Gestational Diabetes

Please note:  I am not medically trained - this has been taken from my own personal experiences.  Before commencing any diet, please seek medical advice.

Gestational Diabetes - two words that I really didn't want to hear.

I had been diagnosed with GD in my previous pregnancy at 28 weeks and had a complete nightmare.  I was told to control it with diet, but received very little support so within a week I was on Metformin tablets.  Three weeks later, these were not controlling my glucose levels so I was given Glyburide to take in conjunction with Metformin but by 35 weeks, the growth scan showed my baby was already 9lbs and so they decided to give me steroids to develop his lungs then carry out a c-sec at 36 weeks. This involved a sliding insulin scale and a stay in hospital prior to delivery.

Fortunately, he was perfect and required no extra immediate intervention, although he did become hypoglycemic and was taken to Special Care for a few hours (a whole other story!)

My glucose levels returned to normal straight after delivery.

I then carried on as normal - enjoying the fact that I no longer had to worry about what I was eating, so I truly made up for those few weeks of restricted diet, and, within a year, I weighed more than when I was pregnant, despite breastfeeding.

We decided that we would like to have another child, but all research pointed towards a high chance of getting GD in subsequent pregnancies.  I felt that I couldn't justify putting myself and another baby through such a difficult pregnancy again without giving myself as much of a head start as I could.  To this end, I joined Slimming World and lost 3 and 1/2 stones over 7 months.

When I fell pregnant, I was still classed as "Overweight" with a BMI of 28, but I knew I had done all I could.  My first blood tests came back as normal, and apart from the usual morning sickness that lasted all day, I felt ok. I was under Consultant Led Care at the hospital but they were happy enough with my progress to wait until 28 weeks for a Glucose Tolerance Test, as long as I had normal urine tests with my midwife every 2 weeks.

Unfortunately, at 18 weeks, things started to go wrong.  I began to get severe dizzy spells, with shaking and confusion.  I recognised this as related to my glucose levels and so took my readings at home.  I was having a hypoglycemic attack and my levels were 3.1.  I spoke to my midwife and didn't really get any answers, but over the coming couple of days, I was getting up to 4 a day.  It took up to 6 hours to recover each time and I knew this really wasn't right.

I found the telephone number for the Gestational Diabetic Nurses at my hospital and rang them directly.  I was referred to the Diabetic Consultant and was seen within days.  He was very concerned with my levels and sent me for a fasting blood test to rule out pancreatic cancer.  Thankfully, this came back negative, but it took two weeks to get the results back, which was obviously a very worrying time. 

By the time the results came back, I was getting fewer hypos but my glucose levels were beginning to rise.  I was self testing four times a day and was supposed to keep my figures below 7.8 two hours after eating.  I was regularly hitting above this, particularly after breakfast or any high carbohydrate meal.  I recognised my hypos as my pancreas attempting to function, but working to hard, then my hypers as it really beginning to give up.  I was completing a food diary and was following what I thought was a healthy diet, and one that they were happy with - Weetabix or plain porridge for breakfast and a slice of toast, sandwich and crisps for lunch, normal home cooked evening meal, plus snacks of fruit in between.

On returning to see my consultant, he immediately prescribed 500mg Metformin, once a day, three days later increasing it by a further 500mg, then a further 500mg, and then a final 500mg until I was on the highest dose.  Luckily, I only suffered mild stomach discomfort with the increasing dosage but was extremely disheartened as I knew the next step would be Glyburide and I was still only 24 weeks pregnant.  Having experienced one premature delivery, I was determined to carry this pregnancy further.  I was happy to take Metformin as there were no apparent after effects having taken it with my son.

The high glucose levels were affecting my day to day life.  After eating, I was having to sleep - this was no ordinary pregnancy lethargy - it was more like passing out for an hour as I truly couldn't function.  The stress of attempting to control my diet but still failing to control my levels was becoming more and more depressive.  I was so upset because there was a research paper released and widely publicised about GD and how it was caused by being overweight and unhealthy, and would lead to my children being obese.  In my case, yes, I was a bit overweight, but within the recommended BMI measurement, but my father had been diagnosed with Type 2 at 55 years old and had eventually died due to complications from it nearly 30 years later.  My mother had Type 2, too, before she died.  I felt embarrassed admitting that I had GD as I thought everyone was judging me, and then, by not being able to control it, I felt I was failing my unborn baby and family.

