How to Control Your Blood Sugar During Pregnancy
Lisa Kogan, who was nine weeks pregnant when she was diagnosed with diabetes, reflects on the one-two jab life gave her.
Photo: Ika84/Getty Images
Life can turn on a dime. One minute you're sitting in your lawyer's office discussing the possibility of adoption, the next you're standing in your bathroom staring at a little stick that—against all odds—has somehow managed to register two skinny pink lines. Anyway, that's my story. I was 41 years old, I was pregnant, I was cautiously euphoric. And then the world turned upside down.
It was September 24, 2002. Nearly three weeks after examining me, my obstetrician had sent a letter saying my glucose appeared "slightly elevated" and suggested a glucose tolerance test. Fed up with my inability to ever get her on the phone, I called a colleague's husband, a respected OBGYN, and read him the results of the test. There was a pause—I remember that—and then I know he said, "Uh-huh, okay, hold on a minute while I make a call." After a very long minute, he got back on the line with what struck me as an absurd question. "Are you wearing shoes?" he asked. "Yep, I'm in my sensible pregnant-girl flats," I answered. "Good," he said. "I want you to grab your bag and get into a taxi. You'll be going to 168th Street and Saint Nicholas Avenue. Take the elevator to the..."
It was going way too fast. "Listen," I said, "I'm pretty beat, but maybe tomorrow." And then he cut to the chase: "You're diabetic," he said, "and this baby can't wait until tomorrow." He explained that my soon-to-be-former doctor had taken much too long to diagnose me and that my baby's organs were being formed in an environment of uncontrolled sugar. He said other things, but it was all a blur. Thirty-five minutes later, I found myself at the place that would become my second home: Columbia University's Naomi Berrie Diabetes Center in New York City.
I have endured great pain in my day. A large woman named Helga waxes my bikini line every May, and I had a roommate who once listened to Enya for nine straight hours—so believe me when I tell you I understand human suffering, and I realize that in the grand scheme of things a little finger jab or an occasional shot in the arm doesn't really hurt all that much. But needles freak me out. It's irrational, it's phobic, it's not changing anytime soon. Before I meet the doctor, I am given a hemoglobin A1C test—a simple finger stick that determines your average blood sugar for the past three months. "Not that hand; this one," I sob. "Wait, this finger. Use this finger. Hold it; I'm not ready," I plead as I breathe in the nauseating smell of rubbing alcohol on cotton. The little girl in the next chair rolls her eyes. A slightly more sympathetic preschooler assures me that "they're quite good here." It is not pretty when you're seated with two people under the age of 7 and the only one who wants her mommy is you.
Just then I feel a hand on my shoulder. "Hi, I'm Dr. Robin Goland. We'll sit down and talk in a couple of minutes," and in a futile effort to further reassure me, she adds, "I promise you're not the first woman in history ever to be diabetic and pregnant." But I'm pretty sure she's wrong. "Actually, Dr. Goland, I believe I'm the first woman in history ever to be pregnant."
Holding my newly pricked finger as if I'd been bayoneted, I settle in for a chat with Dr. Goland. She is a combo platter, equal parts wry, compassionate and no-nonsense, a slim powerhouse in her late 40s who I imagine cheerfully defusing a mid-level nuclear device while forging a permanent peace in the Middle East and harnessing solar energy. Over time I'll find out that she has absolutely no grasp of pop culture and once forgot her child at an ice rink, but this is only our first date. Today I need her to be clear, kind, heroic—and that's exactly what she is.
She explains that there are 18 million diabetics in the United States, and nearly one-third of them are walking around undiagnosed: "The problem is that often a person with diabetes feels no different from someone with normal blood sugar. Their blood vessels could be getting damaged, but they have no idea anything's wrong. In most cases, an individual's normal blood sugar, after fasting overnight, is under 100. The symptoms people generally associate with diabetes—urinating frequently, unquenchable thirst, poor wound healing, feeling very tired—don't usually occur until the blood sugar is above 250. The slow rise in blood sugar, from out of the normal range to frank diabetes to really severe high blood sugar, can take a decade or more."
To my total shock, the result of my hemoglobin A1C test indicates that my diabetes is not gestational. Gestational diabetes usually strikes after the 20th week of pregnancy and disappears within an hour of giving birth. But at nine weeks along, it's apparent that I was diabetic before ever becoming pregnant. The test reveals my A1C level to be 8.4 percent. A normal count would be 6 percent, and many people are at 4 or 5 percent. Dr. Goland asks me about my family history (cancer galore). She asks me if I smoke (never). She asks me about my diet and fitness routine (used to see my trainer three times a week, currently see my refrigerator three times a night). Now it's my turn to ask the questions.
"What exactly is diabetes?"
"Well," she begins, "there's Type 1 and Type 2. Type 1 occurs because your own immune system attacks your insulin producing cells. When that happens, you can't make insulin, so to survive you have to take it by injection. Type 2 is much more common. That's a disease where the pancreas makes insulin but the body doesn't respond to it normally. We call that insulin resistance. And in the end, over years, the pancreas often has trouble making insulin. The result in both of these diseases is that the blood sugar goes too high."
"Then what happens?" I ask.
"Blindness, loss of limb, kidney failure, heart attack, stroke."
With each word I shift deeper into catatonic noodle mode.
"But," she adds, brightening, "every one of these things can be delayed or prevented. Because we didn't used to know how to keep blood sugar normal and how to prevent the complications, a lot of people are under the misconception that first you get the disease, then you get the problems, and that's that. The truth is, if you work to control it—and it is work—none of this is inevitable. You can be a healthy person with diabetes—you may never experience any of these complications."
My eyes scan the room as I try to take all of this in. There's a Harvard diploma hanging on the wall, pictures of three tanned tourist kids in front of some Greek ruins, a tiara-wearing teddy bear resting on the windowsill. I massage my ever expanding stomach and finally ask the million-dollar question: "Is my baby okay?"
Dr. Goland says it's too soon to tell. She wants to send me to a lab so they can run more tests, and I start a fresh round of sobbing. Directing me to the nearest box of tissues, she steps out of the room and returns followed by a band of angels. "You know what, Lisa, you don't need to get yourself to another lab. We're going to take some blood right now." Two nurses, Dr. Goland, and one vampire/medical assistant named Berenise ("She's the best") bring me into an examination room and start rolling up my sleeves in search of a good vein. It's a remarkable tribute to peer pressure and vanity that I ever allowed my ears to be pierced, and I explain how that procedure actually made me pass out. They have me lie down, and the process begins.
"So," says Dr. Goland, who seems to believe in the power of distraction, "what's Rosie really like?" Through clenched teeth, I tell her that I work for Oprah and that though I've never really said this to anyone before, "I guess the thing that makes Oprah so special to me"—they all lean forward—"is that she's never stabbed me in the arm with a sharp needle."