My daughter arrived a little early. About a month early, actually. But she is healthy and doing just fine. She weighed 5 lbs 11 oz at birth and my OB estimated that had I gone to full term, she would have been around 8 lbs. A good size, but not as big as you might expect for having gestational diabetes.
As the pregnancy went on, I found it easier to control my blood sugar. The glyburide definitely helped. Towards the end, I was skipping my morning walk since I was able to keep my post-breakfast glucose under 130 without it. I was tired in the mornings and it was getting warm, even at 8am. I continued with my evening walks with my husband and son, and that has continued to be a night time routine, even when I wasn't able to go after our daughter was born, my husband still took our son out.
The other thing that I found really helpful was a protein shake I could eat for lunch when I was too nauseated for other sources or protein or just too tired or hungry to make something requiring more effort. I used a shake called Spiru-Tein that I have had before. In fact, I drank it during the first trimester of both pregnancies when I was nauseous but needed to eat. I was worried it would raise my glucose levels too much, so I hesitated to try it until I felt like I had my blood sugar pretty well under control. Although it only has 11 grams of carbs, I mix it with milk and it tastes pretty sweet. I found the best way to make it is to mix one scoop in the blender with 1 cup of milk, about 8 ice cubes. The vanilla one almost tastes like a milk shake.
There were some days when I felt nauseous and didn't want to eat any protein, not even peanut butter or cheese (the two forms of protein I could tolerate best when I had no appetite). I would feel depressed because I didn't want to eat anything, but I needed to eat something for the baby, something with protein. Once I found I could make this shake, feel full, and have a post-lunch glucose level of around 95, I felt a lot better. I didn't have to stress about whether or not I had an appetite because I had a backup meal I knew I could tolerate.
Once my daughter was born, my OB told the nurses they didn't need to test my blood sugar any more (they were testing it every few hours at first) and that I could resume a normal diet. I tried to continue to eat well from the hospital menu, but I did indulge in chocolate pudding the first night and loved every spoonful.
Since coming home from the hospital, I try to follow the basics of the diet I had been on. I try to eat snacks between meals and have protein any time I eat. And I try to still drink about 3 glasses of milk per day. But I've gone back to having my morning coffee with milk and I've been indulging in a little chocolate every night. But I don't eat cereal for breakfast - I have something with protein, usually a PB&J sandwich on whole grain bread. And I still try to limit my carbs at meals and eat brown rice instead of white, etc.
It's been weird sitting down to eat and not having to remember to set a timer for 1 hour. And I still mentally go over what I'm eating, even if I don't actually write it down in a log anymore. I also find that after I eat, I feel like I'm forgetting to do something (test my blood sugar).
In about a month, I'll start testing my blood sugar again so I can take the results to my OB on November 6. Hopefully everything returns to normal. I asked him if I was likely to get GD again if I have another baby. He said chances were good, but if I get my weight down and change my eating habits and continue to exercise regularly, he has seen women who don't develop GD on a subsequent pregnancy.
Monday, September 21, 2009
Friday, September 4, 2009
Good news
I saw my OB today. I only gained 1 pound in the 3 1/2 weeks since my last visit. Although I started this pregnancy 10 pounds heavier than my first, I may actually not go over my all time high weight from last pregnancy. We'll see - I'm about 3 pounds under what I weighed at my last prenatal visit during my last pregnancy and I only have 4 weeks to go.
I confirmed with my doctor that I will take the glyburide up until the night before my scheduled C-Section (unrelated to the gestational diabetes). But the good news is that once the baby is born, I don't need to test my blood and I can eat whatever I want. He specifically mentioned cake and ice cream. I'm excited. I thought I'd have to test my blood even in the hospital and order off the diabetic hospital menu.
A week or so before my follow-up exam 6 weeks post-partum, he said I should start testing my blood here and there - both fasting and after meals, but not the 4 times a day I do now. And then I should bring those results with me. If all looks OK, I'm good. I won't even have to do another glucose tolerance test that I was dreading (I read online that they usually do one 6 weeks after you deliver to be sure the diabetes is gone). He said since we have such good glucose monitors these days, it makes more sense to test your blood with how you eat normally. He also said hopefully I would make lasting changes based on what I've learned. And certainly I will since I think it will help ward off Type II diabetes. But at least I'll be able to have more than 15 g of carbs at breakfast and I can indulge in chocolate mousse once in a while.
I confirmed with my doctor that I will take the glyburide up until the night before my scheduled C-Section (unrelated to the gestational diabetes). But the good news is that once the baby is born, I don't need to test my blood and I can eat whatever I want. He specifically mentioned cake and ice cream. I'm excited. I thought I'd have to test my blood even in the hospital and order off the diabetic hospital menu.
A week or so before my follow-up exam 6 weeks post-partum, he said I should start testing my blood here and there - both fasting and after meals, but not the 4 times a day I do now. And then I should bring those results with me. If all looks OK, I'm good. I won't even have to do another glucose tolerance test that I was dreading (I read online that they usually do one 6 weeks after you deliver to be sure the diabetes is gone). He said since we have such good glucose monitors these days, it makes more sense to test your blood with how you eat normally. He also said hopefully I would make lasting changes based on what I've learned. And certainly I will since I think it will help ward off Type II diabetes. But at least I'll be able to have more than 15 g of carbs at breakfast and I can indulge in chocolate mousse once in a while.
Tuesday, August 25, 2009
Glyburide follow-up
The glyburide really seems to be working. I've been well under 95 every morning, except the morning after I forgot my glyburide and had a fasting blood glucose level of 104.
Despite the fact that my fasting number is so much lower, I quickly discovered that I still need to go for a walk after breakfast to keep my post-breakfast reading under 130, otherwise it ends up slightly elevated. But a 10-12 minute walk will generally keep it under 120.
The rest of my post-meal readings are consistently under 130 (with a few exceptions I have posted about previously), so I am able to keep them in check through diet and exercise. It really seems to be the mornings I have the most trouble with.
I want to ask my OB at my next visit (Sept 4) when I should stop taking the glyburide. The nurse indicated I would take it until I delivered, but not after since you can't take it while breastfeeding. But the information that came with the prescription says you should stop taking it 2 weeks before your anticipated due date so it won't show up in your breast milk. I might be taking a low enough dose that it's not a concern, but I do want to verify since I intend to breastfeed exclusively.
Despite the fact that my fasting number is so much lower, I quickly discovered that I still need to go for a walk after breakfast to keep my post-breakfast reading under 130, otherwise it ends up slightly elevated. But a 10-12 minute walk will generally keep it under 120.
The rest of my post-meal readings are consistently under 130 (with a few exceptions I have posted about previously), so I am able to keep them in check through diet and exercise. It really seems to be the mornings I have the most trouble with.
I want to ask my OB at my next visit (Sept 4) when I should stop taking the glyburide. The nurse indicated I would take it until I delivered, but not after since you can't take it while breastfeeding. But the information that came with the prescription says you should stop taking it 2 weeks before your anticipated due date so it won't show up in your breast milk. I might be taking a low enough dose that it's not a concern, but I do want to verify since I intend to breastfeed exclusively.
Thursday, August 20, 2009
Looking on the bright side
On the tough days, it is easy to think about the downside of having gestational diabetes. But this morning, during my morning walk, I was thinking about the upside.
For one thing, I'm eating better for the baby than I had been. The lack of appetite that persisted after the first trimester had me eating a lot of cereal and PB&J sandwiches. I'm eating a better variety of foods now.
I'm also learning healthy eating habits that I think will stay with me and help me ward off Type II diabetes, such as eating smaller meals and eating snacks in between, as well as combining proteins with carbs.
I'm gaining less weight than I would otherwise. I started this pregnancy 10 pounds heavier than my last pregnancy and was worried about ending up 10 pounds heavier at the end than at the end of my last pregnancy. But since I started the diet and exercise, my weight gain has slowed and I'm almost hopeful that I will plateau and end up right around where I did last time.
And the other thing I'm happy about is that we are talking to our neighbors more now that we are out walking every evening (and I'm out every morning). The evenings here have been unseasonably cool and pleasant and we often see neighbors out in their yards or walking their dogs and stop to chat. We've even met some new neighbors, including a couple that lives 2 houses away that we never manged to introduce ourselves to in the 4 years we've been here.
For one thing, I'm eating better for the baby than I had been. The lack of appetite that persisted after the first trimester had me eating a lot of cereal and PB&J sandwiches. I'm eating a better variety of foods now.
I'm also learning healthy eating habits that I think will stay with me and help me ward off Type II diabetes, such as eating smaller meals and eating snacks in between, as well as combining proteins with carbs.
I'm gaining less weight than I would otherwise. I started this pregnancy 10 pounds heavier than my last pregnancy and was worried about ending up 10 pounds heavier at the end than at the end of my last pregnancy. But since I started the diet and exercise, my weight gain has slowed and I'm almost hopeful that I will plateau and end up right around where I did last time.
