We've covered what gestational diabetes is, how it's diagnosed, some controversies surrounding both of those things, and what the standard medical treatment for diabetes during pregnancy is. This post is going to take a look at how to control diabetes through diet and lifestyle changes, and how to monitor pro-actively while taking charge of your health care team.
As a reminder, I tend to be unapologetic (and certainly not politically correct) about pregnancy issues. I also believe strongly that as mothers we need to be in charge of our care – part of which means being educated and proactive about doing what is best for ourselves and our babies.
Food is Medicine (and Food is Deadly)
Treating gestational diabetes holistically first requires understanding that pregnant women naturally become insulin resistant to make sure the baby is getting the glucose that he or she needs for the brain.
This means that a pregnant woman does not need to get a lot of sugar in her diet.
Secondly, you need to understand that the current “ideal diet” model given to pregnant women (and everybody) is very high in sugar levels.
Yes, it recommends whole grains, wholemeal, etc. At the risk of sounding very repetitive, it doesn't matter how whole your grains are or how complex your carbohydrates are – your body still converts them all to SUGAR.
Pregnancy is a time when your body has greatly increased nutritional needs. You ARE eating for two. But you do not need to eat the standard modern diet for two. You don't need to eat junk food for two. And you really don't even need to eat carbohydrates for two.
Your amazing pregnant body is already more resistant to insulin, so the sugar that does go into your body will stay in your blood stream longer. You need to stay on low levels of carbohydrates and get plenty of fat and protein.
All Pregnant Moms Need Protein and Fat
A pregnant woman carrying a singleton needs around 80-100g of protein per day. You'll need more if you're carrying multiples. Aside from this protein, the majority of your calories should come from fat, not carbohydrates.
An appropriate level of protein and plenty of fat calories produces a healthy baby. Adequate protein (and salting to taste) help keep pregnancy complications like pre-eclampsia from developing. It keeps blood sugar levels even and helps stop blood sugar spikes.
This has been shown to be true over and over again in non-pregnant diabetic patients. There's a persistent fear, however, that somehow a low-carbohydrate diet is dangerous. This fear transfers over into paranoia when it comes to pregnancy. It is not true that a low-carbohydrate diet is dangerous to pregnant women. You're going to get some carbohydrates every day if you're eating a lot of vegetables, if you're having any dairy products, and if you're having fruit here and there. But if you cut out the complex carbohydrates (grains) and keep out the sugary junk food, your levels are going to be much, much lower than the standard modern advice.
Special Considerations for Gestational Diabetes
I have long advocated a sensible diet like the Brewer Diet or Chris Kresser's Healthy Baby Code for pregnancy. Both of these programs allow small amounts of starchy foods such as potatoes, sweet potatoes, and rice. If you're struggling with gestational diabetes, however, I recommend you avoid even these. Stick with lots of low-carbohydrate vegetables (broccoli, cabbage, mushrooms, peppers, onions, green beans, and basically all greens such as salad greens and spinach, for example). Avocados and olives are lovely treats. You may want to have lower-carbohydrate fruits like blueberries from time to time, or a few tomato slices. Having them with plenty of fat, such as with a bowl of cream, is a good idea. A square of dark chocolate from time to time is another nice treat.
We often eat carbohydrate foods as a snack and to satisfy mild hunger. You should get your satisfaction from fats instead. Both of the pregnancy diet programs I referenced cover the importance of fats in your diet. Fat helps your baby's brain grow. As long as they are good fats (butter and other dairy fats, animal fats, coconut oil, olive oil, olives, avocados, fish oils, etc) these are great for you and for your baby. Serving your vegetables with fats causes you to actually enjoy them and feel satisfied. I have found that one of the best ways to eat meats during pregnancy is with a rich reduction sauce (a sauce of homemade broth and the drippings from a roast chicken or pot roast).
Meet an Experiment
Megan is 34 weeks into her 5th pregnancy as of the date of this writing. Until this time around, pregnancy was rough for Megan – she had severe gestational diabetes with each of her previous four babies, as well as complications from pre-eclampsia.
I found her via her blog while I was looking for real stories of moms dealing with gestational diabetes and treating it in a way different than conventional wisdom dictates. I found myself spending the next few days reading every single post, then emailing her for an update!
This amazing mama is even more amazing for how well she has advocated for herself and for the baby she's carrying on board. She's working with a maternal-fetal medicine specialist, and I think even her doctor is floored with how well things are going.
Megan and her husband, “Mr. Marine”, moved to a low-carbohydrate diet before she fell pregnant with their current baby. She felt pretty convinced that the total lifestyle change that the diet brought would be good for her newly conceived baby and help keep her blood sugar levels under control.
She's worked with her doctor and is religiously monitoring her blood sugar levels. Post-meal levels are good. Her fasting level was a little high for the doctor to feel comfortable with, so she does take an oral medication (Glyburide) to help control fasting blood sugar levels (remember, this is the level when you first wake up in the morning).
Megan is following what is generally called the “Paleo” diet – a very low-carbohydrate diet that emphasizes fat and protein. At this point she's excited that she's hit 34 weeks with no insulin, no major problems, and a healthy pregnancy for herself and her son. I think she's an awesome and amazing inspiration.
