today.

Hi.

Hello.

Thank you for having me.

I'm so excited.

Yeah, of course.

Why don't you go ahead, I kind of introed you already, but just give us more of a personal intro of who you are, why you do what you do, all of that stuff.

Yeah, so my name is Sarah.

I'm actually a mama of two boys, three and two, and I, I am a labor and delivery nurse.

I am a high risk OB nurse as well.

I've been a nurse for over eight years now, and this is.

Really my magic sauce being working with Mamas, but specifically with GDM Mamas Gestational Diabetes.

I really love educating mamas in general, and I had an awesome opportunity to work in maternal fetal medicine, which is a fancy name for the office that you go to for your anatomy scans and any kind of.

Procedures or any kind of high risk complications in pregnancy, and I've learned so much since I've been there and I've actually learned that mamas with gestational diabetes have so little access to resources and support and actual like evidence-based.

Guidance.

So I brought that to the online space, even though I hate being online.

We were just talking about that.

Yeah.

Like I didn't even have an Instagram before, but I feel like this is so necessary to really help Mamas and I just enjoy every day just making a difference.

So that's a little about me.

Yeah, that's perfect.

So did the gestational diabetes thing, is it personal at all?

Like did you have that with either of your pregnancies?

No, I actually did not.

Okay.

But I've always took care of mamas with gestational diabetes because I've worked in two of the most busiest hospitals in New York City.

Okay.

And most of our patients are high risk.

So it's the bulk of who we take care of.

And in MFM, the bulk of the patients coming in have gestational diabetes.

So it's like I talk to these mamas all day and I, my heart really goes out to them.

I think that little clarification for if you're listening and maybe it's first baby or you've just never been with A MFM, again, just to let you guys know that MFM, that maternal fetal medicine is kind of like she said, just where you get sent when you're not that quote unquote normal pregnancy, so anything.

That kind of moves you outside of normal, especially prenatally when we know ahead of time.

Mm-hmm.

Then they might have, you see an MFM concurrently with your OB GYN or your CNM or your midwife, whoever you're seeing.

So it's not like some huge, oh my gosh, I have to see an MFM.

Like that means something's really bad.

Like sometimes it is just be, I don't wanna say just because, 'cause GDM is a thing that's really hard to deal with for a lot of people, but sometimes it is just because, hey, you've stepped outside of the boundaries of normal, so they wanna get these extra kind of.

Highly experienced specific eyes on your pregnancy as well.

Yeah.

So, and also it could be for anything really.

We also do a lot of consultations, for women trying to get pregnant and they have some kind of issues, whether it's hypertension or they have diabetes or anything, like they come in for consults.

Mm-hmm.

And these doctors are really like.

They went to school more than an ob, so they are specialized in like fetal complications and sonograms.

Right.

So like we're doing a lot of like testing as far as anything like she, like lo exactly.

Said like anything that's without, with not in the nor realm of normal.

Right.

Right.

And then any of you doing fertility stuff, I'm sure, yeah.

You're gonna come across an MFM.

That's, I feel like that's where I actually hear the MFM.

Yeah.

The most, aside from like the work at the bedside where.

You know, we're in it with the patient, but also that prenatal fertility stuff.

Hundred percent.

And then often you get, might get transferred over then away from your MFM, which is great.

Yeah,

yeah.

'cause they have to clear you for

IVF.

Right, right, right.

Yeah.

Okay.

Anyways, sorry.

Side note for all of you, you guys just in case.

Case, it's a tangent.

Well I feel like sometimes it just gets thrown around like, alright, we're just gonna send you to see the MFM and if that's me and I'm.

26, I pregnant with my first baby.

And you're like, I'm sorry, where am I?

Go like, what do you mean this fancier doctor?

So I think it's nice to just honestly know the acronym and know what it means a little bit.

Yeah.

So it's helpful for

sure, because everybody comes across it at some point.

Yeah, I think so too.

Yeah.

Mm-hmm.

So we are obviously here today to talk about this gestational diabetes conversation a little bit more, and I think obviously you will agree with that, but.

This conversation is super valuable, not just because you and I know that, you know, people get this diagnosis and they get left hanging, but also because I think it's one that can feel so scary, fearful because we test for this early in pregnancy, usually around 28 weeks, we can talk about high risk or when they test earlier as well.

So it's not like you're.

40 weeks.

And then we say, oh, you have high blood pressure.

Let's induce you.

Like this is something that can be going on the entire last trimester, potentially even earlier again.

And so it's like you have all this time to think about it, deal with it, consider the implications.

And so I do think it's a topic that out of, you know, gestational diabetes, preeclampsia that I know that can come up at any time, but often shows up toward the end, you know, GBS, a lot of those things are end of pregnancy, right?

And this one is actually right.

I mean, if a third of your pregnancy is a little bit consumed or taken up by GDM, that's a big deal.

Yeah.

And so I think as you know, that's why this diagnosis or this positive screening can really kind of start, I think the ball rolling in terms of how you feel anxious, all of that stuff.

Because you have a lot of weeks and nights to, to lay there and think about the implications.

So Why don't you talk about what.

We do, I'm gonna say here in the US 'cause I know it's not exactly the same all over the world.

In regards to gestational diabetes screening moms, what that looks like during pregnancy.

I love this question.

I actually just did a live right before we went on.

'cause I was like, I have the perfect opportunity to go live because my kids are not home and they're daycare.

That's right.

But I love this question because I actually got this question like a few times this week as well, and I don't think people know their options, which is.

Really, not okay.

Mm-hmm.

So, there are different options for screening and like lo said, we usually screen around 24 to 28 weeks, but sometimes they, we do screen earlier.

If you have risk factors, like you had GDM before, you have PCOS, you have a hi, high.

Hemoglobin A1C.

Any risk factors we will screen earlier.

But the three options that you do have is the regular glucose test, which, you know, everybody knows about, which has the dyes and, and whatever controversial.

The second option is the fresh test, which is actually FDA approved.