And the other thing I'm happy about is that we are talking to our neighbors more now that we are out walking every evening (and I'm out every morning). The evenings here have been unseasonably cool and pleasant and we often see neighbors out in their yards or walking their dogs and stop to chat. We've even met some new neighbors, including a couple that lives 2 houses away that we never manged to introduce ourselves to in the 4 years we've been here.
Complications
Since starting the glyburide, I've been doing much better with my glucose levels. My fasting blood glucose has been 90 or below every day since I starting the glyburide, usually around 85. And the few times I've gone over 130 after a meal, it's never been over 135 (with one exception) and I could usually pinpoint something in my diet (or lack of exercise) that caused it.
The one exception was Monday night. That afternoon, I noticed a contraction just before 3pm. I thought it was a BH contraction at first, but realized it was a little painful. Only about a 3 on a scale of 1 to 10, but the BH contractions have never been painful. I was working at the computer and jotted down the time. Twelve minutes later, I had another one. And another 12 minutes after that. I knew that 6 contractions in an hour, even BH contractions, warranted a call to the OB, and if they continued at 12 minutes apart, that would be 6 within an hour. The next came 10 minutes later, but was milder. And another mild one came 10 minutes after that. By then, my son woke up and I couldn't keep track. But I called my husband to come home and called my OB's office. The nurse called back and said to go to triage.
I spent 2 1/2 hours at triage, being monitored. It was over the dinner hour and I asked if they had food since I was due for a meal and I had gestational diabetes. They brought me a turkey sandwich with an apple and some kind of sugar-free gel dessert. I ate the whole sandwich although I suspected it had more carbs than the bread I normally eat, but I only ate half the apple.
Immediately before I ate, they also gave me a shot of terbutaline to stop the contractions. One hour after I started eating, my blood sugar was 152. That was pretty high even for a higher carb bread. I also hadn't gone for a walk, obviously, but considering that my post-dinner blood sugar when I do take a walk is in the low 100s or even mid-90s, I suspect the terbutaline had something to do with it.
When they released me, they said no exercise or lifting until my OB cleared me. This worried me since the last time I skipped my post-meal walks, my blood sugar was too high. Fortunately, I got ahold of my OB on Tuesday and he cleared me to resume normal activities. The contractions hadn't opened or thinned my cervix and the fetal fibronectin test they did came back negative, meaning I was unlikely to deliver in the next 2 week. He said controlling the gestational diabetes was more important. So although I skipped my morning walk on Tuesday (and had a blood sugar of 131 after breakfast), I resumed my walks that night and have been doing OK ever since.
The one exception was Monday night. That afternoon, I noticed a contraction just before 3pm. I thought it was a BH contraction at first, but realized it was a little painful. Only about a 3 on a scale of 1 to 10, but the BH contractions have never been painful. I was working at the computer and jotted down the time. Twelve minutes later, I had another one. And another 12 minutes after that. I knew that 6 contractions in an hour, even BH contractions, warranted a call to the OB, and if they continued at 12 minutes apart, that would be 6 within an hour. The next came 10 minutes later, but was milder. And another mild one came 10 minutes after that. By then, my son woke up and I couldn't keep track. But I called my husband to come home and called my OB's office. The nurse called back and said to go to triage.
I spent 2 1/2 hours at triage, being monitored. It was over the dinner hour and I asked if they had food since I was due for a meal and I had gestational diabetes. They brought me a turkey sandwich with an apple and some kind of sugar-free gel dessert. I ate the whole sandwich although I suspected it had more carbs than the bread I normally eat, but I only ate half the apple.
Immediately before I ate, they also gave me a shot of terbutaline to stop the contractions. One hour after I started eating, my blood sugar was 152. That was pretty high even for a higher carb bread. I also hadn't gone for a walk, obviously, but considering that my post-dinner blood sugar when I do take a walk is in the low 100s or even mid-90s, I suspect the terbutaline had something to do with it.
When they released me, they said no exercise or lifting until my OB cleared me. This worried me since the last time I skipped my post-meal walks, my blood sugar was too high. Fortunately, I got ahold of my OB on Tuesday and he cleared me to resume normal activities. The contractions hadn't opened or thinned my cervix and the fetal fibronectin test they did came back negative, meaning I was unlikely to deliver in the next 2 week. He said controlling the gestational diabetes was more important. So although I skipped my morning walk on Tuesday (and had a blood sugar of 131 after breakfast), I resumed my walks that night and have been doing OK ever since.
Thursday, August 13, 2009
First dose of glyburide
The glyburide prescription didn't get called in until Wednesday. On Tuesday, my fasting blood sugar was 93 and the rest of the day I was under the 130 post-meal limit. So I thought that if my fasting blood sugar on Wednesday was still under 95, maybe I could delay starting glyburide for another day and see how I did.
Tuesday night, my post-dinner blood sugar was 99. I had the same bed-time snack as the night before (peanut butter and a tsp of low sugar jam on a slice of wheat bread with a glass of milk) at the same time as the night before (9:35pm). Wednesday morning, I tested my blood sugar at 7am, the same time as I tested on Tuesday. My reading was 99. Quite a bit higher than the previous day and several points over the limit. I guess there really isn't anything I can do about it.
So Wednesday I picked up the glyburide. I was reading the info that came with it and noticed that it said to discontinue use 2 weeks prior to your expected due date if you plan to breastfeed. The nurse had told me I would take it up until I deliver, but not after I deliver since you can't take it if you are breastfeeding. Which makes me wonder how long it stays in your blood. I'll have to ask my OB at my next appointment since I definitely plan to breastfeed.
Last night with my night time snack, I took 2.5 mg of glyburide. I woke up several times last night to pee, but didn't notice any signs of hypoglycemia. Although it might be hard to tell when you are half asleep. My fasting blood sugar this morning was 84. After breakfast, it was 116. I had the same breakfast as yesterday (1 whole grain waffle (12.5 g of carbs) with peanut butter and a side of cottage cheese and coffee) and yesterday my blood sugar was 124. And that was after a nearly 20 minute walk! Today, I didn't get out for my walk, partly because I was tired and partly because Thom was working from home and I didn't have the energy to take Aaron with me. So having a lower baseline really helps in the morning.
Tuesday night, my post-dinner blood sugar was 99. I had the same bed-time snack as the night before (peanut butter and a tsp of low sugar jam on a slice of wheat bread with a glass of milk) at the same time as the night before (9:35pm). Wednesday morning, I tested my blood sugar at 7am, the same time as I tested on Tuesday. My reading was 99. Quite a bit higher than the previous day and several points over the limit. I guess there really isn't anything I can do about it.
So Wednesday I picked up the glyburide. I was reading the info that came with it and noticed that it said to discontinue use 2 weeks prior to your expected due date if you plan to breastfeed. The nurse had told me I would take it up until I deliver, but not after I deliver since you can't take it if you are breastfeeding. Which makes me wonder how long it stays in your blood. I'll have to ask my OB at my next appointment since I definitely plan to breastfeed.
Last night with my night time snack, I took 2.5 mg of glyburide. I woke up several times last night to pee, but didn't notice any signs of hypoglycemia. Although it might be hard to tell when you are half asleep. My fasting blood sugar this morning was 84. After breakfast, it was 116. I had the same breakfast as yesterday (1 whole grain waffle (12.5 g of carbs) with peanut butter and a side of cottage cheese and coffee) and yesterday my blood sugar was 124. And that was after a nearly 20 minute walk! Today, I didn't get out for my walk, partly because I was tired and partly because Thom was working from home and I didn't have the energy to take Aaron with me. So having a lower baseline really helps in the morning.
Tuesday, August 11, 2009
Glyburide
I saw the dietitian and the nurse this morning after having trouble controlling my blood sugar last week. The last 3 mornings my fasting levels have been 95 or under and my post-meal levels have mostly been OK the last two days. But looking back over the week, my averages were too high. And they pointed out that even when my fasting levels weren't high (prior to the triage incident and in the last 3 days) they are still hovering right around 95.
I had really hoped to control my blood sugar through diet and exercise, in part because my OB thought I would be able to, but mostly because I feel that is best for me and the baby. So I was disappointed when they decided to start me on medication. I had hoped that since I was doing better since I started exercising again that we could modify my diet a little first. But the dietitian didn't see that I was eating a lot of carbs and she feels that the high levels are most likely due to pregnancy hormones. Plus the fasting level which seemed to be their highest concern, along with my post-breakfast levels, which could be high due to a higher fasting level, seems to be harder to control with exercise and diet. And she said she didn't want me to starve myself by cutting back my carbs even more. And some mornings, I was so hungry, I felt like I was starving myself.
The medication is Glyburide. The nurse explained that it makes the pancreas pump out a little more insulin and that it doesn't cross the placenta. I can't take it when I'm breast feeding, though, so I won't take it past the delivery. They are starting me on 2.5 mg, to be taken with my night time snack.
