Gestational Diabetes and Homebirth

[samhope]

So I was just given the diagnosis of gestational diabetes based upon my fasting home glucose scores being high (95-117 depending on the day over a week).  All of my 1-hour after food scores are within the normal range, unless I eat something crazy sweet in which case it goes to the 130's.  I never did the at the doctors glucose test.  I have not eaten grains, much starch (a bit of potato 1x a week), or sugar for 2 years.  I make everything from scratch.  I also only eat 24 hour feremented goat's milk yogurt and no other dairy.  Any advice on how to get my fasting scores down to normal, like a particular snack to eat during the night or before bed?  My midwives want me to start eating some grains, so I am sprouting some quinoa today.  I have an appt with sweet success for next week, but feel like I should start doing something now b/c I really want a homebirth!  Also, is it important to only eat 6 times a day?  I tend to graze all the time unless I am planning on exercising.  Thanks for any tips!  Was already looking at decreased odds of getting my homebieth because son was late preterm (34 weeks) and now this.

[msmiranda]

Those are pretty high fastings ... I don't have any natural remedies to offer, but I can tell you that taking metformin has worked beautifully for me in keeping my fasting down in the 70s or low 80s during this pregnancy (whereas by this point in my last pregnancy I couldn't keep it out of the 90s, and it was occasionally in the low 100s).  Fasting numbers are the hardest to control, is my understanding.  I have heard about waking up at like 2 a.m. and having a high-protein snack, though I never tried this because I loved my sleep too much!  I've also heard that taking cinnamon helps with fasting blood sugar ... this was 2 years ago I did this research so my memories are a little fuzzy, but a quick google search will probably bring it up.

[Katie8681]

Why not do the three hour glucose tolerance test?  It's not fun, but it will give you more information about how your body is handling glucose.  

[MarineWife]

You could try a high protein snack right before bed. If that doesn't help, you could try what the PP suggested about eating a high protein snack in the middle of the night. I don't know if it will help but it might. I wouldn't do the 3 hour GTT because I don't think it gives an accurate picture of how your body reacts to your normal eating habits (unless, of course, you normally eat 50 grams of straight sugar by itself on an empty stomach). I think the numbers you are getting at home are more accurate.

Of all the starches you could be eating, a little bit of white potato is probably one of the worst for spiking blood sugars. Something with more fiber would be better, like whole grain brown rice or maybe sweet potato, and always eat some protein with it. I can't remember if sweet potato is ok or not with diabetes.

[Pkitty]

I'd probably consider a medical review (although it sounds you may be doing that).  You may require insulin.   All the grazing in the world or special diets aren't going to help if your body is either not producing enough of it's own insulin or you have insulin resistance.

Having uncontrolled diabetes in pregnancy can lead to some not so good consequences in pregnancy and labour.  You don't really want a baby that's grown too big to get out of your pelvis and you end up with a shoulder dystocia.

As for a general diet for diabetes, you need something low GI so you don't get as big spikes in your blood sugar levels -  protein is good for that.  So maybe snack on some nuts.

[samhope]

If the doctor recs meds, then my homebirth goes away.  I introduced a yogurt smoothie before bed and my morning scores are between 77-96.  Mostly in the low 90's.  My meal scores continue to be fine.  The big thing is to eat right at 8 hours as my scores keep climbing if I don't.  From what I have been reading, there is no real known risk as long as my fasting scores are under 105 (NDDG scale), which they are.  There seems to be a lot of inconsistency in care around borderline numbers for fasting (under 99), with some doctors jumping to insulin and others fine with diet alone.  Crazy all the variation in care.  Wish there was some solid research about risk for these lowish/high #'s!

[emmaegbert]

I had a HB for #2 with diet-controlled GD. Actually in that case, I believe HBMWs would have considered me still a HB candidate if I was on oral meds but would risk me out with insulin. I would have a talk with them about what exactly they feel risks you out before panicking about losing your HB eligibility. What are the target blood sugar ranges you should be meeting? Which meds would risk you out?

Now, a caveat about my response-- I never really had an issue with fasting numbers. When I had the 3hr GTT, it was my 1hr number that was high, 2hr was literally borderline. Fasting and 3hr were normal. This pretty much bore out in my self-monitoring afterwards.

After my diagnosis I ate no grains, no sugar (and really no "natural" sweeteners either) and very limited fruit (small servings, and I did concentrate on the lower sugar fruits, like berries, melon). I ate plain yogurt, cheese, cream, butter, and never had any problems from those foods. I very consciously upped protein and fat in my diet (b/c I started losing weight unintentionally once I cut the carbs way back). Legumes didn't seem to be a problem, with the exception of chick peas. I could eat VERY modest servings of quinoa or buckwheat (like 1/4-1/3 cup cooked at the most).

One thing about spacing meals is that it may allow your blood sugar to return to fasting levels before you are stimulating more insulin production, etc. I ate 6x per day pretty carefully and I ate a pretty good snack before bed (lots of other GD moms at the time were on a GD support thread, they almost all ate something like PB before bed, some even woke in the night to eat a handful of almonds at 2AM or so). For me, if I skipped a snack or something, I would find my blood sugar would go low and I would feel really crappy. In this way, I believe a pregnant person is pretty different from a non-pregnant one.

I would suggest detailed logging for a week or two to see if you can get a more detailed picture of what is going on. You want to record food, exercise, blood sugar levels, and other concerns (like illness, sleep, stress... all of which can affect your blood sugar readings by the way). You can even do a 1hr and 2hr post-prandial for a bit to find out when your peak is (my 2-hours would look great after certain foods, but a 1hr spike showed it was probably not a great one for me). I occasionally tested BEFORE a meal to see if I was at a fasting level in between meals. More than any diabetes educator can do, that log will tell you how YOUR body is responding to things. Anyway, try eating different things, try exercising at different times of day, etc, and at least for me, it didn't take long to find out what "worked" and what was a problem.

Another piece for me that seemed to make a HUGE difference was exercise. Specifically, a brisk walk in the late afternoon/early evening would drop my blood sugar right down. And it would persist for my AM fasting level too. Other forms of exercise, not so much. (I tried many!)

I am now pregnant with #3 and planning a HB. Together with my MWs, we have decided to skip the GTT and just go with self-monitoring. From my perspective, what actually matters is whether I have elevated blood sugar, not IF I would have elevated blood sugar if I drank 100 grams of glucose syrup after a 12-hour fast. Because I would, literally, never do that. As I understand it, the long-term health implications with GD are, #1) that you are at much higher risk of developing type 2 later in life (so I already know that and don't need to do the GTT to find that out) and #2) that the fetal exposure to chronically elevated blood sugar will predispose your baby to higher risk of type 2 diabetes as well. (there are other risks to baby exposed to very high, out-of-control blood sugar numbers, like heart problems, hypoglycemia after birth, etc but it doesn't sound like you have those)

So I am checking at least one post-prandial and one fasting per day. If I get to 30 weeks or so without any high numbers, we may even ease up to just one a day (rotating what one).

Good luck and I hope you can continue to keep your fasting numbers within healthy (and HB-eligible) targets.