Thirty-three to thirty-eight weeks’ pregnant: what worked for me with gestational diabetes

After the initial shock of my gestational diabetes diagnosis, I got down to business. Four times a day, I tested droplets of blood for glucose. I wrote down my scores and meals in a notebook. A friend sent me simple food guidelines. The Gestational Diabetes UK website has been a phenomenal resource. I also attended a brilliant education session at St Thomas’s hospital.

All of the above brought me peace of mind because I discovered:

I began to see this as a great opportunity to soak up advice on nutrition, as although the condition should go away after pregnancy, there is a higher chance of me developing diabetes in later life.

Soon, I learned what food worked for me. I am one of the lucky ones with the choice to manage gestational diabetes with food alone. It felt like a huge reprieve to see my early blood glucose scores come up good – not that there is anything wrong with medication, but being an IVF mum, I have an aversion to yet more medical intervention, unless absolutely necessary.

Another huge positive after the diagnosis has been the surge of motivation to stay active and relaxed. I’ve done a pregnancy yoga video most mornings since week 33 of pregnancy and I’ve upped my walks. I’ve been loving the sunshine and I have meditated everyday to stay chilled, as stress can spike blood sugar.

The best news of all is this: at our 34 week and 36 week scans, we saw the impact of the changes I made on our baby. After two weeks, my amniotic fluid came back down within normal levels. After four weeks, our baby’s abdominal measurement had reduced from the 97th centile to the 73rd centile. That was the truly the best feeling – to see the difference it made to our baby.

So, I’m sharing here the main discoveries that have helped me to manage gestational diabetes with a food plan alone. (Please note: these suggestions won’t work for everyone – but hopefully they are a starting point after a gestational diabetes diagnosis).

1) Dairy milk is more carbohydrate than protein

Mum100-IVF-blog-gestational-diabetes-semi-skimmed-milk-nutritional-contentBefore my diagnosis, I didn’t know this! Whilst I knew there was carbohydrate in dairy milk, in the form of lactose, I always thought the white stuff was much higher in protein. There was an old association in my head with body builders, downing pints of milk to bulk up their muscles. Yes, there is protein in dairy milk, but there is actually more carbohydrate.

For me, I found there was no need to restrict dairy milk entirely. I still have ordinary milk in tea, for example, and I used ordinary milk to make a cheese sauce. I just don’t have glasses of the stuff anymore and I switched to an alternative milk at breakfast.

2) Sometimes ‘healthy’ isn’t what it seems

Mum100-IVF-pregnancy-blog-gestational-diabetes-dairy-milk-alpro-almond-milk-rude-health-almond-milk-carbohydrate-nutritional-informationInitially, I switched to a ‘healthy’ milk alternative to make my porridge. I picked Rude Health unsweetened almond milk because it sounded just the job. Everything about the packaging shouted this was a much better choice for me than semi-skimmed dairy milk. So, I bought it!

I learned through this experience to read the nutritional labels. Having Rude Health almond milk with porridge spiked my blood glucose to 8.2 (over the 7.0 limit). Thanks to helpful GD mums online, I then switched to Alpro unsweetened almond milk with porridge, which keeps my post-breakfast blood test under 7.0.

3) No more Daddy bear bowls!

Mum100-IVF-pregnancy-blog-gestational-diabetes-porridge-portion-controlOn the subject of porridge, some women with gestational diabetes can tolerate porridge and others can’t. I fall somewhere in the middle. For me, it’s completely down to portion control. One of the main things that I think was spiking me over the blood glucose limit before the diagnosis were the Daddy bear bowls of porridge I gobbled down, two to three times a week. My typical portion before the diagnosis was enough for two adults, according to the recommended serving size. Add to that the lactose in dairy milk, the concentrated sugars in sultanas or dried goji berries, then a chopped apple or banana on top – and really this staple breakfast choice was carbs on carbs on carbs on carbs!

Through weighing out my porridge oats, I discovered that I can tolerate a smaller (aka normal size!) portion of porridge (35-40g), made with Alpro unsweetened almond milk (no carbs), mixed nuts and a handful of berries. I always stir in a spoon of peanut butter too (heaven!).

4) Peanut butter is my lover!

Mum100-IVF-pregnancy-blog-gestational-diabetes-pip-nut-peanut-butterI’m now obsessed with peanut butter! Fuck, it has literally saved me these last 7 weeks – it’s a total love thing!

My peanut butter of choice is Pip & Nut, as it is just made with peanuts and salt, no added sugar. I need some food in my life that feels naughty and peanut butter totally does it for me. Okay, so ladelling it down is probably not a great idea, as it’s high fat, but a spoonful of Pip & Nut transforms me from feeling deprived to feeling totally satisfied!

