Looking for meal ideas for Murphy's Law pregnancy: Gestational-diabetic-menu-filter?

October 17, 2008 5:50 PM

Can you wonderful ladies (and awesome supporters of same) who have experienced gestational diabetes, even though you already ate pretty well, post as many meals as you remember eating/liking/working for you?

So, this might be a bit long. My sister is just shy of 28 weeks pregnant with twins, and was just diagnosed with gestational dibetes. Other complications include: PCOS fertility problems (she's been taking Metformin since she started trying to get pregnant), reduced high order multiples (7 down to 2), vanishing cervix (cerclaged at 17 weeks), has always had GI problems (motility/reflux/insoluable-fiber-evilness), has been on strict bed rest for 10 weeks now (exercise=going to pee), has had preterm labor for 7 weeks (monitoring at home and on a breathene turb pump), both twins are small and one of her twins might not make it due to growth restriction. She's a healthy eater, loves her organics and whole grains. Her idea of "pigging out" on bad food would be 3 freshly-baked chocolate cookies and a glass of whole milk. (we switched to whole-fat foods when she wasn't gaining any weight week after week. Yes, we're back to low-fat and skim foods now).

So, onto the main course: glocose fun-ness. She's already a healthy eater, and the suggestions we've found so far on the web are abysmal -- 5 ritz crackers, a string cheese and a tablespoon of peanut butter as a snack?? her snacks are usually cottage cheese with a bit of diced pineapple, or like 1/2 cup of plain yogurt with a tablespoon of whey powder. Her insurance isn't allowing her to get a nutritionist to talk to her, but she'll be testing her glucose 4xdaily starting monday. She's not really sure what she should be changing, and between reflux, sensitivity to insoluable fiber, and now gestational diabetes, it's all getting to be a bit much for us to figure out. Bust out the pivot tables and Crystal Reports, folks.

We don't know too many glucose numbers, but her 1 hour non-fasting level was 150. Her 3-hour fasting was normal on on the fasting and 3rd hour, but was consistatnly 10 points over on hour 1 and 2.

So, back to the original question.... Can you wonderful ladies (and awesome supporters of same) who have experienced gestational diabetes even though you already ate pretty well do me a big big favor? If you could post as many meals as you remember eating/liking/working for you, we would really really appreciate it. I'm turning out to be a pretty decent cook and i look after her 2-3 days a week. Mom looks after her 2 days a week, and would rather do take out from a restaruant than cook for her, and her husband just needs left-overs to reheat.

I'm so grateful to each and every one of you for any meal suggestions you might have. it's the putting-it-all-together part that's (the latest thing) really wearing us all out. And that's so not fun for the lady who has precious few things to enjoy right now.

posted by Sweetdefenestration to health & fitness (10 comments total)

Meal planning for GD isn't really any different than meal planning for "regular" diabetics. I can't really suggest specific meals, but if you pop down to your local library you'll find probably hundreds (certainly dozens) of cookbooks specially for diabetics, and anything that's in there should be fine for her from a GD point of view. (GD is really just the same as "regular" diabetes, except that it goes away instantly once the placenta is delivered.)

Some websites that were very helpful to me were:

Gestational Diabetes: Nutrition and Questions (note the 1998 date), the Glycemic Index, and this 'Living with Diabetes' website that has tons of useful information on where foods fall on the Glycemic Index. Also The American Diabetes foundation. I'd acutally start with the last one. Here's another good site from the Mayo clinic.

Basically its carbs and sugars she wants to watch out for. If she's already eating well, she can pretty much have most veggies in almost unlimited amounts (they're what's known as a zero on the glycemic index), and pretty much any protein in more-or-less unlimted amounts. Her cottage cheese, for example, is probably fine is she changes the fruit to a veggie or a low-GI berry. Balance the carbs and sugars with proteins, and cut back on the starches (so, yeah, no more cookies - sigh). Multiple small meals over the course of the day. Make sure she eats her proteins.

