Gestational Diabetes - My Story and Recipes

To contact us Click HERE
This is a little bit of a departure from my normal blog posts. However, I thought sharing my experience with gestational diabetes would be good to raise awareness and let other pregnant gals hear a first hand account.  I hope you keep reading and that you learn something.  The recipes, ideas and meal suggestions are healthy for anyone diabetic or not.


Heading into my third trimester gestational diabetes was not on my radar.  It blindsided me.  I didn't expect to be diagnosed. I've been very proactive about my health. I've focused on eating well, maintaining a good weight and getting exercise. I only had two of the risk factors: I'm over 25 and I do have history of type II diabetes from both my maternal grandfather and paternal grandmother.  Although they both were diagnosed  late in life and already had other health problems so it just didn't seem relevant.  When I failed the first 1-hour non-fasting glucose test I figured it was a fluke and I would pass the longer 3-hour fasting glucose test.  I didn't.

What is considered elevated blood glucose levels vary by doctor and practice.   From what I've read, I go to a fairly conservative practice. Below you can see the American Diabetes Association scores to diagnose gestational diabetes verses the practice I go to and then what my scores were.

Blood Glucose Tolerance Test Results for the 3-hour Fasting Glucose Test

The 3-hour fasting glucose test involves not eating for 12 hours, then having blood drawn.  That's the first fasting score.  Then you drink a very sugary liquid that has a specific amount of glucose in it.  Blood is drawn three more times at one hour intervals to see how your body is metabolizing sugar.  In order to be diagnosed with gestational diabetes you need to test high on two of the four blood draws.  I failed the 1-hour and although I didn't quite fail the 2-hour it was close enough.

At first I was mad, I felt let down by all my carefully planned meals and the changes I had already made to my diet before pregnancy: cutting way back on processed foods, growing and preserving my own vegetables, eating fresh and simple food. And then there were the changes I'd made for pregnancy.  I had increased my protein to over 60 grams a day, added foods high in omega three fatty acids three times a week and only bought hormone free, pastured meat and dairy.  I also felt unjustly diagnosed because only one test was actually high enough to fail.

Then I got over it.  If monitoring and regulating my blood sugar with diet and exercise would equal a healthier baby and a better pregnancy/birth experience than this was good.  It took about a week of reading up on gestational diabetes and several teary appointments with the midwives for me to not feel like I had somehow failed myself and my unborn kid.  I realized all the changes I made were still good and even mitigated some of the problems with having high blood sugar.  It wasn't something I had done, I couldn't have prevented it.

What is Gestational Diabetes?

I started reading about what having gestational diabetes means.  Gestational diabetes (GD) is caused by hormones put into the mother's blood stream by the baby's placenta that create insulin resistance.  As the placenta increases in size so does the amount of hormone produced.  The mother may need up to three times as much insulin to regulate her blood sugar during her last trimester.  If her pancreas can't increase insulin to meet the demands of her body glucose builds up in her blood stream resulting in GD.  Generally the placenta doesn't produce enough hormone to effect insulin levels until the third trimester.  Most testing is done between 24-28 weeks.

Here's a comparison of what a normal pregnant body does verses someone who has gestational diabetes.


Since gestational diabetes becomes an issue in the third trimester it doesn't affect the development of the fetus.  There are no birth defects connected to GD.

A normal pregnant woman's blood glucose levels never go above 120 mg/dL, nor do they dip under 70 mg/dL. With GD blood sugar may go as high as 200-300 mg/dL.  Here's a compairson of how a normal, prediabetic and diabetic's blood glucose levels look like after eating.  Gestational diabetes is similar to being diabetic or pre-diabetic.

Although insulin does not cross the placenta, glucose does.  The extra blood glucose goes through the placenta, giving the baby high blood sugar levels. This causes the baby's body to make extra insulin to get rid of the excess blood glucose. Since the baby is getting more energy than it needs to grow and develop, the extra energy is stored as fat.  This means the baby is bigger.  I've read in a couple places that mother's who have given birth to babies over nine pounds are very likely to have had undiagnosed GD.  Having previous big babies is another one of the GD risk factors.

In extreme cases, untreated, exceptionally high blood sugar can cause still births.

