Ten Things Gestational Diabetes Has Taught Me

on Tuesday, 20 May 2014. Posted in Gestational Diabetes

Since being diagnosed with gestational diabetes at 29 weeks pregnant I have learnt so much!

All of us can learn how to better manage our blood sugar levels giving us more energy, curbing cravings and reducing overeating.  

Here are some of the key things I’ve discovered, which I hope you will benefit from as well;

 

Nutrition

1. Total carbohydrate is more important than sugar on a diabetic diet.

Initially when I made changes I just thought I needed to cut out any sweet treats; no cake, chocolate, milo, ice cream or dessert. I didn't worry so much about the healthy complex carbohydrates I was having. What I learnt was that it is the total carbohydrate in something that is going to have the impact.

While having brown rice, wholemeal pasta, grainy bread or quinoa are all good things in terms of their nourishment, fibre and the satiety factor that they bring. Having too much in one serving still means it is converted to glucose in the blood and will still spike your blood sugar levels as the body is so inefficient in processing it all.

I have become much more aware of the "total carbohydrate per serving" part of the label which to be honest I never paid any attention to before. I now look at the total carbohydrates per serving and check how much a serving size really is and then mentally work out how much I can have at any given meal.

The dieticians taught us to think in what they call 'exchanges' similar to servings. One piece of bread roughly equals one exchange. They recommend having;
• 2 - 4 at breakfast, lunch and dinner and
• 1 - 2 in snacks mid morning, mid afternoon and possibly evening.
That's a total of 9-18 exchanges (piece of bread equivalents) per day.

I find that I need to stick to about 2.5 - 3 per meal and about 1.5 per snack to keep me within a good range.

When you see brown rice in the table below for example and that just 1/3 of a cup of rice (before cooking) is 3.5 exchanges you can see how easy it is for me to exceed my recommended carbohydrates in a meal.

I've put together this table with info from my pantry cupboard giving some examples of what I've learnt about carbohydrate servings.

 

% carb

Total carbs per serving size

Serving size

Approx number of ‘exchanges’

Brown Rice

72.5%

51g

1/3 cup raw

3.5

Wholemeal Pasta

62%

62g

100g raw

4

White Pasta

69%

69g

100g raw

4 ¾ 

Wholemeal Wraps

53%

20g

1 wrap (37g)

1 1/3 

Quinoa

67%

34g

50g raw

2 ¼

Wholemeal Bread

38%

22.5g

2 slices (59g)

1 ½

Burgen Bread

30.8

25g

2 slices (83g)

1 ¾

Red Lentils

35%

17.5g

50g raw

1 1/8

Green Lentils

29.6%

15g

50g raw

1


Remember that recommended exchanges are 2-4 per meal and 1-2 per snack. Carbohydrates are also found in virtually all food, including important healthy food groups such as dairy products, fruit and vegetables.

2. Low GI carbohydrates are not the be all and end all.

As I mentioned above total carbohydrate is the key thing to watch out for. So while low GI carbs (the slower, steady release ones) are a better option, you still need to really watch the total amount.

As you can see in the table above even 'healthy' options like wholemeal pasta, brown rice and quinoa can quickly overload you on carbohydrates. These are things I have in small servings at present.

It is interesting to note that Grainy Burgen Linseed bread is denser than the regular wholemeal so while it is lower GI and lower carbohydrate as a percentage, 2 slices actually has more carbohydrate than 2 slices of the other bread. The slices are basically bigger and heavier, so you need to really pay attention to serving sizes and the portion you are eating.

3. Timing is really important.

The dieticians recommended we spread our carbohydrate 'exchanges' evenly throughout the day. This fits in nicely with the constrictions of a growing baby making space for your stomach smaller, so smaller regular snacks have worked well. 

My typical breakfast hasn't changed, its still
• ½ a cup of my muesli (1 ½ exchanges)
• ½ cup milk (¼ exchange)
• 2 Tbsp Greek yoghurt (¼ exchange)
• 1 piece of fruit (1 exchange)
= Total of 3 exchanges

This breakfast fills me up and gives me a good start to the day and keeps my blood sugar levels steady by mid morning when I check them again.  On weekends I might have scrambled eggs on toast or porridge with sliced fruit and almonds.

For me, timing a snack with some carbohydrate in mid morning and mid afternoon has been important. I found if my normal 10am snack go pushed back to say 11 or 11.15am then I would have a higher after lunch reading as my body hadn't been able to keep things as steady.

If you skip a meal or snack and let your blood sugar levels go too low your body will kick in and actually release stored glucose back into your blood stream, by which time you're also probably starving and when you do eat you get a 'double dose' of sugar into the blood. So regular routines are important.

Timing of exercise is important too – more on that further on.

4. It's a balancing act to feel satisfied.  

I've adopted a range of strategies to feel full and have enough energy while controlling blood sugar levels.

