T2 much worse after pregnancy

[Blessedarethecheesemakers]

Hello, I haven’t posted for years. I was diagnosed in 2014 after my second pregnancy with gestational diabetes, and kept my hba1c in the 5s for years with a low carb diet (I lost about 30kg after my diagnosis but I’m still heavy). Then in late 2019 I found myself pregnant again at age 44 (biggest shock of my life) and a blood test at the start of pregnancy showed fasting levels of 9, and after even the lowest carb meals I was still getting 9,10.11. Metformin didn’t touch the sides so I was put straight on insulin (overnight and before meals). My readings were controlled with insulin (the units ramping up at the end of the pregnancy). After the baby I tested for 48 hours as advised and my readings dropped straight down again to brilliant levels. I had diabetic eye screening during and after the pregnancy and I was completely clear.

However my Hba1c 6 months after birth has come back at 8.3 - higher than it’s ever been. My cholesterol is also up. I’ve been put on metformin and dropped the carbs right down again (I won’t lie, I wasn’t religiously low carb all the time after having the baby because of a combination of new baby plus general pandemic / lockdown, but I didn’t go totally mad either, but my activity levels were low during lockdown). I’ve also just been put on a statin and I’m continuing on high blood pressure medication (I’ve been on it for years). I restarted proper low carb and metformin on 1 March and have just moved up to 4 tablets a day.

My questions, for which I’d be grateful for any insights:

- this seems so sudden - has my deterioration been partly as a result of my twilight pregnancy and being on insulin during it?

- Does anyone have any experience on how long metformin might take to make a difference?

- I’m struggling emotionally - I feel physically completely well, plenty of energy even with a baby at my age, back at work already, busy life with 3 kids, and I’m not in denial at all about my condition and its seriousness but every medical interaction I have leaves me feeling like I’m constantly being told how sick I am and that my body is failing.

thank you in advance.

 

[Brunneria]

Hey, welcome back! I remember your name from when you were posting before.
Glad to know you found low carb helpful, and that your babies are doing well.

Re Metformin.
I understand it can take 2-3 weeks to build up to an effective dose. Of course that depends on the size of the dose and whether you start off on one tablet and build up to more over several weeks.
Having said that, Metformin doesn't directly lower blood glucose. Its function is more complex than that, reducing the amount of glucose your liver releases from glycogen, and reducing insulin resistance somewhat. Again, this is dose dependent. The result is lower blood glucose overall, and an improvement in HbA1c, but it doesn't mean that it lowers bg significantly after a chocolate brownie, or pie and chips.

So I wouldn't have too high hopes about Metformin reducing your bg to normal levels. Diet and lifestyle changes will have far more impact.

T2 is an insidious beastie, and while you feel great now, the slight incremental deterioration caused by sustained high blood glucose may take a while to develop - and it may take a while to even notice, because the changes are so slow.

My suggestion would be to educate yourself now, learn the consequences of uncontrolled blood glucose are likely to be, test your blood glucose to realise exactly what is going on in your body, and take steps now (sustainable steps), and then stick to them.
It will pay off in the long run, and at 44 yrs old, you have a nice long run ahead of you.

 

[Blessedarethecheesemakers]

Thanks Brunneria, that’s really helpful. Yes I’m hoping that getting back onto my low carb diet will make a difference - I’ve noticed my usual quick weight loss when I start back onto low carb so hopefully I can successfully sustain it again. I’ve still got my glucose meter from the pregnancy so will restart testing again. The trick for me is to form the habits - I found it pretty easy to sustain low carb for years, but then during the pregnancy I was advised to add a little more carb which I did, and then afterwards I think I became guilty of carb-creep and what would have been an occasional meal a few years ago became part of the normal rotation.

 

[Resurgam]

I was eating low carb when bringing up a family and I think they benefited from having the foods I ate as the basis of their diet. Both are tall slender and fit, my son has five children.
I used to have a couple of postcards with shopping lists on them, so as to ensure variety, these days I have a shopping list more in hope than expectation - some things seem to have vanished - but I expect they'll turn up again in time. If you can get the habits sorted out the rest should be straightforward. I suspect I had an inability to deal with carbs from my youth, but it took until I was 65 to be diagnosed type 2 thanks, I believe, to habitual low carbing.

 

[Blessedarethecheesemakers]

I was eating low carb when bringing up a family and I think they benefited from having the foods I ate as the basis of their diet. Both are tall slender and fit, my son has five children.
I used to have a couple of postcards with shopping lists on them, so as to ensure variety, these days I have a shopping list more in hope than expectation - some things seem to have vanished - but I expect they'll turn up again in time. If you can get the habits sorted out the rest should be straightforward. I suspect I had an inability to deal with carbs from my youth, but it took until I was 65 to be diagnosed type 2 thanks, I believe, to habitual low carbing.

thank you, yes my husband is an avid low-carber and we try to base our family meals around it so I have the right family situation around me. I just need to keep going. My challenge is that I’m dealing with higher base numbers now, whereas previously in my diagnosis my numbers were much lower and it was very easy to control with diet.

 

[Blessedarethecheesemakers]

Hi, just coming back to update 3 months later - my latest hba1c has come back as 6.8 (51 in new money) - in February it was 8.3 (67). I’m keeping on working at it and have got lots to focus on for the years/decades ahead but thank you for the helpful and encouraging comments - you really helped me through my shock and dismay at my February readings.

 

[lucylocket61]

Just a thought, but my blood sugar levels are heavily affected by my hormones. Menopause was a challenge, to put it mildly. So your hormones recovering from your pregnancy may have needed time to settle again, specially if breast feeding is/was involved.. Best wishes.