Gestational Diabetes question

[KDK12]

I've recently been diagnosed with gestational diabetes and am currently trying to control it by diet only.

I am testing my blood glucose 2 hours after each meal - the hospital have told me my after meal target is less than 6 mmol.

In a nutshell, is anyone else in the same boat? And if so, what are your after meal blood glucose targets? I am struggling to keep it under 6 for some meals, and from some amateur google research (!) it seems like 6 is a low target. Help!

7.7 too hours after might be a bit too high, but it's not scarily so. Some carbs can cause bigger or faster spikes than other (cereal does it for me, for example, whereas toast doesn't) so it may be the way your body is reacting to certain foods. It may be a good idea to test an hour after you've eaten and then an hour after that. Your blood glucose may not have moved much from 7.7 you see, so the overall picture might not be as bad as it may initially seem. The docs may ask you to do that themselves anyway. Also, make a note of what you ate and when so they can get more of an idea of how your body is responding to various things.
This website has been very helpful, and reassuring, for me to dip in and out of. Lots of people in the same boat which, often, is better than speaking to a consultant - my experience tends to be that docs etc are very scientific but don't account for what it is like to live with something. Saying that, I tend to be a bit scathing about the so called health care professionals as I have managed brilliantly for 32 years and have had some crap advice (some of which would be potentially fatal) from the so called 'experts.'

Hi,

I had gestational diabetes in each of my 3 pregnancies. I had it from around 7 weeks each time, and although my first two pregnancies were controlled with diet, it was severe in my 3rd pregnancy and I used insulin from under 12 weeks. My target was under 7 after 2 hours in the first two pregnancies, and under 8 after just one hour in the 3rd (they had changed the advice since then in my hospital - thought it better to test after one hour in case it was taking ages to come down).

I found I could not have very much for breakfast. I think this is because the pregnancy hormone is highest in the morning. Porridge did not work for me, and nor did Weetabix. Milk brought my sugars up I think. I managed with 2 small slices of wholemeal toast spread with butter and no sugar peanut butter (no peanut allergies in my family). I had this with water. Whole fruit wasn't too bad but anything ontaining concentrated forms (dried fruit, fruit juice etc) was really bad for sending my blood sugar sky high. I cut right down on carbohydrates. Sweet potato was very good here. Sometimes at restaurants ( carveries) they put sugar on carrots etc so watch out. Instead of rice or pasta cook half rice/pasta and half veg mixed into it. Had to abandon bananas for a while too.

Hope that helps.

i'll definitely try testing an hour after i've eaten, i think i'll do that tomorrow. i have been keeping a diary of what i've been eating, but i'm not sure what did it for me today.

thanks for the link, i'll check that out now.

hopefully i'll have a better day tomorrow - i feel a bit overwhelmed by it all today. thanks for taking the time to reply.

Good luck KDK!

hi, as others have said 6 does seem a really low target, but maybe its because they are asking you to test 2 hours after meals, if i remember right mine was 7.8 but to test 1 hr after meals, and the fasting levels to be 5.5 or below. but if you are not sure about why the target is low im sure the diabetes midwives would not mind if you just ask them why it is, as you heard most people have target of 7+
anyway good luck!
i had gd with my last baby, ended up on the medication and insulin but it was all okay in the end he was healthy and not a massive baby at all, i found the food i ate did not really make a difference as it was the fasting levels which were higher and meal ones okay so that makes sense about the pregnancy levels being higher in the morning causing that!

funnily, i've not really been having a problem with breakfast. i can eat a slice of toast, boiled egg and a very small glass of orange juice with good results. likewise with porridge.

i've been ok with butternut squash, so maybe sweet potatoes will be ok too - i'll give them a go.

i've been drinking small amounts of milk as a snack with some nuts. i miss chocolate milk though!

anyway, thanks strikeuptheband, that does help.

cheers firawla, it's good to hear that your baby was fine and healthy. i'll try testing 1 hour after meals tomorrow and see how that works out.

Sorry I should have said! The range was 5.5-6 two hours after eating. I think GD control is much tighter than for other types of diabetes due to the relatively shorter duration & effects on the baby.