And, like that one.

Yes.

It's actually FDA approved and ACOG recognizes it, which is really awesome.

That's great because it's a great option that it, it's, available in powder form.

They have a liquid form I believe out, or it's coming out, which is really awesome.

They do.

I, my last pregnancy I did the fresh test to like really just test it out and like.

Try something new.

Yeah.

And there was liquid available then, and that was about a year ago.

If we're talking present day.

Awesome.

Yeah.

And I, I just don't know much 'cause a lot of patients don't, take it often.

Right.

But I did look into it a little.

And then they actually have the one hour and the three hour test available, which is great.

They have the two hour postpartum test.

Available as well.

Huh?

Which is really great.

I didn't know that.

Yeah, because you want to get retested after your baby, since you wanna make sure that you don't have insulin resistance after birth.

Because sometimes it can stay, even though we say, oh, it goes away after the placenta's born.

Right.

So, and the third option you have, which we touched upon in alive two, is to do finger stick paneling, which is basically when you check your blood sugars for two weeks, four times a day.

And this is gonna give us a great picture of what's going on when you, are about day, day in and day out.

However, a lot of doctors do not like this option because if you kind of cheat the system and you kind of eat healthy, you'll have normal blood sugars and you'll pass.

And then we may not screen you appropriately.

Because they like doctors, like, like a test, like you, you do this.

Mm-hmm.

You do a blood test.

Mm-hmm.

Okay.

Like we know.

But it's a great option if you can't tolerate blood draws.

'cause you need to take, you didn't have a few in the three hour.

You have like, you need to get it done like four times.

If you're nauseous from the blood sugar drink, some people throw up, some people have gastric sleeve bypass surgery, so they can't tolerate a lot of, sugar and.

Or drinks in a one sitting.

So it's a great option.

All three.

Yeah.

And I definitely recommend that you talk to your OB and discuss your options because every option is great for you.

Like it's no wrong, no right one.

And I, I mean, I personally did the regular one, but that's me, you know?

Yeah.

Just know your options.

No, I like,

I like hearing that because, so I had this convo on my Instagram recently and.

We were talking about basically, actually it was just me saying, Hey, I want you guys to hear like collectively that if you take the drink.

And you move on with your life, that's okay.

And you may be going, oh, what are you talking about?

Low?

Like, why wouldn't I?

So there is some controversy about the standard glucose drink that we've been drinking for a long time because it has some ingredients in it that people don't like.

There's dyes in it, things like that.

And so there are a lot of people who say, Hey, why are we putting this?

Crap inside a pregnant body.

Like that's the last thing we should be chugging down.

And I get it.

Like there are ingredients in there that you are like, why would I do this?

And you certainly, a lot of people are like, I would not eat this and drink this on a day-to-day basis or whatever.

And so when this in, when I was chatting about this in my stories, I was basically though just saying like, if you want to drink this want or need or have to, whatever, if you take this drink the one time and then move on.

That's okay.

Like you don't have to get really embedded into this kind of controversy or this argument because in theory, like your placenta's job is to filter things out.

Your body's job is to care for you and to filter things out.

Like if you eat really well and really clean and drink really well, and really clean it's not that you shouldn't have options, you should, and Sarah just laid out the three that are, you know, like approved and recognized because there are other ones that are not, you know, the jelly beans.

Mm-hmm.

The orange juice, stuff like that.

Like you're gonna probably have a harder time finding a provider.

Mm-hmm.

Who's cool with those because they're just not like standard.

It's hard to regulate, truly.

Like, are we testing you and screening you Well?

But I ultimately, I want you to hear like.

You have options here.

Mm-hmm.

Like the fresh test, like she said, is recognized by acog.

That's what we've done.

I've done my lab, recognized it and approved it.

Mm-hmm.

It's not covered by insurance.

No.

So you'll have to pay a little bit out of pocket to buy those tests.

I think mine was like 24 bucks.

Mm-hmm.

For the one hour screen.

But ultimately if you're like, I'm just gonna drink the drink, that's all that's available in my area.

Like this is what my provider wants.

It's okay.

Yeah.

This is me just saying that's okay if this doesn't feel like a big deal.

And the other little thing I would say is the traditional drink that you drink, you can often get a dye-free version.

Yeah.

So if that's really, the part of it you don't like is the, the dyes that make it orange or pink or red or whatever.

I've taken dye-free versions as well, so I've had the regular ones like you talked about.

Then my midwife started offering the die free ones and so I took those and then with my most recent baby, I did the fresh test.

So

Awesome.

You can also kind of.

Find some choice even inside of that traditional drink.

I just thought of one last thing.

Lastly, the fresh test is not different in terms of the sugar load that you're getting.

Mm-hmm.

And Sarah?

Yeah.

You can remind us like what the actual dosage is for the one hour and the three hour, but you're still getting all that sugar.

I think some people think I'm gonna take a cleaner one.

It won't make me feel nauseous or queasy.

The fresh test still hits you, is it 50 grams?

Yeah.

For the one hour screen.

One hour,

yeah.

Yeah.

So the fish just still hits you with 50 grams of sugar.

Yeah, it's just.

You know, cleaner in the way that it's being delivered to your body.

So just so you kind of understand the difference between the fresh test and that traditional drink as we still need you.

Yeah.

Does that

make sense?

Exactly.

We still need you to take that sugar in.

Yeah.

To see how your body responds, to see what happens to the sugar.

Right.

It's just without the dyes and the preservatives and it's just cleaner.

Exactly.

Yeah.

Yeah.

Yeah.

Perfect.

Okay, so you mentioned when you were chatting about screening that if you were to be high risk, which it seems like sometimes we don't know that until you're having a subsequent baby, because we're talking about, oh, you're higher risk 'cause you were GDM last time.

Yeah.

PCOS.

Other things can indicate higher risk.

You know, even if it's your first baby.

So when might they suggest screening earlier on?

And are there any other reasons that they might also suggest doing an early yeah, gestational diabetes screen?

