GD, not gaining weight, increasing carbs, insulin... someone help me understand this!

[Indadhanu]

I had a follow up appointment with my dietician on Tuesday.

BSLs look great (daily average of around 4.8mmol/L), and apparently my meal plans looks ok, like a fairly generous GD meal plan (I haven't changed much as my usual diet wasn't causing issues, except I did end up cutting breads/rolls/wraps and rice and sugary treats like my glass of milo or ice cream I usually indulged in every few days, as these all tend to send my BSL soaring and my BSLs had been creeping up over a few days as well).
But when she looked at my weight gain she said I need to increase my carbs and bring all the breads and rice products back in and add in two pieces of fruit a day plus loads more protein because my levels are on the normal range but I'm hungry all.the.time (and cranky, and exhausted) since cutting those carbs and now I'm not gaining weight either :-/ I hadn't gained weight in two weeks and it's been 2.5 weeks now, I'm 30 weeks today, and my weight is still the same as, I'm 65kg and I've gained 8kg this pregnancy (started at a BMI of 23). So now my diet plan has me eating more food and MORE carbs than I was before I was diagnosed with GD, and I think this is going to mean that keeping my BSLs under control will be difficult.

I was also told that if the GD was going to get a lot worse, we'd know in the next 4 weeks as this is when the hormone peaks or insulin resistance peaks and I'd end up with high BSLs to foods that didn't used to push my results up. Then I got a stern talking to that this was supposed to be a time significant weight gain for the baby, which I knew, and that I should be gaining at least 300-500g per week based on my pre-pregnancy weight to a target weight of around 70-72kg at 40 weeks, which I also knew, and that I'll risk having a 'small' baby if I don't gain the weight because I don't have the fat stores to compensate for no weight gain (now we've gone from big baby threats from the Obs to small baby warnings from the dietician ). Yeah, trust me lady, I'm NOT trying to lose weight, if I could be eating all the hot chips in the world I would right now and there'd be no issue with my weight gain (but I'd have major BSL issues lol). I would love to argue the 'don't have the fat stores' comment, as my bum and thighs certainly DO have adequate fat stores that I could lose IMO but I know I'm meant to have a certain amount of fat stores to sustain breastfeeding as well etc etc etc.

I've been confused about the theory though... I think I get it now...

If my body is insulin resistant, then my pancreas is usually making enough insulin but my body can't/isn't using the insulin to absorb all of the glucose that is in my blood, and the glucose accumulates in the blood instead of being used for energy. Right?
And the biggest issue with raised blood sugar levels is that because even though my body is making enough insulin, the insulin doesn't cross the placenta so the baby gets raised blood glucose level and this puts pressure on it's body to make excess insulin and also to use the excess glucose, which gets stored as fat?
So right now, it seems like I've found the amount of carbs-glucose my body is able to absorb effectively. But the amount I am absorbing is not enough to sustain me and the baby at this stage of the pregnancy.
So I need to eat more carbs to have more glucose to have more energy to sustain the growth and weight gain the baby and I need to go through.
But if I eat any more carbs, the glucose is just going to accumulate in my blood (as I have seen with high readings when I eat more carbs) because my body can't/won't use the insulin my pancreas is making?
So, eating more carbs will make more glucuse, but it'll just put more pressure on the baby to make more insulin to cope with the massive glucose load in the blood.
If my own body isn't coping with the energy levels needed to grow a healthy baby, and isn't producing enough insulin to convert the glucose to energy, I'm going to end up needing insulin to be able to use the glucose?

That is how I am understanding it. Is it right? I think I'm finally getting my head around it. Obviously if I need insulin injections, then I need them.

It's confusing though. In the diabetes education class the educator said the excess glucose would be stored in our body and the babies body as fat, and she made out like people with gestational diabetes eat too much and can afford to just cut down on carbs - because the less carbs we eat then the less fat we'll store, and this will make us and our babies healthier as it would slow/stop weight gain and even cause us to lose weight as we'll be forcing our body to use our fat stores for energy. And also that we needed to cut as much as we needed to cut to avoid insulin until we couldnt possibley avoid it anymore because too much insulin in the body was bad, it would cause the baby to grow too big, and could lead to more insulin resistance and an increased risk of Type II diabetes later on...?
Making sure that we were eating ENOUGH carbs and GAINING enough weight wasn't even covered.
That's why I had cut the carbs and sugars that make my BSLs go up. I thought I was doing the right thing. I knew my weight gain was fine for a 'normal' pregnancy, but going on what the educator said I was just trying to control is by diet and exercise and avoid the insulin as much as possible. This is the impression I had been getting from friends who had been diagnosed with GD as well. Keep cutting and controling the BSLs with diet. I thought even though my weight was fine for 'normal' pregnancy, maybe it was different for people with GD?

