GD my placenta!

After nearly two weeks of jotting down every meal and snack and recording my blood sugar four times a day like the good student that I am, I had a follow-up appointment this morning with both a perinatologist and dietitian.  The good news is my numbers are "beautiful," in the dietitian's words.  Just a couple of days into recording I called the dietitian because I was worried my numbers were too low.  While the fasting blood sugar taken first thing in the morning before breakfast is usually between 75 and 85 (within their desired range of 60 to 90), my one-hour-after-eating numbers have only twice even made it into their range of 100-130, usually between 80 and 95.  Numbers do not appear to be creeping up at this point, rather bouncing around between those ranges, even with a few "experiments" and generally relaxing the restriction on carbohydrates. 

The bad news is I've got a lot of pregnancy to go and as the perinatologist in particular pointed out, I need to be psychologically prepared for those numbers, especially the morning fasting blood sugar, which is notoriously hardest to control with diet and exercise alone, to go up as I get further along and the placenta continues to grow.  While I have enjoyed being less strict with the diet over the past week or so, and have to admit I was pretty anxious for about a week after being told I'd "failed" the early gestational diabetes screen, in hindsight I'm actually glad I was on the diet for a couple of weeks before beginning to monitor my blood sugar four times each day.  I think, had I seen these low numbers early on, I wouldn't have taken the diagnosis as seriously and would have "experimented" a lot more.  As it is, the three small meals + three snacks, all the while watching my carbs in general and my sugar intake in particular, has already become a bit of a habit.  I'll admit that part of me was really hoping they'd let me off the hook, at least until the glucose tolerance test (the "sugar drink") normally administered between 24 and 28 weeks and go from there.  But I think particularly because it's so early, they want me to continue to monitor my blood sugar levels, but only twice a day, and stick to the somewhat relaxed diet as much as possible between now and my next appointment in one month.

So for anyone coming to this blog by way of searching for gestational diabetes (something I did a lot those first few days), here's what I've found to be helpful.  First a GD cheat "sheet":

As far as GD is concerned, you've got your carbohydrates and your proteins; fats and non-starchy veggies are "free" (you can have that double-double from In 'n' Out but order it protein style or discard the top half of the bun - it's a little like entering opposite land, at least for pregnant women, I think because they don't want to tell you that, basically, you can't eat anything). 15 grams of carbs = 1 serving. Carbs include the obvious: breads, grains, and cereals - and the not so obvious: milk/dairy, fruit, and starchy vegetables. You can subtract grams of fiber from overall grams of carbohydrates for an adjusted serving size; for sugar alcohols (in sugar-free items), subtract half (i.e. if an item has 14 total grams of carbs including 8 grams of sugar alcohols, you'll subtract 4 of those grams for an adjusted serving size of 10 grams of carbs or 2/3 serving).

Protein is your friend. Protein slows down the sugar so balancing carbs and proteins is key. 1 ounce of protein = 1 serving. Think eggs, meat, of course, nuts/seeds, nut butters (good luck if you have a nut allergy...or if you're vegan, for that matter), cottage cheese, fish/tuna, soy/tofu, and cheese.

For breakfast and snacks, I try to have 1 to 2 servings of carbs plus at least 2 servings of protein (1 for snacks). For lunch and dinner, I can have 2 to 3 servings of carbs and at least 3 servings of protein.  Packing in that much protein is harder than it sounds, not because I don't like all the protein products, but because they take a little more effort to prepare and eat.  Carbs are quick and easy, unfortunately.

A typical (A+ kind of) day would go something like this:

7:15 am - breakfast: 2 multi-grain waffles (I like the Trader Joe's variety) with 1 tbsp. almond butter, 1/4 cup chopped pecans, and sugar-free syrup, plus scrambled eggs with a little bit of cheese.

9 am - snack (the dietitian wants me to eat every 2 to 3 hours - not a problem for me but I guess this might be hard for non-snackers): small homemade granola bar (I analyzed my recipe and each bar contains 4 grams of sugar from honey - still technically a no-no, but I figured I'd try it and see how my numbers looked...they were fine), 1/2 cup low-fat cottage cheese, and 1/2 nectarine. 

{Digression} - I forgot to add that you're not allowed cold cereal - ever - nor should you have dairy or fruit first thing in the morning.  Additionally, you should never have dairy (milk, yogurt - cheese is usually okay) and fruit together in one meal or snack.  That said, I haven't had a problem with combining things like Greek yogurt (much higher protein content than regular yogurt) or a soft cheese like cottage cheese with fruit, thankfully (because who can eat plain Greek yogurt? not me).  I've also been able to have cereal for breakfast, so long as I include some protein (nuts in the cereal, eggs or turkey bacon on the side, etc.), without it affecting my blood sugar levels. For now at least.

12:45 pm - lunch: turkey/cheddar/pesto wheat wrap with 1 ounce potato chips and 1/2 apple (as with Elias, I've had a consistent craving for potato chips this pregnancy, something I rarely eat otherwise; sweets are my vice!)

3 pm - snack: one serving peanut butter pretzels with one babybell cheese

6 pm - dinner: 3 pieces of Trader Joe's frozen spinach pizza with a side chicken caesar salad (frozen pizza is usually light on toppings, so you can boost the protein content by adding meat and cheese - or getting pizza out, where toppings aren't usually a problem; passing on the crust will help keep the overall carbs in check)

9 pm - snack: Skinny Cow ice cream sandwich (these things are ridiculously good); I'm also a big fan of the popcorn/candy/Fresca combo in the evening, but obviously the candy is out.  Chocolate covered almonds (no candy coating) don't seem to bother me at this point, oddly, but a possible alternative in the future might be those cocoa dusted almonds.  Additionally, we use coconut oil and Himalayan salt (both of which you can find at TJs) to stove-top pop our popcorn (I say we as if I ever make it - that would be Neal's job), both of which have various, supposed health benefits. And hey, if not, the coconut oil will make your house smell like the beach and Himalayan salt is pink!

The evening snack is actually pretty important as it helps to control that fasting blood sugar level the next morning (something about how if you go more than 10 hours without eating your liver produces more glucose, thereby ironically increasing your blood sugar level despite the long fast between dinner and breakfast). So, yes, a lot of eating has been going on around here.  I think eating every 2 to 3 hours is key - as soon as I'm peckish, it's time to eat again so I'm never really all that hungry.  And if I'm never ravenous, I'm less likely to go for the easiest snack on hand, or snacking while preparing a meal, etc.  I actually lost weight the first week or so, but I was up about a pound the next week.

I rounded out the epic morning of prenatal medical appointments (on this, our last day of private medical insurance...hello, Medi-Cal!) with my monthly visit to my OB/GYN, getting to hear the baby's heartbeat not once, but twice this morning.  That never gets old, does it?  The 20 week, sex-revealing ultrasound has been scheduled for early September, so stay tuned for that announcement, as well as other pregnancy and kiddo shenanigans in the meantime, I'm sure.