Most women with gestational diabetes won't experience any symptoms, so the only way to know is to get tested.  Anymore it is a standard part of prenatal care. As for the cause, it's mostly genetic.  Partially the genetics of the mother and partially of the father, as the placenta that is producing the hormone is a combination of the parents just like the baby.  The only things that the mother can control to help prevent or minimize GD is to keep her weight, blood pressure and cholesterol in a healthy range.  Also not smoking, but you already knew you weren't supposed to do that while pregnant.

Gestational diabetes is fairly common, the American Diabetes Association reports that 18% of pregnant American women develope GD.  Once you've had GD you have a 20-50% chance of getting type II diabetes within 5-10 years. But you only have a one in three chance of developing GD in a subsequent pregnancy.  I thought that was interesting.  I'm not doomed to have GD the next time around.  Although I will do a yearly diabetes screening since I now have a such a high chance of developing diabetes.

What Happened After Being Diagnosed with Gestational Diabetes

After being diagnosed I signed up for the gestational diabetes class at the local hospital.  It was one time deal that took three hours.  A licensed dietitian who specializes in diabetes taught the class.  It was me and two other newly diagnosed pregnant ladies.  The other two were also first time moms.  One poor gal was only there because she couldn't stomach the glucose drink and they couldn't do the blood tests so her doctor figured better safe than sorry.

Our teacher lead us through what GD is and then explained that most GD can be controlled simply by eating carbohydrates in small amounts spaced out over the day.  We got a basic meal plan to follow:

Breakfast: 30g carbohydrates
Snack: 15g carbohydrates
Lunch: 30-25g carbohydrates
Snack: 15g carbohydrates
Dinner: 45g carbohydrates
Snack: 15g carbohydrates

In order to get enough calories through out the day we get to eat every 2-4 hours and at each sitting never more than 45g of carbohydrates.  Also, distributed through out the day should be at least 25g of fiber, 60g of protein and 60g of fat.  Total calorie intake should be around 1,700. This plan varies by practice and your specific needs. This is what I was given.

In addition to eating in this special manner we were also encouraged to exercise by taking a walk for at least a half hour each day.

We were then treated to a long section of the dietitian holding up foods to demonstrate what  a reasonable serving of carbohydrates were in different things from peas to rice to oranges.  Luckily this wasn't suprising to me as I've measure my portions for years.  I could tell it was new to the other moms in the class. I would guess they were going to have to change the way they ate more drastically than I was.

Next we got a Gestational Diabetes Record Book to keep track of what foods we eat each day.  I already had a food diary where I recorded my protein intake.  I adjusted it to also track carbohydrate, fats and fiber.

My blood glucose meter.  I prick my finger
 with the gray  thing, then insert a blue strip into
the meter and  feed it the drop of blood.  Ten
seconds later my blood sugar level pops up.  

We then got blood glucose meters and were ask to take readings four times a day; once before eating in the morning and then an hour after each meal.  We were warned if we couldn't keep our blood levels under 95 mg/dL in the morning and under 130 mg/dL an hour after meals we would be put on medication.

Then we were let out into the world to figure out how to fit this new "treatment" into our lives.

At first pricking my finger to take blood glucose levels made me a bit queezy, but now it is normal.  And I like getting the instant feed back of how I am doing. Tip: if you get unexpected numbers wash your hands and test again. Sometimes I just didn't get my finger clean enough.  I also found the almond scented soap I was using gave me artificially high readings.  I switched to an unscented and haven't had any further issues.

Eating by this new plan I am almost never hungry.  I have found that I naturally eat just a little more than 1,700 calories.  Before being diagnosed I was gaining about a half pound a week in my second trimester.  I had gained 25 pounds which was the high end of where my midwife suggested I gain for the whole pregnancy.  I was told my weight gain would probably plateau once I started following the GD plan and it did.   In the first week of eating for gestational diabetes I lost about an 8/10ths of a pound and then gained no weight for the next three.  Just in the last couple weeks I have gained a half pound back.  To me that's a sign this is working.  My baby isn't making the extra blood sugar into surplus fat.

What I am Eating with Gestational Diabetes

A half cup of cottage cheese with an
orange or strawberries for breakfast.

I am now 36 weeks pregnant and I am doing well managing my gestational diabetes.  It took me a couple weeks to figure out what works for my body, everyone is a little different.  Luckily the midwives understand that there is a learning curve and gave me a pass on the couple times I have spiked my blood sugar.