So, yeah, so they usually would do the screening at the first viable, sonogram.

'cause they want, if you have a risk factor, they want to know early on if you have gestational diabetes.

So that can be as early as nine to 12 weeks.

Really.

Okay.

Which, yeah, I didn't realize that.

Yeah.

So what you said before, when you're struggling with GDM for the rest of your pregnancy, it That's really true.

Could be the whole thing.

Yeah.

Yeah.

And I actually have a mama in my GDM Mama membership now, which I offer, it's a monthly membership.

She actually was diagnosed at 12 weeks.

So she's been dealing with this and now she's 32 weeks-ish.

I don't know when this is gonna come out.

Hopefully she has a feedback.

Yeah, she's rooting for that.

So I don't know when this is gonna come out, but you know, she's been struggling with this for so long.

And that's why they need the support, because can you imagine?

Like you have all these cravings and you're nauseous and you finally have the ability to eat.

Yeah.

And then you're told you can't eat whatever you want, what can't eat.

Yeah.

So it's psychologically, mentally draining, especially if you don't have support system really, like supporting you and, and eating healthy with you.

It's just really draining.

So yeah, it could be as early as that.

Reasons could really vary.

Again, it could be for having a high, like a pre-diabetic, A1C range.

Mm-hmm.

It could be.

Mm-hmm.

Like your last baby was big, like 10 pounds.

So we wanna know.

Mm-hmm.

If you have GDM, it could be you have PCOS, which is a really common one.

It could be, any like indication, like, you know, I mean, I'm trying to think offhand right now, I'm blanking.

But do we

do it, do they do it for weight of the mom, the bmi, like BMI or anything?

I feel like I had a mom once say, I think they just tested me early because of my size, but.

Is that actually like clinically a reason to screen early?

I don't think so.

That you're aware of.

I would, I would have to double check that on ACOG's recommendations.

Well, it felt weird to me and so I thought, huh.

I think they might have just thrown that at you.

It might not actually be true, and I've had mamas tell me that they had to take the a glucose test like three, four times in their pregnancy.

Yeah.

Which is ridiculous.

Like just after 28 weeks and then again and again.

Yeah.

Yeah.

Like, like they would do it early just to double check.

Yeah.

They would do it early, like, uh, nine, 12 weeks and they would do it again at 24 weeks and they would do it again at 32 weeks.

And it was just ongoing.

And I was just telling the mom like, you have options.

Like you could have just said, can I do the two weeks of paneling instead?

Here's Sarah

and I telling you, you don't have to do that guys.

Okay.

Yeah, that's, I mean, if there's no medical indication at all, that is nuts.

Yeah.

And it's something that I keep getting dms about, and I just find it really frustrating because they don't know how would they know any better?

They're they're not in this field, they're not medical professionals.

And even me and you, like we, we might not even know that unless we actually do our own research and it is online.

Like everyone could look up acog, American College of Obstetrics and Gynecology.

You can look that up, but unfortunately, which we always chat about in the membership, is that there are guidelines and a lot of doctors don't follow those guidelines, unfortunately.

Mm-hmm.

So you have to really start getting familiar with these resources.

That should be the standard of care.

Yeah.

Yeah.

I can link whatever ACOG allows to be out there for free in the show notes too, if you're listening and you wanna know.

'cause it is true.

The other, I mean the other part is like guidelines change.

Yeah.

So for all I know, five years from now, someone's listening to this, they're like, that's not true.

Now we screen at 20 weeks.

So yeah, it is, it does pay off for you.

Mm-hmm.

Listener to like do your own research.

Own research and do a little quick.

You know, Google before your screen or if they suggest something, this is specific to kind of like prenatal appointments and birth, but I always tell my patients when you're at or not, my patients, my students, when you're at in a prenatal appointment, whether it's your 12 week or your 28 week or your 37, I love to say, leave your appointment and ask like, Hey, what's gonna happen at the next appointment?

Like, don't walk out without asking that, so that you could go home and maybe like look into the GBS screen if they say, oh, we're gonna do this next week.

And you can say, okay, I wanna know what you're talking about before I walk in.

And that just happens.

And so, yeah, I think that can be valuable.

Same with like GDM, if it's like, oh, the screen's coming up in four weeks,

can you tell me about that?

I'm gonna do some

digging about it.

Yeah.

And, and have some knowledge before,

you know, in theory I

say yes to it and consent to it.

'cause this is a consent thing as well.

So, yeah,

a hundred percent.

And you can ask what are my other options?

Yeah, definitely.

Like do I have to do, you

know, and some doctors are not okay with the fresh test, believe it or not, and you know,

no, no, I think that's actually pretty normal.

I always, I was with midwives who were great about, you know, kind of all of the,

that's awesome.

More natural

things, or whatever word you wanna use.

But I know that's not like universally true across the United States.

And so it is very possible that those of you listening could.

March in there and say, I'm gonna do the fresh test, you know, thanks.

And then you get some fight about it, or the labs sometimes won't run.

Mm-hmm.

That there's like certain labs that will mm-hmm.

And they do all the time, but some still say no.

Yeah.

And so, yeah, you may have to advocate a little bit for that.

So the more you know, the better.

Right.

Good thing you're here.

Okay.

So let's, let's talk about, you know, I, I'm sure it.

It.

There could be some new, a little nuance or difference depending on when you are diagnosed with GDM.

But let's say you are, you just take in your one hour screen and then if you do not pass that screen, then we do a three hour screen.

And Sarah's mentioned that a couple times of there's like a one hour and a three hour, and after the three hour is when, then it's like, yes, you do have gestational diabetes.

So let's say someone is sitting.

In that seat and they've been told or they just got the phone call.

What is kind of the, the, what's next for them?

So unfortunately, I love this question because unfortunately there is a big gap between the next steps.

A lot of them are left in the dark, like, what do I do next?

They have to wait maybe a week or two for their appointment with a diabetic educator or endocrinologist.

