GESTATIONAL DIABETES - AN OVERVIEW

I’ve faced this battle once before, in my last pregnancy, and I had hoped not to be back in this boat this time around. But here I am, diagnosed once again, and I thought that it couldn’t hurt to share my experience in hopes that it may help others as well.

*Remember, I am not a doctor or a nutritionist, just a regular woman sharing what I’ve learned and what has worked for me. I have been treated through both Duke Medicine and UNC Health Care and both treatment plans have been extremely similar.*

This is not anyone’s fault. If you are a generally healthy person, you very likely did not cause this. Your placenta did! When I was first diagnosed, I was bowled over with guilt and sadness, until I began to understand that a hormonal imbalance caused by my placenta was truly to blame. These hormones cause insulin resistance, meaning that your body can’t process glucose as well as it normally would and it begins to build up in your blood, thus high blood sugar levels.
It goes away! Remember what I said about the placenta? Well, for most folks, once your placenta leaves your body, so does the diabetes. So celebrate delivering your baby and getting rid of those wacky hormones.
It can be treated through a well-regulated diet and if need be, medications. You will focus on limiting carbs to certain amounts at certain times of day.
This is not a ZERO CARB diet. This is not Atkins or Keto. This is about eating healthy (whole grain) carbs in controlled portions throughout the day to regulate blood glucose levels.
Your schedule is going to go on lock down. You have to eat three meals a day and you have to snack in between and before bed. It sounds sort of nice in theory, but you may find that you feel like you’re eating all the time. That will be because you are eating all the time.
You don’t have to be miserable. This isn’t about deprivation or counting calories, it’s about balance. You may need to choose a salad, but you can enjoy bacon or cheese on the salad, both increase your protein intake. Even ranch dressing! In fact, ranch is likely lower in carbs than some of the “healthy” dressing options.
Yes, you will have to prick your fingers and yes, you will have to do it often. You will get used to the pain but… it’s not fun. Though you may end up looking forward to it because those numbers are so important in understanding what works best for your body.
This is a huge lifestyle transition and can be an emotional hurdle. You’re in the thick of your pregnancy, finally letting yourself indulge every now and again without feeling guilty, when BAM, your life and diet are flipped on their heads. One day you’re enjoying a donut, the next day you’re reading the label of every product in the grocery store. And…. doing math. But you WILL get the hang of it!!

WHAT IS GESTATIONAL DIABETES?

Per WebMD:

“When you eat, your body breaks down carbohydrates from foods into a sugar called glucose. The sugar goes into your bloodstream. From there, it travels to your cells to give your body energy. An organ called the pancreas makes a hormone called insulin, which helps move sugar into your cells and lower the amount in your blood.
During pregnancy, the placenta — the organ that feeds and delivers oxygen to your baby — releases hormones that help your baby grow. Some of these make it harder for your body to make or use insulin. This is called insulin resistance.
To keep your blood sugar levels steady, your pancreas has to make more insulin — as much as three times more than usual. If it can’t make enough extra insulin, your blood sugar will rise and you’ll get gestational diabetes.”

WHAT ARE THE RISKS?

For baby: low blood sugar at birth, breathing problems and high birth weight.
For you: increased risk for preeclampsia, premature labor or delivery and higher risk for developing diabetes in the future.

HOW IS IT TREATED?

A strict regimen of following your doctor’s food plan combined with checking your blood sugars to learn how your body reacts to certain foods.
Activity and exercise. At least 30 minutes a day will help keep blood sugar levels under control.
If your meal plan is not keeping glucose levels regulated, your doctor may put you on an oral medication or insulin injections

KEEP IN MIND:

Honestly, this diet can seem counter-intuitive. We’re so trained to count calories, limit fat and eat fruits and veggies that it can be jarring to find out that you can eat lots of bacon, but should avoid bananas. This is not a traditional diet! It’s all about controlling carbs.
You’ll eat every 2-3 hours to help keep your blood glucose steady.
Nutrition labels are your best friend. Your first step before eating anything should be to understand the amount of carbs PER SERVING and know how many servings you’ll be having. It’s simple, but it takes work.
PROTEIN PAIRING IS LIFE! Disclosure – I don’t totally get the science behind this, but pairing protein and water with your carbs is vital in helping your body process the carbs. If you’re eating carbs, you need to pair protein with them. Trust me on this one.
Portions are key! If you don’t follow the serving measurements listed on the label, you risk consuming too many carbs. A good example is coffee creamer. You may think you’re using just a splash, but every splash is different. You will greatly benefit from keeping a measuring spoon handy and abiding the serving size.

CARBOHYDRATES 101:

Bottom line: carbohydrates increase your blood sugar level. We’re trying to avoid this.
However, carbs provide energy and should not be eliminated altogether. You need small amounts of good carbs throughout the day.
One serving of carbohydrates is 15 grams. You’ll be advised to have one or more servings of carbs at each meal and snack.
Choose the right carbs: Good (complex) carbs provide nutrients and fiber. Bad (simple) carbs are basically just sugar.
Good carbs: Whole grain breads, crackers, pastas, brown rice, most fruits
Bad carbs: White breads, crackers, pastas, rice plus all of your favorite sweet treats. Sorry!
Carbs are sneaky and pop up in very unexpected places. You’ll need to be diligent in reading food labels and googling before you eat anything. Foods you may assume are “safe” really may not be.
Carbs can be balanced out by pairing them with protein and water. Always have protein if you’re eating carbs.
See my Diet Schedule below for the recommended servings of carbs at each meal and snack in my doctor’s meal plan.

