August 24, 2000
Gestational Diabetes
Question from Beaumont, Texas, USA:
I am a 33 year old female, 35 weeks pregnant. I was recently diagnosed with gestational diabetes. I am trying to control my blood sugar with diet, home monitoring four times a day (fasting and one hour after each meal). Being overweight when not pregnant, I have been used to reading labels and watching “fat grams”. Now having to watch carb grams, I see that a lot of low fat foods are higher in carbs than their full fat counterparts. Do you know why this is? Also, I have been very discouraged so far in what I need to do to keep my readings from being too high. My dietitian wants my reading to be below 120 mg/dl (6.7 mmol/L) one hour after meals. For breakfast, I am supposed to have 2 starch, 1 cup milk, and any meat/vegetable/fat I want. When I eat one serving of oatmeal (2 carbs) and a cup of milk (and that’s all), my reading one hour later is too high: 155 to 165 mg/dl (8.6 to 9.2 mmol/L). If instead, I eat 2 pieces of bread, 1 cup milk, bacon, and eggs my reading comes out acceptable: 110 to 115 mg/dl (6.1 to 6.4 mmol/L). I have tried each a couple of times now to double check. I am still getting the same number of carbs, so why is this? It is hard for me to get used to eating what I previously trained myself was unhealthy food in order to keep my numbers down. The other thing is the before bed snack that the dietitian has me eating. She wants me to eat a sandwich before bed and check ketones upon rising. My ketones were coming back trace, so she told me she wanted me to “really pile that meat and cheese on that sandwich” to get it down to negative. I don’t understand eating all that high fat food right before going to bed. It seems like I have to give up watching my cholesterol in order to control my blood sugar and ketones! I am deathly afraid of needles, and do not want to have to give myself insulin injections, so I will do whatever it takes to keep my blood sugar down for the remainder of this pregnancy, but it seems like I am cutting off my nose to spite my face! Why does my body react this way?
Answer:
I consulted with a dietitian here. It appears that your blood sugar does better with a meal higher in fat and when two meals seemingly have the same carbohydrate count, your blood sugar may respond differently. Fats tend to be digested much slower and this is probably enhanced by pregnancy. So your blood sugar will not go up as quickly after a meal. In terms of the carbohydrates, real the labeling on the food. Some carbohydrates have high fiber content. You need to subtract the fiber from the total carbohydrate amount to come up with the true carbohydrate count. Thus, slices of whole wheat toast may have less total carbohydrate than two slices of white bread or the equivalent of oatmeal. Therefore your postmeal blood sugar will be lower than expected.
Two other points. Do not worry about your cholesterol level during pregnancy. It usually goes up. Also, I usually recommend shooting for a blood sugar of 130 mg/dl (7.2 mmol/L) at onwhour after a meal or 120 mg/dl (6.7 mmol/L) two hours after a meal.
OWJ
