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Friday, September 26, 2008

Everything you wanted to know and more about Gestational Diabetes

This post will probably be a big yawn fest for most regular readers. But, since I had trouble finding a description of somebody's real life experience with gestational diabetes, I thought I would post this. Perhaps somebody who needs the info will stumble upon it someday!

There is adequate information online describing what gestational diabetes is, the causes, and effects. However, I had a hard time once I was diagnosed finding out what I needed to do to control it - basically, what impact it would have on me and my pregnancy. I hope my experience thus far is useful!

I am currently in my 34th week of pregnancy. Around week 28, I went in for glucose testing. At the first test, which requires you to drink a sugary drink and tests your blood one hour afterwards, I received a reading of 155 mg/dl. My health care provider's acceptable level for this test (every provider has different levels they deem acceptable) is 129 mg/dl.

The second test requires you to drink another sugary drink and blood samples are drawn every hour. This drink was harder for me to take. People complain about the lack of carbonation, but that was not it for me. It didn't taste horrible, but I'm not going to lie - the drink made me downright nauseous. I spent the first hour walking, which you are not supposed to do, in order to keep the drink down. That was the only hour I passed. The other readings were all too high. I did not ask for the target numbers from my health care provider for this test, but the numbers I found online were 89 mg/dl fasting, 180 mg/dl at 1 hour, 155 mg/dl at 2 hour, and 140 mg/dl at 3 hour. I was higher on all of these values except for hour 1.

DO NOT CHEAT THE TEST!! It may be tempting, and I received this advice from a couple of people to just walk the whole time, which helps you process the sugar. Nobody wants to have their diet restricted during pregnancy. But - wouldn't you rather know if there is a problem, and steps you can take to minimize the effects? And, I know you want to avoid birthing giant torso/small appendage baby (a typical diabetes affected baby) who may need glucose injections once he comes out and crashes after the sugar high he has been on in utero, and may have complications later in life. Uncontrolled diabetes can even lead to death of the baby.

Due to a miscommunication, I ended up having the test a little late in the recommended time period (usually 24-28 weeks). I actually think it may be better to take the test later, if your doctor is ok with it. Your body and hormone levels are continually changing, and the effects of GD can develop or get worse as the pregnancy progresses. During that time span, 24-28 weeks, it is unlikely there would be much effect on the baby unless your numbers were really high. But, if you took the test too early before GD had fully developed, you might think you didn't have it, only to find out later that you did. That's just my take on it, but you and your doctor can decide the best time to take the test. If you had GD with a previous pregnancy, the tests will likely start sooner.

So, you've been diagnosed with gestational diabetes - now what? Don't start beating yourself up about what you did wrong! I know - easier said than done. You will undoubtedly start getting feedback from well-meaning folks who don't really understand the disorder. The number one reason for getting GD according to my doctor, though I could not find this as #1 online, is having a family history of diabetes. So, see? Totally not your fault. I am also a little older first time mom at 33, and was 15 pounds overweight before getting pregnant, which did not help my odds. But, during pregnancy, I had only gained 16 pounds at the point when I was diagnosed with GD. I think that demonstrates, despite peoples misconceptions to the contrary, that I was not pigging out on sugar/carbs and brought this on myself. I know of several Asian women who had this, and the only "sweet" they were guilty of eating was white rice. This can happen to anybody.

I heard a lot of things that hurt my feelings a bit, particularly people that related this to their own pregnancy experience, and how they were "so thankful" this didn't happen to them - like it is the worst thing that can happen to you (it's not). I know I was doing the best I could before being diagnosed. Now, after having been on the diet for several weeks, I have to tell you I feel really good, and think not only all pregnant women should do a version of this diet, but plan to continue it to some degree for the rest of my life!

The next step after diagnosis is scheduling an appointment with a dietitian and somebody who can teach you how to use the glucose monitor. My insurance has this set up as a class, and about 5 women per week come in (you are so not alone in this). You will most likely be asked to take your blood sugar 4 times a day to start - a fasting test, and a test an hour after each main meal. The goal numbers given by by my healthcare provider are 89 mg/dl fasting and between 80 mg/dl and 130 mg/dl an hour after a meal.

The dietitian will go over the recommended diet (the source my insurance uses is the ADA). Some things will seem like a death sentence at first - like no juice. That was probably the hardest for me, as I had been drinking a big glass of calcium fortified OJ every morning. But, the thing with the GD diet is - by keeping your blood sugar steady all day, you don't crash and feel like you need things with a lot of sugar to get you going. I can't rationalize it, but it really has taken away the "cravings" I was subject to. I just eat what I am supposed to eat, and in general I don't feel deprived or restricted. Like I said - this could quite possibly be the perfect meal plan!

