What was your GD meal plan like?
April 14, 2007 6:15 PM   Subscribe

Looking for other women's experiences with meal plans for Gestational Diabetes? (long, sorry)

Short version - I have been diagnosed with possible Gestational Diabetes, but discovered I do not like my dietician's idea of a healthy meal plan. I would like to hear about other's experiences with meal plans for GD, in order to decide whether my experience is typical or not, i.e. whether I should bother switching dieticians.

Long version - I am borderline for GD. My OB thinks I probably do not really have GD, but instead this is a result of the steroids I was prescribed a month or so ago, for my asthma. Regardless of whether this is GD or still the steroids, I need to control my blood sugar. There is no history of diabetes in my family, I was not overweight pre-pregnancy, and I am already 33 weeks pregnant. I have put on 30lbs so far in my pregnancy, and my OB wants me to only put on another 5lbs in my last 7 weeks, in order to keep within the 25-35lbs healthy weight gain range. The baby is not large, in fact at the ultrasound last week the baby's measurements showed up as absolutely average for all dimensions (I have a separate issue that runs a risk of having a small baby, so apparently these two issues are balancing each other out perfectly!) I went to see the dietician last week, and now have a glucometer and a meal plan. I disliked that she was suggesting some items I consider bad eating choices into my menu plan, eg Splenda-sweetened yogurt and pre-packaged "string cheese". These are items I would never normally eat, I try to buy organic, whole foods type items whenever possible. I consider artificial sweeteners to be unnecessarily chemical, and regardless I dislike the taste of them. Secondly, she told me that I was not allowed any sugary foods AT ALL (chocolate, cookies, cake etc). I have been looking on diabetes.org for nutritional info, and was surprised to see that they suggest you can have sugary foods, as long as you work out an appropriate carb exchange. I very much miss having the occasional piece of chocolate, or serving of fruit sorbet etc and would like to work it into my diet every now and then as a treat. Is the no sugary foods EVER rule typical for GD? Since I am already so far into the pregnancy I figure its probably not worth switching dieticians this late, unless anyone has had vastly different experiences with their GD meal plans. I should note that I am perfectly happy to change my diet, and my blood sugar values have all been well under the goal numbers so far. I am not unwilling to go completely without sugary foods, but it would be nice to have them now and again in appropriate amounts!
posted by Joh to Health & Fitness (14 answers total) 2 users marked this as a favorite
I was close to the line for GD with my first pregnancy 4 yrs ago, and gained a ton of weight, about 50 lbs altogether. I was slightly overweight (like 10 lbs) beforehand. I did the ADA (American Diabetes Association) 1800 calorie diet on the advice of my doctor. I started sometime in the third trimester. About 3 months after giving birth I started Weight Watchers and was able to get myself back to my high-school weight, which I never thought I'd see again. The ADA diet did not prohibit sugary foods, provided you did the appropriate carb exchange. It was a little tough at first, but I am so glad I did it. It dramatically changed my ability to regulate my blood sugar. I still benefit from it now, 4 yrs later. Oh, and I ate an absolutely insane quantity of string cheese. I loved it. But then, I don't mind packaged/artificial stuff too much.
posted by selfmedicating at 6:38 PM on April 14, 2007

email me - in profile. I don't have time to type out the response I want right now.
posted by peep at 6:39 PM on April 14, 2007

You might find this article by Henci Goer interesting. I read it leading up to my GD test because I wasn't convinced of the efficacy of the test or the treatment. It's been a while since I read it, but IIRC, she says that research shows that exercise is the only thing to have a direct correlation to reducing GD, not diet.
posted by cocoagirl at 7:12 PM on April 14, 2007

By the way, I agree with you on the Splenda. I have read several articles about chemists who simply won't touch the stuff based on the fact that it's chemical structure looks very unhealthy to them, just wrong to be eating. I'd certainly avoid it while pregnant.
posted by cocoagirl at 7:14 PM on April 14, 2007

I just bombarded poor Joh with 2 of the longest, wordiest emails ever. Sorry, Joh! Abridged version here:

My OB set my goal numbers, the diabetes educator did everything else. My OB used the conservative guidelines for GD. She wanted to see <9 0 for fasting, and 120 for 2 hours post-meal. i was to test 4x per day - first thing upon waking, and 2 hours after breakfast, lunch, and dinner.br>
I was pleased with the meal plan, because it was as simple as I think it could possibly be. The absolutely only thing I had to worry about was carbs. And not carb exchanges, either. Just the number of carbs. I could have 3 meals and 3 snacks, but needed to go 2 hours between each. Here's how my allowed carbs went:

Breakfast: 30 to 45g carbs
Snack: 15 to 30g carbs
Lunch: 30 to 45g carbs
Snack: 15 to 30g carbs
Dinner: 45 to 60g carbs
Snack: 15 to 30g carbs

I did not have to account for, control, or in any way keep track of protein, fat, or calories. However, it was recommended that I eat protein at each meal & snack, with a heavy emphasis on protein for the before-bed snack.

