Friday Links

Here are some links that may be of interest to GDM Mamas-to-be out there:

The Well-Rounded Mama Blog - Prenatal Weight Gain: When the Conclusion is Made Ahead of the Results

Diabetes.about.com - Infrared Blood Glucose Monitors

Medscape.com: Fasting Glucose and HbA1c together can be used to better diagnose Diabetes

DiabetesHealth.com: New Blood Markers for Type 2 Diabetes May Help to Identify Patients at Risk

We must always laugh to be healthy, and here are some fun links for your Friday Fun:

Jim's Pancakes - Because even if you can't have them, you might find this a creative way to have a family Saturday morning breakfast!

 

Catalogue Living - Gary and Elaine live such amazing lives!

Taste Bud Thursday

Eggplant Bruschetta


My husband found a recipe for eggplant bruschetta online somewhere recently, and we tried it out on some dinner guests a few weeks ago. We added feta cheese to the recipe he found, and when placed on some baguette, it was creamy, melt-in-your-mouth incredible. 


There are a ton of great recipes out there for this easy-to-make appetizer. You can garnish low-carb crackers, small baguette, or even flatbreads with this. You can add tomatoes, scallions, avocado, sunflower seeds, the possibilities are endless.


You can Google for a recipe quite easily, there are tons of variations out there. Click the following for a Google results page based on a search using Roasted Eggplant Bruschetta. The recipe that inspired my husband can be found here: http://smittenkitchen.com - Eggplant Salad Toasts


the recipe we ended up using is this:

• 1 medium eggplant, about 3/4 pound, cut into 1/2-inch cubes
• 4 tablespoons olive oil plus additional for oiling baking sheet
• 1 tsp kosher salt
• 1/4 tsp Cracked Black pepper
• 1/4 cup crumbled crumbled feta
• 1/2 c diced red onion
• 2 medium garlic cloves finely chopped
• Italian Parsley to taste

Preparation Steps:
1. Dice Eggplant, toss in olive oil, season with kosher salt and pepper.
2. Spread Egglant on a baking sheet and bake at 350 until brown (you will need to turn over eggplant to prevent sticking)
3. While roasting th eggplant, dice the red onion and garlic.
3. Once eggplant is finished cooking, remove from oven and allow to cool slightly
4. Combine cooked eggplant, onions, feta, and garlic.
5. Adjust salt, pepper, and Italian Parsley to taste.


Unfortunately, the original recipe from SmittenKitten did not have any nutritional information. However, given that this is mostly healthy ingredients, and if you are careful with what you put the bruschetta on, I call this a "no worry" recipe.


*Taste Bud Thursday will feature a low carb and diabetic friendly recipe each week, hopefully to entice your palate and provide variety in a specialized diet for GDM. Please note that you should always check with your doctor (or a nutritionist) before undertaking any severe diet changes, like cutting back on important nutritional building blocks like carbohydrates. Be safe while you dine, folks.

The Scrambled Egg Mystery

When we found out we were pregnant again, we were scheduled to take a trip to visit with good friends in the US. We had planned this trip for months, and it was on. We figured it would be ok, I just couldn’t ride any of the rollercoasters, and we bought groceries for lunches to mitigate our eating out while at the theme park central to our stay.

What made it even worse, and rather humorous, and kind of made us giggle and make jokes was, Well, we were meeting the gang in, of all places, Hershey, PA.

Yeah. Pregnant, Diabetic tired girl in the Chocolate capital of North America, at a theme park, filled with awesome rides she can’t get on, and awesome food she can’t have. Oh boy…

I was seeing good friends, and decided to make the best of it, and it was an amazing, exhausting, family-friendly trip. My son loved the kiddie rides, and we had a great time catching up with people we love so very much. We discovered my two year-old travels really well, and we had no melt downs in the park, or problems driving for long distances. All in all, a success, and not one motion sickness, preggo mama on the side of the road with first-trimester heaveys.