Pop down to your local library and pick up a book or three on meal planning for diabetics. There are literally hundreds of them out there, and it will add some variety to your life.
posted by anastasiav at 6:39 PM on October 17, 2008

pithy response from a friend: smaller meals throughout the day every 3 hours, limited carbohydrates, no fruit, milk or cereal in the morning. mainly proteins and vegetables. no juices.
posted by billtron at 7:15 PM on October 17, 2008

It sounds like she's getting zero help with HOW to eat, and that's just awful. Here's something I previously wrote that I hope will help.

There's really no magical combo of foods that works for all gestational diabetics, but the carb numbers can work as a starting point.

Switch back to whole dairy products - they have fewer carbs than skim for an equivalent volume, and the fat tempers the affect of the carbs somewhat.

Ditto on anastasiav's comments about protein and veggies - my nutritionist only wanted us counting carbs and eating protein with every meal and snack. No need to track calories, protein, or fat. When you count carbs, you can subtract fiber gram for gram.

For example, lentils are somewhat "high" in carbs - but half the carbs are really fiber. Lentils are an excellent choice and gave me super low numbers.

I'll post some links and recipes after I put my kid to bed.
posted by peep at 7:16 PM on October 17, 2008

Oof, bed rest -- I found exercise really helped keep my blood sugars doing what they were supposed to do & that's just not going to work so well here!

What will help is that she's going to be doing the glucose testing four times a day & that's nice, nearly immediate, feedback about what sorts of things affect her blood sugar. For the first one or two weeks I wrote down what sorts of things gave me high blood sugar & I also kept track of the sorts of things that worked well. I caught on pretty quickly approximately when I needed to stop eating things. Looking at portion sizes for recommended carb intake for meals/snacks was also helpful.

But yeah. The glucose testing will be really helpful in figuring out what's working and what's not. I learned pretty quick when going out to restaurants that I could eat half of that, and all of those or half of those & all of that.

Also a tip that a type I diabetic friend passed on to me if she's doing finger pricks, pricking at the side of the finger pad rather than the middle or tip of the finger causes less discomfort. Apparently there are less nerve endings there, and less callouses.

Good luck (and congratulations to her!).
posted by susanbeeswax at 9:17 PM on October 17, 2008

You've got some great advice already, and peep linked you to the question I asked when I got the GD diagnosis. My general meal plan was the eat the same things I used to, with about a half-size portion of the carbs/starches, and avoid anything sugary. So for example a favourite meal of ours is chilli (with beans and celery because we are odd) served with rice and pita bread. I dropped the pita bread, ate the same amount of chilli and had a half-size rice portion. To this day rice and a pita seems too much, so I guess it helped me a bit in the long term.

Breakfast is the exception - no fruit or dairy products. Eggs are good, but if you don't have time for cooking in the morning, then something like a decent granola bar works too, assuming its not packed with chocolate chips :)

So in summary, cook stuff she used to eat anyway, but just adjust the portion sizes of each element to reduce carbs and increase proteins.

Commiserations to her on the bedrest, wish her well and congrats! You are a great sister :)
posted by Joh at 10:09 PM on October 17, 2008

Here are a few recipes I used or modified:

Lemon Garlic Tilapia (delicious! easy! but as the reviews say, cook it for only 10 min)

Black Bean Salsa Soup

Minestrone Soup

Soups are awesome because you can make a huge batch and it freezes perfectly - very easy for reheating.

Also, snacks I relied on a lot were olives (any kind), the little laughing cow cheeses, turkey pepperoni (beware: high sodium), all types of nuts, cottage cheese, peanut butter, and plain full fat yogurt.

Having salads with every lunch and dinner helps to fill you up if you're having trouble getting enough food - I'm not a huge meat eater so I struggled a bit.

For lunches, I relied a lot on a bento place nearby - plain grilled chicken on brown rice (I ate no more than 1/2 a cup of it), and piled high with steamed broccoli, cauli, carrots, and peppers.