I found I had to eat at the low end of the allowed carbs for each meal (15 for snacks and 30 for meals). I was diagnosed at 32 weeks, lost weight for 3 weeks, and maintained that weight for 6 more weeks (yes, that adds up to 41 weeks).

I strugged at first to get the numbers I needed. I relied on the same meals over and over once I knew I would get OK numbers from that meal. After about 4 weeks, my blood glucose numbers really started to plummet. At that point I added a tall decaf mocha (full fat) from Starbucks to my breakfast meal. I didn't even add up the carbs. I just tried it, tested, and my numbers were OK. I also occasionally had 2-4 hershey kisses immediately after dinner.

4 hershey kisses might sound very depressing. I thought I was going to die when I was diagnosed, but after a few weeks on the diet, I craved navel oranges like I used to crave chocolate (unfortuate, since I could only eat about 5 slices of orange as a serving). But I really did lose my craving for sugar. I became super-easily satisfied. I savored that mocha every morning and appreciated every drop.

My own personal, non-medical opinion is that eliminating 100% of "sugary foods" (which would include fruit, especially for diabetics) is unnecessary. You seem like you have a very reasonable attitude about it.
posted by peep at 8:14 PM on April 14, 2007 [2 favorites]

I had gestational diabetes about seven years ago. My plan was virtually identical to peep's. One possible exception: I was told to avoid fruit in the mornings because it would likely spike my numbers.

As I recall, my meetings with my nutritionist got more productive after we had some glucometer data and food journal to look at. Even with those broad guidelines, some carbohydrates kicked my butt harder than others. (see glycemic index if you haven't already)

One thing I definitely remember, though, is that my nutritionist asked me about my eating habits, personal preferences, and so on. If she'd been indifferent to any of that, it would have been a huge signal to find someone else.
posted by gnomeloaf at 8:28 PM on April 14, 2007

gnomeloaf writes "I was told to avoid fruit in the mornings because it would likely spike my numbers. "

Actually, I got that advice, too. And ditto with the "some carbs kicked my butt" statement. I could eat white potatoes (1/2 cup) but couldn't even eat 1/3 of a cup of brown rice. For some people it's the exact opposite. Test, test, test.
posted by peep at 8:38 PM on April 14, 2007

That gestational diabetes is in fact an issue at all is questionable. I'm with Henci Goer on this one (following above article and her previous books). Her research is typically good and there's other research support on this one.

I would not ingest artificial sweeteners in pregnancy. Reduce processed foods and eat mostly whole real foods. There is no reason (or research) to suggest that cutting out organic fruits and adding processed and chemical laden products is an improvement. Personally, I would ignore any dietician that suggested this.

If you think that lowering the glycemic impact of foods is a good idea, then eat a high carb/glycemic food after or with some protein or fat to slow the digestion. Ice cream has a lower glycemic impact than sorbet because the fat slows down the digestion of the sugars! Eat sweets in moderation, after or with a meal, and definitely include an occasional dessert of ice cream with nuts (to further lower the glycemic impact)!

I wouldn't stress. Happy pregnancy!
posted by kch at 8:42 PM on April 14, 2007

Pretty much every thing peep said.

I would add that exercise, even just a half hour of something relatively easy, always made my numbers better for up to the next 24 hours.

And thirding the 'some carbs kicked my butt... test, test, test.'

Having been both through GD & as an ex-nutritionist, I have to say, it sounds like the nutritionist you saw isn't very informed about managing diabetes. If you feel like you need more nutritional advice, you might check & see if there's a Joslin center near you. Or find a nutritionist that specializes in diabetes. Joslin recommended to me what peep's folks said & it worked very well + I got a piece of German chocolate cake on my birthday and my numbers were fine thanks to planning ahead.

And I worked at the time with a woman who was type I from early childhood. She let me in on the fact that the best place to prick, if you've got the finger ones, is not at the top of the pad, or in the middle of the pad, but off to the side. Apparently there aren't as many nerves there, the skin isn't as thick.

Good luck & congratulations on the little one!
posted by susanbeeswax at 10:42 PM on April 14, 2007

Thanks for everything so far, wonderful! Just to clear something up, fruit is not included in the "sugary foods" category my nutritionist banned me from. Like gnomeloaf and peep, no fruit in the mornings. Also no milk products in the mornings, which sucks because it means I can't have yogurt or cereal, and I quite like All Bran, which is nice and healthy as cereals go (I may try it tomorrow anyway and see how the numbers come out).
posted by Joh at 11:17 PM on April 14, 2007

There is a lot of good advice already, as far as sugar goes, you want to avoid the ones that your body will process too quickly, especially any refined sugar. For my blood sugar issues I found that I could process a little bit of honey sweetened dessert better than regular stuff. But as was said before, I quickly lost my cravings for sweets as refined sugar changes your taste buds drastically. Without sugar I started craving foods I didn't even like before.