*Fistpump*

Let me tell you though, the air when you get out of the car at the Hershey theme park parking lot smells like chocolate. Everywhere you go, there are reminders of chocolate. There is a place called Chocolate World that sells reams and reams of chocolate. And here I was, not able to partake in the orgy of stuffing my face with the wonderful, creamy, stress-reducing, mood-altering goodness. People were hauling suitcases of the stuff back to their cars! Suitcases!! Yoi.

I was a good girl, and only nibbled on samples of said chocolate, and did pick up some sugar-free Reese’s Peanut butter Cups as a treat. I did have some ice cream one day, and a few kettle chips (from the gynormous bag my hubby bought), but I didn’t indulge in humongous amounts of bad-for-me foods.

It was a triumph of epic proportions. I love chocolate, and it was sometimes difficult not to break down and just have some.

What was harder than resisting the Hershey sugary goodness, in fact, was simply eating while we were travelling in the US. We had lots of groceries for snacks and lunches (mmm picnic lunch stuffs!), and that was a saving grace. But sometimes, you just gotta eat out when you’re travelling, and breakfast and dinner was usually in a restaurant.

Nowhere else were we reminded of the differences from Canada food guidelines and restaurants than sitting down to a meal with our friends, or while en route there and back. There were several times I had to literally waste most of the food on my plate in order to eat my proper carb portion and not overindulge, or order all sides.

Portions were enormous. Nutritional information was not readily available. Everything was swimming in butter, or so salty my hubby and I were taken aback at the tastes. We were amazed at the lack of vegetables and lean protein on menus, and the lack of understanding about Diabetic needs. I asked for a side of whole wheat toast, thinking I would get two slices of bread. I got six. SIX! I asked for skim milk for my coffee. “What’s that?” one waitress asked. With one supper, I asked what the veggie of the day was. The Waiter said “potatoes and corn”. Seriously? I looked it up afterwards. There are some beliefs in the US that potato is considered a vegetable serving. Corn I can understand. But potatoes?

Yeah, seriously.

But that wasn’t the cake topper (there I go with the cake again). For breakfast, our group reserved the big room in the breakfast buffet at the hotel we stayed at. The food looked good, I had lots of choices like eggs and bacon and sugar-free, low fat yogurt, as well as fruit and such. I figured we would be safe to have everyone eat ok there, and be healthy.

My son loved the scrambled eggs, and he’s not normally a scrambled egg kind of kid. We shrugged it off. They’re eggs, right? He wants to eat ‘em now, we won’t argue. They’re good for him. I had eggs as well, they are a good source of protein, and even with some milk that was likely mixed in, would be ok on my ratings. That, plus a half-slice of rye toast, and some bacon, and I was proud of myself. I did have a sip of my son’s orange juice one day, but that was because the bite of rye toast had gone down the wrong way, and my water was empty. *hork*

But, both days we ate there, I spiked after breakfast. Hard spike. Over 10 mmol/L. We were mystified. I re-did my counting, we went over the meal, and couldn’t see where the problem was. I scratched my head, and Hubby was concerned. I thought it might be the rye toast, but half a slice was well under my carb counts. We looked at the yogurt. Possible, but not likely. Was there anything else? Nope. A true mystery.

So, the day we were checking out, we ate at the restaurant nearby instead. I ordered my son a side of scrambled eggs. (read: heaping plate!) and he wouldn’t touch them. He was happier with the dollar pancakes he thought were super awesome as hats (read: sticky toddler).

Puzzled, I figured maybe there was something in the eggs at the buffet that made him like them more, like a spice.So, when I got back to the hotel, I asked the restaurant staff if they could tell me the ingredients in their scrambled eggs.

What they came back with nearly floored me. Literally, I had to shake my head and do a “really?” at the waitress who, after reading the ingredient list, was mystified as well.

There was sugar in the eggs. Liquid sugar.

Apparently, the eggs come in large bags, already mixed. All the cook has to do is open one corner, like a milk bag, and pour the mixture into the bin skillet, and cook them. The ingredients were: eggs, milk, liquid sugar, gelatine, colour, and spices. No wonder my son liked them so much! I couldn’t taste the sugar in them at all, neither could Hubby, but I like pepper on my eggs, and that may have masked the sweetness. Hubby didn’t eat enough of them to really notice, he said.