Diabetes uk have a useful website on it:

www.diabetes.co.uk/diabetes_care/blood-sugar-levels-during-pregnancy.html

Try not to stress too much & definitely ask for a diabetes nurse referral if you've not already had one. You're bound to struggle initially, it takes a while to get the hang of dietary changes. Hope tomorrow if a better day

ack stripey, that is low. i really want to be able to control this by diet though. i am under the care of the diabetic team, my contact at the hospital is a specialist diabetic midwife - she's the one who has called me in on wednesday.

here's to a better day tomorrow indeed! and thanks again for your help :)

I have gestational diabetes and my hospital bases its recommendations on the NICE guidelines issued in March 2008 here. This says

"If it is safely achievable, women with diabetes should aim to keep fasting blood glucose between 3.5 and 5.9 mmol/litre and 1-hour postprandial blood glucose below 7.8 mmol/litre during pregnancy."

thanks herecomesthsun. i've been testing 1 hour after meals just out of interest, and i'm glad i did! yesterday i got a 12.5 (!!) 1 hour after porridge, which was back down to 5.2 by my 2 hour reading.

so all the time i've been thinking i'm ok eating porridge, it's probably been causing mega-spikes that aren't showing up in my readings. a bit worrying! i've had a boiled egg and toast today. no more porridge for me!

I'm 28+5 and have been diagnosed with GD since 13 weeks, I was put on insulin a few days after that. I test an hour after meals, those are the guidelines now afaik so I would question the 2 hours, that's more usual with non pregnant diabetics. I have to get below 7.8 one hour after meals.

The reason for the hour is that most of the time that is when you will see the highest spike and that's the number they're interested in as the spike is what can affect the baby etc. Different foods affect people differently, cereal is bad for me, white bread is bad, normal drinks are off the cards totally. Eggs seem good, wholemeal bread is ok, cheese is fine. It's carbs you need to watch for as well as the more obvious sugars.

It looks like I went undiagnosed with GD in my last pregnancy, sadly she was stillborn last December at 37 weeks so I'm at a different hospital now and being well looked after. Test whenever you feel the need to, if you feel a bit high/odd then test, I did a lot in the early days to get a feel for things.

If you haven't seen a dietician then ask them if they can send you, they're helpful and do let you know about amounts of carbs etc for each meal. I have insulin 3 times a day before meals and am supposed to have 30g carbs for breakfast and 40g at lunch and dinner, I often struggle to reach those though in that I don't eat enough. I'm quite small and they keep telling me not the "usual" candidate for GD which doesn't help when I have it anyway!

If you need any more help/advice please ask.

sorry to hear about your loss cheeseandgherkins :(

yes, testing 1 hour after meals seems to make more sense to me, i'll definitely be doing that for breakfast at least, since i had a huge spike yesterday.

i have seen a dietician, but she wasn't that helpful to be honest - when i asked her how much carbohydrate i should be eating at mealtimes she said she didn't like to give advice like that because i'd find it 'too confusing' (?!) so it's useful to hear what your dietician advised.

anyway, thanks for your reply. i hope the rest of your pregnancy goes well :)

The one I saw was very good. She had a book and asked what I'd usually eat, turned to that page and then showed photos of different food portions. Sounds dumbed down but it makes it very easy to understand. So x photo was x amount of carbs for instance and you work your meal around that.

I'd test an hour after every meal, you can order more strips when you need them, they do say to test when you feel the need also. I would also ask the hospital about it as 2 hours isn't soon enough, you won't see the spike and could be doing damage without realising it. I would certainly be in that boat.

Hope your pregnancy goes well too. If you spike a lot after a certain food then I would personally either avoid that food or try a smaller portion of it as it might be that particular food not agreeing with your body. If you're spiking all the time though then it might be that you won't be able to control it by diet alone.

This is very confusing and rather scary. I've never in two pregnancies been told to test after 1 hour. I'm not in any way doubting you, just to be clear. But it worries me that any tests I've done have been as instructed after 2 hours and potentially, I could have been doing great harm whilst thinking it was all going well. I'm 39 weeks now so it's not like I have any great opportunity to turn it around now. It's all so worrying.

it is very confusing, i agree. especially when there seems to be so much contradictory advice and methods of management.

try not to worry though gwendolinemary, i'm assuming you must have passed the GTT? that would have picked up on any problems i'm sure.

39 weeks! how exciting for you to be so close to meeting your baby :)

It's because the guidelines have changed recently and not all trusts have updated, as far as I know. If you look online you'll see the changes too and that it's recommended to test an hour after eating.