5) Breakfast is now way more interesting

Mum100-IVF-pregnancy-blog-gestational-diabetes-breakfast-variety-optionsHaving gestational diabetes challenged me to vary my breakfasts. For a long time, we did a three-day rotation in our household between the following:

  • Daddy bear bowl of porridge with fruit
  • Eggs of all kinds on toast
  • Some combination of avocado, tomatoes and mushroom on toast

After the GD diagnosis, I started to think about a protein base for all my breakfasts. I still need some carbs in my breakfast, as without that balance I’m starving by 10.30.

These are some of the breakfasts I’ve really enjoyed and they have kept my post-breakfast blood glucose reading under 7.0:

  • Smoked salmon and cottage cheese on granary or sourdough toast (1-2 slices are okay for me, but this varies person to person)
  • Grilled mackerel with asparagus and lemon, on granary or sourdough toast spread with Philadelphia cheese
  • Homemade houmous with vegetable crudités and hardboiled eggs
  • Mozzarella (either hard or soft) with grilled cherry tomatoes and basil on granary or sourdough toast
  • Peanut butter porridge (max 35-40g) with Alpro unsweetened almond milk, soaked mixed nuts and berries
  • Eggs of any kind with spinach, followed by mixed berries and natural yoghurt
  • Scrambled tofu, garlic mushrooms, spinach and tomatoes (I had this out at a vegetarian breakfast café and it was deeee-licious!)
  • Avocado with lime, chilli & mixed seeds with boiled egg and toast

6) How to plate up lunch

Mum100-IVF-blog-gestational-diabetes-lunch-dinner-plate-protein-carbohydrate-vegetablesMainly, I’ve eaten my biggest meal of the day at lunch. This was suggested by our hospital, as I am more likely to burn off excess carbohydrates with activity during the day.

The diabetes nurse suggested dividing up the plate this way:

  • a quarter of the plate protein
  • a quarter carbohydrate
  • half the plate of non-starchy vegetables (ideally a variety including greens)

7) Berry heaven and the useful fruit rule!

Mum100-IVF-pregnancy-blog-gestational-diabetes-blueberries-strawberries-raspberries-fruitBerries have become my sweetest friend. I learned at the St Thomas’s hospital education session a rule of thumb about fruit sugar. Generally speaking, the closer a fruit grows to the equator, the higher the sugar content. So northern hemisphere fruits, as a general rule, are lower in sugar.

Strawberries, raspberries, blueberries work well for me. Pears are better for my blood glucose score than apples. I steer clear of bananas, pineapple, mangoes, figs, all dried fruit and fruit juices, as well as big bowls of fruit salad. Here’s a helpful list of glycemic load in fruits.

I have come to really love a small bowl of mixed berries with natural yogurt and some mixed nuts – it might sound boring but eating a ripe strawberry, very slowly, is a sensational experience!

8) Eggs – my most faithful friend!

Mum100-IVF-blog-gestational-diabetes-eggs-fried-boiled-scrambledWhen my post-breakfast scores veered too close to the 7.0 mark, I reverted to eggs.

Eggs have never failed me, including served on toast.

Good quality protein and fat, B vitamins, vitamin D, selenium and more goodness besides.

Quick to prepare, tasty, a pinch of salt and pepper – what’s not to love?

9) Food pairing for snacks

Mum100-IVF-blog-gestational-diabetes-snacks-food-pairing-carbohydrate-protein-fatThis is a great tip I picked up from the brilliant Gestational Diabetes UK website – I’m so grateful to them because it solved a riddle for me about snacks. On their website, they say #NeverEatANakedCarb because:

Carbs = high blood sugar levels 

Carbs + fat + protein = lower blood sugar levels

Food pairing snacks that work for me are:

  • Half a green apple with peanut butter dip – so good (any excuse to indulge my peanut butter obsession!)
  • Slice of cheddar cheese and half a pear
  • Tandoori prawns with mint yoghurt dip
  • Houmous, handful of nuts and red pepper
  • One slice of peanut butter on toast
  • Philadelphia cheese with carrot and celery
  • One slice of guacamole on toast

10) There’s taking things too far!

Mum100-blog-doctors-orders-chips-gestational-diabetes-ketones-urineEarly in my new routine, ketones started to show up in my urine at my hospital check ups. Ketones are produced when the body burns fat stores. There can be a number of reasons for this with gestational diabetes – see the Gestational Diabetes UK website for good advice on ketones – but in my case, it was because I restricted carbs too much early on.

So, the advice from my diabetes team was to add more carbohydrate back into my diet – I enjoyed that check up enormously and the adjustments I made worked.

11) Yes, obviously slabs of cake and ice cream are off the menu in pregnancy, but…

Mum100-IVF-pregnancy-blog-gestational-diabetes-temptation-chocolate-brazil-nuts-almonds…occasionally in the last seven weeks, I have given in to my old friend chocolate, paired with a few nuts.