There was the reason I likely spiked. A hidden, nasty little surprise for Diabetics like me, assuming that eggs would be a safe bet, and finding out that they were not.

It reminded me how important it is to have information about what you are eating at your fingertips to make healthy, informed choices. In Canada, nutrition information must be provided at point of sale. This has saved us on so many occasions. I can safely eat at McDonalds, because their tray placemats have all the nutrition information on them, and you can ask for it at the counter! (BTW, their salads are great.)

Despite that, the trip was great, and my levels, for the most part, were regular. It is possible to travel with Diabetes, but depending on where you go, be prepared to ask a lot of questions, and be the customer every waiter hates when you demand special preparation and servings.

As a rule, here is what I say. If in doubt, ask, or leave it out.

Round Three and Kicking!

The past two months have been a rollercoaster, and I can now safely say that I am ready to begin anew... again. I know, I know, not the best way to gain readers. Let me tell you, if I'd had the energy, I would have kept blogging. I did two posts this summer, but then gave up when it got to be too much, and I needed to simplify.

In May, we miscarried at 9 weeks, just after I started this blog. We moved forward, we grieved, and then, much to our surprise, on July 22nd, I was late in my cycle, peed on the proverbial stick and it said... Pregnant.

I know. Fast. Both my husband and I looked at one another and went "Uhhh, ok?" and didn't try to get too excited until we made it past the 12 week mark. We decided to keep it very mum. I told one person at work just in case something happened, she would know what was going on. We didn't even spill to parents or close friends. I did not want to go through what we did when we miscarried. We goofed and told people early, and shouldn't have.

I wrote a couple of posts here as I got used to the idea of being pregnant yet again (without spilling yon beans about the bean), and then first trimester tiredness and overwhelmed mama came into play as we dealt with my unruly and recalcitrant body. I slept a lot. OK, so I was a sloth.

A big, pregnant, Diabetic sloth.

Despite our hesitation at welcoming this pregnancy, and as I had decided upon the miscarriage in May, I began testing my sugars with the remaining testing strips I had in my possession right away. From the last go-around, I knew my levels were likely to be all over the map, and this way, I would be prepared, and perhaps we could get my levels under control a bit sooner, and prevent another miscarriage, if that was the problem last time.

My home testing came back all wonky and I realized it was time to get into gear getting the doctors on board. Within two weeks, I had a random fasting blood sugar done just to see where I was at, and blammo, it came back high. Like frosting-for-blood-pancreas-on-a-holiday high.

I did the two-hour glucose tolerance test after that (for what reason I did not know, they wanted to do it), and my levels were 16 mmol/L at one hour, and 19 mmol/L at two hours. Ummm yeah folks, I coulda told you that. I'll never forget the Diabetic nurse's face when she saw the results of those tests in my chart. I guess that is abnormally high for 7 weeks pregnant, because she was amazed. *blink*

The Diabetes doctor I saw first off was wondering if was indeed type 2 Diabetic between pregnancies. According to my GP, and our regular 6 month tests, I'm not. I had to get my GP to forward all the tests he had done for the last two years, since my body was acting like a fully Diabetic machine-o-sugar, and they didn't believe me.

I registered again at the high risk unit of the Hospital where I had my first child, where I saw both the Diabetes Nurse and Doctor. The intake nurses remembered me, surprisingly, and with my very bored husband in tow, we ran the gamut, as well as spent some time with the nutritionist.

Cue sweeping diet and routine changes, plus crazy amounts of perscriptions here. I walked back into my house with boxes of needles, lancets, test strips, and insulin.