They started to talk about my high post-lunch readings, but when I pointed out that it seemed to be higher the times I had fruit, we decided I would avoid fruit at lunch time for now and see how it goes. The dietitian even suggested adding fruit to my dinner (as extra carbs) since my post-dinner readings are so good (usually 110 or less, often under 100 when I go for a walk). I do have fruit with cottage cheese every day for my afternoon snack, so I might just stick with that for now.
They warned me about hypoglycemia - low blood sugar - and that if I woke up at night with any of the symptoms, I should test my blood sugar. If it is below 60, I should have a fast-acting carbohydrate, like 1/2 cup of juice, then retest my blood after 20 minutes (I think that is right, but I have to double-check the time). If that happens 2 nights in a row or if my fasting blood sugar is under 60 2 mornings in a row, I should call and they could cut my dose back to 1.25 mg, but she didn't think I'd have a problem. 2.5 mg is a pretty low dose, apparently.
I'm not thrilled about it, but I want to do whatever is best for the baby. And maybe it will mean I have an easier time controlling my blood sugar after breakfast and after lunch. I'm just worried that I'll end up putting a little sugar in my coffee or skipping my morning walk if the glyburide is doing all the work.
I had really hoped to control my blood sugar through diet and exercise, in part because my OB thought I would be able to, but mostly because I feel that is best for me and the baby. So I was disappointed when they decided to start me on medication. I had hoped that since I was doing better since I started exercising again that we could modify my diet a little first. But the dietitian didn't see that I was eating a lot of carbs and she feels that the high levels are most likely due to pregnancy hormones. Plus the fasting level which seemed to be their highest concern, along with my post-breakfast levels, which could be high due to a higher fasting level, seems to be harder to control with exercise and diet. And she said she didn't want me to starve myself by cutting back my carbs even more. And some mornings, I was so hungry, I felt like I was starving myself.
The medication is Glyburide. The nurse explained that it makes the pancreas pump out a little more insulin and that it doesn't cross the placenta. I can't take it when I'm breast feeding, though, so I won't take it past the delivery. They are starting me on 2.5 mg, to be taken with my night time snack.
They started to talk about my high post-lunch readings, but when I pointed out that it seemed to be higher the times I had fruit, we decided I would avoid fruit at lunch time for now and see how it goes. The dietitian even suggested adding fruit to my dinner (as extra carbs) since my post-dinner readings are so good (usually 110 or less, often under 100 when I go for a walk). I do have fruit with cottage cheese every day for my afternoon snack, so I might just stick with that for now.
They warned me about hypoglycemia - low blood sugar - and that if I woke up at night with any of the symptoms, I should test my blood sugar. If it is below 60, I should have a fast-acting carbohydrate, like 1/2 cup of juice, then retest my blood after 20 minutes (I think that is right, but I have to double-check the time). If that happens 2 nights in a row or if my fasting blood sugar is under 60 2 mornings in a row, I should call and they could cut my dose back to 1.25 mg, but she didn't think I'd have a problem. 2.5 mg is a pretty low dose, apparently.
I'm not thrilled about it, but I want to do whatever is best for the baby. And maybe it will mean I have an easier time controlling my blood sugar after breakfast and after lunch. I'm just worried that I'll end up putting a little sugar in my coffee or skipping my morning walk if the glyburide is doing all the work.
Discouragement
The last week or so has been discouraging. My blood sugar readings were frequently too high even after I started exercising again. And although the first couple of weeks on the diet weren't too bad, in the last 10 days, I've had a couple of days where I really, really craved something I couldn't have. Something as simple as an extra glass of milk or some juice or a bite of Thom's ice cream. It felt depressing to be avoiding those things and still have high blood sugar.
I did feel like I cheated a little. Although I was told I could have angel food cake and had had some previously without a problem, I had some last week when I had family over for dinner. With unsweetened peaches and just slightly sweetened home made whip cream. It would have been OK, but that was when I was just getting back into exercising and knew I was having trouble keeping my blood sugar under control.
Previously, I had been consistently having the same bedtime snack of 1/2 a peanut butter sandwich with a teaspoon of reduced sugar jam and a glass of milk. That snack had seemed to keep my fasting glucose levels in check. But not only did I have the angel food cake for my night time snack that Tuesday, I varied my night time snack several nights in a row because I just wanted something different. But after having high fasting scores several days in a row, I went back to my peanut butter sandwiches. A different week it might have been OK, but I probably shouldn't have changed it the week I was struggling to keep my blood sugar under control.
I also had several days where I just felt hungry all day. Or I'd eat a snack and feel full for only 30 minutes. Those were tough days. I could have had an extra low-carb snack (and once or twice I did), but mostly I didn't feel like eating anything I could have had.
I think the most discouraging day was the day I had a fasting level of 100 and even though I only had one piece of Trader Joe's french toast (15 g carbs) with peanut butter and went for an 18 minute walk, my post-breakfast reading was 136. I had never had a high post-breakfast level after going for a walk. That was disappointing.
Overall, I feel good about how I'm doing with the diet and the amount I am exercising. And most days the diet is tolerable. But some days are definitely harder than others.
I did feel like I cheated a little. Although I was told I could have angel food cake and had had some previously without a problem, I had some last week when I had family over for dinner. With unsweetened peaches and just slightly sweetened home made whip cream. It would have been OK, but that was when I was just getting back into exercising and knew I was having trouble keeping my blood sugar under control.
Previously, I had been consistently having the same bedtime snack of 1/2 a peanut butter sandwich with a teaspoon of reduced sugar jam and a glass of milk. That snack had seemed to keep my fasting glucose levels in check. But not only did I have the angel food cake for my night time snack that Tuesday, I varied my night time snack several nights in a row because I just wanted something different. But after having high fasting scores several days in a row, I went back to my peanut butter sandwiches. A different week it might have been OK, but I probably shouldn't have changed it the week I was struggling to keep my blood sugar under control.
I also had several days where I just felt hungry all day. Or I'd eat a snack and feel full for only 30 minutes. Those were tough days. I could have had an extra low-carb snack (and once or twice I did), but mostly I didn't feel like eating anything I could have had.
I think the most discouraging day was the day I had a fasting level of 100 and even though I only had one piece of Trader Joe's french toast (15 g carbs) with peanut butter and went for an 18 minute walk, my post-breakfast reading was 136. I had never had a high post-breakfast level after going for a walk. That was disappointing.
Overall, I feel good about how I'm doing with the diet and the amount I am exercising. And most days the diet is tolerable. But some days are definitely harder than others.
Excercise Part III
I wrote twice before about the positive effect that walking has had on my blood sugar. It was made clear to me again when I stopped walking completely for 2 days last week.
About 10 days ago, on a Saturday night, I noticed some light spotting. I had spotting later in my first pregnancy, too, so I tried not to worry too much. But an hour later, I started having menstrual-like cramps. The information my OB had given me on preterm labor symptoms include menstrual-like cramps and spotting, so to be safe I called his office. (My sister had preterm labor with her second pregnancy. Fortunately they caught it in time and put her on bed rest. But it makes me more cautious.) I spoke with a nurse practitioner that night and he suggested I go down to triage (which is basically the ER for pregnant women at the hospital where I'm delivering).
After monitoring the baby and my contractions for about an hour, they cleared me to go home. Although I'd noticed some BH contractions on the drive down, they had calmed while I was down there and the baby sounded fine. They suggested I take it easier, but didn't restrict any particular activity (aside from sex). Just to be on the safe side, though, I didn't do my morning or evening walk on Sunday. My blood sugar readings were still OK on Sunday.
But Monday, I was still spotting and again didn't go on my morning walk. That's when I started having higher blood sugar readings. Since the spotting was going away, I went on a short walk on Tuesday after breakfast. After a couple of days of not not walking, even my fasting levels were creeping up. They had been in the low to mid-90s. Three days in a row they were high 90s and I had one 100.
Gradually, by this last weekend, I was doing my full morning and evening walks and the last few days my numbers have been more like they used to be before the whole triage incident. It seems like there is a cumulative effect with the exercise - that first day of no exercise my numbers were still OK. And it took several days of resuming exercise before my numbers started to go down.
But since I had more than 6 post-meal levels above 130 in a week and more than 3 high fasting levels, I had to go see the dietitian again, a week earlier than scheduled.
About 10 days ago, on a Saturday night, I noticed some light spotting. I had spotting later in my first pregnancy, too, so I tried not to worry too much. But an hour later, I started having menstrual-like cramps. The information my OB had given me on preterm labor symptoms include menstrual-like cramps and spotting, so to be safe I called his office. (My sister had preterm labor with her second pregnancy. Fortunately they caught it in time and put her on bed rest. But it makes me more cautious.) I spoke with a nurse practitioner that night and he suggested I go down to triage (which is basically the ER for pregnant women at the hospital where I'm delivering).
After monitoring the baby and my contractions for about an hour, they cleared me to go home. Although I'd noticed some BH contractions on the drive down, they had calmed while I was down there and the baby sounded fine. They suggested I take it easier, but didn't restrict any particular activity (aside from sex). Just to be on the safe side, though, I didn't do my morning or evening walk on Sunday. My blood sugar readings were still OK on Sunday.