I haven't added them back in because I didn't really understand, but I think I understand now. I'm warying of adding them back in and have to deal with high levels, but holy crap I am hungry and physically I feel totally drained. At this stage my fasting and breakfast levels are fine, usually always under 4.5mmol/L fasting and 5.0mmol/L after breakfast, although I am always hungry an hour after breakfast, and I don't know how my BSLs will change adding in more food and carbs.

What are the implications of taking insulin though? And can anyone explain why the educator told us that needing insulin would cause the baby to grow too big? Since it doesn't cross the placenta...? I thought the issue was with the baby having/making too much insulin? Can the insulin cause issues even though it can't cross the placenta? Even the hospital Ob said at my last appointment that most issues (with baby and with birth) arise if you can't control it by diet and you end up needing insulin.

So confusing. I have an Ob appointment on Thursday, and another follow up with the dietician in about 10 days, but I keep hearing so many different things I don't know what to believe!!

[nothing2lose]

I don't know much about GD but I know about carbs!!! Can you bump up your intake of starch resistant carbs? Things like bananas, oats, very dense wholegrain bread, etc? They are not processed in the same way as simple carbs so may not have such an impact on your BSLs.

Good luck!

[sloane]

I'm on my phone so this will be brief but I don't,think,you should be looking at all carbs being the same - so add some back in but make them carbs that are low/er gi - so grainy bread, basmati or doongara rice etc.

I'm not sure why the educator said it was insulin that causes a big baby - I don't know too much about that. unless it's just an indicator that the bsl hadn't been able to be controlled through diet and the baby had been getting lots of sugar? the biggest concern with uncontrolled gd is that the baby's bsl drop substantially when they're born because they have been getting too much sugar. they usually test the baby's bsl after they're born and they expect x number of readings over a certain point (hospitals seem to differ - mine differed between having ds and dd) but I was on insulin both times and dd's readings were good. some hospitals have a policy of scn when you're on insulin others it's only if it's over a certain amount of insulin.

eta, I'm not sure why the educator said that people with gd are just eating too much. the endo explained it to me that you can eat the 'perfect' diet and your bsl will still rise because of the pg hormones etc. that would be backed up by studies that show only 50% of ppl who get gd fit the high risk groups (older, overweight, ethnicity and so on)

[melbel]

You're right that Insulin does not cross the placenta in significant amounts. It the need to use insulin is Indicative of poorer glucose control in general (not your fault just what it means if that makes sense). With poorer glucose control comes more glucose to the baby meaning baby produces more insulin and stores more fat. Insulin in itself is a growth hormone and works like many other growth hormones the body produces. Also Injected Insuln is an imperfect science. Unlike the body which secretes just the right amount all the time with an injection you are having a large bolus shot maybe two to four times a day. This means your sugar will bounce a lot more, it will go down when you have the Injection and tend to swing up again when the time for the next injection draws near. These swings means the baby's pancreas has to work harder eyc etc. unlike in a perfectly working pancreas where the curve of blood sugar levels is a lot flatter.....am I making sense.

Sounds like you need more carbs, look at low GI carbs as much as possible. Basmati rice, etc. have a look at the glycemic index website for more Info on better carbs to eat. But is you need Insuln, you need Insulin, no point star ing yourself and bubba just to stay off it.

[RhiChiChi]

Gosh, I would be really frustrated with what has been/is being said to you.

What I would do is swap your simple carbs for more low GI/dense carbs like wholegrain bread instead of white, wholegrain pasta instead of white, avoid rice, eat more vegetables and increase protein, so you feel full / not hungry.

What are you actually eating? I can tell you what I ate in a day b/c I stuck with the same foods most of the time b/c I was avoiding going on insulin.

Breakfast was 2 weet-bix with skim milk and an apple
Mid morning snack with a skim milk cappuccino and a vaalia yoghurt
Lunch - wholegrain sandwich with low fat cheese, avocado & tomato & a banana
Arvo snack - low fat cheese and water crackers
Dinner - Some sort of protein and veg or cup of pasta with bolognaise sauce & salad or veg on the side.
Didn't have dessert
Drank alot of water

Don't worry about the weight gain - I gained hardly anything at all once I was on my GD diet plan & my OBS had no issue with it, in fact he didn't even weigh me, it was only the GD clinic that weighed me. I was also told to eat more in the arvo but I really didn't need it and b/c my levels were fine they stopped checking my diet.