I searched and searched the Internet for information on GD - reading other people's experiences and different research papers.  What I really wanted was a simple diet plan, telling me exactly what to eat and when.  I was beginning to see a pattern in my levels but still had no answers.  I then read about GI levels in foods and how following a low GI diet reduces your glucose levels and stabilises them.  By combining proteins and carbohydrates and making other sensible food choices, I developed my own eating plan by looking at the quantity of carbohydrates food contained.

My body was almost completely unable to process carbohydrates in the morning, therefore, cereals were out of the question.  I had thought Weetabix with no sugar would be ok as I perceived it as a healthy option but when I looked at the carbohydrate content, I knew I needed to try something different.  I then moved onto plain "Oats So Simple" as porridge has a higher protein content to offset the carbohydrates.  The dietitians were happy with this low GI option but my body couldn't cope, plus I was hungry again within an hour of eating.  I would hold off eating until after my 2 hour post blood test, but I was so unhappy and my levels were still too high.

I continued reading and tried a suggestion of a very low carbohydrate breakfast of 3 egg cheese omelet.  Finally, I had success.  My levels were down to 5 to 6 two hours after eating and I was no longer feeling ravenous.  I then worked out healthy snacks which didn't include another thing which I had assumed healthy - low fat yogurt - in fact very high in sugar!  Lunch of a homemade wholemeal sandwich and crisps kept me within my limits, but my evening meal was still an issue.  I couldn't understand how grilled pork chops with carrots and mashed potatoes could send my levels soaring.  It was a low calorie meal with protein to offset the carbohydrates.  But, I found mashed potato has a very high GI level.  By substituting new potatoes for mash, I lowered the GI level of my meal and kept my target levels.

I found other food affected me badly like Baked Potatoes, Baked Beans, anything with white flour, white rice or white pasta.  Diet drinks, although they didn't immediately affect my levels, did make me crave sweet stuff.

The diet I followed was extremely restricted but very healthy. Every time I wanted something that was going to send my levels off, I thought of my little baby growing inside me.  She hadn't asked for me to be her mother and deserved the best start I could give her.  I pictured her floating around in sickly sweet amniotic fluid and growing too big, too soon, and therefore being born prematurely, with all the complications that could entail.  She shouldn't have to deal with the fallout from my selfishness.  Plus, as I've already said, high levels made me so lethargic, my other children were suffering,

Saying that, there were times I treated myself.  One of the random treats I found which had a positive effect, was McDonald's!  I found I could eat a Big Tasty medium meal, with Diet Coke, and my levels were still within target afterwards!  McDonald's breakfasts were a no-go though.

I couldn't eat Chinese takeaway, but Indian was ok (chicken massalla, 1/2 portion of pilau rice, few chips and 2 poppadoms).

After further experimentation, I was able to add a slice of wholemeal toast to my breakfast and swapped out the omelet for 2 fried eggs, 2 slices bacon and 4 sliced mushrooms.  I used proper butter on my toast as butter seemed to have a positive effect, plus it made the wholemeal toast more bearable! Any fruit juices were a definite no, any time of the day, but fruit was fine after 11am.

I was struggling to sleep through the night because I was so hungry and I have always loved breakfast cereal as supper so found that Weetabix with warm milk was perfect.  My body struggled most to process carbohydrates in the morning, so this was a perfect finish to the day as although higher GI than porridge, it was something I loved and the sweetness helped curb my craving for chocolate before bed.

My experience was all about trial and error but I made a promise to myself to write down what I had discovered and share it with others to show that there is light at the end of the tunnel.  It was truly one of the hardest things I have had to deal with over such an extended period but if I can do it, anyone can.  I hope by sharing I may reduce some frustration another GD mum may be experiencing and give them somewhere to start with taking control of their own journey.

