Gestational Diabetes Diet

I have had gestational diabetes for all three pregnancies.  Each time it gets harder and harder to manage.    For most pregnancies, diet control and exercise are sufficient to manage blood glucose levels.  This was my experience for my first two pregnancies.  However, this time, I have had to be put on daily insulin shots.

[Note: A little bit about gestational diabetes. Gestational diabetes is the manifestation of glucose intolerance for the first time during pregnancy. The glucose intolerance results from hormones released by the placenta, which makes insulin less effective in processing glucose. This resuls in higher blood glucose levels. Most women are able to produce sufficient extra insulin to compensate for the increased insulin-resistance. But for women like me, that doesn't happen. We simply cannot produce enough insulin our bodies need. This extra glucose floats around our bodies and enters our babies' bloodstreams.  The babies respond by producing extra insulin, storing the extra glucose as fat. Failure to control glucose levels can lead to serious consequences, such as macrosomia (very large babies), death in-utero of the baby, and dangerously high blood pressure for the mother. In the long-run, both mother and child are at higher risk of developing Type 2 diabetes.  Because of the severe risks involved, it is critical for the mother to keep her blood glucose under control.  This is usually done via exercise, diet and as a last resort, insulin therapy.  Typically, the glucose intolerance gets worse as the pregnancy progresses because the placenta gets larger and more insulin inhibiting hormones are released.]

Despite my insulin therapy, I have continued to find it a challenge to manage my glucose levels.

Teochew Fish Porridge has always been my 'safe' go-to food to cope with gestational diabetes. It is low in calories and full of brain building fish for the baby. During my first two pregnancies, when I was working full-time and lunching at the food court, it would often be the only thing I would have for days on end. Perhaps alternating with Yong Tau Foo. I did not mind too much as I love fish porridge and fish soup.

Last week, my diet was thrown into disarray. And it wasn't because of Christmas. Unfortunately, my body now cannot tolerate white rice, and even fish porridge, which doesn't have very much rice in it, has caused my blood glucose levels to spike to unacceptable levels. My go-to food is now on my list of 'Banned Foods'. It was very depressing. But this is typical of gestational diabtetes, as glucose intolerance increases as the pregnancy progresses.  It is like a moving goal post.  One week white bread is OK. The next week, it's a no-no. One week white rice is OK, the next it's not.  Each week, more and more foods get put on my banned foods list.  As of yesterday, only wholegrain bread, whole wheat pasta and brown rice (in small amounts) are safe for me.

I am going to have either a wholegrain sandwich or wholewheat pasta for lunch. Maybe I'll discover that these are off the list too. My doctor may continue to increase my insulin dosage, but the cruelty of insulin therapy, is that the insulin makes me even hungrier...too much insulin, and I could end up with higher glucose levels because I'm eating too much!  But if I don't eat, then I might lose weight (insufficient weight gain is something I've always struggled with during pregnancy).

Fortunately, Baby is already 38 weeks.  I only have about two weeks (probably less, as I usually deliver around 39 weeks) left of this craziness.  I suppose if I can't eat anymore carbs, I will just eat eggs,  dairy, meat and lettuce in the final stretch.

My Top Foods to Eat Post-Partum

With my glucose levels hitting new highs, I've had to really be careful about what I'm eating during pregnancy. Here's my list of top (tried to limit it to 10, but impossible) foods (in no particular order) I will waste no time getting hubby to da bao to the hospital after Baby arrives. (Useful for those who will be visiting me during confinement as well... :-) )

1. Chicken rice with lots of chilli and dark soya sauce (the chicken fat soaked rice amd dark soya sauce is very very bad for the blood glucose levels). Maybe I'll send DH down to Tian Tian Chicken Rice. But Wee Nam Kee on Novena Road will be more than good enough for me. Actually, in my deprived state, I'll probably be happy with the chicken rice from the hospital cafeteria...

2. Fried carrot cake, black AND white (again...carbs and dark soya sauce are very bad). My favourite stall near my old place in Yishun has closed down, but Heng Carrot Cake at no. 28 Newton Hawker Centre is not bad, and near my home too.