You will get books and manuals about how to evaluate your food choices and track what you eat plus your blood sugar readings. Probably not the way you want to spend your time. But, for me it almost becomes a little game - evaluating what puts me out of whack (oddly enough, oatmeal. Just plain old oatmeal, nothing added, gave me sky high numbers the couple times I tried to eat it) and how long you can keep your numbers at the right levels. Also, I have eaten out many times, and was usually successful in keeping with the diet plan and keeping my numbers at the right levels. You may feel like goof ordering milk when your friends order wine, but they should understand this is for the baby (I am of the camp that pregnant women should drink milk with every meal. Remember, everything the baby does not get from you diet he takes from your body. Not giving him enough calcium now would inevitably equate to osteoporosis later in life.)

So far my diabetes has been controlled with diet (again, that could change as things progress), but don't fret if you do need to take insulin! It sounds scary at first - that you need to give the injections to your belly - but there is no way this tiny needle can harm the baby. Again, all of these steps are designed to control the weight gain of you and your baby (and protect the health of both of you). Just think - in a few weeks you will be holding your little baby, and all of this will be a distant memory!

So, what does a typical day of eating look like? This is a 2,200 calorie diet designed for somebody who has gestational diabetes, so it may be different than somebody who has regular type II diabetes. Some meals may look like a lot of food, and others may seem a little skimpy. Overall, I feel satisfied after each meal, and don't feel the need to snack more than what is recommended between meals. Since I have been doing this for a little bit, I am not super exact in my measurements or getting everything exactly right on, so some of my meals may be a little off. The goal is to eat every 3 hours or so, approximately the same time every day.

Breakfast:



(1 milk, 1 starch, 1 protein, 1 fat - butter spread)

Breakfast is admittedly smaller than I thought it would be. You always hear breakfast is the most important meal of the day, but yet according to this diet, you eat a very small amount. Despite eating so little, breakfast is typically the meal that trips me up during the day, and is the meal I am most likely to get a bad reading. About half an hour after eating your main meals, you should go on a walk or do some type of in place activity. I typically walk about 10-15 minutes before testing my blood sugar.

Mid-morning snack



(1 starch, 1 protein - cheese, 1 fat - nuts)

A distinction is made between a starch and a carbohydrate. The manual you receive will explain the difference. Also, the only things that count towards dairy are milk, plain yogurt, and milk substitutions (soy, rice). Cheeses are considered protein.

Lunch:


(1 milk, 2 vegetable, 1 fruit, 3 starch, 2 protein, 1 fat - vinaigrette)

Lunch is a really big meal. Some days I end up bringing a small cooler to work! Despite the large quantity of food, I don't feel too full afterwards, and it helps keep me alert for the afternoon. I usually have yogurt at this meal, but I was out. I typically go through a large container of plain yogurt and a half gallon of milk every 3 days. The best plain yogurt I have tried is Trader Joe's Organic - nice and smooth. Stoneyfield has a lot of great active cultures, but it is way too tangy for me.

Afternoon snack:



(1 fruit, 1 starch, 1 protein, 1 fat - peanut butter counts as a high fat protein, so it covers the protein and fat in this snack)
Notice when the fruit came in? At the middle of the day starting with lunch. Interesting, huh?

Dinner:



(1 milk - got more yogurt!, 2 vegetable, 1 fruit, 2 starch, 2 protein, 1 fat)

The meat portions allowed in the diet are really small. A portion equals 1 oz. To approximate, they say to use your thumb as a reference. You usually get two proteins per main meal, so this is about what 2 ounces of steak would look like. This was an adaptation for me, but now really makes sense, and shows how our typical view of a meat portion might be a little high. There are a lot of vegetarian substitutions for meat. I eat a lot of hummus, peanut butter, edamame, beans and lentils instead of meat.

Bedtime snack:



(1 milk, 2 starch, 1 protein, 1 fat)

Here is the real most important meal of the day. This is the "meal" that will help your blood sugar stay steady overnight, and avoid a bad fasting test result in the morning. Animal crackers are probably the best treat you are allowed to eat that make you feel like you are cheating : )

So there it is. I will continue this diet while breastfeeding, and a version of it afterwards (slightly less calories). Maybe at that time I won't be so anxious about what I am going to eat when I go out. But, the overall principle works for me, so it is hard to imagine going back to my previous eating regime which I know now involved lots of peaks and valleys in my blood sugar levels.