We are at 14 weeks now, officially into second trimester. First ultrasound to do IPS screening showed a very normal and bang-on to my estimates baby. We are due March 23rd, 2011. He (or she) was quite active, had a great heart beat, and seemed happy in there. *poke*

The bad news out of all this is that I am fully insulin dependant. I take, via needles, NPH (Humulin) before bed, and again when I wake up. I take fast acting insulin (Humalog) before each meal. The Humalog is on a sliding scale, based on my reading before the meal. The higher the reading, the more units I take.

Let's say that it has been a large adjustment. Partially familiar from my last full-term pregnancy, partially all new, since I am finding it much harder to control this time around. Foods I could have last time I can't touch, and foods I couldn't touch before I can have. Sugar alcohols are causing me more problems, and sugar-free ice cream is a rare treat now. Rice? Yeah, don't even talk to me about rice.... And my wonderbread peanut butter and banana sandwiches? *sob* But pasta, pasta I can tolerate in properly carb-counted portions.

My levels are a moving target as I progress, just like last time. This can be frustrating, maddening, and defeating. And the Diabetic Doctor says this is the easy part of the pregnancy. Oh joy!

I asked if what I was on was a large amount of insulin, and apparently it is not, yet. The Diabetes Doctor told me about one (anonymous) lucky woman who was taking 200 units of insulin a day in the later part of her pregnancy. They had run out of places to stab the needles into her poor, tired flesh. I shuddered. The Doctor said that even with that large amount of insulin, her levels were out of control, and she had a rather large baby. I asked how much of that was diet control, and she grimaced and said "most of it was lack of diet control". Ah-huh. Got ya beat sista. I have a husband who has taken on the Diabetic Challenge in keeping my levels ok.

So here we go again, round three. So far, so good, and more to come! Wish us luck, good eating, and the ability to find a winter coat that will go around this mama's already showing tummy!

Taste Bud Thursday

Cauliflower Crust Pizza

We tried the recipe this week, loved it, and have added it to our "GDM safe" recipe book.

Note: Next time we make this, I promise to add some pictures into this post, it got eaten too quickly!

My 2 year old son ate like a champ, asked for more, and it was gone in minutes. We loaded the veggies and lean hamburger and found that it was quite good for us to boot, when we added up the nutritional value.

We doubled the recipe to get a pizza crust big enough to make a meal with our family size of three. We also used fresh herbs instead of dried, so we used a bit more than the recipe called for.

This recipe would work well for anyone on a diabetic diet, gluten free diet, or simply wanting to eat low carb. A variation is to use zucchini instead of cauliflower, but we haven't tried that (yet).

The recipe and directions are thus:

Crust:

• 1 cup cooked, shredded cauliflower (also referred to as "riced")
• 1 egg
• 1 cup grated mozzarella cheese
• 1/2 tsp fennel
• 1 tsp oregano
• 2 tsp parsley

Top:

• Pizza sauce (Find one with no sugar added if you can)
• Toppings
• Mozzeralla cheese

Directions:

1. Pre-heat oven to 450 degrees
   
2. In a medium bowl, combine 1 cup shredded cauliflower, egg and 1 cup mozzarrella.
3. Fold in the herbs.
4. Press this goup evenly and thinly on a pizza pan.
   
5. Bake crust at 450 degrees for 12 - 15 minutes.
   
6. Remove baked crust from oven.
   
7. Add the pizza sauce of your choice and toppings of your choice.
   
8. Sprinkle Mozzerella on top.
   
9. Return to oven on BROIL - Remove when cheese is melted.

Nutritional information approximate to one pizza based on toppings of just vegetables is:

Entire crust: Calories; 434, Fat 25g, Carbohydrates; 8 (net) 13 total, Fibre; 5g, protein; 41g. one serving: 109 calories, 7 grams fat, 2 net carbs, 1.5 grams fiber, 10 grams protein.


*Taste Bud Thursday will feature a low carb and diabetic friendly recipe each week, hopefully to entice your palate and provide variety in a specialized diet for GDM. Please note that you should always check with your doctor (or a nutritionist) before undertaking any severe diet changes, like cutting back on important nutritional building blocks like carbohydrates. Be safe while you dine, folks.