For figuring out the carb counts of different foods, there are a lot of options; I used nutritiondata.com.

For analyzing the counts for completed recipes, this tool from caloriecount.com is AWESOME. The only thing that bugs me about it is that I've found it's sometimes finicky about knowing when you mean cooked vs dry beans/lentils. You have to get their specific terminology right when you're entering ingredients.

Good luck to your friend!
posted by peep at 10:55 PM on October 17, 2008

When I had GD, I had to take insulin and test my sugar at least 4 times a day. I had a doctor who'd had GD herself and she had me go on a relatively low-carb diet. I could only eat good whole grain carbs, and not a lot of any of it. I went to a dietician who gave me the standard Diabetes diet, but if I'd eaten that much carbohydrate my sugars would have been REALLY high. (I had it pretty bad though - very bad scores on the GD tests.)

One of the most important things to do is always eat some fat and protein with carbohydrates - sugar alone affects your sugar levels much more than sugar with fat and protein.

Breakfast is the worst time of day for sugar levels - I'd usually eat an omelet with spinach, tomatoes and cheese, sometimes on a low-carb whole wheat tortilla, sometimes with a little bit of hash browns. (Potato affected my sugar levels less than wheat bread or wheat tortillas.) On mornings when I didn't want to cook, I'd eat 10-15 multi grain wheat thins with cream cheese.

At lunch and dinner, I could eat pretty much anything if I adjusted the amounts - Hamburger with a whole wheat bun, but I'd usually not finish the whole bun. Actually, the amounts seemed to matter more than the food itself - I would have higher sugar levels if I ate a lot of good carbs than if I ate a little bad carbs. (For example, eating a McDonald's Quarter Pounder, but throwing away half of the bun and only eating half the fries gave me a lower number than eating chicken and a lot of whole wheat pasta.) In general, if I ate a lot, my sugar was high. If I ate enough so that I was full, but not stuffed (and so that I was usually hungry again in two hours) my sugar was fine. It will take a bit of time to figure out what foods affect her levels.

However, eating this way I did not gain weight - my doctor started me on this diet at the beginning of the last trimester and I didn't gain any more weight for the rest of the pregnancy. (about 14 pounds total) This made me nervous, although the baby turned out fine (6 pounds, 5 oz - slightly smaller than my other two children,) and with her having twins, especially with one with growth issues, she needs to be sure she's gaining enough weight. Don't limit fat (at least as far as milk, eggs, and healthy meat, etc. are concerned) you need to watch sugar, but still ensure that those little babies get calories and nutrition!
posted by artychoke at 11:26 PM on October 18, 2008

Thank you all soo much for your suggestions! She'll be grateful to hear about the whole milk bit. A lot of the diabetes books say to keep the fats down, but what you're saying really makes sense. She finally got a Calorie goal of 2200 kcal/day. Score on the juices -- her belly can't do them anyway, so she's not missing out. I'd read your other posts and appreciate them. I was hoping for perhaps some other ideas because of the other dietary issues she's got. And was hoping for some specific advice (which i'm so grateful for having gotten) for the first couple of days while I'm learning about what/how is good for her to eat.

The rub really comes with the fiber. With her GI problems, eating that pile of broccoli would shred her belly up. (For those who don't have problems with gas, imagine little tiny ninjas hurling throwing stars at each other in your intestines. Really. Painful. And not so great for preterm labor). So, green beans are fine, but cabages of any variety aren't. Belly issues crossed with GI index, add that she'll likely only have 4 weeks of this before they take the babies out... I'll bet that by the time she figures out what works and what doesn't, she'll have exchanged bed rest for NICU time. But we still need to try.

Thank you for the recipies and other snackie ideas, peeps and anastasiav! She wasn't sure if she could have laughing cow cheeses because they're soft, but loves them and was so happy to hear of your suggestion! She's been having snacks of a small apple (with skins) or pear plus 1-2 bonnie bell cheeses.