There are downsides, naturally. You can't just eat whatever whenever. I spend about half an hour every morning putting my food together for the day. I have found it is pretty easy to find a good meal when you are out, though, so don't fret. You may want to carry a piece of fruit with you, as that is usually the hardest component to find on the menu at many "one step up from fast food" places. Once you have shown your blood sugar levels have stabilized with diet, you may be able to go down to two times per day testing, a fasting test and one after an alternate meal. That was helpful.

I do find a lot of food choices are a little high in salt. It seems you can find reduced fat items (a few of the recommended starch sources, like the crackers, need to be reduced fat to keep with the calorie and fat levels that define a starch) or low sodium items at the store, but not items that have both qualities. As a result, I sometimes feel like I have been gargling with salt water. I drink a lot of water, about 3 liters per day, to minimize this sensation and to reduce swelling. I also have in the afternoon one of the "free" foods allowed - a hard candy. You shouldn't overdo it on diabetic food choices. You body eventually processes them as carbohydrates.

But what will I do at my baby shower, you may be asking. Well, this is just my experience, but the times I have taken my blood sugar after a party I had the lowest numbers of all - even without walking. I guess you burn a lot of sugar being social! It will probably be ok to enjoy a bite or two of cake to welcome your little one.

Best wishes!! Hang in there!

10 comments:

juliekintaiwan said...

Hugs to you and thanks for this information. I was close to having g.d. during my last pregnancy which was a warning to me about my eating habits. One I haven't necessarily paid attention to, and your post is a friendly reminder.

telfair said...

Hi Jen -- good to catch up with you. This is a great post. I had to take both tests during my pregnancy and for about 2 months of it, I was eating this kind of diet due to the doctor's seemingly ongoing concerns about my blood sugar levels. This is really good information, thanks for putting it out there. FYI -- a blogger named Sueeeus (sueeeus.com) that I read a lot just had a baby, she had GD during her pregnancies as well and also talks a lot about this topic, in case you are interested. Cheers to you & BT & Baby Mouse!

Stephanie said...

I'm not pregnant but still found this post very interesting. I think it's very informative and I'm sure will be helpful to many people. I'm sorry you've gotten rude comments. People don't often realize what they're saying sometimes.

African Kelli said...

holy moly; I hadn't ever read much about this and seeing your diet in photos is really eye opening. are you hungry? Do you feel like you are getting enough to eat?
I am sorry people have made you feel rotten about this. Obviously it has nothing to do with your parenting abilities. You are going to rock. If you put half the effort into the kid as you have this post, that child is going to have a mensa application in hand come kindergarten!

Maureen said...

This is a great post. I went through the testing a bit before you (I'm due Nov. 1st) and thought it was a given. Type II runs in the family, my baby is looking large, and I have excess amniotic fluid. It turns out I don't have it, but being a first time mom-to-be at 37 and going through all the testing for being at an "advanced maternal age" it's definitely not the worst thing that can happen. Good luck with everything!

woof nanny said...

Wow Jen, I really like the way you sound in this--relaxed, calm, confident. Really interesting info too.

Patty said...

This was really interesting to me as I have had type 1 for over 30 yrs but don't know much about gestational diabetes. Your diet brought back a lot of memories. :) I no longer do the exchanges and just count my carbohydrates instead, and then take a dose of insulin according to how many I eat. Congratulations to sticking to your diet. It will all be worth it in the end.

Pink Sky said...

I read this back when you first published it and tucked it away for future reference just in case... and just got diagnosed with GD yesterday, so it turns out I did need it. Thanks so much for such an informative and friendly post!

Raah-Dikha said...

this is an interesting post but have to say that every diabetic is different too. your bedtime snack of milk and crackers would send me skyrocketing. after 9pm i don't eat anything till breakfast pregnant or not. in the morning i am usually at 80-83. being from india i love my rice but have completely switched to brown rice - the result is my 1 hour reading is below 110! the big thing i have found is to avoid wheat and white rice and have brown rice instead. btw, i am 41 and also started out 15 lbs overweight. i have gained 20lbs to date (6 weeks to go and seem stalled), my no.'s were 82, 168, 200 and 136 - just squeaked in because of only one bad reading. did you get the 75gm/100 gm test? i got the 100gm test

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Take care,
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