Hello! Prediabetes post GDM pregnancy

[Millymolly]

Hi!

I’m happy to have found this forum 🙂

I was diagnosed late onset gestational diabetes in my recent pregnancy and since then after slow wound healing with csection they took an HBA1C at 9 weeks after baby arrived and it came back as 42 so prediabetes.

I had got used to the GDM diet, but now trying to get my head around balancing what I need to eat with breastfeeding a big and growing baby, tiredness and struggling to find the time (while also healing from pregnancy and surgery) to exercise as much as I know I should to avoid progressing to type 2 diabetes.

Nice to meet you all and I am looking forward to hearing how people have used blood glucose self monitoring to work out what works for them food wise and how people balance the demands of being a parent of young children with managing blood glucose levels, diet and exercise and can also share what I learned about GDM too!

Thanks for reading,

MillyMolly

 

[Leadinglights]

Hi!

I’m happy to have found this forum 🙂

I was diagnosed late onset gestational diabetes in my recent pregnancy and since then after slow wound healing with csection they took an HBA1C at 9 weeks after baby arrived and it came back as 42 so prediabetes.

I had got used to the GDM diet, but now trying to get my head around balancing what I need to eat with breastfeeding a big and growing baby, tiredness and struggling to find the time (while also healing from pregnancy and surgery) to exercise as much as I know I should to avoid progressing to type 2 diabetes.

Nice to meet you all and I am looking forward to hearing how people have used blood glucose self monitoring to work out what works for them food wise and how people balance the demands of being a parent of young children with managing blood glucose levels, diet and exercise and can also share what I learned about GDM too!

Thanks for reading,

MillyMolly

You probably have a good understanding of diabetes from your brush with gestational diabetes so it is going to be a matter of finding a regime which fits in with your life. Prediabetes is a good opportunity to make some changes to bring your glucose level down into normal range and have a healthier diet.
You may find this link useful in finding a way forward which fits in with family meals as it is a low carb approach with real food which may benefit the whole family to adopt a healthier dietary regime. https://lowcarbfreshwell.co.uk/

 

[Inka]

Welcome @Millymolly 🙂 You should be wary of reducing carbs to a very low level when you’re breastfeeding. You say you followed the “GD diet” when pregnant - how many carbs a day did you eat?How many are you eating now? Are you on any medication for the diabetes?

Final question - what are your blood sugars like now?

 

[everydayupsanddowns]

Nice to meet you all and I am looking forward to hearing how people have used blood glucose self monitoring to work out what works for them food wise and how people balance the demands of being a parent of young children with managing blood glucose levels, diet and exercise and can also share what I learned about GDM too!

Look forward to hearing more of your experiences @Millymolly 🙂

Sounds like you have your hands full!

You can use a BG meter, taking a reading before and again 2hrs after the first bite of a meal or snack, to see what the differences are. Ideally you would want to see a rise of no more than 2-3mmol/L at the 2hr mark. Initially in a way the numbers themselves matter less than the differences between them. Seeing the ‘meal rise’ can be a very simple and direct way for you to observe the effects of different portion sizes, and sources of carbs.

Once you can see how you respond to different meals you can begin experimenting with reducing portion sizes of the carbs where you see bigger rises. You might find that you are particularly sensitive to carbohydrate from one source (eg bread), but have more liberty with others (eg oats or basmati rice) - It’s all very individual! You might even find that just having things at a different time of day makes a difference - with breakfast time being the trickiest.

Over weeks and months of experimentation you can gradually tweak and tailor your menu to find one that suits your tastebuds, your waistline, your budget and your BG levels - and a way of eating that is flexible enough to be sustainable long-term. 🙂

If you are interested in this approach you may find test-review-adjust by Alan S a helpful framework.

If you need to self fund your BG meter, the most affordable meters members here have found are the SD Gluco Navii or the Spirit Tee2 - which both have test strips at around £8 for 50

 

[Millymolly]

You probably have a good understanding of diabetes from your brush with gestational diabetes so it is going to be a matter of finding a regime which fits in with your life. Prediabetes is a good opportunity to make some changes to bring your glucose level down into normal range and have a healthier diet.
You may find this link useful in finding a way forward which fits in with family meals as it is a low carb approach with real food which may benefit the whole family to adopt a healthier dietary regime. https://lowcarbfreshwell.co.uk/

Thank you for the info @Leadinglights! I'm definitely seeing it as an opportunity to change things ongoing. I only had about 3 - 4 weeks of the gestational diabetes diet - I used Gestational Diabetes UK info which really helped especially where I had little time to learn and experiment with foods ahead of baby arriving. A lot of it chimed with the freshwell approach. There's some interesting (and quite surprising) information around carbs and amount of sugar they convert to on there!

 

[Millymolly]

Welcome @Millymolly 🙂 You should be wary of reducing carbs to a very low level when you’re breastfeeding. You say you followed the “GD diet” when pregnant - how many carbs a day did you eat?How many are you eating now? Are you on any medication for the diabetes?