Only a couple of squares, mind you! And I let it melt very slowly in the mouth.

After pregnancy, I don’t have to test my blood anymore but I have decided to use my testing kit to learn about the effects of sugary snacks and desserts on my system.

12) Slow down

Mum100-IVF-blog-gestational-diabetes-slow-eatingBefore the GD diagnosis, I wasn’t a fast eater, but I have been learning how to eat my food more mindfully.

I appreciate each mouthful more and savour the food. I experience the textures and tastes more.

Slowing down really helps me to know when I’m full too.

And anyway, the tortoise always beats the hare, right?

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Thirty-two weeks pregnant: a diagnosis

A silent sonographer in a pregnancy scan is always unnerving. We have Robert for our 32-week scan and apart from the briefest hello in a strong Scottish accent, then an invitation to lie on the bed, we don’t do small talk. Phil sits in the plastic chair beside me. We hold hands and look up at the monitor, excited to see our space baby beamed on screen.

We have this scan at 32 weeks due to my age. Our hospital like to keep tabs on the over 40s and to be honest, I’m happy about that. Robert gets down to his measurements. He draws lines across our baby’s head. He draws a circle around the stomach. He traces the length of the femur bone. I recognise all those parts easily.

Then Robert measures top to bottom in dark pockets. I ask what he is measuring and he says amniotic fluid: click, click, reposition, click, click, reposition.
“Does everything look okay?” I say.
Robert plays us the reassuring pulse of our baby’s heartbeat – swish swoosh swish swoosh – a flood of relief seeps from my head through my heart to my stomach. Robert switches position to the umbilical cord. He flicks on the bright red and blue blood flow. Two colours good, I think to myself.

I am dying to ask Robert, “please can you show us our baby’s face?”
I really want a long look at the face, as I’d been told by a friend that features are really defined at this stage of the pregnancy, even on a 2D ultrasound. We do get a quick glimpse of full lips and nostrils as Robert moves up again, a breathless moment of wonder for me – but then the ultrasound wand moves away and I can’t quite bring myself to ask Robert to show us the face.

For the rest of the scan, Robert returns to the abdomen and those pockets of amniotic fluid. He finishes up and walks over to his computer.
“I’ll be a few minutes writing up my notes,” he says.

Holding hands, Phil and I look up at the monitor for clues. The screen is now displaying a table of figures. My eyes fix on the estimated weight – 5lb 3oz – confirmation we’re in for a big baby. I had expected it with a family history of 9 and 10 pounders. I whisper the weight to Phil and laugh.

I can’t help but ask Robert another question. “I have been leaking fluid every few days since week 24. Was there enough amniotic fluid?”
A new, long word flies our way – polyhydramnios – like a boomerang, the word wraps around my head and flies back across the room at Robert, who offers up the definition.
“Actually, your fluid is too high,” Robert says. “It’s increased since your last scan.”

IVF-pregnancy-blog-32-week-scan-polyhydramnios-excess-amniotic-fluid

A dozen competing questions ping into my head.
“Is everything okay with our baby?” I say.
Robert says he’s referring us to the diabetes team.
“I’m recommending a gestational diabetes test,” he says. “And we’ll see you for another scan at 34 weeks.”
My stomach shrinks. I feel instant guilt.
Phil takes the referral form from Robert.
All I can think is – god, have I harmed my baby?
I want to ask Robert so many more questions but everything about his body language says his job is done. He encourages us to phone the diabetes team in the morning, to speed up getting an appointment.

Outside the scan room, we sit down. Phil says it’s taken the wind out of his sails and I agree. We had both expected another dose of reassurance and a final takeaway scan pic. I do a rapid internet search on my phone – stupid, I know! In Google Images, I am led immediately to the most extreme cases of gestational diabetes. There are pictures of enormous babies – 13, 14, 15 pound babies – so swollen, some of them wired up.

Stop!

Breathe!

Put down the internet!

Gestational diabetes testing

IVF-pregnancy-blog-gestational-diabetes-testing-Diabetes-Endocrine-UnitEarly the next morning, I phone the diabetes team and ask to be tested as soon as possible. A lovely nurse, Christine, squeezes me in the next morning. They are fully booked, she tells me, but she makes it happen. Christine is ‘minor miracle number one’!

On test day, I arrive with an empty stomach to an empty hospital corridor. I’m early, a sign of my nerves. I wait for the locked doors to open, then I go through the blue doors to the Diabetes & Endocrine Unit.

IVF-pregnancy-blog-gestational-diabetes-testing-Rapilose-solution8.30am: I am called through to the nurses’ station for a fasting blood test – as luck would have it, Christine is my nurse. I thank her for such a swift appointment. She has lovely round cheeks when she smiles.

