Gestational diabetes.

[geminigirl]

Hi, I am trying so hard to control my urine glucose levels but find that I'm getting it all wrong. I had a trace of glucose in my urine a week and a half ago, I was told to keep an eye on glucose levels and since then have been testing my pee about three or four times a day I need some good advice regarding meal plans...I'm starting off well with porridge but it all goes downhill after that, please give me some ideas as to what to make for lunch, dinner and the best sort of for snacks etc. I have found that I'm avoiding carbs completely but that only results in ketones in my urine. I'm getting obsessed with testing my pee and don't have another hosp appt for another two weeks. PLEASE help!!!

Have you had blood tests to confirm diabetes, or are you just working from glucose in urine? If the latter, then perhaps don't panic - I've had trace or +1 at almost every appointment from 10weeks, but passed every blood test (two GTTs, one random and one HBA1C). I've got a label of glycosuria, and as far as I can tell, it's fairly uninteresting.

I found porridge to be the best thing, but also think about things like chickpeas, and using almond flour to make sweet things. Eat vegetables for snacks (humous should be ok, esp. if you make it yourself). Look at low GI recipes for ideas.

Thanks callamia, I haven't been told that I have GDM as yet but I have had two previous babies over 4.5 kilos and have always had glycosuria from about 30 weeks onwards. Trying so hard to keep a rein on it but I need to control the high GI foods. I am just working on urine testing at the minute, I have completely normal urinalysis in the morning and late afternoon, it's just trying to balance out what to eat and when.

Mine is high about two hours after eating - so I do 'badly' at a 9:30am appointment, but fine at an 11am one. I would recommend looking at low GI websites for ideas, there is some actually nice and simple enough food ideas to work with. Good luck!

Thanks, I will do, I really don't want to have to transfer care from local hospital to regional specialist unit.

I blood test four times a day for GD and have done so for

over 8 weeks now, so I have a pretty good idea of what works for me. If you have breakfast down then you have done one of the most difficult things actually. The meals earlier in the day are generally more difficult for most people (I just can't deal with porridge as I live in the tropics!). I know what I deal with least well, in my case fruit and rice, I avoid completely, apart from sometimes in very small amounts in the evening when I manage sugars best.

I know what you mean about just avoiding carbs but we need some so what I found is that you need to think of your meals as protein based not carb based and things generally work out better. For example rather than a pasta dish with some salmon pieces in the sauce, have a piece of salmon and some vegetables and pasta as a side dish. I find I eat about one third of a normal carb load by eating this way. It's more expensive and not always as convenient to eat like this, but in works.

I hope that helps a little.

I was diagnosed at 28 weeks and it wasn't so bad the first few weeks, currently on 4 metaformin a day but switching to insulin on Tues when I'll be 36 weeks pregnant. Had a growth scan which shows the baby is big! I will be induced at 39 weeks.

I think I will find avoiding fruit one if the most difficult things akuabadoll , what are the better fruit to eat? I used to eat a lot of grapes and oranges which I am sure are the road to ruin, how about apples and bananas?

iamgoodbutnotanangel why are you switching to insulin at 36 weeks? Were your fasting sugars high?

Honestly picking between one fruit and another is barely worth the effort in my opinion, (you need to consider index and load and its unlikely to be that helpful - I can explain this further, if you wish) although berries are said to work for some (I don't know because I'm in a different part of the world and can't get hold of berries easily).

Hopefully the following should help some -

Get used to the idea of leaving fruits out until late in the day if you find your body can't deal (GDM gets progressively more difficult as the pregnancy progresses for many, I could eat fruit 'anchored' to a protein for a few weeks, but no more so my cheese and apple snack is now cheese and vegetable sticks for example). I know it
sucks but fruit is such a pain.

Forget about fruit juice completely only eat whole fruit with the peel etc (where this applies) with all the fibre. The riper the fruit, the worse your response is likely to be.

Fruit is by far the most difficult thing for me, and where I live it's super hard to avoid. This is why I know a lot about it, I guess. I'm very disciplined and have relocated to two different countries during all this, it's been really important for me to remain diet controlled, meeting new doctors each time. I'm full term now, don't have a big baby by all accounts and have now been told that my birth plan will not be affected by the GDM. I'm happy to help you further should you wish.

Yes, that's the lines along which I was thinking, I bought about 5 kilos of carrots yesterday in preparation! I'll have to get chopping later I suppose!

Its a good mindset to be in ( the protein based meals) and will just tailor all family meals to suit me rather that making two menus. Will throw the odd bit of pasta or spud in to keep them happy!

I am so determined not to have to go on medication and will just have to be really disciplined. It just became really troublesome on Thursday. I have probably been a bit lax about avoiding high GI because I only had a trace or a plus and I was milking it because I knew this would happen, I went to a coffee morning for Macmillan the other day and I'd say that's what tipped me into sugar overload!

