Saying Goodbye to Favorite Foods

One of the biggest struggles a GDM mom-to-be has (in my opinion), is saying goodbye to those favorite foods that are considered "bad foods" for your blood sugar levels. All those foods you were loving before your diagnosis, when you were relieved from having to be on a diet, and could "eat for two". Food like donuts, ice cream, yummy-gloppy, cream sauce pasta, pizza, Big Macs, bananas, and bbq ribs that serve to soothe cravings, fill a preggo-mommy hunger, and make us happy. Heaven for me before diagnosis was Dairy Queen Pinapple soft serve sundaes. Yum.

I know I had trouble in the first few weeks, and again right near my due date. Seeing a co-worker glomming on a sesame seed bagel with cream cheese and lox made me want to rip my hair out, and I crossed the street to avoid looking into the chocolate shop, bakery window, or lineup at McDonalds. And do not get me started on my husband eating Miss Vickies beside me when I was seven months pregnant and couldn't look at a potato chip without both salivating and fearing the BS spike. *evil glare*

Yeah, I love my food, can you tell? *pinches spare tire*

Eating well, and refraining from "bad foods" is by no means insurmountable, of course. You are giving up the foods temporarily, and its not about you, its about your growing baby. You do it for them, and its a good thing. You can feel empowered when you pass up the Oreos in favour of something better, like carrot sticks, or fat-free yogurt.

But, I know that the tempation is there. Having the knowledge that you must eat well does not make it easier to say no to that Oat Fudge Bar when you order your skinny decaf latte on a Monday at work when a whole stack of nonsense arrives on your desk, your spinach salad is about as appetizing as lawn clippings, and you want to repeatedly smash your forehead on the keyboard and scream omggivemestrengthktxsbye. Let's face it. You are pregnant. You have cravings. Your nerves, emotions, sleep patterns, and body are freaking out all the time, and you just want something to make it all better. Right. Now.

The dietician and Diabetic nurse I worked with during my first pregnancy gave me some great advice for coping with those urges to inhale an entire tub of cool whip using a chocolate bar as a spoon. I thought I would share them.

1. She outlined snack choices and alternatives I could live with. Things like sugar free chocolate, stevia, strawberries, avocado, and a whole list of "free" foods. They were yummy, not bland, diet-carboard and made it bearable.
   
2. She outlined the "wait five minutes" technique before cracking open the box of Honey Nut Corn Flakes. If you are craving something that you know you can't have, wait five minutes, distract yourself with email or a quick walk (waddle) around the block. Then, likely the craving will be gone.
3. She encouraged me to drink more water if I was hungry, and that technique I still use today when I feel hungry outside of normal snacks and meals. I drink a glass of water instead, and the hunger usually goes away to the point I can think and make a sound choice.
4. She encouraged me to tell my spouse, friends, and co-workers about my dietary needs, so that if I was finding my willpower at nil, they could prop me up and help make the better choice. This helped me a lot. My spouse became the Diabetic cook-extraordinaire, and gave me a look (which worked) when I wanted to reach for the peanut butter.
5. She gave me a summary sheet of the GI Index. It rocks. I wish food labels had this in their nutrition information. Not all low GI foods will be suitable, but you can make great choices this way, based on how your GDM reacts to foods.
6. She showed me how to Carb count. I did this instead of counting calories or portion size of my carbs. Anything under 15 g of carbs was ok for me in one meal. And if it had high fibre carb content, then yahoo! It was good.
7. She surprised me by telling me it was ok to grieve. I know this sounds melodramatic, but she said it was ok to be uspet about not being able to eat whatever you want. If you get the anger and disappointment out of your system, it makes it easier to move on and be successful as a GDM mom-to-be.
8. She said EAT! It can be scary to measure every bite of food that goes into you, and worry that the 1/4 cup of rice will hurt the baby. But do NOT starve yourself, or not eat balanced, full meals, because that can be more damaging to your baby than GDM, in the long run. And being hungry all the time is no fun either, and makes "cheating" more likely.
   