But Monday, I was still spotting and again didn't go on my morning walk. That's when I started having higher blood sugar readings. Since the spotting was going away, I went on a short walk on Tuesday after breakfast. After a couple of days of not not walking, even my fasting levels were creeping up. They had been in the low to mid-90s. Three days in a row they were high 90s and I had one 100.
Gradually, by this last weekend, I was doing my full morning and evening walks and the last few days my numbers have been more like they used to be before the whole triage incident. It seems like there is a cumulative effect with the exercise - that first day of no exercise my numbers were still OK. And it took several days of resuming exercise before my numbers started to go down.
But since I had more than 6 post-meal levels above 130 in a week and more than 3 high fasting levels, I had to go see the dietitian again, a week earlier than scheduled.
Friday, July 31, 2009
Reading labels
I've been a label reader for years. It's a habit my husband got me into. We avoid high fructose corn syrup (HFCS) and pretty much added sugar in anything that doesn't need it - potato chips, pasta sauce, etc. If you don't read labels, you'd be surprised how many processed foods have unnecessary sugar or HFCS. I also avoid partially hydrogenated anything and pretty much any ingredients that don't sound like food - like mono- and diglycerides.
With gestational diabetes, I'm still reading labels, but now I'm checking carb content, not just sugar. For example, the whole wheat bread I was eating when I started the diet had 21 g of carbs in one slice. Switching to a different whole grain bread by the same company (Milton's one of the few that doesn't put HFCS or partially hydrogenated oils in their wheat bread) that has only 16 g of carbs has helped keep my post-breakfast glucose readings down.
I had looked for "light" bread which I heard would allow me to have 2 slices for 15 g of carbs. I found one brand at Vons. Part of the solution is that their slices are very small. But I decided against getting the "light" bread because of the mono- and diglycerides in it along with some other ingredients I questioned. I'd rather stick with a single slice of bread with natural ingredients.
Even before this diet, I was buying graham crackers for my son from the health food store rather than getting the standard Honey Maid. These are the graham crackers I've been eating, too. They have 21 g of carbs in 2 full sheets, so I eat 1 1/2 sheets for my (approximately) 15 g of carbs. 2 sheets have 6 g of sugar. There is no HFCS or any saturated fat in them. They are also organic, but that isn't strictly important to me - it's just that organic labels tend to use better ingredients. I later started getting the cinnamon graham crackers when I discovered they had no more sugar or carbs than the regular ones.
I just looked up the nutritional content of Honey Maid cinammon graham crackers. In contrast to the ones I get, they have 25 g of carbs in 2 sheets and 10 g of sugar (that is 2 g more than their regular honey graham crackers). They have HFCS plus saturated fat from partially hydrogenated oils.
By reading labels on cookies at Trader Joe's I found some mini biscotti's that allow me 2 for an afternoon snack with another carb and some protein. There are some cookies that have 15 g of carbs in a single cookie, or in 2 much smaller cookies. By reading labels and not just getting my favorite cookies, I'm able to have more cookie for the amount of carbs so I still feel full after my snack, but my blood sugar doesn't skyrocket.
With gestational diabetes, I'm still reading labels, but now I'm checking carb content, not just sugar. For example, the whole wheat bread I was eating when I started the diet had 21 g of carbs in one slice. Switching to a different whole grain bread by the same company (Milton's one of the few that doesn't put HFCS or partially hydrogenated oils in their wheat bread) that has only 16 g of carbs has helped keep my post-breakfast glucose readings down.
I had looked for "light" bread which I heard would allow me to have 2 slices for 15 g of carbs. I found one brand at Vons. Part of the solution is that their slices are very small. But I decided against getting the "light" bread because of the mono- and diglycerides in it along with some other ingredients I questioned. I'd rather stick with a single slice of bread with natural ingredients.
Even before this diet, I was buying graham crackers for my son from the health food store rather than getting the standard Honey Maid. These are the graham crackers I've been eating, too. They have 21 g of carbs in 2 full sheets, so I eat 1 1/2 sheets for my (approximately) 15 g of carbs. 2 sheets have 6 g of sugar. There is no HFCS or any saturated fat in them. They are also organic, but that isn't strictly important to me - it's just that organic labels tend to use better ingredients. I later started getting the cinnamon graham crackers when I discovered they had no more sugar or carbs than the regular ones.
I just looked up the nutritional content of Honey Maid cinammon graham crackers. In contrast to the ones I get, they have 25 g of carbs in 2 sheets and 10 g of sugar (that is 2 g more than their regular honey graham crackers). They have HFCS plus saturated fat from partially hydrogenated oils.
By reading labels on cookies at Trader Joe's I found some mini biscotti's that allow me 2 for an afternoon snack with another carb and some protein. There are some cookies that have 15 g of carbs in a single cookie, or in 2 much smaller cookies. By reading labels and not just getting my favorite cookies, I'm able to have more cookie for the amount of carbs so I still feel full after my snack, but my blood sugar doesn't skyrocket.
Changing my night time snack
After having fasting blood glucose readings of 96 several times in one week, I e-mailed the dietitian to see if I should change anything. I had been having a night time snack of 3 graham cracker halves with peanut butter and a glass of milk. She recommended changing that snack to have whole wheat bread or wheat crackers instead of graham crackers. Since switching to a snack of 1/2 peanut butter sandwich on whole grain bread with just a smidgen of reduced sugar jam and a glass of milk, my fasting glucose readings have been 95 and under, although usually just slightly - around 94. If it tips back up over 95, I'll try cutting out the jam, but that is my one snack that I pretend is dessert so it's nice to have that little bit of sweetness.
Take out; Take two
I mentioned having success with Daphne's take out a few weeks ago. I haven't been in the mood for Greek again and I've pretty much been eating all my meals at home. But on Wednesday, I was running errands in the morning and really didn't feel like trying to make something at home for lunch, so I thought I'd try Chinese. There was a Pei Wei near where I was. I'd never been to Pei Wei, which is run by P.F. Chang's. I ordered my meal with brown rice and chicken. Although it was supposed to be a spicy entree, it tasted sweet and I worried that there was sugar in it and made sure to eat a lot of the chicken even though I couldn't finish the meal. I just looked up the nutritional info on their website and that entree does have 12 g of sugar and 26 total grams of carbs.
If I had planned ahead, I should have looked this information up before going. It's really helpful that most chain restaurants provide this info online. Even though my glucose level was under 130 after lunch, it was just barely, and the next day, when I was feeling lazy and not very hungry, I ate the leftovers, even though there probably wasn't 3 oz of chicken left and the remaining rice had a lot of the sugary sauce. My glucose after lunch yesterday was the highest I've ever seen it: 167. I didn't feel different physically from the high blood sugar, but I did feel disappointed in myself since I suspected it wasn't enough protein and potentially too many carbs and I didn't supplement the meal with anything else. But I didn't expect it to be that high.
I guess the key to eating take out successfully is to research the food first. What's sad is that I didn't really enjoy the entree very much anyway. It would be one thing to have a high glucose reading after enjoying a piece of chocolate or some homemade ice cream, but it was doubly disappointing to have a high reading after eating mediocre take out.
If I had planned ahead, I should have looked this information up before going. It's really helpful that most chain restaurants provide this info online. Even though my glucose level was under 130 after lunch, it was just barely, and the next day, when I was feeling lazy and not very hungry, I ate the leftovers, even though there probably wasn't 3 oz of chicken left and the remaining rice had a lot of the sugary sauce. My glucose after lunch yesterday was the highest I've ever seen it: 167. I didn't feel different physically from the high blood sugar, but I did feel disappointed in myself since I suspected it wasn't enough protein and potentially too many carbs and I didn't supplement the meal with anything else. But I didn't expect it to be that high.
I guess the key to eating take out successfully is to research the food first. What's sad is that I didn't really enjoy the entree very much anyway. It would be one thing to have a high glucose reading after enjoying a piece of chocolate or some homemade ice cream, but it was doubly disappointing to have a high reading after eating mediocre take out.
Sample Day #4
Here is my menu and glucose readings for 7/29:
Fasting BS: 94
Breakfast (7:40am):
1/2 peanut butter sandwich on Milton's Whole Wheat Plus bread
coffee w/cream and 1/2 tsp of turbinado sugar
20 minute walk
BS 1 hour after breakfast: 116
Snack (10:15am):
2 Rye Crisp crackers
1 oz cheese
Lunch (12:20pm):
Take out from Pei Wei:
brown rice, and Spicy Korean chicken
milk
BS 1 hour after lunch: 129
Snack (4:20pm):
Cottage cheese
fresh peach (chopped and mixed with the cottage cheese)
1 1/2 graham cracker sheets
Dinner (6:45pm)
Salad with tomatoes
deviled eggs
garlic flatbread (1/4 of flatbread from Trader Joe's freezer section has 25 g carbs)
milk
20 minute walk
BS 1 hour after dinner: 101
Snack (9:30pm)
peanut butter on 1 slice whole wheat with tsp of reduced sugar jam
milk
This was one of the few days I didn't have any high readings. Usually my fasting or post-breakfast or post-lunch glucose reading is high.