I mean, I've heard different things.

The way it works right now where I work is that they do have to wait like a week or two because we have so many patients coming in and we have to schedule these patients in.

And so you're really.

A lot of them are very frustrated.

They're struggling, and a lot of them that I'm really proud to say they do their own research and they find me, which is awesome because I've had a mama in the membership that she had.

She found out she was diagnosed, she was going away for the weekend, and she had an MFM appointment like.

Tuesday or something like she found out like maybe Thursday.

She, she's gonna have an appointment on Tuesday.

She found me online.

She joined the membership, watched all the calls, got all the handouts, and by her appointment by Tuesday she knew everything walking in and her blood sugar, like she already was taking her blood sugar, like she was already on the right track and they were really impressed and they just like spent like five minutes with her.

I see.

So that's like the best case scenario.

However, I hear like people are just really struggling.

They don't know what to eat next.

They don't know how to check their blood sugar, believe it or not.

Mm-hmm.

Mm-hmm.

They're not checking their blood sugar correctly.

They don't, they just are freaking out.

Like, what does this mean?

What do I have to do now?

It was my baby gonna be okay?

Am I gonna have my dream birth?

I mean, a lot of their dreams, they feel go like.

And they're, you know, in their mind, they just feel overwhelmed, so

mm-hmm.

That's, mm-hmm.

Unfortunately, the system that we're in, it's more of a business and it's more like scheduling patients in.

So that's where I come in.

Yeah, no, at a practical level.

So this mom's sitting there and she will be checking her blood sugars throughout her pregnancy after this diagnosis.

So that's like step one, understand that now you're gonna be doing, you know, finger sticks to check your sugars until baby is here, right?

And then maybe potentially after, depending on how things go or what happens.

So I think even that sometimes can be shocking of.

It's not like, oh, I'm just going to eat better.

Mm-hmm.

Yes, there are some changes you're gonna have to make with your diet, but also you're gonna be checking your blood sugars day four times a a day.

And Don mention like, some people ha don't know how to do it or never have.

But I'm sitting here thinking like, if Kelvin got told my husband, if he got told tomorrow, Hey, you have to start checking your blood sugars four times a day.

He'd be like.

I don't know how to do that.

Yeah.

Like what are you talking about as well?

So I think for the lay person or whatever vocabulary you wanna use there, just even that alone is like, okay, I don't know how to do that.

I'm not a nurse or whatever, don't mm-hmm.

Poke myself four times a day.

And so even that is just such a, like an impactful and immediate thing that starts happening.

Yeah.

So when it comes to diet and nutrition as well.

Do you feel like patients get separate consults or it's just kind of like one.

Start off appointment and then their follow up of like, we're gonna change your diet, we're gonna do these blood sugar checks, and we're gonna talk about implications for birth later on.

Like how does that look like for them too?

Yeah.

So I can only speak from my, where I work and my experience.

Right.

So usually it's a class that they're enrolled into, which is discusses like the basics, like what is GGDM and how to check your blood sugars, how to,

mm-hmm.

What to eat, how to count your carbs,

mm-hmm.

All the things that go into it and your normal blood sugars, what they should be, how you should log it.

And they basically tell you that, for the next two weeks we're gonna try diet and exercise and then we'll follow up with you in two weeks.

And if the butt sugars are still high, then we will start medication.

That's essentially okay.

The gist of it.

And they, is that pretty normal, a just a two week timeline to kind of see how it's going?

It depends.

Do know if like your A1C is high or your blood sugars, we tell them like if your blood sugars are uc, like really, really high.

Like your fastings are like one 20, consistently.

Yeah.

Or like your post meals are like 200 or something.

Mm-hmm.

Like we tell them.

Please call us.

Yeah, but generally, like if you're, if you have no other risk factors, but usually if it's like a patient that had GDM before and they see that their blood sugars are high, they'll call us and tell us like, oh, my blood sugars are high.

Right.

Yeah.

Right.

So I guess also the flip side is that of that is I think that some people can say two weeks to figure this out.

Yeah.

Before medication.

Like what's the rush?

But I think that actually you can just answer that.

There's implications, right?

Mm-hmm.

To a baby who's.

Say like getting too much sugar at a really basic level.

And so I think that's why if you're 28 ish weeks, when you get your diagnosis, maybe 29, if you did it late and then it's a couple weeks of figuring this out, maybe it took you a week to get in front of someone or into the class or whatever, then we're talking, you know, you're 33 weeks, 34 weeks.

So we do, it's like we do wanna get a handle on that quickly.

So we can kind of help mitigate possible implications of that.

Yeah, yeah, yeah.

I love that because I actually told that to a mama yesterday.

She was just so confused, like, why were we keep checking up on her?

And I told her, right.

It's not like when you have diabetes outside of pregnancy, when you have diabetes outside of pregnancy, you meet with.

Your endo or your endocrinologist or your pcp.

Mm-hmm.

Like every three months you check your A1C.

Maybe every three months they talk about your diet.

Maybe they do it once a year even.

It depends on, on your situation.

And then you just move on with your life when they just give you a medication and whatever.

Yeah.

Here there's a baby involved and with a baby we're worried about a lot of complications that can happen if your baby is exposed to high blood sugar.

I mean, right.

It's a list like.

I mean, lo knows all of this, but like, I'm sure she's talked about it too, like, you know, big babies, which can cause shoulder dys, soia, which babies shoulders are stuck when you're pushing, which is an emergency.

Mm-hmm.

That is

not fun for us.

Mm-hmm.

Uh, we

don't want any damage to babies.

It can cause, implications like.

Possibly, God forbid, stillbirth, if your baby is exposed to high blood sugars, it can cause baby to be big and your fluid, your amniotic fluid is high, which causes other complications, you know, can cause complications for the mother.

It can cause preeclampsia.

I mean, it's just really harmful.

For us not to keep a watchful eye on you.