Final question - what are your blood sugars like now?

Thanks @Inka! So I followed the dietary advice on the Gestational Diabetes UK website at the end of pregnancy so I was more eating a small amount of carbs (for example 2 tablespoons of rice) and then testing to see if it was ok. But I think it might be likely that my tolerances are different now since with GD I think what you can tolerate can change depending on what is going on with baby.

I'm not on medication since I'm prediabetic at the moment and for carbs, I am just eating a reduced amount overall. Once they diagnosed me prediabetes initially I went back to the GD diet which was eating low carbs and high protein and pairing more sugary foods like fruits with fats, but now I became a bit less strict. Finally I realised I think I really should start testing to know where I am with food because I have no idea if any of it is working. I generally am avoiding ultra processed foods as far as I can.

I have finally found my blood glucose monitor from pregnancy so I will start to use that this week since I have no idea how my blood sugars are since the HBA1C of 42, but I have my next check up next week.

I read something recently that said each feed uses around 50g of carbs which did make me wonder about reducing it too much and sounds like you would agree then?

 

[Millymolly]

Look forward to hearing more of your experiences @Millymolly 🙂

Sounds like you have your hands full!

You can use a BG meter, taking a reading before and again 2hrs after the first bite of a meal or snack, to see what the differences are. Ideally you would want to see a rise of no more than 2-3mmol/L at the 2hr mark. Initially in a way the numbers themselves matter less than the differences between them. Seeing the ‘meal rise’ can be a very simple and direct way for you to observe the effects of different portion sizes, and sources of carbs.

Once you can see how you respond to different meals you can begin experimenting with reducing portion sizes of the carbs where you see bigger rises. You might find that you are particularly sensitive to carbohydrate from one source (eg bread), but have more liberty with others (eg oats or basmati rice) - It’s all very individual! You might even find that just having things at a different time of day makes a difference - with breakfast time being the trickiest.

Over weeks and months of experimentation you can gradually tweak and tailor your menu to find one that suits your tastebuds, your waistline, your budget and your BG levels - and a way of eating that is flexible enough to be sustainable long-term. 🙂

If you are interested in this approach you may find test-review-adjust by Alan S a helpful framework.

If you need to self fund your BG meter, the most affordable meters members here have found are the SD Gluco Navii or the Spirit Tee2 - which both have test strips at around £8 for 50

Ha, yes they are keeping me busy 🙂 That's incredibly helpful testing info, thank you @everydayupsanddowns! I really wasn't sure what to be looking for at all with the testing and very helpful in terms of looking at the rise in BG rather than a set number.

Is there a difference in what I would be looking for in terms of a small snack vs a meal or is it more you don't want a spike of more than 2-3 mmol whenever you are eating?

I found the testing so helpful in pregnancy as I had a very short time to change diet - just a few weeks really - and pinpoint what foods I couldn't tolerate - it was really surprising how much some foods would just cause spikes - but it was very much about just not reaching the target amounts (for example 7.8mmol) while pregnant and I had little time to experiment so just cut some stuff out as a result. I had no idea you might be able to eat a food at a different time of day and tolerate it better.

I will have to self fund since they haven't actually recommended I use one - but since I saw the benefit in pregnancy I think it's definitely worth the initial experimentation and thank you for the links! I think testing will also let me feel a bit more relaxed about eating and the foods that I know do work for me since it's hard not to feel slightly bad about eating food which really on the face of it is healthy and good for people, since currently I just don't know how it is for me. Just finally retrieved my testing kit from pregnancy from a very random box someone had stowed it away in (I hadn't realised I would need it again so soon) so ready to go for now 🙂

Great to meet you all!

 

[Inka]

Thanks @Inka! So I followed the dietary advice on the Gestational Diabetes UK website at the end of pregnancy so I was more eating a small amount of carbs (for example 2 tablespoons of rice) and then testing to see if it was ok. But I think it might be likely that my tolerances are different now since with GD I think what you can tolerate can change depending on what is going on with baby.

I'm not on medication since I'm prediabetic at the moment and for carbs, I am just eating a reduced amount overall. Once they diagnosed me prediabetes initially I went back to the GD diet which was eating low carbs and high protein and pairing more sugary foods like fruits with fats, but now I became a bit less strict. Finally I realised I think I really should start testing to know where I am with food because I have no idea if any of it is working. I generally am avoiding ultra processed foods as far as I can.

I have finally found my blood glucose monitor from pregnancy so I will start to use that this week since I have no idea how my blood sugars are since the HBA1C of 42, but I have my next check up next week.

I read something recently that said each feed uses around 50g of carbs which did make me wonder about reducing it too much and sounds like you would agree then?

