Aviva Simonte - Gestational Diabetes
To look at Aviva Simonte now, you wouldn’t guess that she ever had a weight problem. But Aviva struggled with her weight for most of her younger years. She joined a diet program similar to Weight Watchers when she was 12 years old and came from a family that had constant struggles with weight issues.
As she became a young adult, Aviva learned to manage her weight by working out at the gym. She also watched what she ate and tried not to consume fattening foods.
All that changed when she became pregnant with her daughter in 2004. “I viewed my pregnancy as a license to eat,” admits Aviva. She let herself have hamburgers with buns, ice cream, french fries, and other high-calorie fast foods. It didn’t help that, as the pregnancy progressed, she developed some uncomfortable conditions that prevented her from working out: her feet became extremely swollen, then she threw out her back. By the end of her second trimester, she had already put on 40 lbs.
Almost all pregnant women are tested for gestational diabetes between their 24th and 28th weeks of pregnancy. When Aviva had this routine glucose test at the beginning of her third trimester, she was surprised that it indicated her blood sugar was high. Even during the follow-up procedure, which required her to stay in the clinic for a three-hour glucose tolerance test involving three separate blood draws, she still thought everything would be fine. “I was basically in denial,” says Aviva now.
Aviva was at work when she got the call with the diagnosis: she had gestational diabetes (GDM). “I burst into tears! I was sobbing in my office. I didn’t know much about gestational diabetes. The nurse on the phone tried to calm me down, telling me that the condition was manageable…”
The next day, Aviva attended a class for patients that are newly diagnosed with gestational diabetes at the Diabetes Education Program of the U-M Comprehensive Diabetes Center. She asked her husband, Jimmy, to go with her for moral support. The educator gave the eight women in the class an overview of the disease, explaining what happens when the pancreas cannot make enough insulin, coupled with the effect of extra hormones being released by the placenta, and emphasized the importance of monitoring their blood sugar levels.
In the class, the participants were given glucometers to learn how to test their blood sugar themselves. “They made us prick our own fingers, which I was scared to death to do,” Aviva confides. The good news was that, with careful eating and by exercising regularly, she would be able to control her blood sugar. However, Aviva would have to monitor her blood sugar by testing with the glucometer four times a day: immediately upon waking, then two hours after each of her three meals.
After the class, Aviva and Jimmy went to a one-on-one appointment with a nutritionist. By then, she was feeling very overwhelmed with the amount of information coming at her, coupled with her emotional reaction to her situation. One of the takeaways from the appointment was a book called Nutrition in the Fast Lane, a fast-food dining guide with nutritional information for foods from dozens of popular restaurants. “We went out to eat after my appointment, and I utilized the book right away,” says Aviva. “But I was thinking that I could still eat fast food and make it work.”
The final, and most lasting, lesson in diabetes education came the following week, when Aviva met with the Director of the Diabetes Education Program, Cecilia Sauter, M.S., R.D., C.D.E., to review her eating habits. Cecilia was concerned, since Aviva was struggling with keeping her blood sugar under control. She explained that some patients may need insulin if the meal plan alone does not keep the blood sugars in the target range.
“The last thing I wanted was to give myself insulin shots,” Aviva said, “and I was in fear for my baby’s health.” High blood sugar can mean that the baby will grow too large, which can cause problems during delivery. Also, the baby can be born with low blood sugar. In addition, women who have had GDM have a higher chance of developing type 2 diabetes within 10 years. “Cecilia was very nice, but she was direct, too. I appreciated that she didn’t coddle me. I stopped in my tracks and evaluated how I was eating, because she really got my attention.”
Cecilia taught Aviva the types of foods and the proper proportions that should make up her meals. Then Aviva came up with a meal plan based on healthy versions of what she liked to eat. “To be safe, at first I ate the same thing every day. Later that got challenging, so I learned how to vary my meals, even if I was eating the same ingredients.” And instead of snacking on chips, as she did in her first two trimesters, Aviva would choose yogurt, apple pieces, almonds, low-fat cheese sticks, or peanut butter on celery. “What I really liked was that Cecilia gave me room to make it my own eating plan. She learned about my eating habits and what I liked, then helped me to make healthy choices. The key was that it wasn’t rigid; I could fit the nutrition into my box, instead of the other way around.”
In addition, Cecilia’s program included weekly reviews of Aviva’s daily glucose scores, which Aviva emailed to her at the end of each week. “If there were any scores that were over 120, I had to explain what had happened,” Aviva states. “Cecilia was great. I had her phone number and email address and I could communicate with her whenever I needed to. I felt very supported.” If Aviva was discouraged, Cecilia would ask her, “What’s one little change that you can make today?”
Cecilia also taught Aviva about the importance of exercise in lowering blood sugar. While Aviva had typically worked out five days a week prior to her pregnancy, she was so uncomfortable that she hadn’t felt like exercising since the middle of her second trimester. Cecilia encouraged Aviva by reminding her, “Any activity will have a positive effect on your blood sugar.” For instance, she suggested that Aviva lift canned food like mini-handweights while watching television, or walk around the house a few times. This simple technique helped to lower Aviva’s glucose readings to acceptable levels at a time when she felt that she had “hit a wall.”
Was Aviva successful? “I stuck to my eating guidelines very diligently,” Aviva says. She only gained 5 pounds in her last trimester, when most women gain between 15 and 25 pounds during the second and third trimesters. “My doctor thought I would deliver a big baby, maybe 8 or 9 pounds, but Bella weighed only 6 pounds, 15 ounces when she was born!” Aviva says proudly. Not only that, but Aviva has lost a total of 65 pounds since her pregnancy: she has shed the 50 pounds she put on while pregnant, plus 10 pounds that she gained in preparation for becoming pregnant (when she quit smoking), plus an additional 5 pounds from maintaining a healthy lifestyle post-delivery.
Aviva reports that she fits exercise into her routine — trying new activities, such as Tae Kwon Do — and has permanently changed her eating habits. “A lot of what I do now is based on what I learned from Cecilia Sauter. I pay attention to carbs and portion sizes now, when I didn’t before. And I view eating as putting fuel into my body, not a recreational activity. I’ve learned that if I feel too full after eating, it’s not good.”
Cecilia’s influence and Aviva’s experience having GDM has had another positive effect on her life. While she was on maternity leave, Aviva reconnected with a former coworker who got a job with a small biotech company, whose line includes diabetes products. Aviva had a strong interest right away and wanted to know more: “I knew I was supposed to be working for this company! I wanted to translate my experience of having gestational diabetes into helping other people.” Aviva called her friend every two weeks until a position opened up in the company, and she works there today.
“Diabetes is different from other diseases, in that you can’t just take a pill and forget about it. It affects many of the choices a person makes every day of their life that they have diabetes, and it’s a constant struggle — one that I identify with,” Aviva shares. “I wouldn’t have the same passion for this field if I hadn’t had gestational diabetes myself.” Now Aviva runs into Cecilia at diabetes education lectures, which Aviva attends as part of her job. “I respect Cecilia so much because of my experience with her!” says Aviva. “I’m not sure that I could have gone through my pregnancy and controlled my diabetes without her support.”