We have been using lentils more (think soups, curries, dahls and salads) and I have been filling up on extra green vegetables whereas the rest of the family will have a larger serving of the carbohydrate rich foods, I'll just have one spoonful.

I've also incorporated a lot more pumpkin, carrot and kumara (sweet potato) into our diet rather than standard potatoes as these three options are all very low carb.  And besides roasted carrots are just devine!

We've added even more green vegetables into and alongside meals such as doing a leek and potato gratin rather than just a potato one, or having stuffed butternut pumpkin with loads of other vegetables inside.

I have an extra large serving of salad as an entrée which fills me up before the main. Its all about getting in enough nutrition and enough food to feel satisfied without tipping the carbohydrate balance.

Previously during the pregnancy, for lunch I might have had 2 toasted sandwiches followed by a piece of fruit (which would be 5 exchanges!) Whereas now I will jut stick to one toasted sandwich with salad or a raw carrot and folloed by some grapes or berries and yoghurt.

I have definitely gone for the full fat dairy option rather than the low fat alternatives. Low fat options are always higher in sugar, or have fake sweeteners (which I avoid).

This was one piece of confusing advice I found the dieticians gave out. Most of the literature online and also what they told us in person was to opt for low fat dairy. But when low fat yogurt has 29g as opposed to Greek yoghurt with 4.5g of carbohydrate per serve I know which one I am choosing!

I think that the dieticians are recommending low fat options as they have to sit in a middle ground and play the balancing act because diabetes is often associated with obesity and increases rates of heart attack and heart disease.  They continue to emphasise the low fat message, citing these reasons. But I think for a healthy sized expectant mother full fat is fine for this period of time and this purpose as it certainly boosts your satiety.

Overall, it really is a tricky balancing act as you do have the elevated hunger of pregnancy and genuinely need more calories than prior to pregnancy so its often about finding low carb things to fill you up, and then making the most of the carbs that you do have. More info on great snacks I've discovered here.

5. Ways that I was oh so wrong...

It's been a real case of experimenting to see what works and what doesn't. I never realised how much carbohydrate was in my homemade pizza. I still stand by it as a delicious and healthy option, but because flour (again yes even wholemeal) is so high in carbohydrate I have to watch how many slices I have. Rather than 2-3 (maybe 4) just 1-2 is my limit along with a large mixed salad.

Pastry was the same thing – very high carbohydrate so again small portions were the order of the day. Even with vegetarian spinach and ricotta pie or chicken, leek and corn pie. Having a centre piece with less pastry rather than a corner piece helps.

Before the info session with the dieticians, as I mentioned above I thought it was all about cutting out sugar and sweets. So my 'treat' foods while on holiday were corn chips with guacamole and dips rather than chocolate. What a shame I missed out on some of my favourite sweets and still had quite a serving of carbs from the chips!

6. How to Overcome Cravings.

I have a sweet tooth and really do love desserts. We were on holiday in Tasmania during my two weeks of 'flying blind' and really noticed the change in weather, aka we were freezing! It was literally snow jacket, woollen hats, scarves and gloves weather. I did notice while everyone else was having coffees and hot chocolates that I felt deprived with my cup of tea. It just seems a waste to pay good money for someone to give you boiling water and a splash of milk. As I don't drink coffee my treat while out at a café would normally be a smoothies in summer or hot chocolate in winter so I sorely missed that lovely satisfying hot frothy cup between my hands. So what do you do when you are tempted by gorgeous café cabinets filled with interesting fruit tarts, pastries, cakes, biscuits etc, or when grabbing a quick lunch for the family at bakery? It became really challenging.

So how do you get around sweet cravings? Fruit is an obvious choice and whole fruits (with the skin on) together with some nuts, seeds or Greek yoghurt were good. I was well aware that adding some fats and/or protein alongside the fruit would slow down the release of the sugar, lowering the GI and increasing the satisfaction factor.

Try it out if you haven't before. In general I always recommend pairing carbohydrates with protein and fats in snacks and meals. Now it has just taken on a new importance for me myself.

When you really feel like something sweet...well, I opted for organic stevia as a sweetener. Stevia is a plant which is naturally incredibly sweet and you can purchase sachets of it as a white powder in the sugar/sweeteners section of the supermarket. It does look and act a bit like artificial sweeteners (without the man made nasties) and certainly I found half a sachet was enough to add to Greek yoghurt for example for a nice sweet hit. I would have ½ a cup of yoghurt topped with fresh fruit or frozen berries (berries are very low carb). This was my go to snack or dessert if I felt deprived and it really hit the spot.

I have discovered that chocolate (as in real chocolate) is low GI and can be enjoyed in moderation. I can have a piece or two of dark chocolate either at the end of a meal or just after taking my blood sugar levels. If the blood sugar reading is low then I can justify the treat, but I will usually have it along with something really healthy choice as well. And of course I sit down and savour it slowly!

