Tuesday, April 5, 2011

all about gestational diabetes

I had gestational diabetes with Theo, diagnosed at 30 weeks.  This time, I was tested earlier and diagnosed at 28 weeks.  Last time, I had a total freakout meltdown.  I didn't want any pregnancy complications, especially one that I knew was going to require a lot of work and uncertainty on my end.  I learned that gestational diabetes, for me, is very manageable and far from the end of the world.  In the end, I was thankful to be put on a diet that would curb my weight gain.

By 28 weeks with Theo, I  had gained 27 lbs.  I ended up losing a few then gaining some back and my total weight gain with him was 29 lbs.  I know I would have been at 40 or more lbs had I not gone on the diabetic diet.  I was lucky enough to manage my diabetes with diet alone and didn't have to go on Insulin shots like a lot of people do.

This time, I was hoping and wishing that I wouldn't get diagnosed with gestational diabetes because at 28 weeks my weight gain was only 20 lbs.  No luck.  But this time I wasn't depressed, just disappointed and determined to go Insulin-free again.  So I started off on the diet a few weeks ago and so far it hasn't been too bad.  My sugars have been relatively normal, like that of a person without diabetes.

I have to check my blood sugar with this four times a day.  Once when I get up (before I eat anything) and two hours after breakfast, lunch, and dinner.  Fasting sugars should be below 96 and post-meal sugars should be below 121.  Out of 120+ glucose checks so far, only 3 have been high.  They have been post-meal sugars (133, 141, and 121).  The 133 and 141 were on the same day so that seemed like a bit of a fluke.  I remember last time that the further along I got, the higher the readings were.  The more out of whack the body is, the harder it is for the pancreas to regulate the Insulin.  As long as fewer than 25% of my sugars exceed the cutoffs, they'll allow me to stay diet-controlled. 

The diet...

I have to eat 6 times a day.  It's a lot of planning, it's a lot of grocery shopping, it's a lot of list-making, and it's a lot of eating.  A lot of time spent eating.  It can be really exhausting and annoying at times.  Because of the way my work schedule is, sometimes I end up having to eat 4 times while I'm at work.  I'm sure my co-workers think I'm just some crazy, pregnant fatty, but the truth is that I loathe having to eat so often.  I know...it doesn't make sense...how does eating ALL the time curb weight loss and keep sugars under control?

Well, the idea behind the gestational diabetes diet is not to eliminate carbs or sugars from the diet.  It's to maintain a healthy level of carbs/sugar in the body.  I am supposed to eat a certain number of carbohydrates for each meal and snack, which should be balanced by protein.  I do notice a difference in the way I feel physically if I don't have a balance of carbs/protein throughout the day.

This book is so helpful in planning meals both at home and out to eat.  Once I've become aware of how much sugar is in certain foods, they become less desirable.  When I follow this diet while dining out, I never leave a restaurant feeling like a fat cow.  That's a nice change.  Counting carbs just becomes part of the conscience.  And once I've taken note of the carbs, I compare the calories and fat.  You'd be amazed how many calories and fat are packed into those delicious oversized restaurant entrees. 

Here's a typical menu for a day.

Breakfast:  45g Carbohydrates
I might eat one of these frozen breakfast sandwiches (30g) and 8 oz of 1% milk (12g). 

Snack: 30g Carbohydrates
1 cup of grapes (29g)
1 slice of cheese (0-1g)

Lunch:  60g Carbohydrates
Turkey, cheese, and mayo on diet wheat bread (~20g)
Sugar-free chocolate pudding cup (13g)
Handful of raw baby carrots (10g)
12 oz 1% milk (18g)

Snack:  30g Carbohydrates
1/4 cup raw peanuts (5g)
1/2 cup lowfat cottage cheese (6g)
Pre-packaged applesauce or fruit in it's own juice (~18g)

Dinner:  60g Carbohydrates
Salad greens with light dressing (5g)
2 slices of thin crust pizza with meat and cheese topping (55g)

Snack: 30g Carbohydrates
Oscar Mayer Deli Creations Cracker Combinations (30g)

Like I said, it's a lot of eating.  But managing the carbs somehow simultaneously manages the calories and I stay around 2000 per day.  One thing that really helps is Splenda.  I am a sweet tea addict and I can make it sugar free and caffeine free at home and drink it throughout the day and at work at night.  Also, diet root beer and Diet Sierra Mist add taste as good as their sugar-filled counterparts and some flavor to my meals and snacks. 

Having gestational diabetes doesn't allow much room for cheating because of having to constantly check your sugar and keep record of all the results.  Truth be told, sometimes I forget to check it until 30 minutes or an hour after I was supposed to.  When that happens, I just add 10 or 15 points to my result and hope that I'm close. 

The biggest problem with gestational diabetes is called macrosomia, or super fat baby.  The problem with super fat baby, duh, is that it won't fit through the birth canal.  My doctor told me that even when diabetes is controlled, babies tend to develop broader shoulders and have more fat deposited on their shoulders than babies to non-diabetic moms.  The problem with broader shoulders is shoulder dystocia, which happened with Theo's birth, and according to the doctor that delivered him, is one of the scariest things that an OB can face during a vaginal delivery.  Basically, the head is delivered and the shoulders get stuck.

Theo's shoulder dystocia was mild (lasting only about 10 seconds) but some cases are severe.  Once the head is delivered, it's nearly impossible to push the baby back in to do an emergency c-section.  A possible complication for the baby is broken collarbones.  If the baby stays in the birth canal with the head out and the lungs compressed, oxygen to the brain is lost and the result can be brain damage or death.  Thankfully, Theo suffered no immediate or long-term damage.  His was so mild and he was a below-average sized baby, so gestational diabetes cannot necessarily be blamed for the situation.

I've asked a bazillion questions and researched it....there's just no way to know in my situation if I was borderline too small to deliver vaginally or if the shoulder dystocia occurred due to some other factor like his position coming out, my position, etc.  In other words, it's super duper important that I manage my diabetes well this time to ensure that it does not play a factor in delivering vaginally.  I have toyed with the idea of not having an epidural because IF shoulder dystocia were to happen again, there are different positions the mother can get into to try to loosen the shoulder/shift the baby's weight/position.  Obviously when you are numb from the waist down, there is no getting up and hopping around.  (Not that hopping would be involved, regardless). 

I don't think I'm quite ready to make that commitment.  That's scary.

After my appointment Wednesday, I'll be scheduled for my 35 wk check up two weeks later and that will start the weekly visits.  Eeek! 


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