Every GDM mom-to-be has a different set of food triggers. One mom can be sensitive to potatoes, another sensitive to fruit of all kinds. The severity of the GDM, your body type/shape, and familial risk factor have a lot to do with it as well. I knew several GDM mom-to-be's that could safely eat carbs and fruit, just in small quantities, and no insulin was necessary.

I hated those moms.

I had to cart around needles, insulin, and testing kits. My tummy had track marks like a drug addict, and made bare belly maternity shots impossible. I felt a little hollow when some moms could walk into the weekly Tuesday afternoon consult with the Diabetes doctor, a double-double and a donut in their hand, seemingly ok with the juxtaposition they were displaying. I would pull out my thermos of water, hard boiled egg, slice of spongy Betty Bread and some low fat cottage cheese and glare at them from inside my mind. Partially because I wondered how they could have that and not spike their BS through the roof, and partially because they were making poor choices when I was struggling so much not to.

Saying goodbye to those foods, albeit temporarily, is hard. As a GDM mom-to-be, you have to make some really big sacrifices, and add a level of complexity to your life to safeguard the health of your unborn child. Altering your diet, and balancing your nutrition untimately is a great big accomplishment, and one that should not go unnoticed. You should be proud that you can do it.

And in the end, when you greet your wonderful, normal weight, happily squalling baby, you will know that every time you traded Fibre 1 no sugar cereal for waffles, it was worth it.

Miscarriage and GDM

So I started this blog with the best of intentions, namely to keep myself motivated in the long, long 9 (10) months of pregnancy as a GDM mom. Not long after I posted my introduction, I miscarried.

We were at 9 weeks, had heard our Peanut's heartbeat, and were devastated. Even though the pregnancy was a bit of a surprise that required some financial finagling, we were going to be welcoming baby #2 by Christmas, and were hesitantly excited.

I couldn't really touch this blog until now. I didn't have anyting to say, really. But then I thought about the journey I have been on since I miscarried and I thought I should share.

A part of me was amazed at how quickly my blood sugars returned to normal afterwards. I kept testing for a few days after the official miscarriage began, and then sporadically until I had my next cycle. Normal, sometimes a tad high after we dined on "things-thou-shouldst-not-eat", but manageable, and not a cause for concern. I was concerned I had slipped into the Prediabetes or even Type 2 world, and was scared it was now going to be a full-time reality, not just a pregnant one.

I scheduled a visit with my doctor, of course, and he checked off every box on the bloodwork sheet when we discussed my overall health. He figured a physical might not be a bad idea to do, given we might find a problem, you never know. He checked B12 levels, since a deficiency in this vitamin can be risky in pregnancy. I think he also checked my iron and cholesterol levels to be sure. He tested me for PCOS (again), we did a random fasting bloodsugar, and did all kinds of hormone tests. Every test known to a doctor was done, I think, except for anything requiring my other bodily fluids I'd rather not mention here. Ew.

We discussed me, which I had expected. Yes, my weight needed to go lower, and my exercise level needed to be higher. Yes, I needed to keep going on eating better, as we had been doing since getting my test back high. He said to take someone with me to testing, since this was a lot of tests to take blood for, especially after fasting.

Whee! 7 vials of blood made the caffeine I put into my system afterwards very effective.

No red flags came up in the bloodwork, thankfully, and no mention of really high levels of fasting bloodsugar made my stress come down a notch or two on the "holycrapmylifeisover" meter. Likely, at my follow-up visit tomorrow, my awesome doctor will caution me that my levels were on the high end of normal, which they were last time we checked, but I was taking matters into my own hands with exercise and better eating already, and wasn't worried. Bring it on, man! *flex*

This whole thing got me thinking, though. Could my early diagnosis and high blood sugar levels have caused the miscarriage? When I was pregnant, I was scheduled to see the Diabetes doctor, but it was set for two weeks after I miscarried, so I was not able to get a perscription for insulin, and my sugars were getting harder to control each day. my levels were so wonky that I couldn't even look lovingly at a carb from across the table. A quarter cup of basmati rice was spiking me from a high 6 to a low 10! Not good. Not good at all.