Exercise and Activity

7. It's important to time exercise right.

I write this having just returned from my afternoon walk. I have become much more structured with my exercise and in particular when I fit it in. I found that my higher blood sugar readings would typically be after lunch or dinner so every day I take a 35 minute brisk walk after lunch. Some evenings I'll also walk after dinner.

Exercise helps to lower blood sugar levels so it is good to time it after a meal. Normally I eat around 12 – 12.30pm and go for my walk around 1.15pm which allows time for my food to digest but also means I am working on steadying my blood sugar levels within the two hour window after that meal.

Sometimes I check my blood sugar levels both before and after a walk (just out of curiosity) and I've found that it lowers my blood sugar level reading by about 1 to 1.5 points.

Blood sugars are measured as the amount of glucose in millimoles per litre of blood (mmol/l) and the general healthy range is between 4 – 8. For gestational diabetes a few years ago the goal was to keep them below 8, it then changed to below 7 and is currently below 6.7, so things are tightening up!

My readings are typically between 4.1 and 4.7 in the morning when I wake up. In the 5's after breakfast and in the 5's or 6's after lunch and dinner. Exercise is the only natural antidote to a high reading. It can also be used in advance of a meal if you know that you're going to attend a function and might not be able to control your food choices so well for example. Exercising beforehand or soon afterwards will help control blood sugar levels.

8. I've been reminded how much better I feel with regular exercise.

The other thing I've learnt is just how much better I feel when I do exercise this regularly. I did have a break from much walking after a few weeks of running around the 4 months pregnant mark set off quite severe sharp back and sciatic pain. Having now focused on good lower back position and co-activation of pelvic floor and transverse abdominals (the ones that wrap around your body like a corset) I'm back on track and virtually pain free.

I feel fit and strong again after just the last 3-4 weeks of upping the exercise, and while it is still fairly simple – brisk walks with a few inclines and simple full body strengthening exercises at home is about as advanced as I get – it has been great for lots of reasons.

Getting out in sunshine/sunlight every day is great to boost my mood and help me sleep deeper at night. I feel fitter and stronger for the birth. My back pain has gone and I feel my core is much stronger. My posture is improved.

Overall I feel in a much better place heading towards the birth and recovery so it has been a real blessing to be forced into this routine which actually is so good for me!

Overall

9. I have less sweet cravings and less fatigue

While I didn't know it may have been related to the diabetes, I certainly was finding I was very tired throughout the afternoon and that handfuls of grapes, sweet things from the cupboard or other fruit would appeal as a quick pick me up.

Having a high GI sugary snack gives your body a glucose rush which tends to leave you feeling lethargic and wanting more sugar an hour or so later. While I understood this in theory, I wasn't really aware of the pattern that had developed for myself. Now with hindsight I can see that what a difference focusing on maintaining steady blood sugar levels really has on how I feel.

When you are following the principles that maintain blood sugar levels steady, sweet cravings often disappear altogether. On a physiological level I think that they certainly do. (Being surrounded by others who are indulging in your favourite snacks is another thing altogether but this is more of an emotional craving).

When you don't feed your body 'sugar like things', it doesn't crave 'sugar like things'. It doesn't take long to make the transition, so give it a go if you're reading this and wish you had more energy or less cravings throughout your day.

10. Lastly – I've learnt (yet again) to always to be thankful!

It is so easy to take so many things in life for granted. In the big scheme of things I have realised that I will look back on this whole time as a small thing. But if you that are reading this are going through it too, you will know that feeling of it taking over your life and being at the forefront of your mind all the time. You will understand the moments of worry, concern and guilt.

On the other hand I am so incredibly thankful for all the positives that this has brought me (and my baby). Not only am I taking especially good care of myself, which is also good for baby, I'm getting more sunlight, exercising regularly and am feeling stronger. But more importantly I have learnt so much through this whole process and I know that the lessons learnt will stick with me for the rest of my life. They will help me and my family and I'm sure that they can help others, so I hope to be able to share this story and these tips for navigating GDM with other expectant mothers out there.

It's funny how we can take little things for granted isn't it!? Like how missing out on runny eggs, soft cheeses and rare steak makes us appreciate them more post-birth. I still remember my first meal out and about with my eldest daughter when she was 5 days old; runny Eggs Benedict at a cafe, simply divine!

This even more modified temporary 'diet' just reminds me how much I do treasure and love a good piece of cake cooked to perfection or a sweet dessert and yes I shall enjoy them wholeheartedly, slowly and mindfully when the time comes again. I can just picture how special that will be!

Absence makes the heart grow fonder.

So all in all, I have learnt a stack load about myself, about the life of a diabetic and about principles for steadying blood sugar levels which will be really useful for the majority of people that I work with.

So thanks God for the blessing in disguise of have GDM!

 

As always, please contact me if you have specific questions you would like answered.

I love hearing from you.

xxx

Lauren 

 

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