Gestational diabetes - and some issues

[zannster]

I found out yesterday that I have GD. I can hardly believe this!

I want to have a HBAC - and obviously not a 12 pound baby - so I really need to get this under control. I just don't know how to work the diet. My MW wants me to be very restrictive, but I've read that many women aren't, and it works just fine. I don't have anything to test blood glucose yet (which I'm really dreading, btw - I hate finger sticks). Right now, I'm just supposed to test ketones.

Anyway, the diet situation. She told me no cereal in the morning, even whole grain. My experience thus far with pg/diet is that if I don't eat some whole grains in the morning, I get constipated - which has very unpleasant results, if you know what I mean. Secondly, I was 99% vegetarian before becoming pregnant...have been eating more fish/chicken since pgcy but still not as much as a hard-core LC diet would require. (Not only that, but I've raised DS vegetarian, and I dread having to explain eating chicken all the time to him). If I keep my protein to mainly eggs/cheese/nuts...well, guess what. Lots of cheese = constipation! I'm going to be dealing with some very nasty 'rhoids at this rate!

So what's the best solution for this? Do I need to bite the bullet and get some home testing equipment, so I can see what effects my blood sugar? Can a GD diet be done mostly vegetarian? (Like maybe a small amount of meat once a day?) For those of you who have had GD, what could you get away with wrt eating whole grains?

[lissame72]

Suzanne -
Ugh! Sorry you have to deal with this! I'm anxiously awaiting the result of my 1-hr screening, so GD is on my mind as well. My best friend just dealt with this and wound up with a perfect <7 lb baby boy! She's also (mostly) vegetarian. I know she did check her blood sugar a lot at first while she was figuring the diet out, so that probably would be very helpful What she found was that reasonable smallish amounts of whole grains were fine as long as she had some protein with them. The problem with cereal is that milk already has a lot of carbs along with its protein, so it winds up being too carb-y. My friend ate a lot of eggs with ww toast for breakfast. Also, I found a recipe here on MDC for high-protein hot cereal with quinoa, which is the highest protein grain (I haven't tried it yet). As for veggie protein, don't forget about tofu, tempeh, seitan and nut butters.

Good luck to you!

[Lauren31]

I know you can eat a lot of unstarchy veggies that have good amounts of fiber in them. That combined with water should prevent constipation just as well as whole grain cereal could. I think it might be more difficult to get the necessary protein you need without using grains/beans or meat etc if they are forbidden/ you are vegetarian. It's only for another few months, I might just bite the bullet and eat high quality meat sources (ie organic, grass fed, free range, etc from farmers you can trust). You do not want too much tofu, soy has a lot of estrogen in it which is not supposed to be awesome for your baby. I hope someone else can offer you advice. I for one HAVE to have protein all day long, preferably eggs, chicken and beef. If I do not I get super sluggish and then my body craves it like it's all I want in the world. I don't think I would be able to be a vegetarian at this point in my pregnancy if I tried.

[~Christina~]

Have they set you up with a dietician of any kind? When I had GD with my second pregnancy I had to meet with a diabetic educator. It seems odd that you'd get the diagnosis and no other directions to follow. There's way more to it than just the amount of carbs you eat. I had to have a certain amount of carbs and protein at each meal and snack to keep my sugars under control. So, you can have carbs at breakfast, just had to keep it to a certain amount. Like the previous poster said, the problem with cereal is the cereal and the milk together is way too many carbs. I kept mine under control with diet alone and had a 8lb 1 oz baby, the same size as my previous baby so try not to worry too much about the "big baby" idea! Good luck, and I hope your midwife can give you a little more insight other than, "no cereal in the morning"

[zannster]

Well she gave me a few more suggestions than that.

She gave me a sheet with recommendations which appeared to be from the Brewer Diet. Then she proceeded to tell me which of those things I couldn't eat. No fruit except berries (including apples, which I thought was odd - they're not very high GI). No fruit juices. No corn. Three starch servings a day, which could include whole potatoes. No milk or soy milk (could use watered down cream as a milk replacement). No soy in general. Plain Greek yogurt, cheese and cottage cheese okay. Maple syrup or agave okay as sweeteners. Four eggs per day. She encouraged whatever ethically grown chicken (I mentioned this as an issue) and fish I could eat. Nuts were also okay as a protein. And 200 mcg chromium picolinate 4x/day. That was about it. She wanted me to check my ketone level again in 48 hours and get back to her.

[jillmamma]

What about beans? Could you do an omelet in the morning with black beans for fiber? Or does that have too much carbs as well? I know if I incorporate more beans in my diet, it does help with constipation as well.

[zannster]

No...beans were taboo too, IIRC. Too many carbs.

I'm starting to hear very specific guidelines from some people...like certain number of grams of carbs and proteins at every meal/snack. If it comes to that, I think I will go crazy. Seriously.

[ishyfishie]

Originally Posted by zannster

Well she gave me a few more suggestions than that.