Saying Goodbye to Favorite Foods

One of the biggest struggles a GDM mom-to-be has (in my opinion), is saying goodbye to those favorite foods that are considered "bad foods" for your blood sugar levels. All those foods you were loving before your diagnosis, when you were relieved from having to be on a diet, and could "eat for two". Food like donuts, ice cream, yummy-gloppy, cream sauce pasta, pizza, Big Macs, bananas, and bbq ribs that serve to soothe cravings, fill a preggo-mommy hunger, and make us happy. Heaven for me before diagnosis was Dairy Queen Pinapple soft serve sundaes. Yum.

I know I had trouble in the first few weeks, and again right near my due date. Seeing a co-worker glomming on a sesame seed bagel with cream cheese and lox made me want to rip my hair out, and I crossed the street to avoid looking into the chocolate shop, bakery window, or lineup at McDonalds. And do not get me started on my husband eating Miss Vickies beside me when I was seven months pregnant and couldn't look at a potato chip without both salivating and fearing the BS spike. *evil glare*

Yeah, I love my food, can you tell? *pinches spare tire*

Eating well, and refraining from "bad foods" is by no means insurmountable, of course. You are giving up the foods temporarily, and its not about you, its about your growing baby. You do it for them, and its a good thing. You can feel empowered when you pass up the Oreos in favour of something better, like carrot sticks, or fat-free yogurt.

But, I know that the tempation is there. Having the knowledge that you must eat well does not make it easier to say no to that Oat Fudge Bar when you order your skinny decaf latte on a Monday at work when a whole stack of nonsense arrives on your desk, your spinach salad is about as appetizing as lawn clippings, and you want to repeatedly smash your forehead on the keyboard and scream omggivemestrengthktxsbye. Let's face it. You are pregnant. You have cravings. Your nerves, emotions, sleep patterns, and body are freaking out all the time, and you just want something to make it all better. Right. Now.

The dietician and Diabetic nurse I worked with during my first pregnancy gave me some great advice for coping with those urges to inhale an entire tub of cool whip using a chocolate bar as a spoon. I thought I would share them.

1. She outlined snack choices and alternatives I could live with. Things like sugar free chocolate, stevia, strawberries, avocado, and a whole list of "free" foods. They were yummy, not bland, diet-carboard and made it bearable.
   
2. She outlined the "wait five minutes" technique before cracking open the box of Honey Nut Corn Flakes. If you are craving something that you know you can't have, wait five minutes, distract yourself with email or a quick walk (waddle) around the block. Then, likely the craving will be gone.
3. She encouraged me to drink more water if I was hungry, and that technique I still use today when I feel hungry outside of normal snacks and meals. I drink a glass of water instead, and the hunger usually goes away to the point I can think and make a sound choice.
4. She encouraged me to tell my spouse, friends, and co-workers about my dietary needs, so that if I was finding my willpower at nil, they could prop me up and help make the better choice. This helped me a lot. My spouse became the Diabetic cook-extraordinaire, and gave me a look (which worked) when I wanted to reach for the peanut butter.
5. She gave me a summary sheet of the GI Index. It rocks. I wish food labels had this in their nutrition information. Not all low GI foods will be suitable, but you can make great choices this way, based on how your GDM reacts to foods.
6. She showed me how to Carb count. I did this instead of counting calories or portion size of my carbs. Anything under 15 g of carbs was ok for me in one meal. And if it had high fibre carb content, then yahoo! It was good.
7. She surprised me by telling me it was ok to grieve. I know this sounds melodramatic, but she said it was ok to be uspet about not being able to eat whatever you want. If you get the anger and disappointment out of your system, it makes it easier to move on and be successful as a GDM mom-to-be.
8. She said EAT! It can be scary to measure every bite of food that goes into you, and worry that the 1/4 cup of rice will hurt the baby. But do NOT starve yourself, or not eat balanced, full meals, because that can be more damaging to your baby than GDM, in the long run. And being hungry all the time is no fun either, and makes "cheating" more likely.
   