After taking my blood, Christine gives me a sachet of Rapilose OGTT Solution. She says to drink all of it, fast. It is incredibly sweet and thick and heavy. My lips and tongue and throat are coated with a syrup snail trail. Yuck!

Christine tells me to wait for two hours in the waiting room. I sit next to another pregnant woman (though you can’t tell she’s pregnant to look at her). We get chatting and I find out she’s also here for gestational diabetes testing. She has a German accent and is wearing a smart green office dress – I find out later she works in the City for Lloyds. This is her second pregnancy. She had gestational diabetes in her first pregnancy, so they are testing her early this time. I’m calling my German friend ‘minor miracle number two’ in this tale, because she is very reassuring about being able to manage the condition, if my test is positive. She is completely as you would assume a German banker would be – practical, logical, unflappable! Those sucking thoughts – mainly “have I completely screwed up this pregnancy?” – they fade away as she shares her experience.

9.30am: An hour after the sickly Rapilose and I have to excuse myself from the chat with my German companion. I close my eyes and lean my washing machine head back against the hard wall. I feel sick, yet I am also craving soft boiled eggs. I think about the first scoop of white from the top of the shell. I drink some water and sit with the fuzzy whirl of nausea. I’m a reluctant passenger on a waltzer, the fairground attendant madly spinning me round.

9.50am: Phew, my head whirl subsides and I start to feel human again. I vow never to eat sugar again!

10.30am: The clock hits the two hour mark and almost to the minute, Christine calls me through to the nurses’ station.
“How are you feeling?” she says.
“I’m okay now,” I say, “but I felt pretty out of it in the middle.”

Christine nods her head and draws a kind smile up her face. I feel relaxed in her care. She plugs a test strip into a digital meter. She pricks my finger, pressing out a bead of blood. She dips the test strip and sucks the red up the strip. The device beeps to confirm enough blood has been drawn in. The result takes a few seconds to display…

9.9

“It’s high,” Christine said. “I thought it might be after how you’ve been feeling. We’ll take some blood too, just to be sure, then you can go and get something to eat. Please come back in half an hour for your results.”

10.50am: The German pregnant lady and I head down to the ground floor of Guy’s Hospital. We stake out the café bar. They are ten minutes away from starting lunch service. I scan the menu, ruling out pasta carbonara, chips and everything below the dessert heading. There’s beef chilli on the menu and broccoli, which seem safe enough. I decide to pass on the white rice. My German friend wants the same as me.

We wait for feeding time like two ravenous zoo animals.

11.30am: Back in the clinic, Christine confirms my diagnosis of gestational diabetes. She takes me through to another nurse, Yolanda, who explains the next steps. I need to test my blood four times a day – once when I wake up and then two hours after breakfast, lunch and dinner. She shows me how to use the blood glucose monitoring kit.

As Yolanda speaks, I scribble down notes, as if it’s my magic superpower. Note-taking has always been my coping mechanism when I feel clueless. The nurse tells me to attend an education session on Friday about nutrition, effects on the baby and implications for labour and birth. She says the baby may have to come early, depending on how things go over the next few weeks. Yolanda gives me leaflets to read at home, quickly paraphrasing their contents. I begin to feel like I’m being left behind in a running race, with speedy Yolanda sprinting ahead of me, calling back instructions that I can’t hear.
“Please, can you slow down?” I blurt out.
I think I hear sarcasm when Yolanda says, “of course, I’ll slow down for you. What don’t you understand? Please, tell me.”
She’s not being sarcastic. I am definitely being over-sensitive, because in the silence of the pause, in the small consultation room, my cheeks get hot and tears come.
“Look, I’m sorry,” I say, “it’s just taken a lot of time to get here. We lost our baby in pregnancy last year. I just want to make sure I understand what you’re telling me to do.”

IVF-pregnancy-blog-gestational-diabetes-testing-blood-glucose-monitoring-system-AgaMatrixYolanda goes over the information again, slower. I can sense she’s running late for the next appointment but the information does go in better this time. Essentially, if I get two high blood glucose scores, over 5.5 first thing in the morning or over 7.0 after meals, then I should phone the diabetes team and they will discuss medication. She hands me a little book to record my scores. She gives me a prescription to pick up at the hospital pharmacy for metformin – just in case I need it. I already have a monitoring device, which Christine gave to me earlier.
Yolanda checks, “is everything clear?”
“Yes, thank you,” I say.

I leave the small room with my red cheeks and paperwork. I say goodbye to the German lady in the waiting room – I never did get her name, which is unusual for me. She’s next in with Yolanda and I know I have kept her waiting, but she smiles cheerily. We wish each other good luck.

Going down in the lift, out of the hospital, I feel an overwhelming urge to sleep. I could kick myself for messing up on food, an area I’ve always considered myself to be knowledgeable.

As always, there’s lots for me to learn…

(To be continued)