Gestational Diabetes & Diet question

Factual Questions
1

I have a feeling that I may regret this thread, but I’ve been pondering all day, so I’m throwing caution to the wind.

Let me start by saying I’m under the care of a physician. I will be seeing a physician again in no time at all. I’m not asking for medical advice.

Ok, with that out of the way:

I am 33 weeks pregnant. I do NOT have gestational diabetes. Everything has been going well, my weight gain has been normal and healthy, my tummy growth has been normal and healthy. Everyone is normal and healthy. I have been following Canada’s Food Guide, as per the advice of my physicians, as well as community health nurses.

However, - due to a family history of Type II diabetes, I am being monitored very closely for gestational diabetes. My last result was a tad weird; however, I do NOT have gestational diabetes.

Now, due to this somewhat odd result, one of my doctors recommended eliminating all sugar from my diet, and severely restricting the consumption of starch (as it is easily converted into sugar). This means no fruit, no breads, grains, etc; however, she was rather vague in her instructions. I have a follow up appointment in 10 days and I will clarify with a different physician (it’s a team practice).

In order to stem the gap I’ve gone online and found the Canada Food Guide to eating for diabetes, gestational diabetes, the Diabetes Foundation recommended diets, etc. They ALL seem to be at odd with her recommendation to eat no fruit, starches, breads, etc. In fact, they all seem to suggest that whole grains are a very important part of a diabetic diet and a gestational diabetic diet. I have spoken again to a community health nurse, and she has indicated that the Canada Food Guide is the best bet for me to follow, and to not eat sweets (i.e. deserts) - this is good enough for me and I am not asking for diet advice.

The question is this:

Is there a reason that a non-diabetic person who has a slight problem processing sugars (and yes, the problem is slight) would be on a more restrictive diet than an actual diabetic? This person has no apparent ill-effects from this issue.

2

Not in my experience, but I don’t do OB.

3

Me: I’m a Type I (thought to be Type II by stupid first doctor), who developed diabetes about 3 years ago.

I’ve pretty much found that all carbs eventually turn into sugars in the blood. And contrary to what some dietitians state, they do absorb quicker if they’re already sugar.

Even though your brain needs carbs for fuel (it can’t use fats or proteins), your body will convert fats to sugars as your brain needs them. So your doctor just wants to restrict any excess sugar from your system, so that they won’t present a problem to you or your baby. (Excess BG will damage small vessels, like your capillaries or the blood vessels in your baby and/or the umbilical cord.)

A diabetic like me, who is insulin dependent, can eat carbs. I just need to inject enough insulin to manage the BG levels that result. For type IIs, besides some diet control, they sometimes use drugs like metformin to control BG. Both of these BG medicine controls are probably not indicated for pregnant women who aren’t gestational diabetics, just having some sugar processing problems.

So yes, I can see why you’d be on a more restrictive diet, since insulin/meformin wouldn’t be recommended for you during your pregnancy.

Good luck!

4

I’m like AWB - diagnosed a couple years ago, Type I, thought to be Type II at first due to idiot doctor.

I don’t really understand, though, why they’d put you on such a restrictive diet. As both Type I and Type II, they never told me to restrict carbs to the point you describe. (Indeed, they all tell me to eat MORE carbs than I ate before diagnosis. But that’s a different thread.) My WAG is that as a pregnant woman, you need to be very careful about nutrition, and healthy carbs (whole grains, vegetables, fruit, etc) are pretty important.

What does “a tad weird” mean, exactly?

If I were you, I’d be buying a cheap blood glucose meter and checking your glucose if you’re worried. Here in the States, you can buy them fairly cheaply at WalMart. Not sure what the situation in Canada is, though.

Is that right? I’ve had more than one conversation with women with gestational diabetes who were put on insulin (not sure about metformin). Insulin is fairly benign and occurs naturally in the body; why would it interfere with a pregnancy?

5

That’s what all the info, including the Canada Food Guide says as well, hence my question.

I had the 2 hour Glucose Tolerance test (i.e. eat a balanced meal, check glucose 2 hours later). It should be under 8 to be perfect - mine was 8.6. 10.6 is diabetic.

No, it’s not right at all - women with gestational diabetes that can’t control it with diet use these drugs all the time.

The REALLY weird thing to me is every time you go to a diabetes website they have fruit pictured as part of the healthy diabetic diet.

6

It is. I eat fruit all the time, and my A1c (which is a 3-month measure of blood glucose history) is often lower than a non-diabetic. According to most doctors/dietitians, there’s no difference between a healthy diabetic diet and a healthy diet for anyone.