Every GDM mom-to-be has a different set of food triggers. One mom can be sensitive to potatoes, another sensitive to fruit of all kinds. The severity of the GDM, your body type/shape, and familial risk factor have a lot to do with it as well. I knew several GDM mom-to-be's that could safely eat carbs and fruit, just in small quantities, and no insulin was necessary.

I hated those moms.

I had to cart around needles, insulin, and testing kits. My tummy had track marks like a drug addict, and made bare belly maternity shots impossible. I felt a little hollow when some moms could walk into the weekly Tuesday afternoon consult with the Diabetes doctor, a double-double and a donut in their hand, seemingly ok with the juxtaposition they were displaying. I would pull out my thermos of water, hard boiled egg, slice of spongy Betty Bread and some low fat cottage cheese and glare at them from inside my mind. Partially because I wondered how they could have that and not spike their BS through the roof, and partially because they were making poor choices when I was struggling so much not to.

Saying goodbye to those foods, albeit temporarily, is hard. As a GDM mom-to-be, you have to make some really big sacrifices, and add a level of complexity to your life to safeguard the health of your unborn child. Altering your diet, and balancing your nutrition untimately is a great big accomplishment, and one that should not go unnoticed. You should be proud that you can do it.

And in the end, when you greet your wonderful, normal weight, happily squalling baby, you will know that every time you traded Fibre 1 no sugar cereal for waffles, it was worth it.

Miscarriage and GDM

So I started this blog with the best of intentions, namely to keep myself motivated in the long, long 9 (10) months of pregnancy as a GDM mom. Not long after I posted my introduction, I miscarried.

We were at 9 weeks, had heard our Peanut's heartbeat, and were devastated. Even though the pregnancy was a bit of a surprise that required some financial finagling, we were going to be welcoming baby #2 by Christmas, and were hesitantly excited.

I couldn't really touch this blog until now. I didn't have anyting to say, really. But then I thought about the journey I have been on since I miscarried and I thought I should share.

A part of me was amazed at how quickly my blood sugars returned to normal afterwards. I kept testing for a few days after the official miscarriage began, and then sporadically until I had my next cycle. Normal, sometimes a tad high after we dined on "things-thou-shouldst-not-eat", but manageable, and not a cause for concern. I was concerned I had slipped into the Prediabetes or even Type 2 world, and was scared it was now going to be a full-time reality, not just a pregnant one.

I scheduled a visit with my doctor, of course, and he checked off every box on the bloodwork sheet when we discussed my overall health. He figured a physical might not be a bad idea to do, given we might find a problem, you never know. He checked B12 levels, since a deficiency in this vitamin can be risky in pregnancy. I think he also checked my iron and cholesterol levels to be sure. He tested me for PCOS (again), we did a random fasting bloodsugar, and did all kinds of hormone tests. Every test known to a doctor was done, I think, except for anything requiring my other bodily fluids I'd rather not mention here. Ew.

We discussed me, which I had expected. Yes, my weight needed to go lower, and my exercise level needed to be higher. Yes, I needed to keep going on eating better, as we had been doing since getting my test back high. He said to take someone with me to testing, since this was a lot of tests to take blood for, especially after fasting.

Whee! 7 vials of blood made the caffeine I put into my system afterwards very effective.

No red flags came up in the bloodwork, thankfully, and no mention of really high levels of fasting bloodsugar made my stress come down a notch or two on the "holycrapmylifeisover" meter. Likely, at my follow-up visit tomorrow, my awesome doctor will caution me that my levels were on the high end of normal, which they were last time we checked, but I was taking matters into my own hands with exercise and better eating already, and wasn't worried. Bring it on, man! *flex*

This whole thing got me thinking, though. Could my early diagnosis and high blood sugar levels have caused the miscarriage? When I was pregnant, I was scheduled to see the Diabetes doctor, but it was set for two weeks after I miscarried, so I was not able to get a perscription for insulin, and my sugars were getting harder to control each day. my levels were so wonky that I couldn't even look lovingly at a carb from across the table. A quarter cup of basmati rice was spiking me from a high 6 to a low 10! Not good. Not good at all.