She gave me a sheet with recommendations which appeared to be from the Brewer Diet. Then she proceeded to tell me which of those things I couldn't eat. No fruit except berries (including apples, which I thought was odd - they're not very high GI). No fruit juices. No corn. Three starch servings a day, which could include whole potatoes. No milk or soy milk (could use watered down cream as a milk replacement). No soy in general. Plain Greek yogurt, cheese and cottage cheese okay. Maple syrup or agave okay as sweeteners. Four eggs per day. She encouraged whatever ethically grown chicken (I mentioned this as an issue) and fish I could eat. Nuts were also okay as a protein. And 200 mcg chromium picolinate 4x/day. That was about it. She wanted me to check my ketone level again in 48 hours and get back to her.

This sounds...odd, to me. I went to a diabetic counselor when diagnosed in my last pregnancy and it was nowhere near as restrictive. The main guidelines were a certain number of carb servings per meal and per snack (1 "carb serving"=15 g of carbohydrates, so I think mine were 2 carbs at breakfast, 3 at lunch and dinner, and 1 at each snack). Certain starches impact certain people differently. I was told to probably skip fruit in the morning (when insulin resistance is highest), but if paired with protein at other times of day, I did just fine. I did have to cut juice out pretty completely, but was still able to have milk here and there. Maple syrup has a pretty severe effect on blood sugar, from my understanding, so I'm surprised that was recommended. The fact of the matter is that what impacts your blood sugar the most can vary hugely from person to person and from one time of day to another. Monitoring, as much as it sucks, is the only way you'll know what you can or can't handle at various times of day.

I've been monitoring my blood sugar at home this pregnancy and skipped the GTT, and since dd1 is allergic to milk, egg, and nuts, my midwife has strongly encouraged a lot of beans for proteins.

[msmiranda]

Originally Posted by ishyfishie

This sounds...odd, to me. I went to a diabetic counselor when diagnosed in my last pregnancy and it was nowhere near as restrictive. The main guidelines were a certain number of carb servings per meal and per snack (1 "carb serving"=15 g of carbohydrates, so I think mine were 2 carbs at breakfast, 3 at lunch and dinner, and 1 at each snack). Certain starches impact certain people differently. I was told to probably skip fruit in the morning (when insulin resistance is highest), but if paired with protein at other times of day, I did just fine. I did have to cut juice out pretty completely, but was still able to have milk here and there. Maple syrup has a pretty severe effect on blood sugar, from my understanding, so I'm surprised that was recommended. The fact of the matter is that what impacts your blood sugar the most can vary hugely from person to person and from one time of day to another. Monitoring, as much as it sucks, is the only way you'll know what you can or can't handle at various times of day.

I've been monitoring my blood sugar at home this pregnancy and skipped the GTT, and since dd1 is allergic to milk, egg, and nuts, my midwife has strongly encouraged a lot of beans for proteins.

I had GD and considered my diet pretty strict, but I still ate apples and drank milk, for pete's sake. I could not stand eggs first thing in the morning when I was pregnant (I had been eating sweet breakfasts like oatmeal for forever) so my compromise was peanut butter toast on the lowest-carb "normal" bread I could find (Nature's Own 100% whole wheat) and a glass of milk. It worked for me even though "they" say no milk in the morning. I had an apple or banana and two or three string cheese regularly as an afternoon snack. I ate a ton of string cheese.

Although it's true you have to keep constipation at bay. Believe me, it can be worse than birth. I know from experience. Vegetables and fibrous fruits can help with that but don't be afraid to take stool softeners.

Saying all that to say, you have gotten some good advice here -- monitor, monitor, monitor and you will find out what foods work for you and don't work. But what your midwife suggested sounds extreme to me.

[birthangeldoula]

I've had GD for my last 2 pregnancies. My GD diet included 20 g carbs for breakfast, 15 g carbs for snacks, and 45 g for lunch and dinner. The goal was to eat every 2 hours to keep my blood sugar at an even keel. Nothing was off limits as long as I knew what the carb load was. The dietitian just said fruit for breakfast isn't recommended as it spikes the blood sugar, and cereal isn't recommended either. I ate plain oatmeal with a protein most mornings. I always found that as long as I'm taking in plenty of protein it keeps blood sugars low. I controlled mine with diet only and my children were average weight.

[zannster]

Thanks for all the suggestions. I bought a monitor and some strips today, though I am dreading using them. Still, I need to at least get a better idea of what's going on. I feel kind of bad about the idea of going against the midwife's recommendations...but maybe a somewhat more lenient approach will work fine.

One of my neighbors brought us a tin of really good looking sugar cookies today, and I sampled one. I cannot wait for Christmas to be over, because I am not good at this!

[cileag]

I love this website for info on diabetes--I put myself on a GD diet mainly as a precaution as I had a couple of slightly higher blood sugars (although still within normal).
http://www.plus-size-pregnancy.org/gd/gd_index.html

My take away from it all is that the most important thing is to combine proteins and carbs---you still need carbs, but that eating them in conjunction with fats or proteins allows the sugars to be metabolized better.

Good luck! And btw, I had a 7 lb 8 oz girl at 41 and 3 weeks pregnant. Good luck!

[crwilson]

I had GD with my last pregnancy, and I was quite strict. I know that my body couldn't handle milk - no matter what I combined it with. But I did have apples before a workout sometimes.