Sample day:

Breakfast (8am)

 3 egg cheese omelet, or

1 Wholemeal toast, butter, 2 fried eggs, 2 bacon, 4 mushrooms

De-caf tea

Water

Snack (10.30am - after post 2 hour blood test)

Apple, sliced

1 - 2 tablespoons peanut butter

De-caf tea

Snack (11.30)

2 Satsumas

Water

Lunch (1pm)

Sandwich - 2 slices wholemeal bread, Flora Light, ham/cheese/tuna/chicken/prawns (any high protein)

Packet of crisps (Multipack size, not standard)

Small chocolate biscuit, like a Club, Penguin, Rocky etc.

Snack (3.30pm - after post 2 hour blood test)

Celery / Carrots

Cheese

5 Ritz biscuits

Evening Meal (5.30pm)

New Potatoes

Veg

Meat or;

Spaghetti Bolognese with Wholewheat Pasta or;

Roast Dinner

Snack (8pm - after post 2 hour blood test)

Melon

Supper (10.30pm)

Weetabix

The Bad	The Good
White Flour	Wholemeal Flour
White Bread	Wholemeal Bread
White Pasta	Wholemeal Pasta
White Rice	Brown Rice
Tomato Soup (check out the sugar content!)	Chicken Soup / Leek & Potato Soup
Baked Beans	Tinned Spaghetti
Chocolate	Peanut Butter
Fruit Juice	Water
Diet Drinks	Weak Low Sugar Squash
Pizza	Same toppings on a slice of Wholemeal Toast
Mashed Potato	New Potatoes
Jacket Potato with Baked Beans	Jacket Potato with Tuna (Eat the skin!)
Sweet Biscuits	Ritz Biscuits with Peanut Butter
Sweet Quick Snacks	Cheese, Ham, Pre-cooked Chicken, Raw Carrots, Celery
Tomato Ketchup	Vinegar
Low Fat Yogurts	Low Sugar Angel Delight
Cake	Ice Cream
	Any Meat
	Any Fish
	Cooking Oils
	Eggs
	Butter

And so, how did it all pan out?

Katherine Elizabeth was born at 38w4d by c-sec, weighing a very healthy 8lbs8oz.  I still had to have steroids prior to delivery and was admitted for this and put on a sliding insulin scale, but this was due to my hospital's policy on elective c-secs.  The c-sec was carried out due to other medical reasons and not because of my GD.  Up to being admitted for steroids, I controlled my levels using the maximum dosage of Metformin and diet.  Exercise was ,unfortunately, not an option as I had quite severe SPD.  By the time I delivered, I had only put on 18lbs, which I lost immediately after delivery.

Katie was perfect and alert at birth, breast fed within an hour and had loads of skin to skin contact.  Unfortunately, she still became hypoglycemic and required heel pin pricks before every breast feed, for the first 24 hours.  She received a total of 20ml formula milk supplement by cup feed, over the first 6 hours, and this stabilised her levels sufficiently so that she didn't need to be taken to Special Care, while my milk was coming in.

My consultant has recommended that I continue taking Metformin post-partum, at full dosage.  He said the latest research shows I am at a high risk of getting Type 2 within 3 years of pregnancy, and although Metformin will not stop Type 2, it may well elongate the time until it develops and will manage the damage Type 2 could do to my body.  Plus, Metformin has now been taken by many thousands of people over extended periods without ill effect, in fact, it has been shown to reduce the risk of certain cancers and increase weight loss.  In my own experience, I have been able to exclusively breastfeed while taking it and Katie is growing at a perfect pace - following the 50th percentile for weight and 75th percentile for height.  I have not noticed any effect on the quantity or quality of milk I produce.  My weight has remained pretty steady as I am consciously not dieting, plus I am enjoying being able to eat chocolate again!

Our family is now complete and my struggle with GD seems so far away now but I hope my experiences will give others a place to start developing their own diet plans and the confidence that through experimenting, it is possible to regain control over their pregnancy.

If you have any comments of questions, please contact me and I will attempt to help.