Would a breakfast of a piece of oat bran toast with probably 1.5 Tbs almond butter and a mug of tea with a touch of honey (prolly <1>
A dinner of apple-sage-stuffed chicken/cornish hens (williams-sanoma, amazingly yummy, really easy), with steamed green beans and smashed new potatoes is something we've been making anyhoo, and that feels already in line with a GD-diet. Does that sound about right to you? (still getting the hang of caloriecount.com).

It sounds as if proportions really matter, and thanks for the guidance, Joh. When I plate dinner for her, I'm thinking 1.5 fist-sized protein, 1 fist veggies, 1 fist carbs seems close to the mark (I'm not so great on understanding portion sizes)? Also, is it a good method to ask her to eat her protein first, followed by half her carbs, then her veggies (she can't have veggies without having a solid base of non-irritating food in her belly first), then go back and finish the rest of her carbs if she's still hungry?

She's resistant to doing all the math, and I don't blame her (and am trying not to be too resistant myself). It took her a decade to figure out what's up with her belly -- hospital stays, nasty medications, labeled flat-out histrionic, invasive procedures, medicalizing so many threads in the basic fabric of human existence.... it's all sounding a bit too familiar to her pregnancy. And, it seems to me, that cramps from bad diahhrea or bad gas is far more of an immediate threat to her pregnancy than slightly elevated sugar levels. (I know, I'm being resistant and defensive, but still don't think I'm wrong.)

Thank you for the glocose-testing tip, susanbeeswax! She's poking and sticking herself so much anyway with the turb pump (I shiver every time i watch her do it), so every little bit she and we can do to minimize her discomfort is a beautiful thing.

Again, I am so grateful to all of you for your suggestions, links and words of support. Hats off to all of you who put in your GD time, and a very-belated congratulations on each of your bundles of joy.
posted by Sweetdefenestration at 1:33 PM on October 19, 2008

Sweetdefenestration, Your basic portion size calculation sounds fine, but of course it depends on what carbs you are serving etc :) Its a pain in the ass. I totally understand why your sister does not want to do the math, and I didn't bother either. You just have to experiment and see what happens. Try meals out, wait til the appointed time (1hr post or 2hr post?) and test the blood sugar. See if you went over, adjust accordingly.

I wouldn't go as far as telling her what order to eat her food in, just let her enjoy her meal as she sees fit (she already knows to cushion her tummy from the veggies anyway). Eating on a GD diet can be a pretty joyless experience at the beginning, so just take it easy and see what happens with your test case meals.

The chicken dinner sounds great. I'm wary of breakfast with oat bran toast AND the honey in the tea, but hey, you just gotta try it out! How much carbs and sugars she can tolerate depends on the extend of her GD anyway, so what worked for me may not work for her, and you guys just need to try stuff and see what happens. Try not to get too anal about meal sizes, calorie counting etc and instead concentrate on finding things she will enjoy eating and see if you can squeak by the required blood sugar numbers. Work the system, instead of being scared of the numbers (I was scared of going over at first, and didn't experiment enough, ate the same boring things too often).
posted by Joh at 5:39 PM on October 19, 2008

Experimenting is definitely key - for me, milk always raised my sugars too high (I switched to Soy Slender - soy milk sweetened with Splenda).

The first meal of the day was where I was most sensitive - but I found that eating yogurt with almonds worked for me, and a few hours later I could have a real breakfast - eggs and toast (and sometimes, an egg mcmuffin!)

Getting in enough calories was a challenge - I just didn't have the appetite. I didn't eat many veggies - too much volume for not enough calories - but I did drink V8 juice. And I relied on adding nuts to just about everything, and ending the day with peanut butter on toast.

And I'm sending many good thoughts her way - its tough to go through, but the end result is worth every minute!
posted by MrsBell at 7:28 AM on October 20, 2008