Monday, December 17, 2012

Combating Gestational Diabetes

Jenni Rongey, a co-Chapter Leader for the Tarrant County Birth Network, wrote this post for the Banned From Baby Showers readers.  I've known Jenni for a few years - she was Jillian in the BOLD Fort Worth production of  "Birth" two years in a row.  She had a VBA2C almost 2 years ago and you can read her birth stories here. She also works as a birth assistant at a local birth center.  She is a wealth of knowledge and I hope you walk away with a new perspective on dealing with gestational diabetes after reading Jenni's comments.  Thank you, Jenni, for sharing your expertise and story with us here.

"Diabetes has affected every part of my life but none quite so deeply as pregnancy. I have personally experienced many of the complications and risks associated with Type II diabetes in pregnant mothers. Multiple miscarriages, strict diets full of counting carbohydrate to protein ratio, insulin injections, pre-eclampsia , c-section, induction leading to an emergency c-section, babies with under-developed lungs that were separated from me for hours or days after birth.

Funny thing is I’ve also seen a diabetic pregnancy where none of those complications reared their ugly head. That was my pregnancy too. So what changed you might ask? I stopped listening to my doctors list off all the reasons why I was high risk and I couldn’t have a normal, uncomplicated birth. I realized that the only thing that separated me from my friends that had normal, low risk, out of hospital births was that I had blood sugar
levels that fluctuated from high to low and they did not. I just needed to figure out how to control my blood sugar levels without medication. Figure it out I did and like so many of our modern day diseases it was all about diet and lifestyle.

What I want to discuss are the measures a woman that has been diagnosed with gestational diabetes mellitus (GDM for short) can take to help boost her chances of having the birth she wants. Merely getting a birth without all the interventions is an uphill battle for someone with gestational diabetes. It’s even harder if you desire a natural birth or one out of the hospital. The best thing you can do is to educate yourself and keep your blood sugar tightly controlled and educate yourself. Did I mention that you need to educate yourself?

First you should know that gestational diabetes can be readily controlled without medication. It takes some planning and determination to stick with your plan but aren’t the things that are most important in life worth a little work? Let’s get to work.

10 Things You Need to Know to Keep GDM under Control

1. Understand Gestational Diabetes – 
Gestational diabetes is a condition where a woman that has never been diagnosed with diabetes suddenly has high glucose levels in the third trimester of pregnancy. Insulin is an important hormone in the body. Its two main jobs are storing fat for future use and escorting glucose (sugar) into the body’s cells where it can be used for energy. When a woman becomes pregnant her body naturally becomes insulin resistant to a degree. This means that some of her cells start refusing to let insulin do its job. Extra glucose is left circulating in her bloodstream where it ends up being metabolized by the fetus. This is the body’s way to secure a steady stream of energy for the fetus as it grows. By the third trimester the mother’s insulin resistance is higher so that extra glucose can be secured for baby’s fat stores before birth. In most women, the insulin resistance isn’t noticed because their pancreas puts out ever increasing amounts of insulin to keep blood sugar levels normal. However in some women, the pancreas just can’t keep up and despite high levels of insulin in the blood stream, blood sugar levels remain elevated. Being diagnosed with GDM does not mean you are diabetic. It can mean however, that you have a greater chance of developing type II diabetes in the future. Learn to take care of it now and you greatly reduce that risk.

2. Understand the Actual Risks of GDM
Big Baby Syndrome - Insulin works in the body by taking glucose out of the blood and putting it in cells for energy. It drives glucose first to muscles, then to the liver, and finally to store in fat. If your blood sugar
remains elevated the baby’s pancreas is left to deal with the excess. It will produce extra insulin which will help store glucose as excess body fat. That is how an uncontrolled diabetic mother can have a baby that is
too large. If your blood sugar is tightly controlled this is not an issue. By the way, if you do have a large baby there are several squatting style birth positions that open the pelvis by an extra 30%. This is a lot of wiggle
room. A large baby alone is not a reason for an automatic c-section.