Fasting BS: 94
Breakfast (7:40am):
1/2 peanut butter sandwich on Milton's Whole Wheat Plus bread
coffee w/cream and 1/2 tsp of turbinado sugar
20 minute walk
BS 1 hour after breakfast: 116
Snack (10:15am):
2 Rye Crisp crackers
1 oz cheese
Lunch (12:20pm):
Take out from Pei Wei:
brown rice, and Spicy Korean chicken
milk
BS 1 hour after lunch: 129
Snack (4:20pm):
Cottage cheese
fresh peach (chopped and mixed with the cottage cheese)
1 1/2 graham cracker sheets
Dinner (6:45pm)
Salad with tomatoes
deviled eggs
garlic flatbread (1/4 of flatbread from Trader Joe's freezer section has 25 g carbs)
milk
20 minute walk
BS 1 hour after dinner: 101
Snack (9:30pm)
peanut butter on 1 slice whole wheat with tsp of reduced sugar jam
milk
This was one of the few days I didn't have any high readings. Usually my fasting or post-breakfast or post-lunch glucose reading is high.
Sunday, July 26, 2009
Sample Day #3
Gazpacho soup (part of dinner)Here is my menu and glucose readings for 7/27:
Fasting BS: 96
Breakfast (7:10am):
1/2 peanut butter sandwich on Milton's Whole Wheat Plus bread
1/4 cup cottage cheese (with less than a tsp of low sugar strawberry jam)
coffee w/cream
BS 1 hour after breakfast: 114
Snack (10:20am):
2 Rye Crisp crackers
1 oz cheese
Lunch (1:00pm):
Turkey, cheese, and avo sandwich on wheat bread
milk
1/2 diet Hansen's ginger ale
BS 1 hour after lunch: 117
Snack (4:00pm):
Cottage cheese
12 cherries (chopped and mixed with the cottage cheese)
2 mini chocolate biscotti from Trader Joe's (12 g carbs)
Dinner (6:30pm):
Homemade gazpacho soup
2 pork ribs (take out from the night before)
leftover pasta
milk
BS 1 hour after dinner: 93
I went for a 20 minute walk after breakfast and another after dinner. Since the morning walks have helped me keep my morning blood sugar in check, I have started putting a small dollop of reduced sugar strawberry jam in my cottage cheese at breakfast. 1 Tbsp of the jam has less than 5 g of carbs, so I thought that a tsp or less would be pretty insignificant while making it easier to eat.
I've settled into a pattern of having the same breakfast every morning. At first I didn't. But I'm generally too hungry and/or groggy to make something more advanced than peanut butter on bread with cottage cheese. My afternoon snack is pretty consistent, too. Cottage cheese with some kind of fresh fruit mixed in. Lately that has been peaches or cherries.
And then I was having 3 graham cracker halves for the other carb. But I discovered some chocolate and hazelnut mini biscotti at Trader Joe's that have only 6 g of carbs per biscotti. I know my guidelines said not to eat cookies, but I found out last Tuesday that I could have angel food cake with fresh (unsweetened) fruit and homemade whipped cream (no sugar), so I thought if some sugar in the AFC is OK, why not in something chocolate if it is less than my prescribed number of carbs? Not every day, but I thought I would try it out and see how it affected my blood sugar. I seemed to do OK with it. But I do plan to ask the dietitian if it is OK. It makes it a little more enjoyable to have a little treat now and then.
Parties
As I discovered Friday evening when we went to a get-together at a neighbor's house, eating at parties can be a challenge. The hostess knew I have gestational diabetes, but I told her not to worry about making anything special for me. I was still learning the diet at that point and just figured I'd work something out.
I figured there would be plenty of carbs in the form of crackers since it was an appetizer kind of event, and that there would be cheese for my protein. But I needed carbs from either milk or fruit and I didn't know if there would be fruit (and I was pretty sure they wouldn't be serving milk), so I just took some milk along with me in one of my son's thermos straw cups.
But when I got there, I looked at the crackers and pita chips and realized I had no idea how much I could have. I asked the hostess if she had the package from the pita chips, and she did find the nutrition info for me. I had about 6 pita chips which was under 30 g of carbs, and added a couple of Triskets. Then I loaded up on cheese and veggies and dip. I also found some little smokies, but just had 3 since I figured there was sugar in the sauce on them. There were jalapeno poppers that looked good, but I didn't know how many carbs were in the breading, so I just had one. I skipped the spanakopita, even though I figured the filo dough probably didn't have too many carbs.
I took my timer and my glucose monitor with me and tested after one hour. I was well under 130, so I apparently made good choices even without knowing all the nutritional information. I tried to err on the side of having more protein that required since I thought that would help if I had too many carbs unintentionally.
Aside from the milk I brought with me, I just drank ice water, which was fine with me. One neighbor who knew I was pregnant said she had meant to bring sparkling cider for me. I said that was OK because I couldn't have juice anyway. Later the hostess worried about finding something for me to drink besides water and even checked if they had diet soda around when she found out I couldn't have juice. I don't much care for artificial sweeteners and rarely drink diet soda, but I do get tired of only drinking water, milk and tea and will have diet soda if I want something sweet and carbonated.
The other issue that I find at parties is that I need to load up my plate at the start to control what I'm eating. I can't estimate my carbs and protein if I don't see it all on the plate at once and it's too easy to overeat if I keep going back for more. I'm used to grazing when I'm at social gatherings, so it's challenging to pack my plate at the start and then stop eating when I'm done. I know when we had a get-together here last weekend with some friends, I loaded up my plate at the beginning and after testing my glucose, I limited my snacking to low carb goodies like meats and cheeses and just very little bread until close to my nighttime snack.
I had thought on my way over to my neighbors' house the other night that surely it's OK to be more relaxed at a party, that it's unreasonable to follow the diet strictly all the time. But it's summer and there are going to be more social gatherings. I can't let my blood sugar spike every weekend just because we are going to a party. But I found it's not too hard to make good choices at a party, even without being able to read nutritional labels.
I figured there would be plenty of carbs in the form of crackers since it was an appetizer kind of event, and that there would be cheese for my protein. But I needed carbs from either milk or fruit and I didn't know if there would be fruit (and I was pretty sure they wouldn't be serving milk), so I just took some milk along with me in one of my son's thermos straw cups.
But when I got there, I looked at the crackers and pita chips and realized I had no idea how much I could have. I asked the hostess if she had the package from the pita chips, and she did find the nutrition info for me. I had about 6 pita chips which was under 30 g of carbs, and added a couple of Triskets. Then I loaded up on cheese and veggies and dip. I also found some little smokies, but just had 3 since I figured there was sugar in the sauce on them. There were jalapeno poppers that looked good, but I didn't know how many carbs were in the breading, so I just had one. I skipped the spanakopita, even though I figured the filo dough probably didn't have too many carbs.
I took my timer and my glucose monitor with me and tested after one hour. I was well under 130, so I apparently made good choices even without knowing all the nutritional information. I tried to err on the side of having more protein that required since I thought that would help if I had too many carbs unintentionally.
Aside from the milk I brought with me, I just drank ice water, which was fine with me. One neighbor who knew I was pregnant said she had meant to bring sparkling cider for me. I said that was OK because I couldn't have juice anyway. Later the hostess worried about finding something for me to drink besides water and even checked if they had diet soda around when she found out I couldn't have juice. I don't much care for artificial sweeteners and rarely drink diet soda, but I do get tired of only drinking water, milk and tea and will have diet soda if I want something sweet and carbonated.
The other issue that I find at parties is that I need to load up my plate at the start to control what I'm eating. I can't estimate my carbs and protein if I don't see it all on the plate at once and it's too easy to overeat if I keep going back for more. I'm used to grazing when I'm at social gatherings, so it's challenging to pack my plate at the start and then stop eating when I'm done. I know when we had a get-together here last weekend with some friends, I loaded up my plate at the beginning and after testing my glucose, I limited my snacking to low carb goodies like meats and cheeses and just very little bread until close to my nighttime snack.
I had thought on my way over to my neighbors' house the other night that surely it's OK to be more relaxed at a party, that it's unreasonable to follow the diet strictly all the time. But it's summer and there are going to be more social gatherings. I can't let my blood sugar spike every weekend just because we are going to a party. But I found it's not too hard to make good choices at a party, even without being able to read nutritional labels.
Friday, July 24, 2009
Exercise REALLY matters
So this morning, I went on a walk and took Aaron in the stroller. We were out for 25 minutes versus my 12 minute walk yesterday. My 1 hour glucose reading? 104. Again, I had the same breakfast as the 2 prior days when my readings had been 132 then 120. Keep in mind that at 6 1/2 months pregnant and pushing a heavy jog stroller with a 30-odd pound toddler, I'm not exactly power-walking. And we were even pausing to read numbers on mailboxes on the way back.