I wondered - looking back at how difficult it was compared to my last pregnancy - if the lack of ability to control my bouncy blood sugar with diet was a contributing factor. So, with the thought of my GDM being a risk factor to miscarriage in the early days of pregnancy, I opened up the trusty Interwebs, and did some researching.

After looking through the Canadian Diabetes Association and the Public Health Agency of Canada, I found no convincing statistics that linked miscarriage to early onset GDM. It was mentioned, but each had conflicting stats, and thus, I couldn't verify anywhere else. Most mentioned that there was a risk, but identified more with type 2 Diabetes, rather than prediabetes, or GDM. In all cases, the percentage of risk was below 10%, and not a cause for major concern. Huh... ok, lets check some US sites.

US statistics and websites tended to be more fruitful. I did found a more concrete statement* while perusing the the WebMD network. The link to the page is here , with the following quoted from the section titled "Clinical":

Miscarriages

• In all women with preexisting diabetes mellitus, there is a 9-14% rate of miscarriage.
• Current data suggest a strong association between degree of glycemic control prior to pregnancy and miscarriage rate. Suboptimal glycemic control has been shown to double the miscarriage rate in women with diabetes. A correlation also exists between more advanced diabetes and miscarriage rates. Patients with long-standing (>10 y) and poorly controlled (glycohemoglobin exceeding 11%) diabetes have been shown to have a miscarriage rate of up to 44%. Conversely, reports demonstrate a normalization of miscarriage rate with excellent glycemic control.

I also found this statement on Healthsquare.com:

Illness

Miscarriages are much less common in the third trimester. Those that occur are more likely to be due to maternal factors, such as an illness in the mother, than to genetic abnormalities in the baby.

Women with poorly controlled diabetes are at great risk for miscarriage. Those whose diabetes is controlled, however, whether it existed before the pregnancy or developed after conception (gestational diabetes), are no more likely to lose a pregnancy than other women. A woman may not know that she has diabetes, however, until it is discovered during a search for the cause of repeated miscarriages. The routine blood and urine tests given during pregnancy are an effort to identify this problem while it still can be remedied.

Other diseases and conditions linked to increased risk of miscarriage include systemic lupus erythematosus (SLE, or lupus), high blood pressure, and certain infections, such as rubella (German measles), herpes simplex, and chlamydia. Experts disagree about the role of hypothyroidism, or an underactive thyroid gland, in miscarriage, but it's likely that a severe case increases the risk.

With conditions such as diabetes, treating or controlling the problem can improve the odds of a successful pregnancy. Special monitoring may also be required.

This was the first I read that my uncontrolled high levels might have contributed to the miscarriage. Should I feel guilty? Did I, because of my frustrating, unruly pancreas, cause my miscarriage?

I wasn't sure I wanted to put that heavy guilt burden on myself. I am no different than most women who go through miscarriage. You wonder if that bumpy carnival ride was to blame, or if the wand ultrasound technician-sadist who poked holes in your ovaries caused too much trauma, or the hot room yoga you were doing (before you knew you were preggo) made it happen. We look for causes, look for someone or something to blame other than simple nature and randomness of life.

I decided that no, I can't. Sometimes, it is what it is. We take the lesson and move forward, better prepared for the next curve ball. I think any pre-existing or high-risk condition in pregnancy can cause miscarriage, or other problems, it just depends on the individual, and their genetic makeup. Sometimes, even with best effort, things happen.

Next time, I will be better prepared to handle the onslaught of crazy my body will go through. Next time I will expect an early, if not immediate GDM problem, and act accordingly upon the positive pee-stick result. And because of my efforts to eat better and move more now, it might just be easier. I hope. We'll see.

* I can't verify all of this information, so please remember that when researching on the Internet, it is important to find several sources that say the same thing, are reputable, and reference other works themselves. Please take the statements quoted in this email with a grain of salt, and talk to your doctor about your concerns. He'sthe expert, not me.