I was just diagnosed with gestational diabetes. I am a nurse and work both night shift and day shift. Thus, my sleeping and waking hours are very irratic. I never sleep more than four hours. This is a lifelong habit, so eating every four hours has been a routine for me. Is it reasonable to not have a period of fasting, but eat every four hours? If this is reasonable, would I spread out the carbs, meat, fat, and etc evenly out for each four hours? When I fast for the eight hours it seems that I am always spilling ketones. Any suggestions?

I have had patients with erratic schedules such as yours. If you want to continue your schedule as it is, then divide up your total daily calories into the meal pattern that you are currently using. I do not think it is necessary to have the same carb, protein and fat balance in each meal, but rather more on a daily basis. Pregnant women frequently have ketones in the urine after a fast, so do not worry about this. If you require insulin, then that can be worked into this schedule as well.

OWJ
Additional comments from Betty Brackenridge, diabetes dietitian:

Since excellent blood glucose control immediately after eating is one of the goals for GDM management, it will be helpful for you to distribute your carbohydrate evenly across your many small meals. Although it is not necessary to have the same composition at every meal and snack, avoiding large carbohydrate loads at any point during the day is advisable. Having some protein and fat each time you eat is another technique that can help smooth out postmeal blood sugars, although, again, exact proportions do not need to be followed.

BB