Last night, we took a longer walk than normal, by just a few minutes. Not only was my post-dinner reading lower, but my fasting blood sugar this morning was under 90, the first time in awhile.
I knew exercise was important to avoiding or delaying developing Type II diabetes, but I thought it was just because it helps you keep your weight down and generally makes you healthier. Until I started testing my blood sugar, I had no idea the dramatic effect it has on helping your body deal with glucose.
Last night, we took a longer walk than normal, by just a few minutes. Not only was my post-dinner reading lower, but my fasting blood sugar this morning was under 90, the first time in awhile.
I knew exercise was important to avoiding or delaying developing Type II diabetes, but I thought it was just because it helps you keep your weight down and generally makes you healthier. Until I started testing my blood sugar, I had no idea the dramatic effect it has on helping your body deal with glucose.
Thursday, July 23, 2009
Exercise matters
The dietitian had told us to try to exercise 10-20 minutes after each meal. I really didn't exercise at all until Sunday evening. In the mornings I had no energy, at lunch it was too hot, and evenings are tricky because by the time we are done with dinner, it was time to get Aaron ready for bed.
But I started to make an effort to have dinner in time for us to go for a walk together as a family in the evening. I didn't notice a huge difference the first two nights. But last night and the night before, my post-dinner glucose readings were in the high 90s - the first time they've been under 100 after a meal. And more importantly, I had rice for dinner, something that tends to drive blood sugar up.
One thing the dietitian pointed out on Tuesday was that my post-breakfast readings were high more often than after other meals. Usually by just a few points. But this is probably due to higher insulin resistance in the morning. So this morning after breakfast and before my 1 hour glucose test, I went out for a short walk, only about 12 minutes. My blood sugar 1 hour after breakfast? 120. The day before, it was 132 and I had the same breakfast both days - peanut butter on wheat bread with a side of cottage cheese, along with coffee and cream.
So I guess even a short walk can really make a difference. I'm going to try to keep up with the short morning walks since that is when I seem to need it the most. And it's actually nice outside at 7:30 in the morning.
But I started to make an effort to have dinner in time for us to go for a walk together as a family in the evening. I didn't notice a huge difference the first two nights. But last night and the night before, my post-dinner glucose readings were in the high 90s - the first time they've been under 100 after a meal. And more importantly, I had rice for dinner, something that tends to drive blood sugar up.
One thing the dietitian pointed out on Tuesday was that my post-breakfast readings were high more often than after other meals. Usually by just a few points. But this is probably due to higher insulin resistance in the morning. So this morning after breakfast and before my 1 hour glucose test, I went out for a short walk, only about 12 minutes. My blood sugar 1 hour after breakfast? 120. The day before, it was 132 and I had the same breakfast both days - peanut butter on wheat bread with a side of cottage cheese, along with coffee and cream.
So I guess even a short walk can really make a difference. I'm going to try to keep up with the short morning walks since that is when I seem to need it the most. And it's actually nice outside at 7:30 in the morning.
Wednesday, July 22, 2009
Take out
One of my biggest fears was that I wouldn't be able to eat out or get take-out much on this diet. Not that we do either very often, but being pregnant and having a toddler means there are some nights when I just plain don't want to cook.
For example, my first day on this new diet, I was so hungry and weak in the morning (probably from not having enough protein the day before) that I barely had energy to make lunch. I didn't want to deal with making dinner. So I had Thom bring home Daphne's Greek Cafe. I got the chicken kabob plate. It comes with rice, which I measured to make sure I only had 2/3 of a cup and it turned out that is exactly how much was included. I ate the rice, the chicken and veggies that were on the skewers, and the Greek salad, but gave the pita to my son. And I ate a peach with it to get my 3rd carb serving. Post dinner blood sugar level was 110! So my first non-home cooked meal worked out great.
We had been going to In-N-Out about twice a month recently. I ordered a cheeseburger and fries and Thom, Aaron and I split a milkshake. I'm still trying to figure out how to make that work since it is our favorite place to eat out as a family. I'm thinking I can order my burger protein style which reduces the carbs from 39g to 11g (oddly it also reduces the sodium by over 300 mg - who knew the buns were so salty?), skip my share of the milkshake, and just steal some of Thom's fries or only eat half an order (one serving has 54 g of carbs). And then I can either order milk (maybe pretend it is a milkshake) or bring some fresh fruit for my other carbs. Too bad a strawberry milkshake wouldn't count as my milk and/or fruit carbs.
For example, my first day on this new diet, I was so hungry and weak in the morning (probably from not having enough protein the day before) that I barely had energy to make lunch. I didn't want to deal with making dinner. So I had Thom bring home Daphne's Greek Cafe. I got the chicken kabob plate. It comes with rice, which I measured to make sure I only had 2/3 of a cup and it turned out that is exactly how much was included. I ate the rice, the chicken and veggies that were on the skewers, and the Greek salad, but gave the pita to my son. And I ate a peach with it to get my 3rd carb serving. Post dinner blood sugar level was 110! So my first non-home cooked meal worked out great.
We had been going to In-N-Out about twice a month recently. I ordered a cheeseburger and fries and Thom, Aaron and I split a milkshake. I'm still trying to figure out how to make that work since it is our favorite place to eat out as a family. I'm thinking I can order my burger protein style which reduces the carbs from 39g to 11g (oddly it also reduces the sodium by over 300 mg - who knew the buns were so salty?), skip my share of the milkshake, and just steal some of Thom's fries or only eat half an order (one serving has 54 g of carbs). And then I can either order milk (maybe pretend it is a milkshake) or bring some fresh fruit for my other carbs. Too bad a strawberry milkshake wouldn't count as my milk and/or fruit carbs.
Eating together
Since I work from home, I typically make dinner for my husband and myself (and oftentimes my son, but more often he wants dinner before Thom gets home from work). One challenge I face is trying to come up with meals that we both can enjoy. I don't expect Thom to follow a GD diet just because I am, but I also don't want to make separate meals. So for example, last night, we both had BLTs, but mine was made with whole wheat toast while his was made with rosemary olive oil toast. I also supplemented my meal with extra protein which he was content without.
Some meals are easier to accommodate. Stir fry - we both just eat brown rice now instead of white. Summer pasta (pasta with fresh tomatoes, basil, garlic and olive oil) - I just reduce my amount of pasta and increase my tomatoes and add a protein on the side, his meal stays the same.
Prior to being on this diet, I had little appetite and had trouble finding something I wanted to eat. Some nights, I just couldn't make up my mind, so I told Thom he was on his own and I would eventually put something together for myself, although it was often a PB&J sandwich on whole wheat bread, or a bowl of cereal. But now that I have to force myself to eat real food in proper proportions, it takes planning, so I'm pretty much always making meals for both of us. I still don't have my appetite back, though, but that has become irrelevant. I can no longer put off eating until I'm starving and just have to eat whether I feel like it or not. Most of the time, though, as long as I keep it varied, it's not too bad.
Some meals are easier to accommodate. Stir fry - we both just eat brown rice now instead of white. Summer pasta (pasta with fresh tomatoes, basil, garlic and olive oil) - I just reduce my amount of pasta and increase my tomatoes and add a protein on the side, his meal stays the same.
Prior to being on this diet, I had little appetite and had trouble finding something I wanted to eat. Some nights, I just couldn't make up my mind, so I told Thom he was on his own and I would eventually put something together for myself, although it was often a PB&J sandwich on whole wheat bread, or a bowl of cereal. But now that I have to force myself to eat real food in proper proportions, it takes planning, so I'm pretty much always making meals for both of us. I still don't have my appetite back, though, but that has become irrelevant. I can no longer put off eating until I'm starving and just have to eat whether I feel like it or not. Most of the time, though, as long as I keep it varied, it's not too bad.
Sample Day #2
LunchHere is my menu and glucose readings for 7/21:
Fasting BS: 98 (3 points high)
Breakfast (7:10am):
1/2 peanut butter sandwhich on Milton's Whole Wheat Plus bread
1/4 cup cottage cheese
coffee w/cream
BS 1 hour after breakfast: 127
Snack (11:00am):
2 Rye Crisp crackers
1 oz cheese
Lunch (1:30pm):
pasta (about 1/4 of package of Basil & Garlic fettuccine from Trader Joe's)
1 small zucchini, sliced, mushrooms, bell pepper, green onions
18 small, pre-cooked frozen shrimp (from Trader Joe's)
oliveoil
milk
Prep: I chopped all the veggies and sauteed them in olive oil until soft, then added the pasta (which was cold leftovers from the night before), then added thawed shrimp
BS 1 hour after lunch: 128
Snack (4:00pm)
1/2 cup cottage cheese
1 medium peach
Dinner (7:00pm):
BLT - whole wheat toast, mayo, lettuce, tomato, 2 slices bacon
hard boiled egg
1/2 cup cottage cheese
1 cup raspberries
Excercise (7:50pm): 10 min walk
BS 1 hour after dinner: 98
Snack (9:30pm):
3 graham cracker halves
peanut butter
milk
I'm not sure why my morning blood sugar level was elevated. That is the first time I've been over 95 when fasting. I've pretty much had the same snack every night before bed, too.