Definitely test your body, not only to obvious carbs but also to sugary vegetables. Corn and carrots throw me off the charts every time.

Also, DO NOT eat splenda while you are pregnant. There isn't enough information about it yet but only bad stuff is getting discovered.
posted by trishthedish at 7:12 AM on April 15, 2007

Susan's comment reminded me that I didn't even touch on exercise. Swimming was the best exercise for me. The lowest numbers I ever got were after swimming. But if you ever find yourself struggling with numbers, wait about 15 minutes after eating, and then start doing something active. Even just housework helped my numbers. If I exercised at lunch, then I'd do laundry after dinner. I'd take a bunch of trips back and forth from the bedroom to the laundry room. Or sweep. Little tiny bits of activity also help get your numbers down.
posted by peep at 8:06 AM on April 15, 2007

Your story sounds very much like mine. I had very high fasting numbers, otherwise normal numbers, and a diabetes counselor who made it her business to try to scare the bejesus out of me. There is still a lot of doubt whether or not I had GD, but my baby was a normal 8lbs 1oz at 38 weeks, and healthy, which is what counts in the end.

I could type a book about this, but let me try to stick to just a few things:

You can make plenty of personal eating choices without using artificial sweeteners. Talk with your dietitian about the choices she's suggesting - in my case the dietitian worked more with old men with Type II diabetes and hadn't really thought about the consequences of artificial sweeteners in pregnancy.

Do follow the advice about cutting out all cakes, cookies, etc until you have a handle on the pattern of your blood sugar numbers, what causes unusual readings and what does not. It sounds like from what you've written that you've just started tracking your blood sugar - one you have about 5-7 days worth of readings you can experiment a bit more with the rest of your diet.

Its not so much about "carb exchange" as it is about where foods fall on the Glycemic Index. (Here's another good GI site)

Exercise, exercise, exercise. I just took a 30 minute stroll before bed each night, and it made a big difference.

Protein in the morning, baby! Soy sausages and scrambled eggs became a staple for me.

There are some studies that suggest that the spice cinnamon can have some effect in lowering the blood sugar of diabetics. I'm far from saying "don't do any of the other stuff" but for me adding a tablespoon of cinnamon to my daily diet seemed to help my sugar levels.

Finally, you don't say what your blood sugar levels are, but that can make a huge difference. In the end, all the "fuss" about GD (and count me in the camp that thinks its probably more fuss than is necessary) is mainly about fetal weight. This study suggests that so long as your baby stays under the 70th percentile in weight, its not necessary to get crazy about insulin, etc. as a treatment.

Email me if you want to talk to someone who went through this very recently, and good luck to you and the baby.
posted by anastasiav at 10:40 AM on April 15, 2007 [1 favorite]

OP, you can get a second opinion on your diagnosis. Check with your health plan, but second opinions are pretty standard. GD is a risk factor for developing type 2 diabetes later in life. If I were you, I'd want to know for sure--I would not accept a "borderline" diagnosis. But that's me.

The American Diabetes Association (diabetes.org) has a nice message board section, and there is a board dedicated to GD.

A bit about eating with diabetes: This is a total chemistry equation. The way I think about it, carbs in - energy burned while exercising = what your blood sugar is (roughly). Almost every food has carbs. Counting carbs or using diabetic exchanges is a very good way to keep your diet under control. One serving of carbs is 15 g of carbs. The carbs and/or diabetic exchanges is listed on the labels of almost every pre-packaged food, and the ADA publishes an exchange book to figure exchanges for homemade food. The exchange method is the "old fashioned" method, and carb counting is relatively new, but accepted and endorsed by the ADA as an acceptable method to use for a diabetic diet. The glycemic index is still undergoing scientific scrutiny, and I don't think it's part of any clinical care guideline.

Exercise, if you are able, is your biggest ally here. If your dietician did not talk about this as a part of your diabetes management plan, find a new RD. (And make sure you see a real registered dietician (RD) or certified diabetes educator (CDE), not a "nutritionist.") Ditto this if he/she does not try and help you figure out what will work for you. Changing your diet is not going to be about sticking to a pre-determined list of foods photocopied for the nth time. A good RD or CDE will listen to you and consider your lifestyle, the others in your household, your schedule, allergies and other factors to collaborate on an eating plan that works for you.
posted by FergieBelle at 3:14 PM on April 15, 2007 [1 favorite]

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