Low blood sugar in the newborn – If your blood sugar has been chronically high or is high during labor then your baby may be born with low blood sugar. Remember that your baby’s pancreas puts out extra insulin to help get rid of the excess glucose in its blood. When the supply of excess glucose is shut off by birth, the pancreas still takes a while to slow down production of insulin. This can result in low blood sugars. Symptoms of low blood sugar in the newborn can be hard to see but they include irritability, lethargy, excessive hunger, and rapid pulse. For a baby exhibiting signs of low blood sugar the best cure is to put the baby to the breast early and often. Usually no other treatment is needed to help stabilize blood sugar as long as it is not dangerously low.

Significant increase in interventions – The most dangerous risk of being diagnosed with GDM is merely being labeled as a gestational diabetic.  A woman diagnosed with GDM has up to a 50% increased chance
of induction or c-section just by being diagnosed. She may also be subjected to frequent sonograms, non-stress tests, and other invasive and unnecessary procedures. Many doctors want to induce around 38 weeks to “make sure the baby isn’t too big.” If you keep your blood sugars tightly controlled and within normal range your risk of having an overly large baby is no greater than a woman without GDM. Educate yourself so you can defend your choices if it comes to that. If a natural or low intervention birth is what you are wanting, you will need to be ready to fight for it. The best thing you can do is keep your blood sugar in the normal range. Ready for the how-to?

3. Eat a Diet That Does Not Raise Your Blood Sugar and Insulin Levels.

If a food raises your blood sugar it will also raise your insulin. The pancreas will fight hard to put out extra insulin to take care of any extra glucose in the bloodstream. The damage inflicted by excess insulin circulating in the body is enormous but for the purpose of GDM I will distill it down to one important complication, pregnancy induced hypertension. Insulin raises blood pressure and this is part of the reason that women with uncontrolled blood sugar in pregnancy are at a higher risk of developing pre-eclampsia. So exactly what foods will raise your blood sugar and insulin levels? Glad you asked!

4. Go Grain Free
Grains are the number one culprit in high blood sugar with sugar close behind. Are you surprised that sugar isn’t in first place? Unless you are drinking gallons of corn syrup laden soda and eating Snickers for snack
everyday (and if you are, quit that!) most people consume more wheat, corn, rice, and oats than sweets in any given day. This makes them the number one food to control. Do you really need to cut out all grains, even whole grains?  The answer I’m afraid is yes, at least until you have had a week or two of absolutely normal blood sugar readings. Then add in whole grains, if you must, one serving at a time. Pay careful attention to how you respond to any particular grain. I personally can’t even look at rice without my blood sugar hitting the ceiling but small amounts of corn or corn tortillas can usually be tolerated. If you monitor your blood sugar carefully you will know when you have reached the upper limit of your grain intake whether that is one serving a day or four. Along with grains you have to watch your intake of starchy vegetables, mainly potatoes and peas. White potatoes are the vegetable world equivalent of white bread. Sweet potatoes offer great nutrition with a much lower impact on blood sugar. What about sugar? Obviously sugar needs to be severely limited in your diet (even if you aren’t dealing with GDM.) Have you noticed that most of our favorite desserts and treats pair grains with sugar? Talk about a double whammy. So what’s a pregnant girl to do? Eat fruit…..just kidding! Check out recipes for grain free treats that are sweetened with honey, maple syrup, or other unrefined sugars. There are thousands of tasty recipes on the web waiting for you. If you are the experimental type in the kitchen you can start trying out wheat flour alternatives like almond or coconut flour.