3. Chili crab with fried mantou from anywhere, really, but probably Jumbo Seafood.

4. Kaya Toast with half-boiled eggs (and dark soya sauce!) and teh-c siew dai. From Ya Kun, of course!

5. Laksa! From any stall that calls itself Katong Laksa!

6. Fried Seafood or Beef Hor Fun from any good tze char stall. Lotsa green chillies please!

7. Bak Chor Mee Pok Tah lotsa chilli. I hear the Teochew Street Mushroom Minced Meat Noodle in Chinatown is really good, but I'm not sure about the wisdom of queuing more than 20 mins for food... Anyway, I'm such a mee pok slut that any stall will do...

8. Dry Prawn Noodles wih pork ribs and lotsa chilli, from Noo Cheng Prawn Noodles at Adam Road Hawker Centre. Super shiok!

9. & 10. Chendol and Pulot Hitam. From Ivin's. Actually, anything from Ivin's - ayam buah keluak, udang masak nanas, opor ayam, babi pongteh, beef rendang, sambal kangkong, nonya kuih-kuih... I miss my Peranakan food.

11. Roti Prata from Thasevi's at Jalan Kayu.

12. Mee Goreng from Thohirah's at Jalan Kayu.

13. Nasi Lemak from Selera Rasa Nasi Lemak at Adam Road Hawker Centre.

14. Chocolate dessert - any kind! Best if made by yours truly from one of Nigella's books. But with a newborn, I don't think I'll have time to muck around in the kitchen for awhile...

15. Durian. The King of Fruits is so loaded with sugars that I am only allowed 1 seed a day! So why bother. But believe you me, once I deliver, I will be sending hubby straight to Combat Durian along Balestier Road to buy me some durians.


All I can say is, thank goodness for breastfeeding, which will allow me to indulge a little without worrying about my weight!

My Top Ten Pregnancy Peeves

(Warning: This is going to be a long post!)

My boys.

We are expecting our third child in Jan 2011.  This pregnancy has been a little bit more difficult than the previous two.  I attribute that to age and the fact that I have two older boys to run after!  Nevertheless, I am enjoying this pregnancy, as I had enjoyed my previous two.  I have been blessed in many ways.  My morning sickness was mild compared to the horror stories I have heard.  I don't have stretch marks.  My hair and skin feel great. I don't have swellings of my hands and feet.  I don't get impossibly huge.  And until my recent complications, my body was agile enough to walk 4 -5 km weekly + engage in Pilates classes.

I do however, have some pet peeves. And when something peeved me off recently, I was inspired to make a list of my "pregnancy peeves".  So here are my top 10.

Pregnancy Peeve #1: Morning Sickness. Ok, I know I said my morning sickness was mild compared to the horror stories I have heard.   However, when you are feeling weak because you are hungry but can't bear the smell of the morning prata (or the morning papers - yes, the smell of the Today newspaper made me sick...), the last thing you want to do is think about how much worse it could be.

And don't be fooled, morning sickness can happen throughout the day. Apparently, one trick is to take dry toast and crackers.   I found it helped.   Probably because they were tasteless and had no smell. "Sng Boey" (preserved sour plums) a traditional nausea remedy does not help.  And in fact made me feel worse.

I remember often feeling upset because it meant it took more effort to do the things I had to do (work, kids etc.), but I was encouraged by the fact that it would fade after the first trimester.  And it did fade.  My heart goes out to those suffering from hyperemesis gravidarum, which is basically severe nausea throughout pregnancy.  

Pregnancy Peeve #2: The Fat Look. That in between stage at around 4 - 5 months when you aren't showing much yet, but your tummy is getting bigger. i.e. you just look fat.  And you are too small to wear proper maternity clothes so you have to get regular clothes in bigger sizes that don't quite fit because the rest of the proportions are just wrong.  Then you really just look like you don't know how to dress yourself.

Pregnancy Peeve #3: Don't Touch My Tummy! You wouldn't touch my tummy, or even talk about it when I am not pregnant. So what makes you think it's OK when I am? My tummy has been the subject of countless conversations with perfect strangers, especially in elevators (whether it's sharp or round, or big or small, or wide or compact, or boy or girl shaped). And these strangers have felt free to feel me up. I don't even think it's OK for my friends to touch my tummy. It's private. So HANDS OFF!

Pregnancy Peeve #4: Don't Guess the Age.  On a related note, please try not to guess how far along by the look of my tummy or compare it with the next lady's.  I don't appreciate being subject to such close scrutiny.  Would you?

Pregnancy Peeve #5: Toilet Breaks. I can live with the more frequent trips to the loo during the day, but when I have to keep getting up during the night (especially in the last few weeks), I get really grumpy.  I need my sleep!!!

