I Have What Now???
When you find out you’re pregnant, you feel all the things. You are happy, nervous, excited, nauseous. You determine to take care of yourself like you have never taken care of yourself before. Your motivation: you are growing a little human! It is probably the most important thing you will ever do! You get the best pre-natal vitamin, you eat all your veggies (even when you don’t feel like it), you start doing yoga, you manage your stress, and you go to all of your prenatal appointments. You feel like a rock star!
Today is the day where you have to go to the lab to do the dreaded glucose tolerance test. You get to drink the orange gu that is a million percent sugar and tastes disgusting, and then wait in the room with nothing to do for two hours, yay! You get your test back and it says your glucose was high. You can’t believe it, you have been doing all the things right! “I have what now??? Gestational Diabetes?”
The Certified Diabetes Educator (CDE)
Immediately, you feel like you have failed. Your doctor sends you to a Certified Diabetes Educator, and you walk into your first appointment with your head down feeling like you may never be able to eat anything again. This is where I come in. I am a Certified Diabetes Educator and my favorite patient is you! You are so motivated to manage this thing called gestational diabetes, and I truly desire to help you do that. I want to assure you that you have not failed. Not even a little bit. Gestational Diabetes is not necessarily because of something you did or didn’t do. Sometimes it’s just what happens. There are certain risk factors that put you at higher risk.
My job is to guide you through the rest of your pregnancy and teach you how to continue taking care of yourself in the best way you can. You can do this! Everything is going to be OK!
First, the most important thing is that you are monitoring and managing your blood sugars. You don’t need to be perfect in this. Managing blood sugars is more of an art. If you have one reading that is high, don’t worry! Worrying actually makes your blood sugars go up also! Try to think logically about it and solve the problem so that it doesn’t happen again. Consider things like: What did you eat? Was there something in the food you were unaware of? Like sugar? Are you under extra stress? Did you get enough sleep last night? There are many other factors affecting blood sugar, although food is the most common culprit. Check your blood sugars at least four times a day. It is helpful to check first thing in the morning (your fasting blood sugar) and then one hour after each meal.
Second, it does matter what you eat, but you can still eat many of the foods you love! Everybody is a little different here which is why it is helpful to have a CDE or Registered Dietitian (RD) guiding you through the process. Many of my patients are still able to enjoy a small sweet treat occasionally. There are 3 rules I give to my patients when I am counseling them.
- Work with your CDE or RD to determine an appropriate carbohydrate target for each meal. I like to give my clients a range so it is a little easier to hit the target with each and every meal. This is typically somewhere between 30-60 grams per meal depending on the patient’s blood sugars, weight, and activity level.
- Balance your carbohydrates with a good source of protein and fat. Balance is really key. When you add protein and healthy fats, you reduce the speed at which your carbohydrates turn into sugars in your blood stream. Do you remember the glycemic index? The whole concept in based on the fact that anytime you add fiber, fat, or protein to a carbohydrate, it will affect your blood sugar less.
- If you are going to eat a sweet, it MUST fit into your carbohydrate target. AND, you must NEVER eat a sweet all by itself. When you eat sweets by themselves, they almost ALWAYS spike the blood sugar.
Third, if your blood sugars are too high, it is absolutely OK to start on a medication to help keep them down, even insulin! You must remember that THE MOST IMPORTANT thing is that you control your blood sugars and you must do whatever it takes. That includes the possibility of starting oral medicine or insulin. Don’t be afraid. Your health care partners will help guide you. AND it is very likely that as soon as you have that baby, you won’t need to be on it anymore.
Lastly, I recommend trying to be as active as possible. Get into an exercise routine that you enjoy and that you can do consistently. I also recommend going for a short walk after each meal to help get any extra sugar out of your bloodstream, especially after large meals. Your muscles use the sugar quickly and so there is less chance of having a high reading if you go for a walk.