Yes, you’re correct. Reducing carbs to a very low level is potentially dangerous when breastfeeding. Here’s an extreme example:


https://www.dailymail.co.uk/health/...-ditching-bread-rice-pasta-breastfeeding.html

Excuse the Mail link and hyperbole, but even though ketoacidosis is rare when breastfeeding, it’s still not a good idea to eat a very low carb diet. Although it might not have such extreme results, it can still affect you. Breastfeeding is an amazing thing and your body needs the right nutrition to do it. That includes carbs.

The GD you had usually occurs because of the strong insulin resistance you (and all mums) get in the latter half of pregnancy. That specific resistance will disappear once you have your baby because it comes from the placenta, so a) don’t think your body will react the same to foods as it did in pregnancy, and b) focus on supporting your body to breastfeed by eating appropriately. Breastfeeding will also help you lose weight if you have any to lose, and it does so painlessly. It also reduces your baby’s chance of developing diabetes.

When I was breastfeeding, I had additional snacks as well as my three meals a day. The early weeks of breastfeeding are a big change to the body and it becomes a total milk powerhouse. This settles down after the first two or three months. As breastfeeding progresses, you’ll see the change in what your body needs as your baby grows. That is, you might not need snacks so much after a few months. Once baby is on solid food, it will change again.

 

[Millymolly]

Thank you @Inka that’s really helpful to know and I appreciate you sharing your experience. It does just feel like my body needs the extra energy and I guess it still isn’t in its day-to-day state.

I also don’t have a lot of weight to lose now so I wouldn’t want to lose too much more right now, particularly reading the article. I think certainly the breastfeeding and cutting down on anything with added sugar has made a difference to returning to prebaby weight as initially post birth I was eating not so healthy snacks, and it being 5 months now. I do plan to breastfeed for 2 years if I can (which I did with my first) since I know it will reduce both of our risks for developing diabetes but I do know GD means a significantly raised risk of developing type 2 many within 2 years so I also want to make sure I am doing what I can. As you say when baby is on solids hopefully the snacking needs will be less since he feeds so much now!

I’m hoping the next HBA1C shows a change in the right direction. Can I ask, did you still test to work out which carbs and snacks worked for you at that time? And did you change the amounts of carbs you would eat?

Thanks!

 

[Inka]

I’m Type 1 @Millymolly, but even if I wasn’t diabetic, I feel the need for snacks would be the same. I ate my snacks without insulin. In the first few weeks, I needed lots of snacks, including during the night when I fed. My snacks were things like flapjacks (a good mix of fast and slow acting carbs) and milk, biscuits, etc. Yes, I tested and my blood sugar (without insulin for snacks) stayed in range. My snacks varied from 10-25g carbs approximately. I went by ‘feel’ - how I was feeling. Despite my diabetes, I listened to my body.

The need for snacks reduced gradually. I don’t remember when it stopped but my guess would be at 5 or 6 months. Then I didn’t need any extra snacks on a regular basis, but did have occasional snacks eg if baby had been feeding a lot.

I fed my last baby past 3yrs and I think it’s a great thing you’re planning to do 🙂

You mention you don’t need to lose weight. Just keep an eye on things. I know at least three women who were told they had GD but later went on to develop Type 1. The GD wasn’t GD at all, and was an early indicator of their failing beta cells. I’m not saying you have that, but just keep it at the back of your mind as a possibility in case things don’t seem right to you or your doctors. Type 1 comes on much more slowly in adults, and a number of cases of “GD” are actually not GD at all.

 

[Millymolly]

I’m Type 1 @Millymolly, but even if I wasn’t diabetic, I feel the need for snacks would be the same. I ate my snacks without insulin. In the first few weeks, I needed lots of snacks, including during the night when I fed. My snacks were things like flapjacks (a good mix of fast and slow acting carbs) and milk, biscuits, etc. Yes, I tested and my blood sugar (without insulin for snacks) stayed in range. My snacks varied from 10-25g carbs approximately. I went by ‘feel’ - how I was feeling. Despite my diabetes, I listened to my body.

The need for snacks reduced gradually. I don’t remember when it stopped but my guess would be at 5 or 6 months. Then I didn’t need any extra snacks on a regular basis, but did have occasional snacks eg if baby had been feeding a lot.

I fed my last baby past 3yrs and I think it’s a great thing you’re planning to do 🙂

You mention you don’t need to lose weight. Just keep an eye on things. I know at least three women who were told they had GD but later went on to develop Type 1. The GD wasn’t GD at all, and was an early indicator of their failing beta cells. I’m not saying you have that, but just keep it at the back of your mind as a possibility in case things don’t seem right to you or your doctors. Type 1 comes on much more slowly in adults, and a number of cases of “GD” are actually not GD at all.

Ah amazing you did bf for 3 years! And a good point to just listen to what body needs, after a big feed I definitely need something too. Flapjacks are the best!

Thank you for letting me know about the type 1 I hadn’t heard of this so it’s worth keeping in mind depending on what happens over coming months. My appt got delayed for HBA1C but hopefully I will have a better idea of how things are going in a couple weeks!