Like people are like, oh my gosh, like you guys are just like really on top of me and it's just really 'cause we want the best for you and your baby and we can't have you walking around those high blood sugars.

Like I tell them like one or two high blood sugars is fine.

But if it's consistent, it affects your baby tremendously and your baby's exposed to hive.

Levels of blood sugar and then they start producing high levels of insulin.

And then when you baby's born and they cut the cord, baby's blood, sugar drops and 'cause there's so much insulin in this baby's body and mm-hmm.

If baby can't transition normally and stabilize it, baby can go to the NICU and Right.

It's just really harmful in every kind of way.

So that's why we are so strict with our parameters.

Like people say, why are.

Why does my fasting have to be less than 95?

Yeah.

Why does my meals have to be less than 9 1 1 40?

And it's because of the research that we found, you know, based on acog again, that high levels of blood sugar can cause a lot of complications.

Yeah, that's perfect.

I think sometimes we wanna shy away from like the conseque, not consequences.

Consequences.

The implications.

Yeah.

Consequences.

Side effects con conversation.

Right.

Because.

It can sound really scary.

Mm-hmm.

Or it can, I feel sometimes it feels like we're stepping into those waters of, look at all this bad stuff that can happen if you don't listen, you know?

But edit.

That's just the reality, right?

Yeah.

Like high blood sugar in the maternal body.

Has a lot of possible implications.

And like we were saying, the timeline here is short.

It's not this lifelong diabetes that, you know, other people may be dealing with.

And so we wanna get on top of it really quickly because we have eight, 10 weeks maybe.

Mm-hmm.

To stay on top of it.

And it could be a shorter timeframe if, if induction becomes indicated or something.

Mm-hmm.

So it's like we have a few weeks.

You know, a couple months to try and do the best we can with what we know right now and, and have this be, you know, the best circumstance inside of the fact that now there's gestational diabetes on board in that pregnancy.

So I think it's valuable to hear that, because my guess is, and I've not had, I didn't say this either when we started, but I didn't have G DM with any of my four pregnancies.

so this isn't personal for me, but I imagine I can picture myself thinking like, everyone just chill for a second.

Yeah.

Like I'm getting this figured out.

And I imagine sometimes it doesn't feel like there's a lot of chill coming from the other direction, but I do think it's because it's like, well, we've got eight weeks to try and get this at the best place it can be, you know, or whatever.

Yeah.

And so I guess I just like wanted you guys to hear that as well.

If you're feeling a little bit of like, everybody calm down, you're making me anxious type thing.

Yeah.

Is is, yeah, we're trying to do this and turn this around or get it at a good, you know, as healthy as it can be level as soon as we can.

So, yeah, a

hundred percent.

Okay.

My own thoughts just led me to my next question, which is the induction conversation.

Mm-hmm.

So we've addressed, Hey, you could have GDM, Hey, here's what might happen when you do, Hey, you could end up on medication if diet and exercise alone is not controlling your sugars.

And then you're gonna hit a point where there's gonna be an induction conversation, I'm assuming.

This conversation will come up for everyone with GDM.

You can correct me if I'm wrong.

Yes.

So it comes

up for regular healthy women.

True.

True.

So of course it's gonna come up for, GDM.

So when do you feel like that comes up?

What does ACOG say about when they feel like you should be induced?

If you should, you know what your optionality is inside of that.

Yeah, I love this question.

Because ACOG says one thing, doctors say another, right?

Mm-hmm.

So really it's a case by case situation.

If a mother has uncontrolled diabetes, like meaning her blood sugars are high and.

Slash or baby is big.

The fluid is high.

Mm-hmm.

That means that MFM will determine your delivery date earlier.

Okay.

Because we're looking at the whole picture.

We don't

Are you saying sorry, that they like.

Will move your, yeah.

Yeah.

Your EDD, the due date up?

No,

not your

due date.

The delivery, or do you, what do you mean?

Or your delivery?

Your delivery.

When?

Well, when they want your baby delivered by, you're saying?

Yes.

Like, yeah, like it's gonna move up.

Yeah.

Sorry.

Okay.

Meaning like that's, let's say, let's say like 37 weeks or 38 weeks.

Right.

Just like a mother who has preeclampsia.

Mm-hmm.

If a mother has preeclampsia, they'll say, okay, you'll be delivered.

Even sometimes we saw like 35 weeks, right?

Mm-hmm.

Mm-hmm.

So it's really case by case situation now.

Mm-hmm.

Having said that.

If your blood sugars are normal and your diet control technically and your baby's growth is normal, and there's no, like high fluid polyhydramnios, technically Acox has 40 weeks.

Okay?

Okay.

But a lot of doctors, but they want,

they do recommend induction by 40 weeks.

You can go to 40, but no, they don't recommend beyond.

Yeah.

Yes.

But a lot of doctors don't go by that again.

And I have this conversation all the time in the membership, because I break down, like what happens if you don't wanna have an induction and what your options are for that.

Now, as far as diag medication, like if you're taking medication, they do, recommend.

ACOG recommends delivery by 39 and five, I believe.

Correct me if I'm wrong.

Which is really interesting.

Probably like around 39, I would say.

39 to 39 and five, yeah.

Days.

And that's really interesting because most mamas taking medication again, are usually delivered earlier.

Mm-hmm.

I'm sure you know that low.

Mm-hmm.

But again, it's probably because they're looking at the whole picture, meaning your baby, your blood sugars, and your baby's growth again, and your also your nst.

So if your nst, your non-stress tests are non-reactive, like we look at so much.

So it's not like a rule.

They can write the standard, but it should be a case by case situation because your baby might be doing well, but another mom's baby might not be doing well on the NST or whatever.

Mm-hmm.

Now, I talk about like how to navigate those conversations with your providers.

So first of all, it can come really early.

Like sometimes they can even tell you like.

Maybe 34, 35 weeks.

MFM might tell you like, oh, we're gonna recommend delivery by x, y, and z, 38 weeks, whatever.

It can come early.