Hopefully all hospitals will update their information and guidance soon.

www.nice.org.uk/nicemedia/pdf/CG063Guidance.pdf

1.3.1 Target ranges for blood glucose during pregnancy
1.3.1.1 Individualised targets for self-monitoring of blood glucose should be
agreed with women with diabetes in pregnancy, taking into account
the risk of hypoglycaemia.
1.3.1.2 If it is safely achievable, women with diabetes should aim to keep
fasting blood glucose between 3.5 and 5.9 mmol/litre and 1-hour
postprandial blood glucose below 7.8 mmol/litre during pregnancy.
1.3.1.3 HbA1c should not be used routinely for assessing glycaemic control
in the second and third trimesters of pregnancy.
1.3.2 Monitoring blood glucose and ketones during pregnancy
1.3.2.1 Women with diabetes should be advised to test fasting blood
glucose levels and blood glucose levels 1 hour after every meal
during pregnancy.
1.3.2.2 Women with insulin-treated diabetes should be advised to test
blood glucose levels before going to bed at night during pregnancy.

Those are the nice guidelines if that helps.

Hi KDK12 how are things going? Glad your finding a 1 hour test more useful, having read through the rest of thread from when I last posted, I just wanted to add a few things. I was never given any advice about the amount of carbs (others obviously have been so I bow to their knowledge) but I was told to avoid white bread/pasta etc in favour of brown. You sound like your doing everything you can and I know you will want to avoid insulin but I needed (no suggestion of diet control for me) and it wasnt too bad (I'm diet controlled now but just stick to roughly what I was eating while preg) My DS was fine btw I was induced at 38 weeks because of his size, so if you end up being induced and want to talk it through I'm willing to be sounding board! He was properly chubby when he was born but lost the excess chub very quickly. Sorry that got away from me a bit! Anyway hope your doing OK

I, like saurus, am a type 1, since almost birth, so too am here to help.
Please try not to worry OP. I think they are being very tight with your BG's (6.1-6.3, and bringing you in to discuss alternatives?, WHAT, ease off!!)
If you have any questions, please ask away.

hi strawberrypenguin, i feel a lot more optimistic after seeing the consultant yesterday - she seemed pleased with my figures and actually told me not to worry about all the low 6s.

she also seemed to be happy with my hba1c level (which i knew nothing about until yesterday!) which is 5.4%. no mention was made of needing metformin or insulin at the moment, so i was very happy.

i am due to be induced at 38 weeks, which is ok i guess - i was induced for my first pregnancy so i kind of know what to expect. wouldn't be my first choice though!

cheers oblomov, i feel much better having seen someone at the hospital with a more relaxed approach. the constant testing is stressful, but has been immensely useful in figuring out what works in my diet.

i've had a look at the NICE guidelines cheeseandgherkins, i just wish my hospital were on the same page. either way, i'm really glad i sought advice on here because i wouldn't have known that my breakfasts were causing spikes without testing at 1 hr.

hi there!
I'm another who has gestational diabetes - it started off being called 'borderline' but I think we've all acknowledged that it's there, I'm just about still managing it with diet, struggling with the exercise TBH.

My targets are also based on 2hr post-eating: under 6.5, aiming for 6.0
And the fasting when I wake up: under 5.5, aiming for 5.0

My fastings are the problem, I test after dinner and am usually ok, but when I wake up my levels seems to have risen around half of the time and I can't quite work out what I'm supposed to do about that - I'm asleep after all! I expect they'll move me to insulin before bed (am on metformin at the moment) if I can't get them down more regularly.

My biggest problem is exercise - I have a 3.9 DS and my DH works long hours so I'm alone with DS pretty much 7am-8pm. He won't go into a buggy now, so I can't push him on a brisk walk, but he won't keep up if I walk with him at any decent pace. After 8, either I'm getting DH & my dinner ready or collapsed on a sofa. If anyone has any brilliant ideas I'd be really grateful!

Oh, BTW at my most recent chat with diabetes mw, she mentioned that if you have a cold or other sickness it can push your blood glucose levels up too - which is interesting as I've had a heavy cold for most of a week now and have noticed really fluctuating levels. Today I was 6.2 on waking, 3.2 (!) after breakfast and 6.9 after lunch (which was odd, I ate a normal lunch and would normally be 5.2ish) Not sure what's going on there.

hi ladymaybe - could you get your hands on an exercise bike? or maybe you could try a pregnancy fitness DVD, Davina does one I'm sure.

I tend to eat my evening meal quite late (8.30-9ish) then go for a walk 20 minutes after. At the moment, my OH is off work so I am usually managing another quick walk earlier in the day - even 10 minutes helps. Could you do 10 minutes of stair climbing? Hope you can find something that works for you.