In relation to insulin & the effect it has on the body and eating and insulin etc... I really am clueless. Hopefully someone can come in & explain it to you.

[leesha]

I hardly gained any weight when I was diagnosed with gd and infact I lost weight. No one was ever concerned about it tho as my fundal measurements were normal.
I was just diet controlled and my advice to you is to eat low gi foods and more often. I didnt do just the three main meals per day. I had about 6 and they were small portions and always low gi foods. As I got further along my levels didn't spike as they said they would and I think it was due to what and how I was eating! No more than 3-4 serves of carbs per meal and make them low gi carb foods were possible. Basmati rice is better than most rices, wholemeal multigrain breads, smaller portions of pastas and cereals...
Not sure why they said insulin will cause a bigger baby as that's simply not true. It's all the sugar your body can't control that passes to bubs.
My bubs was born 3.77kg which is an average size and his blood sugars were tested after birth about four times and he was fine.
Also I did at least a half hour walk each day and exercise will keep levels stable.

[Indadhanu]

The dense grainy breads and low GI breads seem to have the same effect on my BSLs as the others do now, which is very confusing for me. I switched to doogara rice and low gi versions of bread products but after a few days it ended up just as bad as the others It was annoying, my levels initially were fine but they've gradually got worse.

My breakfast is usually my morning coffee w/ milk and sugar plus a bowl of Special K or porridge or 3 weet-bix, either of those with milk and sugar (at this stage my after breakfast levels are fine but I'm always hungry). Dietician wants more protein, might have to add in some nuts or peanut butter or something (nutella? hehe).
My mid-morning snack is usually my Yakult and the dietician said add in fruit or yoghurt and some protein.
Most of my lunches are salads jam-packed with vegies and I've also added some lentils, corn, beans and egg plus chicken or ham or tuna. I try to make up 3 serves of carbs with the lentils/beans/corn etc. I can have an absolutely massive salad that spills out of my bowl and I'll still be hungry. If I eat one sandwich or one wrap, or have a serving of rice, no matter what bread or type, and my body has started going BAM heres a 7.something mmol/L reading. But the dietician wants me to add the bread or rice or pasta back in to my lunch, and make sure there is always a good amount of protein.
Afternoon tea I struggle with as I am usually really hungry, but I stopped having my usual milo, and lately it's just been a tea with a tiny bit of sugar, no milk. The dietician wants two serves of fruit here or a serve of carb and a protein, depending on what I have for morning tea.
My dinners are usually some kind of protein with vegetables (usually carrots, corn, peas, broccoli, cauliflower, and pumpkin), and half a 'serve' of potato and half a 'serve' of sweet potato. Or a curry or stir fry, which I used to eat with rice but the rice, even doongara, pushes my levels up so I stopped the rice and eat it with loads of veges and cauliflower, but the dietician says it's too low carb and I need to add the rice back in, or pasta, or more potato/sweet potato, or a slice of bread/small roll etc.

I can't help but being worried about the weight gain RCC, because my dietician has mentioned it. But as I said, I have heard so many things. It's confusing. She said my intake of vegetables was perfect, need more fruit, getting a healthy amount of fats, protein is alright but judging by my hunger it could probably be better, and my carbs seem ok usually for GD but they want me to follow the weight gain graph and do not want me to lose weight, so they want more carbs in my diet.

[sloane]

do you feel up to gentle exercise after you eat? if you have time, that is! so if you want/need the carbs then just an easy walk to help process them perhaps?

and everyone has different readings for the famed foods so maybe even some more trial and error? sorry if you've tried it all already and I'm repeating.

[aussienic]

I gained 30 kg with my first pg and was borderline GD. with my next 3 I was on insulin and I only gained 12kg. I can't see how the weight gain is an issue. If baby is growing nicely and you are feeling healthy with no issues with the GD I can't see why they have a problem

Your BSL seems fairly good to me.. Maybe a little on a low side from what I remember. I was averaging around 6-7 before meals with DD and was on insulin from 13 weeks. after meals was anywhere from 8-12. It was high but still ok..

[MrsFabuloso]

I don't know about GD hun, so don't know if this will help or not, but what about adding in some good fats? Rather than the carbs. Would that make much of a difference? Add in things like avocado, coconut oil, olive oil, natural nut butters...and maybe put some LSA (crushed linseeds, sunflowers and almonds) meal on your cereal of a morning.