So I de definitely recommend you talk to your provider and ask them, what do you, what is your policy about inductions for what GDM if they tell you?

Mm-hmm.

Oh, everybody has to be induced with diet control by 39 weeks.

There's your answer.

Right.

And you can do, with that information what you want, and you should ask them more questions.

If you don't wanna get induced, can I do non-stress tests and biophysical profiles?

Yeah.

Until I deliver.

If your blood sugars are normal and your baby's, heart rate is perfect on the monitor and your growth is normal, baby's fluid is normal.

Baby is, growing appropriately.

I mean, technically your baby's getting a hundred on all the tests.

So it is reassuring, meaning there's no, like issue like right now that's critical for you to be delivered at this moment.

So technically, if you wanted to explore that option, you can.

It's really hard because some providers just don't feel comfortable with.

Yeah.

Mamas with GDM continuing their pregnancy past a certain point, especially if they're taking insulin.

I mean, this is something that is really, talked about a lot in the membership as well, and the dms that I get, I mean, people are just freaking out because, oh, I'm taking insulin.

I have to be induced.

Again, it's a conversation to have with your provider.

I mean, if your blood sugars are normal again and you want, you feel com and you feel baby moving, that's another thing.

Sometimes if you're not feeling, baby moved, we're concerned, so we need all these things checked off.

But some providers are just not comfortable and mm-hmm.

You have to know that 'cause you need to know how to plan that out.

Yeah, so basically you guys, what I want you to hear is it's really a case by case basis.

Yeah.

It sounds like pretty standardly everyone is going to be delivered or induced by 40 weeks.

Of course there's probably, there's still choice in that.

I'm sure some people say, no, I'll do NST and bpps.

I'm still not, but.

Like inside of that, that like Sarah's saying, like if your sugars are great, if your baby's doing great, like there's this flexibility here that is available to you, but your provider may not always present to you.

Yeah.

So just to hear that and know that I think is.

Really important.

'cause you might not get that from your provider to you, but it is, it is real.

It is true.

It is there.

So yeah, you had mentioned, insulin and I just wanted to circle back on that really quick.

I, I feel like I always do this.

Like, tell me really practically.

'cause I want moms to know like, not exactly what will happen.

No one can know exactly what will happen.

But you had mentioned, if diet and stuff isn't working in those first couple of weeks, then we switch to medication.

Is it always straight to insulin?

Because I know there's oral meds as well.

Yeah.

So it's not always this immediate jump to insulin.

Correct.

Correct.

You could potentially, we could do orals.

If that's not working, then we move to insulin.

So there's kind whole kind of spectrum.

Yeah.

That we move across.

Yeah.

As we're trying to control your sugars.

Correct.

So,

yeah.

So usually, so a few years ago when I first started as labor and delivery nurse, everyone was on glyburide.

I don't know if you remember that low.

Yep.

Yep.

Honestly, they found so much evidence that glyburide causes neonatal low blood sugars.

So they stopped.

Yeah.

It, it was not, I, I remember running around like a chicken without a head check, checking all these baby's blood sugars, taking them to the after birth.

Yeah.

It was just horrible.

And after they did research, they found in General Glide causes low blood sugars to anyone, man.

So it's not the standard drug for anyone anymore, but it's still out there.

Now the other option that most doctors are recommending is either metformin and insulin.

However, there's a lot of controversy about metformin.

They are prescribing it, but it does cross the placenta.

So there's that, right?

I mean, there's not a lot of studies with pregnant women, let's just be honest, right?

So we, they're not really testing medications with women.

And it, many years, like a couple years ago when I first started.

Metformin was contraindicated in pregnancy.

I don't know if you remember that.

Mm-hmm.

Mm-hmm.

Like if someone was on Metformin before pregnancy and they got pregnant, we would switch them.

Yeah.

But now it's the standard.

Okay.

So just so you know, it does cause a lot of like GI upset in general, like anyone taking Metformin.

And there is a cap to Metformin, so the cap is a thousand milligrams.

Some mamas.

Need more medication after, and we can't give more.

So there are mamas who are on metformin and insulin, which at that point it's like, what's the point of that?

Yeah.

So a lot of providers feel more comfortable with insulin.

Especially like the old school doctors, because you can control it.

So you can titrate it.

Yeah.

Meaning you could increase it for sure.

You can give it before meals.

You can, you know, give the different types of insulin like, but a lot of doctors.

Don't like it also because it causes low blood sugar and they just don't want their patients to be like struggling with increasing it or lowering it or whatever.

And patients are scared of insulin.

They're scared of injecting themself with insulin.

Yeah.

They don't know how to do it.

They don't wanna do it.

They'd just rather take a pill.

Right?

So just know your options.

You have two options, and you can make a decision that what's best for you and your baby.

Yeah.

And then insulin, I would add to, you know, in labor then, if you need to be on insulin drip and the fluids and just balancing all that, this is not your concern, right?

But it just change changes the labor a little bit.

So it adds another layer to your labor, right?

Because then you're gonna continue to need it throughout your labor and delivery.

So, oh,

you might not

the insulin.

Yeah, you might not because the protocols, I mean, every hospital's different like where I work.

Yeah.

That's usually like type one or type twos if they needed insulin.

Yeah.

But the mamas who have GDM gestational diabetes and they're taking insulin, we check their blood sugar depending on your hospital every two to three hours.

And we only start insulin if your blood sugar is one 20 and higher.

Mm-hmm.

That's like a whole new PO policy that we have now, and it's very rare for mama with gestational diabetes to be on an insulin drip.

Okay, I didn't realize that.

So even if they're using insulin throughout the pregnancy to treat well, are you continuing to dose them then during labor though?

You're just saying they're not on a drip.

They're not on a drip.

We just check their blood sugar.

Right.

Okay.

And we just change the line.

So meaning the IV line.

So we either give them, normal saline, which is no sugar, or if their blood sugar is low, we'll give them a little, a normal saline with blood, with, glucose.

D five.

