A pain in the pancreas

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I posted this entry over in a closed community on LJ, but wanted to have a place that I could refer non-community members to, since I feel like I am giving this information out all the time.

Oh the wonder that is Gestational Diabetes!

First, a couple mythbusters –
1. You only get GD if you are overweight/have a bad diet: Wrong! I am an XS when not pregnant, and was a vegetarian who ate almost all organic for 5+ years when I was diagnosed.
2. If you just don’t eat a lot of sugar, you are following a diabetic diet: Wrong! Eating like a diabetic is more about scheduling, pairing foods, and counting carbs than about not eating ice cream.
3. GD means that you are high risk and will have an enormous baby that your body can not push out. Wrong! By controlling my intake and keeping an eye on my blood glucose (with a finger-poke monitor) I birthed a perfectly average 7lb baby vaginally without medication, at a birth center.

The short version of my GD:

Ella’s pregnancy:
I was still with an OB when they offered the test, and didn’t see any reason not to take it. I failed, but I felt like there had been an issue with the timing (the nurse who took my blood said I had drank the syrup after I knew I had) so I was not too worried about failing the second test. I agreed to take it, and failed all three blood draws by quite a bit. I saw the nutritionist that my insurance said I had to meet with, and she was surprised I had failed also. I had no risk factors – I have no family history of any diabetes, I was less than 25, I was not overweight, I was working out 3+ times a week, my diet was “better than 90% of the people I see” and I had not had any symptoms. She agreed to give me a monitor and let me keep a food diary for a week, and we would go over the results together. A week later, it was clear to both of us that somehow, I am just lucky enough to have a crappy pancreas. Where a normal pregnant woman can eat 60+ carbs per meal and in 2 hours have a bG (blood glucose) level of less than 120, I would eat the same meal and be nearer 200. All of that extra glucose that my body was not breaking down and storing, was going to my kiddo. We discussed insulin, but I asked if I could try and control it with diet and exercise. The nutritionist met with me a number more times to help me interpret my results (certain foods act as triggers and it’s hard for a nonprofessional to see the pattern sometimes) and a month after I had been ‘diagnosed’ I was keeping my levels in the safe range without insulin.

The hardest part for me was relearning to trust my body. I switched to midwife care late in my pregnancy, after being told by one of the OB’s in my practice that I had a 70% chance of having a c section, since GD mom’s always have big babies. While I was scared of this, I knew I had been following the diet, and their lack of trust that I was not just forging my numbers was the last (of many) straws that broke the OB’s back. With my midwives, I found a way to quit seeing myself as ‘broken’ and start to gain perspective – I have a crappy pancreas, but the rest of my body works. By giving my pancreas a break, there was no reason that my body would not take care of my baby.
Ella was born perfectly average, and we were sure to have her nurse right away just in case she went through any glucose withdrawals (unmanaged diabetes babies are so used to a steady stream of sugar, that when they are cut off they can have serious complications. We knew there was very little change of this since I had been managing my diabetes, but we also had glucose water and an eye dropper ready for her in case she did not nurse.) They forced me to eat all through labor so that my bG levels did not drop, and all was well.
This pregnancy: I decided not to drink the nasty syrup, and just started monitoring my levels after I ate, around 18w. Between 18w and 22w, I could see my body starting to struggle with meals that a month earlier it had processed fine. I pulled out all of my old papers and food diaries and started making meal plans and poking my fingers 4 times a day. I have no doubt that my pancreas is just weak again this time, and that by being on top of my GD, that we will have another healthy baby (at home this time!) My midwife trusts me, and I trust my body (with some help from my brain.) GD is not something that you have to succumb to – it is something to be managed.
A quick word on my thoughts about denying the routine testing:
It may be surprising that I do not advocate everyone, across the board, take the test. If you feel comfortable denying the test, by all means do so – I am not trying to scare anyone into tests they do not feel apply to them. In our case, I had no risk factors, and had I not taken the test, I feel that we would not have been as healthy, or had the wonderful birth experience that we did. But that was our experience. I am optimistic that if a woman chooses not to take a test, they are educated about the choice, and is not doing so foolhardily. Talk to your provider about alternative testing, take the time to learn the warning signs, learn about a true diabetic diet, and trust your body. I admit I am a fluke, and the last thing I want is for my experience to be the basis of someone’s fears.

So what do you eat?

Here is a sample meal-plan for a week. (Note: This is based from meeting with a nutritionist over time and finding what my body can digest easily and how many carbs I can tolerate at each meal to keep my bG levels within healthy range (80-120). It should not be seen as your meal plan, but should illustrate that I am not starving or eating the same bland food for every meal.)

Diabetes is a pain in the pancreas
(click for larger+notes)

The main points:

  • Morning/fasting levels should be around 80 (too much below means I need a nighttime snack, too much above means I need to look carefully at my dinner/snacks)
  • All following levels (2 hours after meals) should be less than 120
  • Always pair a carb with a protein
  • Being active needs to be part of the plan – the more scheduled activities the better. Activity after eating is a great way to boost your bodies ability to cope if you went overboard.
  • Try not to let yourself be hungry, since then you get bitter and angry. Eat low on the glycemic index, since these foods digest more slowly and make you feel full longer.
  • Breakfast: 30-40g carbs
  • Lunch: 30-45g
  • Dinner: 30-50g
  • Snacks: 15-30g

Blank form here.

Great resource links:
Fitday.com – A free online food diary that does your calculations for you, charts your intake, lets you set up daily goals (for calories, calcium, protein, all your vitamins) and tells you if you have met them, etc. It is geared towards people looking to lose weight, but you can really skip over that part if you are not in weightloss mode (like for example, if you are pregnant!) You can buy an advanced version, but I’ve never felt like I am missing anything with the free version. If you get the PC version, let me know what you think.
Kmom’s GD page – This is the site I refer everyone to, even though it was originally written for plus sized moms. GD is surprisingly controversial, since there is no standard guidelines for all caregivers and patients to follow, and Kmom does a wonderful job of trying to give a balanced view of all sides (including research and anecdotal evidence). It is written in English (unlike most comprehensive sources on GD) and has links to GD birth stories, a glossary, GD and breastfeeding advice, and a million and two links to other places to explore. This was my go-to site to learn about GD, and I still reference it regularly.
Anything else?
I didn’t intend this to be so long, but feel like I am still leaving so much out. Feel free to ask questions, or make suggestions.I hope this can help ease an anxious mom or two’s minds – GD is not the end of the world. It’s a bit of a pain in the pancreas, but a very small thing in the grand scale of things you will be willing to do for your child.

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