Talking with Your Care Provider
Like Megan, you have to learn to be an advocate for yourself and your baby. If you read her story you'll find that, especially in the beginning, she met with resistance to do things “differently” – but she persisted.
This is almost always the case during pregnancy when you want to do something different from the norm. Even if you have a home birth midwife you may find you need to advocate for something you want for you and your baby that is “different” from what she normally does! Now is the time to learn to be an advocate for your child.
If you have failed an oral glucose tolerance test and you think it was a false failure (which may in fact be the case if you're following a healthy pregnancy diet, especially if you're normally only getting lower levels of carbohydrates), you should tell your doctor or midwife that you want to monitor your blood glucose levels over the next few weeks while you eat your normal diet. There's a good chance they'll be fine.
If your levels are elevated (remember levels are naturally elevated slightly during pregnancy) and it's decided to keep your diagnosis, be ready to advocate. Plan to follow a diet that will minimize insulin spikes while still nourishing you and your baby.
It's really hard during pregnancy, but drop the grains and starches that cause spikes. Get plenty of protein, and especially plenty of fat. You and your baby will need the fat for energy since you won't be fueling your energy needs with carbohydrates. The fat spares the protein so it goes towards building your baby. Your vegetables will give you lots of vitamins and minerals – and the fat you're getting will make sure you're actually absorbing them.
Let your care provider know that you're being aggressive with treating this through diet and lifestyle. Think of your baby and his or her health when the going seems tough. When your pregnant buddies are reaching for ice cream and saltines you need to go for a plate of broccoli and hollandaise or a bowl of chicken soup (salted to taste!) I know first-hand how hard it is to stand up to cravings for carbohydrates during pregnancy (and I'm the gal that sounds like a broken record about pregnancy diet!)
Also plan out an exercise routine that will help your body use sugar. I don't think you should go all out and exhaust yourself (though if you do training such as Crossfit it is thought to be safe for pregnancy – adjust your nutrition to account for it, please). But plan to walk daily and perhaps do some prenatal yoga. Then add in something more active a couple of times a week, like prenatal belly dance. I use prenatal belly dance as an example because it will really get you moving, work your muscles, and help you bond with your baby. Any exercise that fits that description is a good idea a couple of times a week.
Again, tell your care provider about your diet and exercise plans. Insist that they review your recorded post-meal (postprandial) blood sugar readings.
Your care provider will probably want to see you for extra appointments and may want to monitor your baby via ultrasound more actively. You talk with him or her and decide what you feel comfortable and what you together feel is prudent.
You Lead Your Team
If your doctor, like Megan's, would like to try an oral medication you can weigh the pros and cons and discuss it in light of what your blood sugar readings look like. Megan also has an extra snack in the evening to deal with fasting levels – you and your doctor can together discuss strategies like this.
It's impossible for me to account for every situation, because every woman is unique. It is possible that your midwife will want to transfer you to an obstetrician's care if you fail a glucose tolerance test. However, I highly recommend that you request fair monitoring.
You want to know what your blood sugar levels are doing around the clock and on a day-to-day basis. Ask for a prescription for a monitor and use it religiously. These readings and your regular prenatal checkups are what help you and your care provider to intelligently plan your care and plan your situation.
You want your baby to be healthy and happy. That's usually what your care provider wants to. Use a care provider who sees you as an intelligent and proactive woman. Do not stay with a care provider who sees you as just another case of gestational diabetes. Though he or she must deal with many women like that, YOU are not one of them.
Again, be sure your care provider understands you are doing the research, and you are staying on top of things. Feel free to share the research that you find with your care provider. It can be intimidating to do so. It's always hard to be different and to stand up to someone you see as an “authority.” But you're talking about the best outcome for you and your baby. You want to do what research and evidence prove to be true. And that is that a low-carbohydrate diet with good levels of protein and fat nourish healthy babies while keeping a mother's blood sugars at normal (for pregnancy) levels.
As you and your care team see that things are well under control and that you're healthy moving into late pregnancy and towards your baby's birth, you can advocate for the things you'd like with the birth and immediate postpartum time for your baby.
Further Resources
To read more about Megan's journey, check out her latest Experimental Life Update – you'll find links to all her previous updates in that post. Also click on “I'm a Caveman” for more details on how she's eating these days 🙂 (Note: Checked on 12/11/2016, site no longer exists)
I had GD in all 3 of my pregnancies. I was working with a naturopath who also attended births, and another midwife. I did a very low carb diet, mild exercise, supplements (such as chromium, and chinese herbs based on the symptoms I had), tested/recorded my sugar before *every* snack or meal (and I needed to eat every 2-3 hours, even during the night, to keep my sugars stable), and kept a daily food diary. I found what foods worked for me in each pregnancy (it did vary), but I was able in each instance to birth my children out of the hospital (1st in a stand-alone homebirth midwife’s birth center, and the other two at home!) and all 3 were between 7.5-9 lbs at birth, happy, healthy, and no post-partum blood sugar crashes for any of them… just know that it can be done, if you’re committed to it. 🙂