Thanks very much for your responses, I am just going to get used to a new way of eating. I have had 2 prev c/s for true CPD, so I will be having an elective at 39 weeks, only 6 weeks to go now .

Unfortunately just being "really disciplined" isn't enough if you do have gestational diabetes; if only it were that simple. I've been on insulin since 9 weeks in this pregnancy and I'm now 35 weeks tomorrow. It doesn't matter how disciplined I am (and trust me, I am) my blood sugars have raised throughout and my insulin needs have in response.

I was the same during my last pregnancy except I started insulin at 13 weeks. The pregnancy before that in Dec 2010 ended at 37 weeks in a stillbirth due to undiagnosed gestational diabetes.

My last pregnancy I was induced at 33+ weeks due to unstable GD and she was 5lb 12, which is large for that gestation. Thankfully all well in the end and is now 20 months but this pregnancy the baby is big too. I've had a few growth scans and on Friday she was estimated to weigh 6lb 11 at 34+4 weeks. I also now have polyhydramnious probably due to GD and am having another scan on Friday to check fluid levels.

This baby may be early too, they would like to induce at 36 weeks but I'd like to avoid nicu this time so I'm taking each day at a time and seeing how things progress. I've had 5 natural births but I don't know if this baby will be born naturally or by a section.

My fasting levels have never been a problem but my after breakfast ones are the hardest to control. Urine testing isn't that accurate either, you should use a finger pricking kit. I have to test 4 times a day plus whenever I feel the need and inject 3 times a day before each meal. I then test my blood sugar an hour after eating.

I'm really sorry to hear about your first little one, you think when you get so far that everything is going well.

Were you supplied with a glucometer or did you have to get one yourself? Have you any trouble with blood sugars after delivery or between pregnancies? I think I will ring the A/N outpatients and have a bit of a chat with them, I'm a bit concerned now that you have told me not to go by the urine testing.

Thank you. I was given one by the hospital both times. I've not had any problems afterwards with blood sugars and hoping for the same this time! I think it's a good idea for you to do that, better to be on the safe side.

It is easier to monitor your sugar levels with a blood monitor as the urine test will only give you a rough indication of levels.

I am on my second pregnancy, the first was no problem but in this pregnancy I was diagnosed with gestational diabetes and put on insulin when I was 16 weeks. I had been getting my levels within limits and then I got unwell and my sugars went really high for a while.

Unlike some others my blood levels are manageable during the day however in the evening and after dinner they go quite high so I have been started on Metformin as well.

Through diet I made a bit of an impact on my levels but as my pregnancy has progressed my insulin requirements have increased even when I have been careful.

Food wise pizza and grapes are my danger foods so I have had to avoid them.

This evening I have +2 glucose in urine....is there any way of knowing how that would equate to a blood sugar range?

I have to admit I had a couple of roast potatoes with dinner today but the rest was veg and turkey, skipped dessert and have just had wheaten bread and cheese with tea. There is probably quite a lot of sugar in wheaten though, would granary or whole meal be better, trying to avoid bread as much as possible because I would eat it all day if I could!

I think the link between blood and urine sugar levels is pretty sketchy. Have the hospital told you to check your urine levels? Sugar in urine doesn't necessarily mean anything at all. Have you had a gtt to check for gd? Don't limit your diet unless you have to!

Dr wasn't overly concerned but just said to cut down on sugar in diet as glucose tolerance becomes a bit wonky at about 28 weeks whether you have GD or not. Maybe I'm being too cautious? Will try to cut down anyway.....

Until they diagnose you with gd, I'd stop testing your urine and worrying about low GI and just try to eat a broadly healthy diet. Sugar in urine is not seen as a reliable indicator of gd, chances are it's just one of those things. I'm surprised they are not organising a gtt for you sooner to test though if you have had large babies previously. How far along are you?

I'm 33 weeks now, doc (consultant) said that if I was still having glucose in urine he would organise fasting sugar or GTT at next appt which is in about 10 days.

Firstly, very sorry to hear of your first cheese what a truly terrible thing.
I didn't mean to suggest that diet controlled is always possible, rather the OPs question was regarding food, so I stuck with a response about that.
I too am rather surprised that your doctor is in no hurry to do a GTT and have you test with a glucometer if needed gemini, but then again I have experienced a range of responses through changing doctors, all of them seeming to believe that their version is the only correct response.

While it is tempting to wait for a firm diagnosis in advance of a GD diet, with your timeframe, I would be more inclined towards trying to do more than just eating a healthy diet in a more general sense (I know, at least from my own experience my blood sugars would be completely out on a broadly healthy diet). I guess the strongest argument for trying now rather than waiting 10 days is regardless of doctor's interpretations and possible need for medical support this is something you can try and do for yourself right away, something that you can control (even if you can't influence as much as you wish). As you say, only 6 weeks to go.... Good luck, I hope it all goes well.

Have rung tha ANOPD and waiting on a call back from the Sr in charge who is speaking to the consultant about it. Thanks everyone.