Some nitty gritty of of navigating my GDM

I mentioned that with my first round of gdm (with Lily), I was sent to see a nutritionist. She was very nice, but she didn't really give me a lot of hands-on, practical, day-to-day solutions. She gave me a list of snack and meal ideas, but it wasn't very, um, varied (it gave one sample day of meals. I had 7 weeks of diabetic dieting ahead of me and needed more than 3 meal options.), and it included a lot of foods with artificial sweeteners (which give me migraines). 

In the end, I left with a glucometer kit and a decent amount of frustration and confusion. Example of confusion: she told me to increase my daily calorie intake but also told me not to gain more than 5 pounds for the rest of my pregnancy. If you've had a baby before, you know that the end is when you put on weight pretty quickly because of the baby growing and, usually, decreased physical activity because of how uncomfortable you are. She did not explain to me how this was supposed to work. I cried a little more because I just didn't know what to do (and yes, I tried asking clarifying questions, but it didn't earn me any better explanations). 

Eventually, though, I stopped crying and buckled down to figure things out on my own. 

One thing I did learn from the nutritionist that gave me a place to start was that I could have 2 servings of carbs at breakfast, 3 at lunch, and 4 at supper. I also learned that I needed a mid-morning snack, mid-afternoon snack, and pre-bedtime snack (1 serving of carbs at each snack). I started looking into nutritional information on foods I usually eat and began keeping track of how much of what I could eat. One tool that I found to be extremely valuable was using the app My Fitness Pal, which is a free food diary. I had used it to keep track of my calories when I was pregnant with/losing weight after Claire, but I knew it would also tell me how many carbs per portion, as well. Any time I was about to eat anything, I plugged it into My Fitness Pal and checked the carbs per portion. It was empowering, dramatic as that sounds. Having that tool allowed me to eat normal foods/what everyone else was eating...I just had to calculate the correct portions.

One VERY VALUABLE piece of information that I learned from my research that wasn't explained well to me at my meeting with the nutritionist was the significance of balancing carbs with proteins AND fats (she only talked about proteins). This is crucial (and was why she increased my caloric intake), because the protein-fat-carb balance is what determines how well your body can break down glucose. If you don't have enough protein AND fat, your body can't break down glucose slowly enough to keep your blood sugar stable. Additionally, you do actually need to eat carbs. Cutting them out or even down too far doesn't give your body what it needs to fuel, and your body tries to compensate in unhealthy ways. The important part is knowing how to balance everything.

THIS IS IMPORTANT INFORMATION TO SHARE WITH SOMEONE NEW TO DIABETES. This bit of education was the key for me in figuring out how to keep my levels normal and balanced. Note: when a diabetic's glucose numbers are off, it makes you feel quite awful and very unlike yourself. This stands for if they are too high or too low. Headaches, nausea (in addition to pregnancy nausea), blurry vision, weakness, foggy headed-ness. I actually also get a tell-tale feeling in my chest when my glucose is too high. It feels like a pressure/higher heart rate. I can almost always predict when my glucose is too high, thanks to this.

For women with gdm in the state of North Carolina, the medical standards for "normal" glucose levels are 90 or below after fasting and 120 or below 2 hours after meals. My fasting numbers are super sketchy this second time around, but I usually have no problem keeping my post-prandial numbers under 120. Part of managing this includes a fairly strict eating schedule that I keep to: 
1. breakfast
2. snack 2 hours later
3. lunch
4. snack 2 hours later
5. supper
6. snack at bedtime
7. potential extra snack if it's a longer evening- it's pretty important to have a snack AT bedtime to give your body something to help stabilize things while you sleep

It's very hobbit-ish.

The important thing to keep in focus while eating a diabetic diet is carbohydrate portion control. The nutritionist allotted me 2 carbs for breakfast, 3 carbs for lunch, and 4 at dinner + 1 portion at each snack time. 15 grams of carbohydrates is roughly one serving. Those 15 grams look different from food to food, though, which takes a little learning. Examples:
Apple: half of an apple
Tortilla chips: ~7-8 chips (some brands are 9-11 chips)
Bread: one slice
Pasta: ~1/4 cup cooked
Grapes: ~10-12 grapes
Strawberries: one cup
Banana: half of a banana

After a while, calculating carb amounts became much easier for me, and I began to have quite a list of foods' carb counts memorized and didn't have to think so hard. Keeping my post-prandial (after meals) glucose numbers within the right range (under 120) became easier and more doable. I did feel sad that when I'd want to eat 2 pieces of pizzas...I could only eat one (and usually skip the crust). Or that I couldn't eat the same desserts as everyone. But, the the fact that I could still eat pizza, pasta, and Mexican food (in limited portions) was really encouraging and normalizing.

When I was going through gdm with Lily, I had difficulty controlling my fasting numbers until I learned a little trick: I started eating avocado toast before bed as my nighttime snack. Avocados are an excellent source of fat for diabetics. The fat content is so high that it broke down the glucose of the bread/toast slowly enough to keep my numbers stable. It was like magic! Once I started that routine, my numbers almost never went unchecked. This pregnancy is different, though, and even avocado toast can't do it without medication to help (and, I've been super sick after eating avocados on several occasions, so I can't really stomach it anyway. Such a BUMMER.).

I pretty quickly found a few things that would adversely affect my numbers on any given day: stress, nausea, headaches/migraines, hormonal surges. If I had a migraine overnight, my glucose numbers would be higher in the morning. If I was feeling stressed about something, my numbers would be elevated, regardless of what I ate. If I had a day where I just didn't feel well, my numbers would run higher throughout the day. There is no hard-and-fast solution for diet-controlled diabetes, because there are going to be factors you can't control. It took me a while to realize that and to give myself a pass; at the beginning, I would find myself stressing that I had done something wrong in managing my sugar, and the next thing I knew, my glucose was even higher. Once I began letting myself off the hook for things I couldn't control, my stress lowered and, overall, helped my sugar stay more stable.

Also, physical activity and exercise can help lower your glucose. Now, if you're 30-something weeks pregnant, having Braxton-Hicks all day and fighting sciatic nerve pain, this isn't going to be your best solution for glucose control. Likewise, if you're 18 weeks pregnant, constantly on the verge of nausea, and fighting several migraines each week, you can't depend on exercise to do your work for you...diet is super important, guys.

I wish that when I had visited the nutritionist she had shared more of these details with me. It took me weeks to pull together all of this information and figure out tangible solutions for myself. I also wished I'd known that this diabetic lifestyle is not fully formulaic; it ebbs and flows, because our bodies are constantly moving, changing, and doing things. Thankfully, I went into my second diabetic pregnancy with so much more knowledge and a lot less fear. Don't get me wrong- I was BUMMED. It is lousy to face Thanksgiving and Christmas knowing that you can't eat just whatever you want. Or that you can't eat half a sleeve of crackers when you're feeling nauseated. Or that you can't drink Coke when you're feeling headache-y/migraine-y. But it's doable. And not the train wreck I was convinced it would be.

I'm hoping to post some actual meals and snacks that I eat regularly, so that if anyone needs some concrete ideas at any point. Maybe before this baby is born...