Mostly, I think it's about finding out what your body will and won't handle. I did keep track of all my dietary intake, including grams of proteins, carbs, and fiber. I ended up getting an average of 50 grams of fiber a day - so I had no problems with constipation.

Try not to get overwhelmed. It's really hard at first, but then it becomes second nature and manageable.

[folkgirl]

I really think that testing is the best way to know. I hope it doesn't suck for you as bad as you fear. It's a pain in the ass but there are worse things in life IMO. I know that I have some trigger foods that will cause me to spike and some (surprising) things I can eat with no trouble at all. I take the approach that as long as I am getting the numbers I'm supposed to get I can adjust my diet accordingly. I don't think being overly restrictive is necessarily a good thing--and BTW, of all things I would not say beans are a food to avoid! I try to stay low carbish but I also want to get as complete nutrition as possible so I don't cut out entire food groups, although I would if I just had to to keep my numbers in control.

[Sri Radha]

I have GD and I am a strict vegetarian. The nutritional counselor I saw told me I can eat what I want, it's just the portion sizes I have to watch. I can have 30g carb at breakfast, 15 carb snack, 45 for lunch, 15 carb snack, 45 for dinner and another 15 carb snack. I am also trying to eat high protein. You can do this as a vegetarian without any problems. You don't want to restrict yourself too much because you don't want ketones in your urine. I did this before I saw the nutritional counselor and I did have ketones in my urine. You do need carbs, you just have to watch how much.

[ellairiesmom]

Been down this road before & am here again...it is a pain & I'm sorry you gotta deal with it...

I wanted to mention that some foods will work fine for you now but then toward the last 6 weeks might not. So it really is good to have your test strips to help keep on track. I had been doing great with having milk & was also loving my afternoon cheese & apple snack but then a couple weeks ago (right around 33 weeks) my AM fasting #s started creeping up (just like last pregnancy) & I found I had to remove that apple & cut back on my milk. My body just didn't like the sugars in the milk any longer.

Another "trick" I have to do at this stage to keep my AM fasting #s down is eat a nice serving of protein right before bed. I ended up finding that a hard boiled egg or 2 really made a difference there. Of course, now I am eating more eggs a day than anyone could possibly imagine but I am going for a VBAC so it is impt to have good #s & having the GD considered "controlled". Thankfully, I love eggs & it is easy for us to get natural ones locally.

[zannster]

I've tested a couple of mornings and several meals. So far, the results really aren't bad. A couple of days ago, I even had a latte (with sugar!) and nothing else with it, and that tested fine. I've just found that I need to keep carbs down a bit in the morning, but other meals are somewhat flexible. I've also discovered that the handful of times I've been finger poked by medical pros, they must be using equipment with much harder settings than I need - because it always hurt a lot more than doing it at home! I've been eating chicken a couple of times per day (esp in the morning) just because it's easier than trying to come up with vegetarian substitutions. But maybe I'll play around with that after I get home. Good to know that I may need to watch it more closely as I get farther along...33 weeks is not so far away.

[folkgirl]

Originally Posted by zannster

maybe I'll play around with that after I get home. Good to know that I may need to watch it more closely as I get farther along...33 weeks is not so far away.

Yeah, 33 weeks is just a rule of thumb. I got diagnosed around 14 weeks and things went kind of crazy for me around 26-28 weeks. I am on meds and we had to do a bunch of adjusting for a couple of weeks but things have evened out for the time being.

[zannster]

I don't quite know what to think about this. I sent two days worth of diet records and BG/ketone tests to my midwife. In spite of all the BG tests being FINE, she tells me that I'm eating too many carbs. My ketones have steadily improved but I'm still making some - like 15 (light) in the morning and trace during the day. Would this be solved by eating more? Maybe eating right before bed? Am I increasing my risk of more problems later by not being more restrictive now? I don't see what the problem (with my diet) is when all my two-hour tests are fine.

[folkgirl]

Here's some info on ketones in pregnancy from KMom's GD pages. Despite having an extreme case of myself GD and a very, very medically managed pregnancy I am not monitoring my ketones at home so I can't speak from personal experience, but based on what others have said in this thread and what I get from skimming that page, it seems like the issue could be that you are eating too little, not too much. It would probably be worth continuing to experiment with your diet to see if you can can stop dropping ketones, but that's JMO.

If your post meals and fasting are fine, I wouldn't worry too much about GDM. Maybe you can pick a day once a week and test 4X just to make sure things aren't creeping up, since true GD (if it exists) progresses with pregnancy. I definitely don't think you should be eating a super-restrictive diet--that's overkill. Even with my extreme situation I strive for balance. The ADA (or similar) diet is one that should be sound for all pregnant women, not just GD patients. To be honest it doesn't sound like your midwife understands GD very well, or else she's just being overcautious which is not necessarily a good thing. So I would encourage you to self-educate as much as possible. Also, what criterion did she use for diagnosis? Did you take a one hour and a three hour or just the three? The three is considered the gold standard for identifying GDM--the one is just a screening and is known to be highly inaccurate.

Good luck and please update again or post if you have any questions!