I wondered - looking back at how difficult it was compared to my last pregnancy - if the lack of ability to control my bouncy blood sugar with diet was a contributing factor. So, with the thought of my GDM being a risk factor to miscarriage in the early days of pregnancy, I opened up the trusty Interwebs, and did some researching.

After looking through the Canadian Diabetes Association and the Public Health Agency of Canada, I found no convincing statistics that linked miscarriage to early onset GDM. It was mentioned, but each had conflicting stats, and thus, I couldn't verify anywhere else. Most mentioned that there was a risk, but identified more with type 2 Diabetes, rather than prediabetes, or GDM. In all cases, the percentage of risk was below 10%, and not a cause for major concern. Huh... ok, lets check some US sites.

US statistics and websites tended to be more fruitful. I did found a more concrete statement* while perusing the the WebMD network. The link to the page is here , with the following quoted from the section titled "Clinical":

Miscarriages

• In all women with preexisting diabetes mellitus, there is a 9-14% rate of miscarriage.
• Current data suggest a strong association between degree of glycemic control prior to pregnancy and miscarriage rate. Suboptimal glycemic control has been shown to double the miscarriage rate in women with diabetes. A correlation also exists between more advanced diabetes and miscarriage rates. Patients with long-standing (>10 y) and poorly controlled (glycohemoglobin exceeding 11%) diabetes have been shown to have a miscarriage rate of up to 44%. Conversely, reports demonstrate a normalization of miscarriage rate with excellent glycemic control.

I also found this statement on Healthsquare.com:

Illness

Miscarriages are much less common in the third trimester. Those that occur are more likely to be due to maternal factors, such as an illness in the mother, than to genetic abnormalities in the baby.

Women with poorly controlled diabetes are at great risk for miscarriage. Those whose diabetes is controlled, however, whether it existed before the pregnancy or developed after conception (gestational diabetes), are no more likely to lose a pregnancy than other women. A woman may not know that she has diabetes, however, until it is discovered during a search for the cause of repeated miscarriages. The routine blood and urine tests given during pregnancy are an effort to identify this problem while it still can be remedied.

Other diseases and conditions linked to increased risk of miscarriage include systemic lupus erythematosus (SLE, or lupus), high blood pressure, and certain infections, such as rubella (German measles), herpes simplex, and chlamydia. Experts disagree about the role of hypothyroidism, or an underactive thyroid gland, in miscarriage, but it's likely that a severe case increases the risk.

With conditions such as diabetes, treating or controlling the problem can improve the odds of a successful pregnancy. Special monitoring may also be required.

This was the first I read that my uncontrolled high levels might have contributed to the miscarriage. Should I feel guilty? Did I, because of my frustrating, unruly pancreas, cause my miscarriage?

I wasn't sure I wanted to put that heavy guilt burden on myself. I am no different than most women who go through miscarriage. You wonder if that bumpy carnival ride was to blame, or if the wand ultrasound technician-sadist who poked holes in your ovaries caused too much trauma, or the hot room yoga you were doing (before you knew you were preggo) made it happen. We look for causes, look for someone or something to blame other than simple nature and randomness of life.

I decided that no, I can't. Sometimes, it is what it is. We take the lesson and move forward, better prepared for the next curve ball. I think any pre-existing or high-risk condition in pregnancy can cause miscarriage, or other problems, it just depends on the individual, and their genetic makeup. Sometimes, even with best effort, things happen.

Next time, I will be better prepared to handle the onslaught of crazy my body will go through. Next time I will expect an early, if not immediate GDM problem, and act accordingly upon the positive pee-stick result. And because of my efforts to eat better and move more now, it might just be easier. I hope. We'll see.

* I can't verify all of this information, so please remember that when researching on the Internet, it is important to find several sources that say the same thing, are reputable, and reference other works themselves. Please take the statements quoted in this email with a grain of salt, and talk to your doctor about your concerns. He'sthe expert, not me.