Yeah.

So we'll keep switching the lines depending on your blood sugar, right?

But most mamas are not on insulin during labor.

It's only if you have uncontrolled, blood sugars, meaning like it's really, really high or, you have type one or type two diabetes.

Right.

Okay, perfect.

Thank you.

Yeah.

Okay, so induction definitely gonna be on the table.

You've gotta decide what to do with that and honestly how to navigate those combos.

Yeah.

But you do have options post birth.

You've mentioned a little bit, and I just wanna touch on this 'cause I think that's the last little bit for.

This kind of whole spectrum, how might it go?

Yeah.

One thing you mentioned already is that the thought is when the placenta leaves the body, your G dms kind of just gone, but I know that you could speak to that a little more.

then the other thing is kind of.

Baby could struggle with some low blood, blood sugars while they kind of regulate, to being outside of your body and managing, you know, their own sugars and insulin on their own.

Yeah.

So do you wanna speak to both of those a little bit?

Yeah.

Kind of what it means for you post birth and then.

A little bit of baby care implications post birth.

Yeah.

Let's start with, I guess baby

do it.

Go for it.

Okay, awesome.

So when you're in labor, we will check your blood sugars, like I said, every two to three hours, depending on your hospital.

Sometimes it's even every hour depending on the protocol.

After you deliver and you have gestational diabetes, we stop checking your blood sugars.

So that we only check it if you have type one or type two, or like you had crazy blood sugars and we don't know where you fit in the spectrum.

Yeah, we'll check it then.

But otherwise so technically you are done and everyone gets really excited about that and they just order pizza and whatever after they deliver, which is awesome.

You get to enjoy.

Right.

But, let's chat about baby First, like I said.

So after baby's born, we will start checking baby's blood sugars after one hour of birth.

Mm-hmm.

And so that one hour, that golden hour, we, we really recommend doing skin to skin, which I know you always talk about low.

So you guys should check out all her info on that also.

But.

You know, skin to skin and just really promoting that bonding, which helps regulate their blood sugar and their respiratory rate and their heart rate.

And we also want you to start breastfeeding and latching baby and really giving that baby some colostrum because colostrum will help their blood sugars.

Regulate as well, which is beautiful.

So we'll check it one hour after birth.

And every hospital has different policies, so sometimes they'll check it like every hour for three hours.

And if all of them are normal, they'll check it every like in six hours or, and nine hours and 24 hours.

I mean, every hospital is different.

Like I said, I'm only speaking from the hospitals that I worked at.

And, if the baby's blood sugar is less than 45, that's considered low.

So what we will do is we actually have glucose, she, which is really awesome.

Mm-hmm.

And it's basically like a sugar, a vial, a tube of, sugar.

And we put it in the baby's cheek and that will help the baby's blood sugar come back up.

And we will help you latch.

We will want you to breastfeed baby, and then we'll recheck it.

And every hospital has different protocols as far as rechecking it and notifying the provider and whatever.

If babies', blood sugars are consistently low and slash if their blood sugar is just really low, like if we check it the one hour and it's super low and then we, we obviously have to recheck it.

Again, as a nurse, we know that.

Yeah.

So you check in and it's low.

We check it again and it's low.

If it's critically low, we would have to take the baby straight to NICU because the, your baby's, your anyone's blood sugar affects your ba, your brain, and it could cause neurological complications and babies can't talk.

So we gotta move fast to save this baby's life.

And even an adult, like if an adult's blood sugar drops.

They might not be able to respond, they might not be able to talk.

They may faint.

Yeah.

So it's really important to, for nurses to be on high guard and to assess the baby really quickly for any signs of like lethargic, like when they're really tired, they're breathing really fast, and you know, other signs.

So that's baby.

Now, most babies do really well if you control your blood sugars.

But there are exceptions to the rule, especially if your baby is super big or super small.

Sometimes even if you don't have GDM and baby's super small, sometimes they just can't regulate their blood sugar because they're, you know, preterm or, or they're super small or whatever.

So it can happen and in that case, maybe it goes to the NICU to be stabilized and usually it's not.

Something that's like life threatening after they stabilize baby, but it, it really impacts the, the bonding between the mom and the baby.

And it's kind of scary.

I mean, I don't know if you ever had a baby go to the nicu, but I did not for this, but for high Billy, and it was just really traumatizing.

So I don't want that for anyone, and that's why I always talk about baby's blood sugars as well, so.

Just know, like what happens, what the protocol is.

And you can even start collecting, colostrum in pregnancy.

Like if you're low risk, you're cleared for pelvic, you know, you don't have to be on pelvic rest.

you can start collecting that closer to delivery.

Like if you have an induction scheduled or you're like closer to term.

You can start collecting that.

obviously stop if you start contracting and if you have a history of preterm labor, please do not do that.

Or short cervix or anything like that.

but you know, you could bring that with you and give that baby some colostrum as well to help you really navigate that timeframe.

as far as the mother, so she, we again, we stopped checking her, but sugars, and then we kind of tell you, you can do whatever you want.

You can go home and eat whatever, right.

That's not necessarily true.

when you have gestational diabetes, your chances of getting diabetes type two in life, are, I think I heard, the research say that in the, by the time your baby's five, your chances of getting type two diabetes are 50%.

Which is really scary because I don't think anyone says that straight up.

No, I think it's always just like in my, I didn't know the numbers, I just know if you have GDM, your risk of type two is higher.

Yeah.

But that's, I mean, that's pretty significant.

Yeah.

Of a number for sure.

Especially if you have consecutive.

Pregnancies with GDM,

right?

And you're not checking your A1C in between and you're not implementing the health healthy lifestyle choices and you're just doing whatever, which I know, I get it.

Like postpartum, you kind of lose yourself.

Yeah.

And especially if you have like toddlers and other kids, you're not gonna be, you're not priority anymore, which you should be because if you're not taking care of yourself and your blood sugars, you might.

Jeopardize your health and we want you around for your kids and to teach your kids healthy lifestyle choices.