DAILY SCHEDULE: *this is my schedule and a very common one, you will be given your own by your doctor, but it will likely be similar to this.

FASTING (<95): The minute you wake up, wash your hands and test your blood. Blood sugar should be below 95.
BREAKFAST, 1-2 servings of carbs (<140): Have breakfast within an hour of waking up. Your blood is highly sensitive in the mornings, so it’s best to avoid the sugars in fruit, dairy and other sweets. Test your blood one hour after your first bite, it should be below 140.
SNACK, 1 serving of carbs: A couple of hours after breakfast, an hour or two before lunch. Do not test blood after snacks.
LUNCH, 3 servings of carbs (<140): Test your blood one hour after your first bite, it should be below 140.
SNACK, 1-2 serving of carbs: 2-3 hours after lunch, a couple of hours before dinner
DINNER, 3 servings of carbs (<140): Test your blood one hour after your first bite, it should be below 140.
SNACK, 1-2 servings of carbs : yes, another one before bed! 2-3 hours after dinner before you go to sleep. Its important to have at least one serving of carbs in your night time snack to keep your blood sugar steady through the night.

MY GO-TO FOODS

Eggs – protein
Almonds – protein
Cheese – protein
Lean meat – chicken, turkey, shrimp, you guessed it… protein
Non-Starchy Veggies – Tomatoes, carrots, broccoli, lettuces, greens, cucumbers, bell peppers, green beans, zucchini, onions, garlic, cauliflower, brussel sprouts, mushrooms, asparagus, eggplant. Not all veggies are freebies!
Water – another tool that helps your body process carbs, pair it with everything!
Peanut Butter – this is a strange one, but it’s a life saver. If you choose a PB with lower sugars, it generally has a ton of protein and can therefore be paired with carbs resulting in decent blood sugar numbers. It’s a great way to get something sweet without blowing your day. Think whole wheat toast with peanut butter.
Whole Grain Bread/English Muffins – again, this isn’t a zero carb diet. I personally am able to eat whole grains without ruining my numbers, so a sandwich on whole grain bread or a wrap on a whole wheat tortilla are great options for me. That being said, white bread will send me through the roof. Each person responds differently, but whole grains are “good carbs” so it’s worth a try. See how your numbers react and if you’re in the clear, keeping bread in your diet may save your sanity!

WATCH OUT FOR:

Bananas – unfortunately very high in natural sugars
Beans – most are complex and can contain good protein, but they have to be counted as carbohydrates
Greek Yogurt – protein, yes, but stick to plain over flavored
Corn – just ridiculously high in sugar
Starchy veggies – sweet potatoes, potatoes, beets
Coffee creamers – look for the carb content and be aware of how much you’re using! If you’re drinking sweetened coffee, have it WITH your breakfast and don’t drag it out all morning long. It’ll mess with your numbers.
Dried fruit – can contain lots of sugar
Hummus – like beans, hummus contains great protein, but has to be counted as a carbohydrate. Read the label!
Sauces and dressings – some are sneaky high in carbs
Potato chips, french fries, sweets and sugary drinks – duh

FINGER PRICKING:

You will most likely be provided with a blood glucose meter through your insurance company. It will be called in as a prescription through your pharmacy, which you’ll pick up and bring to your appointment.
Your doctor or nutritionist will show you exactly how to use it and have you practice there in the office.
Your glucose test kit will contain the meter itself (like a small computer), the needles (called lancets), a lancing device (the cartridge in which you load the needles that controls how deep the needle goes) and test strips, which will be inserted into the meter. You’ll touch your blood to the test strip and it will give you a very quick reading.
You’ll test your blood at least 4 times a day. The minute you wake up (called your Fasting number) and then following meals, either one or two hours after your first bite, your doctor will let you know when and how often.
Be sure to wash your hands before testing! If there are any substances on your fingers, it can affect your reading. If you get a bizarre reading that doesn’t seem right to you, wash your hands thoroughly and try again.
On most lancing devices, you can control the pain by controlling the depth of the needle. The deeper it goes, the more painful it is, so be sure to set it to the lowest value that will still give you a big enough blood drop. Mine is either 2 or 3.
You will look for your blood glucose reading to be below the values given by your doctor. Mine are fasting below 95 and below 140 after meals.

LOGGING YOUR NUMBERS:

You’ll need to document every single blood sugar reading you take as your doctor will be viewing these to be sure your diet is successful. Use a notebook and pen, a spreadsheet (see my file below), or even an app to keep track of these. There are a LOT of apps available, but I find them to be very cluttered when all I need to log is four simple numbers a day.
For the first few weeks of each round of GD, I have kept a small journal documenting all of my meals and snacks along with all of my blood readings. I find that this helps me see what works and what doesn’t! If I tried a peanut butter sandwich on whole wheat bread and got a great number after, I can refer back and know that whole wheat bread may be a good option going forward. White bread was a disaster, so noting that helped me avoid it altogether. If I ever feel stuck on snack ideas, I can see what’s worked in the past.
There are a couple of fancy meters that have blue tooth and can connect with your phone and automatically record your numbers into an app, but my insurance has never covered those!
The file below is what I use to record my numbers on my phone. I save it in Google Sheets and can access it from any phone or computer.

FILE: Blood-Glucose-Readings Download