That said, a lot of diabetics choose to restrict carbs because (at least if you’re Type II), in some cases, you can go with minimal or no drugs. For Type Is, sometimes it’s just easier to not eat carbs (I know I’ve had meals where I go “I just don’t want to think about it right now, I’ll have the steak and salad, hold the potato, please”). But most of the medical community (not ALL, just MOST) think that a healthy diet + drugs is better in the long run than no/low carbs and no drugs. But we’re getting into religious arguments here, so I’ll shut up now. :smiley:

I’d definitely follow up and find out exactly what the doc meant; it seems excessive to be put on such a low-carb diet right away (if ever). The only docs I’ve ever heard that advocate such a diet are a few who go against the common therapies and who advocate a restricted carb diet over the standard advice of a healthy diet + insulin/oral drugs. The docs who do advocate that tend to be a few select diabetes specialists who a lot of the mainstream docs don’t agree with at all.

7

Alice, I have one random thought as to why your doctor may have prescribed such a restrictive diet. It really is a shot in the dark, and I hesitate to even mention it, cause I don’t want to cause you unnecessary worry. But you seem fairly rational, so here it goes:

My father is a pediatrician and I’m a first year medical student (so those are our “creds”). We were randomly discussing gestational diabetes, and my father mentioned that hypoglycemia in the neonate was a major issue with untreated gestational diabetes. I was surprised by this, because I thought that common sense would dictate that it would be hyperglycemia, as that is the general issue surrounding diabetics in general. He explained that in utero, the fetus is receiving some amount of maternal blood; if this maternal blood is high in glucose, the fetal pancreas will begin to put out high amounts of insulin to promote cellular uptake of the glucose. After birth, however, maternal transfusion stops, and the baby only has its normoglycemic blood to deal with, but it still has high blood-insulin levels, leading to acute hypoglycemia.

So, maybe, your doctor is recommending such a strict diet because your baby will be making an abrupt transition from your blood to just its own blood, and such a sharp transition between blood with two potentially drastically different glucose levels is not something a normal diabetic needs to be concerned with. It would be similar to, let’s say hypothetically, you’re diabetic and want to donate blood to a non-diabetic–you would be required to keep your glucose within even tighter check than a normal diabetic.

Does that make sense?

8

Humm - sort of; however, the actual reason the Dr threw out (and it was literally tossed out in the midsts of a bunch of other unrelated weirdness) was that I needed to control sugar or I would have a really big baby - a know risk for women with gestational diabetes (which I do NOT have).

I will also note, that I would assume as a NON-diabetic, I would be a lesser risk for what you describe, than a woman with actual gestational diabetes, and the diet my Dr. suggested is NOT what is recommended for women with gestational diabetes, hence my question.

i.e. if blood sugar is a concern (and I recognize that it is) I would think a woman with GD would be at greater risk and thus need a more restrictive diet, ya know?

9

It is also possible that the doctor “prescribing” this very restricted diet is wrong in her ideas about gestational diabetes. It does happen sometimes, and the fact that she is the lone voice out of a group of doctors would make me, personally, seek another opinion.

10

This is sort of what I’m thinking as well. Or perhaps I just didn’t understand what she was saying (although she was using small words and wasn’t speaking with an accent or anything. :D)

I am following up at my next appointment (they’re coming fast and furious now) because if I actually do need to be monitoring things this closely I’m entitled to an appointment with a dietician (to tell me what the hell I’m supposed to eat) a blood glucose monitor, supplies, etc.

I was mostly wondering if there would be a reason a non-diabetic person would have such a restrictive diet - to PREVENT diabetes maybe? But that’s certainly not what she said.

11

Nothing you can do eating-wise will prevent diabetes. Weight is a factor for Type II, but simply cutting carbs (as opposed to losing weight) isn’t going to do anything as far as whether or not someone will develop diabetes.

I vote for “doc doesn’t know dick about diabetes” since, in my experience, most docs don’t. I ended up flying across the country to consult with a diabetes specialist because I got so fed up with clueless local doctors. And I still more or less figure out my own care, with the help & guidance of the across-the-country docs. You’d think more docs would be knowledgeable about one of the most common diseases of our times, but alas, 'tis not so, at least not in my experience.

CDEs, on the other hand, are great, and under appreciated. Have you seen one?

12

As another wild-assed guess, was she maybe more concerned about high glycemic index foods that are practically injecting sugar straight into your veins? There’s a big difference between having a balanced meal with carbs, proteins, and fats that includes some high glycemic index foods and having, for example, some raisins for a snack (raisins being a high glycemic index food).

As for cutting all sugar from your diet, well, there is no dietary reason for humans to eat refined sugar - we just like it. It would probably be a good idea for everyone to cut all refined sugar from our diets, but that isn’t going to happen. :slight_smile:

13

Sorry, I must have read over the part of your post where you realized your doc’s diet was more stringent than even for women who have gestational diabetes; I thought it was just more stringent than for people who have regular old diabetes. In that case, you’re totally right, and I have no idea why your doctor would recommend such a strict diet. In any case, you seem more informed and conscientious than most diabetics, so I’m sure you’ll be okay. Good luck :slight_smile: