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?

World Breastfeeding Week 2009 (1 - 7 Aug 2009)

It's World Breastfeeding Week (WBW) once again. This year's theme is "Breastfeeding: A Vital Emergency Response. Are You Ready?" More information can be found on the World Breastfeeding Week website.

I don't really want to talk about event, and themes...I just thought it would be an opportunity to share some brief thoughts on breastfeeding. Earlier this year, I trained as a breastfeeding counsellor and currently I am a volunteer counsellor with a breastfeeding counselling hotline. Even though I have 4.5yrs of breastfeeding experience and have read widely on the subject, it's been a wonderful learning experience for me. And hopefully, I've helped a few mums along the way...

I receive many different types of calls. One of the most common (and painful) stories I hear from new mums is that they don't have enough milk for their babies. Many are exhausted, and suffering from post-natal blues. The apparent lack of milk affects their confidence terribly and makes them question if they are good mothers.

The lack of milk may or may not be real. If it's real, it frequently is due to poor breastfeeding management in the early post-partum period. The best way to ensure a good supply of milk is to drain the breast frequently and effectively, i.e. newborns need to nurse at least 8 - 12 times in a 24 hour period, or every 2 - 3 hours on average. A breast that is suckled sends signals to the brain to release hormones that are involved in milk production. So that when the baby is put to the breast more frequently, the breast starts to increase its production of milk and the baby gets more milk.

Unfortunately, this natural feedback mechanism is often not allowed to work. In hospitals, even those that claim to be breastfeeding friendly, a well-meaning but misguided nurse may encourage the mother to rest and leave the care of the baby to the nursing staff. As the baby is not allowed to nurse on the breast, the body does not receive critical information to jumpstart milk production. For mothers who are genetically blessed with an ample supply anyway, this may not be a problem. But for many mothers, this is the start of a series of problems that can make breastfeeding a very painful journey. A journey that many mothers decide not to complete.

The mother who thinks she doesn't have enough milk, may be tempted to give her baby formula, which then encourages the baby to drink less from the breast, which will in turn produce less milk. It is a vicious cycle.

If the young infant is fed through a bottle and artificial nipples, problems are compounded, as some babies develop a preference for artificial nipples. The mechanism for feeding from a breast is very different from the mechanism for feeding from an artificial nipple (which is generally why breastfed babies have better jaw development). And, even if the mother expresses her milk to feed to her baby through a bottle, a breast pump is not as good as a baby in emptying the breast. Expressing milk on a permanent basis is also very tiring for the mother, and she may be tempted to skip pumping sessions (especially at night). All these factors lead to dwindling milk supplies.

Fortunately, it is often possible to help these mothers achieve a full milk supply. However, it can be a very tiring process, depending on how far down the cycle the mother is. Strategies include getting the mother to nurse her baby more frequently, to ensure that her baby is actively drinking and not just mouthing at the nipple (i.e. milk is being removed from the breast), to pump after nursing sessions to ensure the breast is fully drained, getting the mother to rest, relax, eat and drink well. Often, a mother may have a lot of milk, but because she is stressed, the breast is not able to eject the milk. Finally, we may recommend herbal remedies, such as fenugreek, or medication, such as domperidone. Herbal remedies will not work if the mother is not able to drain her breasts frequently and effectively. Medication can be very effective. But it should only be used as a last resort, if other strategies have not worked very well.

The mothers I speak to are usually very encouraged by the fact that they can do something to make things right again. Often, I can hear their spirits lifted. But because it can involve quite hard work, I know that not all will last the course. Some are angry that they had been ill-advised. And, often, I am angry too.

There's a lot of advice on breastfeeding going out to new mums and mums to be. At the top of my list is always this: Supply = Demand. As long as you abide by this principle, you will always have enough milk for you baby.

Happy Breastfeeding!

Jamie Oliver's Onion Baguettes

Yet another variation on Jamie's Basic Bread Recipe. This time, you slice and fry white onions with thyme and garlic in olive oil and you spread it onto the bread after you shape it (and before the second rise).

It was exceedingly good. Unfortunately, I ended up with ciabattas rather than baguettes.

No matter. Everyone loved it anyway.

Variations on Jamie's Basic Bread Recipe: Raisins

So I was going about preparing to bake my usual batch of bread using Jamie's recipe, and I spied a pack of raisins in the refrigerator. I thought, "Wouldn't it be nice to have some raisin bread?".

Actually, Jamie does have a Raisin and Rosemary version, but I didn't have rosemary at home and there weren't enough raisins.

But I thought I'd just test out adding just a handful of chopped raisins into the dough (anyway, Junior hates raisins and I didn't want the bread to be so full of raisins that he couldn't eat it).

It turned out very well, actually. No disasters! As usual, it was beautifully soft on the inside. The raisins added just a touch of sweetness to the plain bread. It'd be nice to try out the Rosemary and Raisin bread recipe one day. But the next time, I'll have to bake plain bread again, because, for Junior, even a handful raisins is too many raisins for him!