[RhiChiChi]

I remember sometimes having a 'naughty' dinner ie: pizza and my night reading be fine but my morning reading being affected - perhaps this is what is happening with you having sugar in the morning with breakfast & your coffee/tea??

Definately try to do some light walking/exercise. I used to do a slow 20 minute walk after lunch & that really helped with my levels too. So, you can eat more but you are burning off any simple carbs prior to testing.

I agree with the others about the weight gain - my gf had insulin controlled GD with both her kids - her babies were born under or around 6 pounds and her weight gain was minimal. My DD was born 7 pounds 5 ounces on diet controlled GD, most of my weight gain was prior to being diagnosed then I lost weight and stopped putting on altogether. I'd try not to worry about the weight and concentrate on your levels - once you have them under control they tend to leave you alone a lot more. I ended up on fortnightly appts and maybe out to three weeks?? in the end b/c my levels were well & truly controlled even as I went along further in my pg.

Oh, and the other thing I wanted to say was stress played a part on stuffing with my levels. If I was put under undue pressure (ie: work issues) my levels would be up, the dietician you are seeing may not be helping rather hindering you.

[fionas]

I'd be really confused with that advice too! I went from 68 to 69kg so only 1kg weight gain in total for the entire pregnancy. I had insulin and couldn't exercise because of severe SPD. DD2 was 6lb 11oz so on the small size but not tiny by any means.

[Indadhanu]

Had my dietician appointment this morning, she is concerned about the weight loss and has advised me to increase the carbs and go back to eating my pre-GD diet, just spaced out more instead of eating three big meals space it out to six small meals, which was very balanced anyway and gave me just enough to gain 'the right' amount of weight. She's going to call in two days and said most likely she's going to refer me to the nurse to start insulin on Friday. Not sure exactly what this means for my birthing options, but I was advised that the Obs would be extremely reluctant to let me go past 38 weeks and prefer not to induce afer a previous cesarean unless my cervix is favourable for non-chemical induction (ARM, S&S etc).

[~Gee_Whizzy~]

i was put on insulin with DD1 when i hit 32 weeks. my OB let me go til 39+5 and i was induced with gels and no further intervention....

ETA :- sloane is right regarding each hospital and OB being different regarding induction. you can negotiate for more monitoring. i had weekly monitoring from 37 weeks to keep an eye on fluid and placenta function as being on insulin can make the placenta breakdown more quickly

[sloane]

I found that what they want to do depends on the hospital and ob. I wad induced right on 40 weeks with ds, they offered me the chance to be induced earlier but i refused and asled for monitoring instead. With dd they were more relaxed and didn't talk about induction until 40 weeks and i went into spontaneous labour.

You can push them on the 38 weeks in most cases if you want to. They do like to keep an eye on fluid levels and cord function but they can be monitored. I spoke to 2 different IMs and they said there is a small increase in the risk of stillbirth when you go past 40 weeks when taking insulin and that's why they induce and/or monitor.

Hospitals have different policies on what insulin means for when the baby is born (i.e. Scn) so good to ask them their policy.

[Cassius2]

I dont know Indad, i reckon i would still be trying to organise a re-test for the GD. It all just seems really off-kilter ITMS

P.S. i am sorry if i sound like a broken record i know how crazy crap it is to deal with official-dom at hospitals etc

[Indadhanu]

My fasting levels have gradually risen up over the last two weeks Cassius, they're the key ones at the moment. It's really frustrating. Unfortunately theres not a lot I can do for those levels, and the past week I am having to cut out carbs to keep levels down, although the dietician told me I need to increase them, and I've increased exercise, and she said that I have to increase even more to compensate for the exercise! I'm not deliberately doing the wrong thing although an Ob last week told me to keep tighter control of my levels and avoid these carbs. Dietician today told me to add them ALL back in (within reason, I think I might have replied a little to enthusiastically to what she said, because she nervously said "uh, don't go overboard..."). So following her advice I had my usual ham and salad breadroll and I was 6.9mmol/L. I was about 15 minutes late testing, I dunno how much difference 15 minutes would make? Dietician was adamant that a breadroll with salad and protein and without any other carbs shouldn't push my levels up like that.

It's annoying that it's gone from my normal diet being fine, to having to cut back a bit, then a bit more, then having to cut back plus extra exercise, just to keep the post-meal levels down. And my fasting levels rising. And it happened so quickly, in the space of 3 weeks. Frustrating.

[sloane]

it is frustrating but you're right at the stage where they do rise and sometimes there's nothing you can do. it is especially frustrating where something is ok one week and the next it isn't.