Breakfast

Breakfast was the hardest to figure out.  Toast, a cup of milk or one pancake would put my blood sugar 10mg/dL over the limit.  After some experimentation I found I could eat only 15 grams of carbohydrates first thing in the morning.  A half cup cottage cheese with a cup of fruit has been my go to food.  This gets me protein and fiber along with just enough carbs.  My blood sugar is consistently right on target in the 100-110 mg/dL range one hour later.

I've also been eating breakfast cookies, substituting more nuts for the dried fruit.  These are handy to eat when on the go as well.  They have been my take along snacks many times. Each cookie has 26g of carbohydrates.

Breakfast Cookies

Snacks

My snacking didn't change much from what I was eating before.  Usually it's a protein plus a starch or fruit.

• Cucumbers or bell peppers with homemade yogurt ranch dip
• Small apple with string cheese
• 1/4 cup salsa with 1/4 cup cottage cheese and 10 tortilla chips
• 10 pretzels with 2 tablespoons peanut or almond butter
• Hard boiled egg
• 1/4 cup mixed raw nuts
• 1/4 cup of hummus with veggies
• 2 squares of dark chocolate
• 2/3 of a fruit smoothie (I can't eat them first thing in the morning.  They've got too many carbs, but they make a great snack and I freeze the rest for later.)

Lunch
Often I eat leftovers from dinner for lunch.  I also keep Ezekiel wraps (sprouted grain tortillas) on hand and fill them with grilled chicken, veggies, mayo, mustard and some cheese.  I also do a Waldorf salad inspired wrap of chicken, sliced apple, balsamic vinegar mayo, lettuce and toasted pecans.  
Dinner
I am continuing to work on different ideas for dinner.  This is when I am most at risk for eating too many carbs and having a high blood sugar reading.  Things that are working so far:

Cheese burger with grilled asparagus

• Loaded salads, usually a spring mix lettuce base with some combination of hard boiled eggs, nuts, tomatoes, avocado, cheese, peppers, onion, and olives. Topped with a fat heavy dressing.  Lately I've been opting for a creamy honey mustard, yogurt ranch, hummus or a mixture of mayo and balsamic vinegar.  
• Cheeseburger on a bun with grilled veggies
• A grilled fillet of catfish with a cup of baked sweet potato and a half cup peas
• 3 small slices of thin crust pizza (I make three pizzas crusts instead of two out of this recipe.)
• 3 Egg rolls with no sugar added peanut sauce
• 2 cups of wheat pasta with pesto
• Salmon and wild rice beet salad (I'm still working on this recipe)



Pesto with wheat pasta

• Sherried sardine avocado sandwich - don't knock 'em until you've tried them

Dessert

This is a hard one.  I really don't get to eat dessert anymore.  Luckily I haven't had sugar/ice-cream/doughnut cravings because those foods all have a lot of carbs. I decided I didn't want to use artificial sweeteners which makes options limited.  It seems like all diabetic desserts involve some form of equal, nutrisweet or other non-saccharide sweetener.  I've been eating half servings of fancy dark chocolate after my evening walk as my dessert.

For the record I thought maybe I could handle a mini-blizzard which has about 45g of carbs.  Nope.  Even after a walk my blood sugar was elevated.