Jamie Oliver's (really easy) Basic Bread Recipe

Finally! A recipe that works! Jamie Oliver saves the day. A wonderfully easy basic bread recipe which he claims, even kids can use. I love it. It's so easy. No need to worry too much about too little water. I think his use of the term "stodgy porridge" caused some concern, but I think we all roughly know wha t that's like. Here's a pictorial:

Step 1:

You start by dumping all the flour onto your work surface and make a big well in it, like a volcano.

Step 2 & 3: Mixing

You add the yeast and water mixture and slowly mix it with some flour till it looks like stodgy porridge. Then you add the rest of the water and mix.

Step 3: Kneading

Then you start kneading. You later put the dough in a covered container to rise.

Step 4: Proofing & Shaping

The bread will rise (and how it rose!!). You punch it down again and shape it and leave it for another rise.

Step 5: Baking!

Finally, it's time to bake the bread.

It worked beautifully! It was great fresh from the oven. It makes a lot of bread, though, so I had to freeze several loaves. Unfortunately, it wasn't as good thawed. But still nice with some butter or jam. I make this frequently now. My sons love it, and so does my husband. And I don't have to buy supermarket bread anymore.

Bread: A Lesson in Bread Making

So after my two failures with Nigella's recipe. I decided I needed some proper instruction. But of course, I don't have the time to go for a bread making course. Instead, I googled. I found a cool website, called "The Fresh Loaf" which provides information for "Amateur Bakers and Artisan Bread Enthusiast". Apart from recipes, it contains written bread making lessons (with pictures!) and wonderful explanations of the various steps involved in bread-making (including how you would know if your dough is too wet or too dry).

This was my attempt at "Lesson One: Your First Loaf - A Primer for the New Baker". It was not bad at all! It rose nicely. Though I found that the dough just didn't want to hold it's shape. Maybe a tad too much humidity? So we ended up with a ciabatta rather than french loaf.

I wouldn't say it was a runaway success, but it was much much better than Nigella. So a definite pass.

Bread: The Essential White Loaf (Nigella Lawson)

I finally mustered the courage to bake my very first loaf of bread. Properly. Without a bread machine or even the dough hook on my Kenwood Chef. Just good old fashioned mixing and kneading and proofing and bashing and shaping and rising and baking...

I naturally turned first to Nigella Lawson's recipe for "The Essential White Loaf" in How to be a Domestic Goddess. The recipe seemed simple enough. Apart from bread flour, yeast and salt. It called for butter as well as potato water to give the bread a light crumb and last longer.

As much as I enjoy reading her recipes. I must say that this recipe failed totally for me. It clearly was not written for a total novice at bread baking. I can understand that Nigella cannot possibly tell me exactly how much water I need, since this will depend on the type of flour and the humidity and temperature at which the bread is being prepared. But precisely because of this, I thought she needed to provide more information on when we knew that the dough had the right amount of water. Instead, I had to deal with "(b)e prepared to add more water, but bear in mind that you want to end up with a shaggy mess."

Wha?! Shaggy mess?? Is this shaggy enough for you?

And about kneading "(y)ou may need to add more flour as you do so; if the dough seems stickily wet, it means you do want a little more and often a lot more."

Huh? A little ...often...more...?

She lost me and I really didn't know what I was doing. My mother, who has made bread before, happened to be visiting that day. She took a look at my dough and told me straight away that it needed more water. I had no clue. I though kneading it would help to soften it. But I kneaded, and kneaded, and kneaded, for almost an hour (it's supposed to take only 10 or 15mins) and still the dough was tough! Needless to say, my dough didn't rise. It was hard and tough.

I tried this recipe twice. Adding more water the second time. But still, I had no idea when enough was enough. And still it remained tough with uncooked bits of dough in the middle of the bread.

I decided that I would try other recipes before ever coming near this one again.

Nigella Lawson's Chocolate Cherry Cupcakes

I baked these Chocolate Cherry Cupcakes for some friends as to a a treat for their birthdays. The special ingredient is the morello cherry jam which is rather hard to find in Singapore. When I found them at Cold Storage (United Square), I told myself that this was a sign that I had to make these cupcakes!

It is very very easy to make. I must admit that I messed up the icing though, and overwhipped the double-cream slightly.

So instead of a nice smooth icing, it got somewhat lumpy. But it was still good.

It is very very lovely dense cake. I must admit that the first bite was slightly disappointing, because I thought it was too sweet from the jam.

But then, towards the end of the first bite, and definitely by the second bite, the complex flavours kick in, and you get that sour kick from the morello cherry and the wonderfully rich, smooth, bitter background of the dark chocolate. What an explosion of flavours! And for some reason, the sweetness never bothered me again.

I love this cake. I can't wait to do it again. I don't know if I prefer it to the Dense Chocolate Cupcake, though, as they are very different types of chocolate cake. Both are very good.

One in a very traditional chocolately chocolate sort of way, and the other in a snazzy jazzy sort of way.

My friends loved it. It did look rather pretty too, after I added the little rose-buds and packed them in a nice cupcake box (both from Bake-it-Yourself).