I was pretty full from lunch and didn't feel like eating a bigger afternoon snack than I did, but I should have included another carb. I wonder if this is why my post dinner reading was lower than usual. I usually have the same afternoon snack - cottage cheese with some kind of fruit. For my extra 15 g of carbs I add either graham crackers or milk.
For dinner, BLT's with tomatoes from our garden sounded really good, but since bacon doesn't count as protein, I needed to add 3 oz of protein to my plate. I had one hard-boiled egg left and used cottage cheese for the rest. Also, rather than using the leftover rosemary and olive oil bread we had from the weekend, I made mine BLT on Milton's Whole Wheat Plus bread. It wasn't the same, but at least I didn't feel guilty about eating it.
Tuesday, July 21, 2009
Sample Day #1
Caprese salad (see dinner)Here is my menu and glucose readings for 7/19:
Fasting BS: 84
Breakfast (7:10am):
2 hard boiled eggs
mini croissant (16 g carbs - from Trader Joe's freezer section)
BS 1 hour after lunch: 136 (6 points over)
Snack (9:30am):
1 slice Milton's Whole Wheat Plus bread
peanut butter
Extra snack due to hunger (10:30am):
1 rib celery
peanut butter
Lunch (12:20pm):
croissant sandwhich w/2 slices smoked turkey, 1 oz cheese, avocado
grapes
milk
carrot & zucchini sticks w/ranch dip
BS 1 hour after lunch: 108
Snack (3:30pm)
1/2 cup cottage cheese
1 cup raspberries
graham cracker
Dinner (6:45pm):
caprese salad (tomatoes, bufala mozzarella (about 3.5 oz), & basil)
1/6 of Trader Joe's seeded baguette (36g carbs)
milk
Excercise (7:15pm): 20 min walk
BS 1 hour after dinner: 115
Snack (9:30pm):
3 graham cracker halves
peanut butter
milk
We made croissants this Sunday morning because we had overnight guests. Due to the low carb count on them, I decided to have this for my breakfast carbs. I ended up a little high. The dietitian thinks it may be because they are mostly fat (from butter). But I had another one for lunch without a high reading, so she said it could also be that I'm just more insulin resistant in the morning.
Since caprese salad is one of my favorite summertime meals (we use tomatoes from our garden), I was excited to see that it didn't have a bad impact on my blood sugar. Although the walk may have helped, too.
Check-in with Dietitian
I had a follow up appointment with the dietitian this morning. There was also a registered nurse there as well. The good news is that I haven't gained any weight in the last week - I had previously been gaining a pound a week or more.
Although I had a few high post-breakfast and post-dinner glucose readings, she said my averages for the week were under 130. And none of my post-lunch readings were high. She said I was doing a good job with the diet and was pleased I am eating a variety of foods, as well as drinking plenty of milk. I don't need to go back for a month unless I find a pattern of high readings.
I asked if she thought I would have a harder time later in the pregnancy, since I've heard that increased hormones later in the pregnancy can make it even more difficult to keep blood sugar within normal ranges. But she didn't think I'd have any trouble given what I'm eating and how my numbers are. And given the fact that I'm already at 28 weeks.
Although I had a few high post-breakfast and post-dinner glucose readings, she said my averages for the week were under 130. And none of my post-lunch readings were high. She said I was doing a good job with the diet and was pleased I am eating a variety of foods, as well as drinking plenty of milk. I don't need to go back for a month unless I find a pattern of high readings.
I asked if she thought I would have a harder time later in the pregnancy, since I've heard that increased hormones later in the pregnancy can make it even more difficult to keep blood sugar within normal ranges. But she didn't think I'd have any trouble given what I'm eating and how my numbers are. And given the fact that I'm already at 28 weeks.
Monday, July 20, 2009
Unexpected consequences
When I started the gestational diabetes diet, I expected certain changes, such as reduced weight gain, feeling deprived of chocolate, hopefully feeling better as I controlled my blood sugar. But I've also noticed some unexpected changes.
Dairy - I'm eating much more dairy than I used to. Because of the way the diet is structured, I end up having 2-3 glasses of milk per day. I used to drink 1-2 glasses of milk before, just when I was in the mood for it. But now, since I need 3 servings of carbohydrates at lunch and dinner, and 2 servings at each snack after lunch, and not all of those can come from starches, I have to either drink milk (or eat yogurt) or eat fruit. But I'm limited to 2 servings of fruit per day, meaning that I'm forced to have milk at least twice per day. And since my favorite afternoon snack has become cottage cheese and fruit, I'm getting extra dairy there, too. In the long run it is good for me. And I'm just glad I no longer have a problem with lactose intolerance.
No more sharing - I used to happily give Aaron anything from my plate that he showed interest in. He eats pretty well and I like to expose him to a variety of foods. But now, I feel like hungry, snarling animal, protecting my plate of measured portions and snapping at anyone who comes close. OK, maybe it's not that bad, but I definitely don't give up food easily. If I have something I know Aaron will want, I'll try to put extra on my plate to account for what he might eat. But typically it is only veggies that I will give up willingly. My carbs are measured out more precisely, as well as my protein, so I make him go to his dad's plate for those things (if we are all eating together).
Planning - I used to just have to plan my days around Aaron's nap - something too valuable to me to skip or interfere with. Now, I have to plan around meals and snacks. I have to eat every 2-3 hours and I have to test my blood sugar 1 hour after each meal. On Friday, I had a haircut scheduled for noon. I suddenly realized I'd have to carefully plan my morning so I had breakfast, snack and lunch 2 hours apart and was finished with lunch in time for my appointment. But it wasn't until I sat down to eat that I realized I was going to have to take my glucose monitor with me to test my blood sugar during my haircut. It's not a big deal, but it just takes some getting used to.
Focus on the numbers - I find that I focus on my glucose numbers like some people focus on their weight when they have a scale in their house (I don't have one for this reason). I feel a little depressed when my blood sugar is up over 130 after a meal (although it's never been over 140). I even feel a little bad when it is close, but not over, like I could have done better. And I give myself a silent cheer when it is closer to 100 than 130, or when my fasting level is well under 95 in the morning. Although I know it is important to keep my blood sugar in check, I know I shouldn't focus on it so much. I can't seem to help it, though. When I go over my numbers with the dietitian tomorrow, I'm hoping she will convince me that the slight amount I've gone over isn't so bad. I expect that most women with gestational diabetes have a few really high readings and that I don't need to feel bad about a few slightly elevated ones.
Another thing that surprised me was how quickly I have become used to the new diet. I thought I'd feel more deprived that I do. Of course I miss the sweets I can't have, but I find that I have been able to adjust my mindset so that I don't focus too much on what I can't have and instead focus on what I can. I definitely enjoy fruit a lot more than I used to.
Dairy - I'm eating much more dairy than I used to. Because of the way the diet is structured, I end up having 2-3 glasses of milk per day. I used to drink 1-2 glasses of milk before, just when I was in the mood for it. But now, since I need 3 servings of carbohydrates at lunch and dinner, and 2 servings at each snack after lunch, and not all of those can come from starches, I have to either drink milk (or eat yogurt) or eat fruit. But I'm limited to 2 servings of fruit per day, meaning that I'm forced to have milk at least twice per day. And since my favorite afternoon snack has become cottage cheese and fruit, I'm getting extra dairy there, too. In the long run it is good for me. And I'm just glad I no longer have a problem with lactose intolerance.
No more sharing - I used to happily give Aaron anything from my plate that he showed interest in. He eats pretty well and I like to expose him to a variety of foods. But now, I feel like hungry, snarling animal, protecting my plate of measured portions and snapping at anyone who comes close. OK, maybe it's not that bad, but I definitely don't give up food easily. If I have something I know Aaron will want, I'll try to put extra on my plate to account for what he might eat. But typically it is only veggies that I will give up willingly. My carbs are measured out more precisely, as well as my protein, so I make him go to his dad's plate for those things (if we are all eating together).
Planning - I used to just have to plan my days around Aaron's nap - something too valuable to me to skip or interfere with. Now, I have to plan around meals and snacks. I have to eat every 2-3 hours and I have to test my blood sugar 1 hour after each meal. On Friday, I had a haircut scheduled for noon. I suddenly realized I'd have to carefully plan my morning so I had breakfast, snack and lunch 2 hours apart and was finished with lunch in time for my appointment. But it wasn't until I sat down to eat that I realized I was going to have to take my glucose monitor with me to test my blood sugar during my haircut. It's not a big deal, but it just takes some getting used to.