Exercise 
At first I was dubious about how much of a difference exercise would make to gestational diabetes.  But, I am a believer now.  I make sure to get a half hour walk in each day, even the days my hips hurt or my ankles are swollen.  Walks are particularly useful if I take my blood sugar and it's too high or if I know I ate too much, I can use exercise as a preemptive strike.  
Tonight, after a dinner I didn't measure out particularly well,  my blood sugar was 168 mg/dL.  Yikes!  I'm still learning I guess.  I immediately went for a brisk half hour walk and when I got back my blood sugar was at a very acceptable 114 mg/dL.  
Exercise works because muscles need extra energy in the form of glucose when active.  With moderate exercise our muscles take up glucose at almost 20 times the normal resting rate which lowers blood sugar levels quickly.  (For more information click here.)
What Does Gestational Diabetes Mean for Labor and Delivery?
This will depend on your doctor or midwife.  I've read that some doctors insist on a Cesarean birth, but I think that's kind of old school these days.  I am going to a birth center and seeing a group of five nurse practitioners and nurse midwives.  The biggest draws for me are they have a very private birth facility where you have one midwife and nurse who stay with you the whole time and there is the option for water birth.  Also there are no drugs available. I think if I know there is no epidural I won't feel tempted when the going gets rough.  If needed, the hospital is five minutes away.  The midwives have admitting privileges and one of the practice's five OBGYNs is on call.  I like that it is all one cohesive unit and if I decide at any point in the next couple of weeks I'd rather be at a hospital for the birth, they will arrange for that.   
Back to the original question.  As long as I control my blood sugar levels I can give birth at the birth center.  Some doctors do extra ultra sounds and non-stress tests to make sure the baby is okay.  These tests check amniotic fluid level (too much can sometimes be a problem with GD and the baby won't go head down), measure fetus size and make sure the baby's heart is responding normally.  The practice I go to doesn't do those tests.  They just asked me to make sure the baby moves well each day.  So far so good.   They also measure the size of the uterus externally and as long as I am within 3 cm of where I am supposed to be they consider all to be well.  Also, so far so good.  
Gestational Diabetes During Labor
Depending on where you go you might be put on an IV drip of glucose to maintain blood sugar.  Where I'm going they will just have me check my blood sugar every two hours.  And if I need to I can eat something to keep my blood sugar up.  They suggest something with protein.  I am thinking mixed nuts, string cheese and fruit smoothies will be my take along snacks.  Although how hungry does one get during labor?  My fasting levels have always been good, so I shouldn't need any intervention.  
What if the baby is too big?
One of the risks of gestational diabetes is a bigger baby that can't be birthed vaginally.  In my case the midwives consider labor to be the test of whether or not the baby is too big.  If labor doesn't progress, I'll get moved to the hospital and then they can do a Cesarean or whatever is needed.  Hopefully by keeping my blood sugar in the target ranges the baby's weight will be normal.  
What happens after birth?
After it is born the baby is immediately put to the breast.  Breast milk is one of the best ways to make sure the baby does not become hypoglycemic.  Remember the baby wasn't making the extra blood sugar, its mom was.  Once born, the baby may still be over producing insulin and blood sugar levels could drop too low causing hypoglycemia.  Sometime in the first hour the baby gets a heel prick and its blood is tested.  In almost all cases they are fine and their bodies adjust to make the right amount of insulin.  In rare cases, usually if the baby can't or won't be nursed, they give the baby a bottle of glucose water to bring up blood sugar.  
Once the placenta is delivered the mom is no longer getting the hormones that made her insulin resistant.  Within a couple days she will return to her normal non-diabetic state.  Moms should keep checking their blood glucose after birth until their doctor/midwife okays things.  There is the chance that the mother will have developed type II diabetes and not go back to normal.   
Conclusions
I'm looking forward to not pricking my finger four times a day.  Just four more weeks until my due date!

I have a lot more sympathy for folks living with diabetes.  Our industrialized culture eats sugary, refined carbohydrates in large quantities at most meals.  It would be challenging to maintain blood sugar long term without feeling left out.  
I have learned that eating for level blood glucose is very healthy even if you don't have diabetes.  I plan to keep eating small snacks, more protein and smaller quantities of carbohydrates.  However, I won't hold myself to quite such rigid standards.  I'll eat the crusts of my pizza and have ice-cream every now and then.  
Another thing I learned is that I was afraid of fat.  I'd been trained for so long by Weight Watchers and all the other diet preaching out there that low fat and low calorie foods are healthiest.  Fat is healthy too and should make up about 30% of a diet.  Just like protein, fat takes longer to break down (actually even longer than protein) into blood sugar and thus you feel fuller longer and it won't raise blood sugar unduly.  

This chart shows how carbohydrates, proteins and fats affect blood sugar over time.  Carbohydrates have the most dramatic peak between 30 minutes and an hour, proteins a more moderate peak in 2-4 hours and fats a low peak in 8-12 hours.  This chart is from: http://www.tudiabetes.org/forum/topics/583967:Topic:178783

I've been choosing fats that have been processed very little; namely olive oil, butter, and chicken, beef or pork fat that I render at home.  No more fat-free dressings or skimping on the butter for me.

I'd like to end with a message to any pregnant gals who read this because they have been diagnosed with gestational diabetes. Being diagnosed is a good thing.  Even though it is extra time and work to control your blood sugar it is worth it for your health and your baby's.  It's alright to be confused and upset by the sudden changes you'll need to make.  Look at it as an opportunity to learn more about how to live a healthy, happy life.

If you've had experiences with diabetes feel free to share your story in the comments.  It's nice to know I'm not alone!

This post is part of the Simple Lives Thursday Blog Hop