gestational diabetes: how a food blogger is managing

peanut butter toast and pickles: 1 starch + 1 protein + free = this could be a light breakfast ::::

While I have never been one to turn away from a good dessert, I am certainly not obsessed. I’ve learned to appreciate the amuse bouche  for sweets. I don’t have to eat sugar every day, but it does sneak its way into many sauces and recipes in small aliquots. I don’t pay attention to carbs, go crazy for fruits and vegetables, and limit meat. So carefree can I eat a kale salad heavily dressed with my sesame-balsamic dressing. Eat my fill of dim sum styled tripe? Not a problem at all. A caramel oatmeal cookie or two isn’t a big deal for a snack. A bowl of fresh cherries? I can fill up without guilt. Chips and salsa before the chili relleno entree at the Mexican restaurant is no trouble at all.

Now that has all changed.

Two weeks ago, I was diagnosed with gestational diabetes. My first reaction was disbelief. While my two risk factors are family history and my age, nothing else added up. I exercise, even running up to six miles at a time while pregnant this go-round. I ran a ten mile race with my second born when ending my second trimester. I eat lots of fruits and vegetables, limit the sugar and fried foods. I’m not overweight. When I make a cake or a tray of cookies, I share most of the creations. I didn’t have diabetes with my other two pregnancies. I am Caucasian. I’ve never given birth to a baby over nine pounds.

Most women with gestational diabetes recover from it after birth. They are more likely to develop Type 2 Diabetes in the future, however. This future being told for me, this soothsaying, is what really disturbed me, compounded by the concern for the health of my baby. Diabetes first affected me indirectly as a child. My paternal grandfather was diabetic. I remember his sugar-free ice cream well in hot, humid summer visits, the icy, non-creamy sickly sugar-substitute sweet flavor that it had, trying to mimic a rich, vanilla one. I recall saltine crackers and milk were often his bedtime snack, he eating while I sat with him with a glass of orange Tang. When I was eight years old, living in England, he died from complications from diabetes. An infected wound. Gangrene. A lower limb amputation. Sepsis.

And then there was my paternal aunt, his daughter. As she got older, her blood sugars became hard to control. She was overweight, which was exacerbated by lack of exercise due to severe knee pain from osteoarthritis. Exercise helps blood sugar control; she became less and less able to be comfortably mobile to engage in this important activity.

While I am not a primary care physician and do not manage diabetes medications for my patients, I discuss it on a daily basis with them, as it can be the cause of peripheral neuropathy (burning) in the feet and hands. This can lead to decreased sensation, which is a set-up for falls, wounds, for infection, amputations. Diabetes affects blood sugar which can worsen with certain medications, such as cortisone injections. Other nerve damage can occur in the gut, making digestion and evacuation difficult. Uncontrolled diabetes can lead to retinopathy, which can lead to blindness. Kidney damage. Circulation issues. Heart problems. Gum disease.

After I found out about my gestational diabetes, I was extremely angry. Angry at my body for rejecting the “normal” thing it must do during pregnancy. And I was so profoundly disappointed that my body was rejecting its role as vessel to help my baby grow in a healthy environment, that not only could I be hurting her, but also risking my health and losing precious time with my children in the future if I do develop Type 2 diabetes.

Some of my first thoughts were, Why would this happen when I’ve spent over half of my life exercising consistently, considering good food choices, and even becoming a physician to promulgate the virtues of a healthy lifestyle? This is so UNFAIR.

But then life isn’t fair. Life is life.

It’s not about my life before pregnancy. It’s about life NOW, and how my body is changing, hormonally, physically, and with age. Gestational diabetes is about insulin resistance: those wonderful hormones churned out by my body in order to keep this pregnancy on track cause my body to become insulin resistant to the insulin being produced by my hard-working pancreas. The cells in my body that help lower the blood sugar just aren’t responding; those hormones have muted their ability to sense the sugar and to do their job at full task.

I’ve mourned the loss of a fairly normal pregnancy (arguably, what pregnancy is ever really “normal?”). Just after I heard the news, I met with two fantastic, encouraging people: a dietician and a nurse, both diabetes educators, both equipping me with tools to manage my diabetes. I keep track of my diet. I menu plan carefully, balancing carbs. I check my blood glucose four times a day. I exercise every day instead of three times a week, twice to three times a day, even if it’s just a 10 minute walk. Being regimented is the key for me; it always has been (but easier said than done when balancing not only a timed meal plan but also a job and family). It seemed very restrictive at first but in some ways, it has become more freeing. I plan my daily menu. Everything is measured. I eat. Certain snacks are okay. No sugar for dessert. No dessert at all, unless you consider the before-bedtime snack fruit a dessert.  Though I need to think about the daily menu and plan carefully at first, it ultimately has become a way to NOT have to think about what I’m going to eat at the moment I need to eat it. It’s been decided. A done deal.

It does get complicated when Peach and Grub are surveying my plate, wondering if they, too, can have some of my olive-oil scented whole-wheat noodles from MY bowl despite the macaroni and cheese that they wanted and were presented three minutes prior. Or, the three ounces of cheese on my plate somehow looks much more appetizing than their cheese cubes. Maybe it’s my presentation, my dilettante minimalist food styling prowess, that somehow transcends the utilitarian look of cheese cubes on a Dora the Explorer plate.

I also had to mourn the loss of my carefree food blogging, posting my infinite possibilities of recipes and photos. Now I am finally accepting that I must rethink my approach, and taste vicariously through others, for the next few months. I planning on experimenting with some recipes for my current meal plan and using a new post tag “gestational diabetes” so you can all find those recipes gathered in one special place.

The advice I can give to others at my start on this crusade with diabetes, hopefully with the light at the end of the tunnel not being a flickering flame that will go out before I reach it, is that this change in lifestyle CAN be done, even if it seems impossible at first. Anything is possible. Especially for gestational diabetes ladies, don’t let it encompass the last trimester of your pregnancy. Try to enjoy the baby kicking, the excitement of a new family member, the fun of picking out cute baby clothes, or getting a preggo massage. Think of this regimented lifestyle for this time as preparation for your post-partum days. You will be in better shape with all of the walks/runs that you do. If breastfeeding, you will probably rethink your snack options after this training: Doritos versus the handful of grapes and yogurt? The positive: this is a good learning experience. Even if you don’t follow it to a T later, it will shape your eating habits and make them better.

Maybe when I’m fed up with trying to redesign my palate’s interests with recipe testing and obsessing over carbohydrates in said meals, I’ll try some saltine crackers and milk instead, just before bed, like Grandpa, even post-partum. And then I’ll go for the chocolate mousse, just a little.

 

UPDATE: I have a follow-up post on my journey; here is the epilogue.

 

* A disclaimer: While I am a physician, I am not in primary care. I talk to my patients about diabetes every day, but I don’t manage medications or treatment plans. If you have diabetes or have specific questions about your treatments, please ask your primary care provider.