Focus on the numbers - I find that I focus on my glucose numbers like some people focus on their weight when they have a scale in their house (I don't have one for this reason). I feel a little depressed when my blood sugar is up over 130 after a meal (although it's never been over 140). I even feel a little bad when it is close, but not over, like I could have done better. And I give myself a silent cheer when it is closer to 100 than 130, or when my fasting level is well under 95 in the morning. Although I know it is important to keep my blood sugar in check, I know I shouldn't focus on it so much. I can't seem to help it, though. When I go over my numbers with the dietitian tomorrow, I'm hoping she will convince me that the slight amount I've gone over isn't so bad. I expect that most women with gestational diabetes have a few really high readings and that I don't need to feel bad about a few slightly elevated ones.
Another thing that surprised me was how quickly I have become used to the new diet. I thought I'd feel more deprived that I do. Of course I miss the sweets I can't have, but I find that I have been able to adjust my mindset so that I don't focus too much on what I can't have and instead focus on what I can. I definitely enjoy fruit a lot more than I used to.
Thursday, July 16, 2009
My GD Diet
Here are the basics of what I learned in my class on managing gestational diabetes.
Basically it is all about counting carbs, and eating protein at every meal/snack. A serving of carbs is 15 grams. Foods fall into the following categories:
Milk/Yogurt
Starches (bread, pasta, potatoes, corn, beans, etc)
Fruit
Vegetables
Protein (meats, peanut butter, eggs, cheese, etc)
Fats
The first three categories comprise "carbs". But all carbs are not created equal. Before noon, I cannot have anything from the Milk or Fruit categories. Apparently this has to do with how pregnancy hormones affect you in the AM. I guess they supress insulin's effectiveness more in the morning, making glucose spikes more common. (Your body treats lactose in milk and fructose in fruit the same as any kind of sugar.)
I need to eat 3 meals and 3 snacks a day, spaced out 2-3 hours apart. The guidelines are as follows:
Breakfast
15 g of carbs (from the Starch group only)
1-2 servings of vegetables
1-2 oz of protein
1-2 servings of fats
Example: 1/2 english muffin with egg and melted cheese and tomato, coffee with cream (cream is a fat - there are no carbs in cream, so cream is OK in coffee while milk in the AM is not allowed).
AM Snack
15 g of carbs (from Starch group only)
1 oz protein
Example: slice of whole wheat toast with peanut butter
Lunch
45 g of carbs (3 servings from at least 2 of the carb categories)
1-2+ servings of vegetables
3 oz of protein
1-2 servings of fats
Afternoon Snack
30 g of carbs (2 servings from the carb categories)
1 oz protein
Dinner
45 g of carbs (3 servings from at least 2 of the carb categories)
1-2+ servings of vegetables
3 oz of protein
1-2 servings of fats
Bedtime Snack
30 g of carbs (2 servings from the carb categories)
1 oz protein
In addition to the individual meal guidelines, I am not supposed to have more than 2 servings of fruit a day or more than 3 servings of milk/yogurt. Also, no more than 2 portions of starch at lunch or dinner or more than one portion for snack.
The following are forbidden altogether:
Fruit juice and all sweetened drinks (i.e. soda, lemonade, etc)
Sugar, honey, jam, jelly, pie, cake, etc
Artificial sweeteners are allowed (no more than 3 servings a day), but I don't like them anyway.
Oh, there are also some "free" foods. These are foods where one serving is less than 20 calories and less than 5g total carbs so you don't have to worry about them. They include:
bouillon
broth
cilantro & parsley & herbs
decaf coffee and tea
garlic
lettuce
lemon
mustard
salsa
soy sauce
vinegar
diet soda, sugar free gelatin, sugar free drink mix
Nothing you can really fill up on.
I asked the dietician what would be the best way to deal with cheating - knowing that at some point I'll have to have a cookie or birthday cake. I wanted to know if it was better to do it after eating a lot of protein or something. She said to walk. Walking right after eating helps with glucose absorbtion. I'm supposed to walk 10-20 minutes after each meal, before checking my blood sugar anyway. Maybe a longer walk is warranted if I eat some ice cream with dinner.
Basically it is all about counting carbs, and eating protein at every meal/snack. A serving of carbs is 15 grams. Foods fall into the following categories:
Milk/Yogurt
Starches (bread, pasta, potatoes, corn, beans, etc)
Fruit
Vegetables
Protein (meats, peanut butter, eggs, cheese, etc)
Fats
The first three categories comprise "carbs". But all carbs are not created equal. Before noon, I cannot have anything from the Milk or Fruit categories. Apparently this has to do with how pregnancy hormones affect you in the AM. I guess they supress insulin's effectiveness more in the morning, making glucose spikes more common. (Your body treats lactose in milk and fructose in fruit the same as any kind of sugar.)
I need to eat 3 meals and 3 snacks a day, spaced out 2-3 hours apart. The guidelines are as follows:
Breakfast
15 g of carbs (from the Starch group only)
1-2 servings of vegetables
1-2 oz of protein
1-2 servings of fats
Example: 1/2 english muffin with egg and melted cheese and tomato, coffee with cream (cream is a fat - there are no carbs in cream, so cream is OK in coffee while milk in the AM is not allowed).
AM Snack
15 g of carbs (from Starch group only)
1 oz protein
Example: slice of whole wheat toast with peanut butter
Lunch
45 g of carbs (3 servings from at least 2 of the carb categories)
1-2+ servings of vegetables
3 oz of protein
1-2 servings of fats
Afternoon Snack
30 g of carbs (2 servings from the carb categories)
1 oz protein
Dinner
45 g of carbs (3 servings from at least 2 of the carb categories)
1-2+ servings of vegetables
3 oz of protein
1-2 servings of fats
Bedtime Snack
30 g of carbs (2 servings from the carb categories)
1 oz protein
In addition to the individual meal guidelines, I am not supposed to have more than 2 servings of fruit a day or more than 3 servings of milk/yogurt. Also, no more than 2 portions of starch at lunch or dinner or more than one portion for snack.
The following are forbidden altogether:
Fruit juice and all sweetened drinks (i.e. soda, lemonade, etc)
Sugar, honey, jam, jelly, pie, cake, etc
Artificial sweeteners are allowed (no more than 3 servings a day), but I don't like them anyway.
Oh, there are also some "free" foods. These are foods where one serving is less than 20 calories and less than 5g total carbs so you don't have to worry about them. They include:
bouillon
broth
cilantro & parsley & herbs
decaf coffee and tea
garlic
lettuce
lemon
mustard
salsa
soy sauce
vinegar
diet soda, sugar free gelatin, sugar free drink mix
Nothing you can really fill up on.
I asked the dietician what would be the best way to deal with cheating - knowing that at some point I'll have to have a cookie or birthday cake. I wanted to know if it was better to do it after eating a lot of protein or something. She said to walk. Walking right after eating helps with glucose absorbtion. I'm supposed to walk 10-20 minutes after each meal, before checking my blood sugar anyway. Maybe a longer walk is warranted if I eat some ice cream with dinner.
Diagnosed with Gestational Diabetes
After failing my 1 hour glucose tolerance test at 24 weeks, I had to schedule a fasting 3 hour glucose test. I'm 35 and have a family history of Type II diabetes and gestatinal diabetes (my sister had it and my mom believes she had an undiagnosed case when she was pregnant with me). The 3 hour test was miserable, but I got through it.
When my OB called later that afternoon, I knew it wasn't good news. He told me my fasting level was fine, but 3 of the other tests were elevated, although 2 were only slightly so. He said it was a mild case which he thought I could easily control it through diet. He enrolled me in the medical group's gestational diabetes program and said someone would call with details. There was a class to attend, then follow up sessions, and of course monitoring my blood sugar with a glucose monitor.
I searched online for sample GD diets so I could start to watch what I eat before the first class. I could only find a few, and the ones I found contradicted what my sister had told me about her diet. They even included 100% juice with breakfast, when I have since learned that any juice is a no-no, not just at breakfast.
I've been following the dietary restrictions I was given by the dietician on Monday and have been able to keep my glucose levels in check. The first day was the worst. I felt weak and tired all morning and depressed that I would have to forgo all sweets for 3 months. But each day is easier. I decided to record my meals and corresponding blood sugar levels online as a resource for others diagnosed with gestational diabetes and looking for meal ideas.
When my OB called later that afternoon, I knew it wasn't good news. He told me my fasting level was fine, but 3 of the other tests were elevated, although 2 were only slightly so. He said it was a mild case which he thought I could easily control it through diet. He enrolled me in the medical group's gestational diabetes program and said someone would call with details. There was a class to attend, then follow up sessions, and of course monitoring my blood sugar with a glucose monitor.
I searched online for sample GD diets so I could start to watch what I eat before the first class. I could only find a few, and the ones I found contradicted what my sister had told me about her diet. They even included 100% juice with breakfast, when I have since learned that any juice is a no-no, not just at breakfast.
I've been following the dietary restrictions I was given by the dietician on Monday and have been able to keep my glucose levels in check. The first day was the worst. I felt weak and tired all morning and depressed that I would have to forgo all sweets for 3 months. But each day is easier. I decided to record my meals and corresponding blood sugar levels online as a resource for others diagnosed with gestational diabetes and looking for meal ideas.
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