So it's really important that yes, you can indulge a little more, especially after you, you push that baby out, you get a present.

That's right.

Or even a c-section.

You get a present, you know?

But you should continue to have healthy lifestyle choices and really implement what you learned when you had gestational diabetes like.

Walk after you eat, exercise, pair your foods.

Don't just eat carbs.

Drink a lot of water.

You know, really increase your fiber and your healthy fats and your protein and things like that, which are really simple if you think about it.

'cause you've been doing it for a while.

It's basically

what all of us should be doing.

Exactly.

Postpartum actually.

Exactly.

I'm listening that.

I'm like, yeah, all of us should eat and drink and care for ourselves that way.

Yeah, exactly.

So it's really, you're just doing a good.

Thing for yourself Yeah.

And your family.

So I really recommend that you keep doing that postpartum.

Yeah.

And following up with your primary care, checking your hemoglobin A1C af like three months after you can do that.

Because again, it's.

The average of your last three months, and following up and, and doing the postpartum tests, like they say, like six to 12 weeks after you deliver.

Mm-hmm.

So that will really give us a better understanding if your body still has the insulin resistance or not, or if you know you got cured

Yeah.

Of G dms.

So that's that.

You just

said the postpartum test, you're talking about a blood test, right?

The glucose test.

Whatcha talking?

Yes.

So six to 12 ish weeks.

I'm assuming a lot of people can do it at their six week appointment if they have one of those, yeah, you can.

And then three months out, a hemoglobin A1C check is a good idea too, you're saying?

Yeah.

That's like a separate, yeah.

Yeah.

Okay, that's perfect.

I think sometimes you do hear the, you know, you think like, just get this baby out and it's all done.

But I think as a parent, definitely hear your baby's gonna get some blood glucose checks, like that is going to happen.

Yes.

We do it at different times.

Our protocols sound like they were similar to the ones you were talking about.

Yeah.

But baby will get some checks and so sometimes I think parents are like, why are you poking them?

Mm-hmm.

But it is part of it.

Any sort of diabetes coming in means some diabetes check-ins, post-birth for that babe.

And then, yeah, freedom for you most likely, but being thoughtful with that freedom because we wanna take care of you for the years to follow for sure.

So that's great.

Okay, I think we can wrap it up there for today.

I had other questions.

Funny.

I'm like, I'll just put those.

Aside for now.

I

know we could

talk

all like Dave about this.

Yeah,

I I really could.

I, I mean, yeah.

I just, I just want moms to go in and be like, yeah, I heard them, I heard them talk about this.

I know what I, you know, like that idea of people saying, I heard your voice in my head, or I heard your podcast.

It's like, yes, that's what I want for you.

'cause it'll make your experience.

Better.

Yeah.

Even if it's not perfect or whatever, like this kind of stuff, it will make it better.

And that's, that's obviously the goal, right?

Yeah.

Okay.

So you've mentioned your membership a little bit.

Why don't you tell everybody really quickly kind of where they can find you or connect with you if they do want some extra GDM help?

Yeah.

And they need you.

Yeah, I would love to help anyone who's struggling.

You don't have to struggle alone.

You can get support.

You can find me at Instagram.

My name, it's my handle is Gestational Diabetes Nurse.

My name is Sarah Live., I do have an awesome membership that you guys can come into.

It's super low cost.

And, we have a community of mamas just like you.

The mamas are doing exceptionally well.

Like I said, side note, one of the mamas, actually, she was the one that was diagnosed early with GDM and she was on insulin and she, her blood sugars were low, so she stopped her insulin.

Like Nice.

What?

Like, yeah.

And that's

awesome.

Yeah.

Her doctors work so like confused because most patients we increase.

Right.

Once you're on your own.

Yeah.

We keep increasing your insulin and she's doing like they're all doing exceptionally well.

They're all have different stories and they're all helping each other.

They're all giving each other hacks and.

So that's really awesome.

We do weekly, zoom calls.

We do, weekly, recipes and we talk about birth prep, which is really awesome.

And, I also have a blog that I can, give you the link for and yeah, I have a childbirth course, specifically for GDM Mama.

So that's really awesome.

And yeah, I would love to connect with anyone who is struggling, has questions.

I'm here for you.

This is literally giving me so much joy every day, just helping mamas, because as a nurse.

This is what, why we became a nurse.

I mean, I didn't become a nurse.

Yeah.

I don't know about you, but like the money is not worth it.

Nope.

It's not

that good.

Yeah.

It's just really to help women have better pregnancies, be smoother, births, healthier, babies, like this is just what I love.

So please connect with me.

I would love to help you.

Perfect.

We'll put all of that in the show notes I was gonna mention too, I have some resources on Antinatal Colostrum collection, which Sarah mentioned.

Awesome.

So I'll drop those, in the show notes for you guys too, because I would.

Put a pin in that if, especially if you do have GDM as well, but really all of you can put a pin in that.

Okay, last question, just for fun.

What is one thing in your life that's just sparking a ton of joy and Yeah, just giving you life?

I love that question.

I think I touched on it.

Can I give you two?

Yes.

I'll let you.

Awesome, awesome.

My first is my family.

My kids, I mean, they just bring me so much joy and now that they're three and two, it's every day is just like a blast.

I mean, we just potty trained my first one, so it was, it was, is that a blast?

I mean, it wasn't, but now that he's, it's now it's 'cause it's so cute.

And, I'm just really like impressed with how much they know and how much they could chat about.

Just really bringing me so much joy.

And my second one is what I mentioned before, how, how I'm able to help mamas outside of work that actually want to get help.

And that's different because they actually are making the changes and they're telling me like, oh my God, my blood sugar is better, my growth is normal, and I had a beautiful delivery.

And that just brings me so much joy.

Perfect.

Thanks Sarah.

Okay.

Thank you so much for your time.

This was great.

Thank you.

Thank you so much.

Yeah, bye.

Bye.

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