Gestational Diabetes

I hate the term, but by some of the calculations, scales, charts, and guidelines used by some doctors, I have it. In actuality, my blood sugar seems to be too high sometimes and too low sometimes, and those "too high" times happened when I was having my one-hour and then my three-hour glucose test. And the "too low" instances were a little troubling as well. My doctors are being extremely conservative and cautious because I'm living in a poor country in Central Africa.

I've been doing a lot of research on gestational diabetes. It seems that some people just plain don't believe in it, or think that there really are not harmful side effects. Even if the only side effect is a large baby at birth, I'd like to avoid that. I'm small.

But the vast majority of publications agree that you shouldn't take any risks with it. And I'm all for erring on the side of exercise and better nutrition. It's just a huge pain. My doctor had me consult with a nutritionist. Sugar is out, except for fresh fruit and some milk and yogurt. Healthy fats are in. I covered most of my dietary issues earlier this week at What I Eat. I need to eat more, but the selection of foods I should eat and can eat keeps getting narrower.

While the food is challenging, the harder part is the exercise. I'm supposed to be walking for fifteen minutes after each meal. My morning walk is wonderful; it's still cool and pleasant outside. I hate doing it some days, but it's still preferable to my lunchtime walk, either in the hot sun or pacing back and forth in my small, but air-conditioned, office. And my post-dinner walk is a drag because the only place I can safely do it is by doing laps on our terrace. Plus I'm pretty tired by then and the thought of pulling on my sneakers one more time really gets me down.

Then there's the glucose monitoring. I've been doing it four times a day for the last two weeks, and I have another week of doing it that often before I've proved that I can keep my levels even. Then I can go down to twice a day. I don't hate needles; I'm not squeamish about blood. I just hate doing it, especially so many times a day. (I have an upcoming post on how difficult it's been to secure a good glucose monitor here. I was afraid I'd get sent back to the States early because of it.)

All this exercise and healthy eating is supposed to make me feel better, but it's not. To combat fatigue and mood swings, all the books and all the doctors recommend exercise and healthy eating. Logically I know I'm fine because my sugar levels are okay now. I also know in the rational part of my brain that it's all good for the baby. But instead of having more energy and a positive mental attitude, I'm even more drained and prone to mood swings than I was before I started this regime. And that's extremely frustrating.

I know that in the grand scheme of things, these are all small sacrifices to make for the health of the baby. (I've been gluten-free for several years now; I know all about making sacrifices for health, and now I have another person's health involved as well.) I just wish I could get to the point where that logical knowledge made the daily decisions and activities a little bit easier instead of a huge chore.

Why I'm Taking My Malaria Pill

I live in a tropical area where malaria is an epidemic. For most Westerners who don't take any sort of malaria prophylactic, the question is when, not if, will malaria strike you. My husband and I both started taking the weekly mefloquine pill before we arrived here in August 2008. For the first couple doses, Mike had the psychedelic dreams and I had anxiety and insomnia (but we were preparing for a move to Africa; I get anxiety and insomnia every time we move anyway) but after a couple weeks the side effects cleared up, we've taken our pills every Sunday, and neither of us have contracted malaria.

When I became pregnant here, one of the first questions my American doctor asked me was how I felt about continuing with the mefloquine. He and I discussed it and my husband and I discussed it. Mefloquine is the only malaria prophylactic that is approved safe for pregnant women. However, my doctor said that with mefloquine there's a slight chance of miscarriage in the first trimester. The effects of contracting malaria while pregnant can be more severe than normal for the mother and can result in miscarriage at any point during the pregnancy. Living where I do, where malaria is so easily contracted and even with all the precautions I take to avoid getting bites, I decided the risk from the mefloquine was less than the risk of malaria. My doctor, Mike, and other health practitioners I spoke to who know this region agreed. Plus, I was already seven weeks pregnant by the time I found out and had been taking the pill all along with no problems.

I'm generally against taking drugs unless absolutely necessary and just about everything else about this pregnancy has been more organic. I haven't even taken a Tylenol. But sticking with the mefloquine has been the right thing to do for me and my family.