Pregnancy Peeve #6: Leg cramps. Not only do I get woken up by the need to use the loo, I get woken up by leg cramps in the middle of the night.  Most unpleasant, especially when you can't reach your leg because your tummy is in the way.  

Pregnancy Peeve #7: Bed rest. I have had to be hospitalised and put on bed rest for my second and third pregnancies.  Bed rest can be the most painful thing in the world. You are so bored because you really can't do anything, and you have to learn to rely on others to help you.  And after you are allowed to move about, you find that you have lost a lot of muscle tone and just walking to the living room is tiring.  Thank goodness for my iPad.  I couldn't have survived bed rest without it. 

Pregnancy Peeve #8: Girl or Boy? I don't mind people asking me for the gender of the baby, but I get quite annoyed by those who assume that I must somehow be disappointed that I am having a third boy.   Do not assume that we were trying for a girl, or that somehow we think it would be nicer to have a girl the third time round.  We don't care. We really don't.  We just wanted another CHILD.  Gender was irrelevant in our considerations.  

For the record, we are very, very pleased it's going to be a boy and we love him to bits.  So please don't shake your heads and act like it's such a tragedy or imply that somehow we won't love this little boy as much as if it was going to be a girl.  There's no need to talk about how nice it would be to have a girl (is there a point to such discussions?), and enough with the, "Oh...it's OK. Boys are fun too..." etc..  Of course I know boys are fun. I have two.  We don't need your condolences.  Just your congratulations and best wishes.  (And of course, please don't congratulate us for having three boys, we would have been happy with three girls too.  Like I said, gender doesn't matter.)

Pregnancy Peeve #9: Gestational Diabetes Mellitus.  I do not have Type 2 diabetes. But during pregnancy, my hormones go haywire and my body has trouble producing enough insulin.  This condition is called Gestational Diabetes Mellitus (GDM) and if left uncontrolled can have severe consequences for the baby.

I hate it.  Because this means I have to (1) watch my diet very carefully (low calorie, low glucose diet); and, (2) monitor my blood glucose levels four (sometimes six) times a day, seven days a week.  

Both are a pain.  I know that (1) is probably what I should be doing anyway because you really want to have a healthy diet when you are pregnant, but it's really hard to maintain a diabetes-friendly diet especially if you eat out a lot due to work.  At one point, all I was eating was fish porridge every day.  At the same time, there were concerns that I wasn't gaining enough weight  (well, if you were only eating fish porridge you would be losing weight too).  So it has been tricky trying to balance having to eat sufficiently for me to gain enough weight, and not too much such that my blood glucose levels were going crazy.  One would have thought that by the third pregnancy I would have become an expert.  But nope.  No two pregnancies are the same and I've had to learn to adjust to new levels of insulin resistance for each pregnancy.

(2) is literally a pain as this involves pricking my fingertips for a drop of blood to be measured. I'm resigned to having sore fingertips.  I have a system to rotate my fingers so that they don't get too sore, and I try to avoid squeezing lemons or limes.  I have to bring my meter everywhere.  It comes in a small black purse-like holder.  Having GDM is costly too. Each test costs me $1.65 (for the needle, the test strip, alcohol swabs).  That's more than $46 a week.  On top of that there are extra visits to the doctor for monitoring purposes. 

Fortunately, I've not had to be put on a regular insulin regimen yet (though I have had insulin shots).  And fortunately, for me the condition goes away after pregnancy.  However, this may not always be the case.  For some women, pregnancy uncovers Type 2 diabetes, so the diabetes doesn't go away after delivery.  I'm hoping I'll be clear after this pregnancy. I really want to be able to eat normally again.  

Pregnancy Peeve #10:   "Mumnesia".  I hate to say this, but after three pregnancies, I've come to realise that I do get more forgetful and muddle-headed during pregnancy.  Sometimes it feels like a brain fog.  I'm not sure if it is hormonal.  I would like to blame in on a lack of sleep (see causes in #6 and #5).  I also get a lot clumsier due to physical changes.  I have discovered bruises on my arms and legs probably from tripping and walking into walls, and I don't always remember how I get them.  Unfortunately, the forgetfulness will last well into toddlerhood, as I know my sleep deprivation will only get worse in the months ahead!

So what are your pregnancy peeves?