Eat Whole, Real Food from Good Sources
Grass-fed meats, wild caught fish and seafood, and pastured chickens and eggs should make up the bulk of your protein. Local, seasonal, and hopefully organic vegetables will give you your best source of vitamins and minerals.  Organic fruit should be eaten in small quantities. I can hear the rumble of, “Sheesh! I’m not made of money,” out there. I know. I’m not either. Figure out your priorities. If you eat a lot of eggs but rarely touch red meat then spend your money on pastured eggs, and go ahead and buy standard grocery store meat. That small amount won’t be your undoing. You get the idea.  Dairy is questionable for some people struggling with blood sugar issues.  Usually cheese has very little impact on blood sugar but milk is actually quite high in sugar (lactose.) It will just take a little experimentation to decide whether or not milk will be an option for you. For those of you that are Weston A. Price devotees, and you know who you are, raw milk generally has less of an impact on blood sugar than pasteurized. Always eat dairy in the full fat form. It will slow the impact on your blood sugar plus the vitamins and calcium in dairy foods require fat for your body to absorb them.

6. Don’t Worry About Fat in Your Diet

If it’s good fat that is. Fats are necessary to human health. Fats feed our brain,  give our cells structure, and keep our skin glowing and wrinkle free. Fats help us metabolize vitamins A, K, and D. Good quality fats are necessary to  properly nourish mom and baby. The problem is figuring out which fats are  good and which are not.  Saturated animal fats from pastured and grass fed  animals are great! Grass fed beef is high in omega 3 fatty acids. Pastured lard  is full of heart healthy monounsaturated fats. If you eat pastured bacon save the grease and cook your eggs in it just like Grandma used to. Butter, cold pressed coconut and olive oil are all good choices that are easy to find as well.  Steer clear of processed vegetable oils, even canola oil. These oils become oxidized and rancid during processing. To hide the awful smell they are chemically bleached and deodorized. Sounds yummy right?

7. Check Your Blood Sugar Often
How can you know if you are successfully keeping your blood sugars level if you don’t check? Get a glucometer and check your blood sugar several times a day. Yes I know it’s tedious but trust me, it’s better than having to inject insulin twice a day. Your care provider should go over the values that you are looking for but just in case, your fasting blood sugar should be below 100mg/dl and under 140mg/dl two hours after a meal. Consider your glucometer your most important tool to helping you stay on track.

8. Exercise! For Real, Do It!
Consistent exercise is a major key to blood sugar control. When you do any exercise you move large muscle groups. To fuel those large muscle groups your body will direct glucose out of your bloodstream and into the cells of the muscles. Exercise can have a large and immediate blood sugar lowering effect.  If you exercise consistently it will boost your metabolism and make you more sensitive to insulin. Over time regular exercise will help to keep your blood sugars lower. I’m not talking about hours every week at the gym. Moderate walking several times a week for as little as 30 minutes has a huge impact on your insulin sensitivity.  Consistency is what’s important here. The more consistent you are the more benefit you will see. If you find that following all of these recommendations isn’t quite getting the job done there are a few more tricks up my sleeve.

9. Great Supplements
Choose quality whole food supplements that support metabolism and lower blood sugar levels. A whole food prenatal may be in your best interest. It is generally believed that people with metabolic disorders, and GDM is one, have a harder time absorbing nutrients. A whole food prenatal vitamin is more readily available to your body. A whole food chromium supplement is a must.  Chromium is a necessary mineral that helps regulate blood sugar. With depleted soils it is impossible to get all you need from food. Cinnamon is another valuable supplement for lowering blood sugar. While you can buy cinnamon capsules, just sprinkling some on your food everyday is a tastier way to get it. Certain brands carry Chromium blends specifically for blood sugar control that contain cinnamon as well.

10. Coconut Oil 
I know I went over fats earlier but coconut oil is a special one. Coconut oil when taken as a supplement supports your adrenal system, boosts metabolism, and lowers blood sugar. You can take up to 3 tablespoons a day if needed. If you have been on a low fat diet then start small. Begin with 1 teaspoon before each meal and work your way up. You may find benefits at a low dosage or you may need to go all the way up to 1 tablespoon before each meal. You can stir the oil into herbal tea or take it straight from the spoon.

As with anything regarding your birth, the better educated you are the better chances you have of getting the birth you desire. Gestational diabetes is not a one-way ticket to a c-section or induction. With some planning and dedication you can have the birth you envision. Happy healthy birthing to you!

*I am not a doctor or licensed medical professional. I have done my research and these are the steps I took to control my blood sugar during pregnancy. If you have been diagnosed with GDM and are currently controlling it with medication you need to start this diet under supervision of your care provider. You will need to very carefully monitor your blood sugars as you wean off of medication."

For more information, I wrote a post about testing for gestational  diabetes earlier this year, including the criteria set by the American Diabetes Association.


Ivys Mom said...

What a fantastic post! I'm happy to have some detailed info on this! I would love to have some references for the research she did. Could those be made available?

Joy@WhenDoesDaddyComeHome said...

Great information! I know so many women who are opting out of the GD testing because some prefer to only be tested if they have symptoms or red flags that could point to GD or because they assume it isn't necessary because, to a degree, all women are slightly diabetic while pregnant. I do not know what is real info, what is misinformation and what could be dangerous.

It seems that, to many, empowerment means saying no to absolutely anything and everything medical. It'd be great to see a post on this subject soon on why women should reconsider opting out, if women should opt out, symptoms of possible GD, etc.

Also, kind of going along with the post, diet and lifestyle play a huge role in managing GD. Would it be more beneficial for midwives to just encourage this diet. Does the label of GD on your chart really change anything regarding the birth if you take care of yourself? Hmmm... big topic, lots of questions!

HeyBunnie_Lu said...

Thank you so much for this post! I was diagnosed with GDM in the very early weeks of this pregnancy. I'm talking like week 8. When in reality, I was pre diabetic before hand, and the doctors refused to acknowledge this.
Anyway, thank you for all the tips and information. I'm on Metformin now, but my sugars have been going up. Now in week 18. I haven't been eating well, but starting today I'm planning on following your guideline. :) Thanks!

Robin L. said...

Yes!! Bookmarking this to share with friends. What a great post jenni! <3

Laurie said...

Love this! I had GDM but was able to control my sugars perfectly following the same diet you're recommending. Because of that, I had no complications and a wonderful natural birth. I was wondering if you could give specific recommendations for the supplements? I've stopped taking a multivitamin because there's been so much info lately about how poorly they're absorbed. Thanks!

Tami said...

Great info! Thank you for this post!

Diana J. said...

Excellent, excellent post! Thank you so much!

I tried coconut oil by the spoon, and it nearly gagged me... I tried these, and now I can't stop! Much easier way to take it. I nix the honey and use the teensiest amount of liquid stevia in its place - and usually add peanut butter! :)

Thank you!

Charlotte said...

Great post! But I do think it's very important to mention that stillbirth is a risk of GDM under point 2. Even extremely well controlled diabetes still gives you about twice the risk of stillbirth as a non-diabetic woman, which is why doctors prefer to induce at term. It's fantastic to empower women to get the birth they want, but part of educating themselves does mean knowing ALL the risks.

diabeteshealthcare said...

GD is now very common disease in pregnant ladies and the regular checkup and taking the balance diet may prevent a diabetic from its further damage.

Gestational diabetes

Melissa said...

Some other minerals that GREATLY affect the bodies ability to manage blood sugar levels are zinc and magnesium. Magnesium also levels also impact blood pressure levels. And as you said in the post, with depleted soils it is not necessarily easy getting enough of these for your own sake, AND a growing baby on top of that. (That includes nursing for those moms who do.) some great ways to get more magnesium include transdermal magnesium therapy (rubbing magnesium oil on your skin before bed), and concentrated mineral drops, of which you add two or three drops to your water throughout the day. For zinc, along with introducing liver into your diet once a week (seriously folks), chelated forms are best. Zinc Asay from radient life is also a great source. There is a great tutorial on the Food Renegade Blog on how to make your own magnesium oil.

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