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31Aug/150

Update: pregnancy diabetes

My OB decided to have me tested for pregnancy diabetes. I was on the border of the risk group, but she wanted to be safe rather than sorry. Factors that make OBs decide to have you tested are (possibly among other things): if you are obese, if you have a certain ethnic background (Turkish, Hindustan, Oriental), if diabetes runs in your family, etc. My grandmother and uncle from my mother's side both had diabetes, so I was tested.

The test consisted of having a blood sample taken on an empty stomach. Having to drink a disgustingly sweet drink, laden with sugar. Waiting for two hours in a windowless waiting room. Then having another blood sample taken. I nearly fell asleep while waiting for those two hours. I was nearly overcome with the need to lay my head down. It was like the mother of all after dinner dips. This was a sign, in hindsight.

Tested positive, then what?
Turned out the test was no frivolity. My after-sugar test result came back too high, I have pregnancy diabetes. This meant that I had to change OBs again. You are not allowed to stay with your own OB, but have to go to the hospital instead. Appointments with new OB, ultrasounds, internal specialist, diabetes specialist nurse, dietitian, there's a whole parade of people to see.

There's a risk the baby may grow too fat (up to 9 pounds?!), because of too much sugar in the amniotic fluid. An extremely large baby can harm the mother on the way out, so you get extra ultrasounds to monitor the baby's growth. Huge baby was my first worry, as I am not too big myself. I wasn't sure I would be able to handle a monster baby. Plus, it would have effects on her life as she got older. Tendency towards obesity starts in the womb, apparently. And this would then increase her chances of developing diabetes (TypeII) later in life. Also, she would be born with a sugar addiction, and immediately go into a hypo after birth (suddenly being deprived of the large amounts of sugar she was used to in the womb).

But the ultrasounds showed the baby was fine. Her growth curve was still perfectly on track. One worry down, what was next? Diet, a regular schedule for eating, and measuring my bloodsugar levels.

The diet
The diet entails: no added sugar of any kind. So out with the sugar in coffee and tea. But also, no ice cream, soda, cookies, cakes, candy, etc.

I figured: "I don't have a sweet tooth anyway, so I won't miss that very much." But it turned out that I would still miss that refreshing Coca Cola with a slice of lemon and loads of ice cubes on a hot day. And my occasional half a portion of Ben & Jerry's cookie dough ice cream after dinner. And sometimes, just once in a while, I crave something ridiculously sweet, like a Lion chocolate bar (I only need a quarter of a bar to satisfy the craving!) But alas.

The diet also entails: small portions, spread out over the day, and very limited carbs. General rule of thumb: if a product contains 4 grams of carbs (or less) per 100 grams, it is considered low in carbs. If carbs at all, then the good kind (the kind that slowly releases its sugars: wholewheat bread and pasta, quinoa, etc), not the bad kind (the kind with fast sugars, white bread, white rice, white pasta, for example).

Blessings within restrictions
I was afraid I wouldn't be able to eat fruit anymore, but it turned out that while some fruits were off limits (pineapple, banana, watermelon, grapes), there was still a lot of fruit I could eat. Strawberries, cherries, kiwis, even Galia melon.

After embracing the dietary restrictions resolutely, and struggling daily to stick to the eating/bloodmeasuring schedule (eat every two hours. Measure bloodsugar levels 1,5 hours after each meal. My daily routine is a constant series of alarms), my bloodsugar values were excellent. Immediately. Every time I tried to eat something new, I weighed how much I had had of it, and then measured my bloodsugar afterwards. I can even eat potato chips! (if I schedule it in, in a 2-hours-apart-from-anything-else food-slot).

Here's a list of things that I have added to my diet that I do very well on:
- 'meerzaden pave' from Vlaamsch Broodhuys. Most breads contain sugar, to make the yeast work. This bread does not! Plus, it's delicious.
- wholewheat knackebrod, and wholewheat melba toast
- wholewheat pasta. I like the Honig macaroni, al dente. Must be al dente. If you completely cook wholewheat pasta, it turns too soft and gets yucky (in my humble opinion). (I can eat 40 grams (weighed uncooked) easy)
- 'Senoble kwark' from Dirk van den Broek. Most quarks contain sugar, even the plain ones! This one only contains 3,3 grams per 100 grams of the stuff. Lowest amount of carbs I could find, and it is creamy and delicious.
- nuts. Any nut really, except cashews, as these are high in carbs. I usually mix pecans, pistachios, smoked almonds and macadamias. Walnuts are very good for pregnant women, but I'm not a huge fan ;)
- cheese! Most cheeses, like brie and Gouda, don't contain carbs at all. Cream cheese (Philadelphia) and soft goats' cheese (Chavroux) contain carbs, but I've found I can still eat these, in moderation, with my bread or crackers.
- sliced meats. I have become a regular at my friendly local butcher, where I get 'fricandeau'. They slice the well-done butt-end of the meat especially for me, as I need to avoid the pink stuff. Also: cooked ham (tostis!).
- snack cucumbers and tiny tomatoes. I add them to any bread meal or snack to liven things up.
- 'Albert Heijn Excellent Ambachtelijke Mayonaise'. 99% of all Albert Heijn Excellent products are hogwash. Overpriced and not very excellent. But this is the best mayonaise I know. We used to buy our mayo in Belgium (where Levi's parents live). I love my mayo creamy, slightly tart, never sweet. Most (ALL!) mayonaises in the Netherlands contain sugar. This one, does not. Best. Mayo. In. The. World.
- Tyrell's Veg Crisps. With only 38,6 grams of carbs per 100 grams, it's better than regular chips (Lay's original: 52 grams of carbs per 100 grams).

My food schedule on a typical day might look like this:
7.30: a bowl of fruit: a handful of strawberries, a kiwi, and 50 grams of quark. Also: a wholewheat Wasa cracker with some cream cheese, fricandeau and cucumber and tomato.
9.30: 60 grams of bread, cream cheese, cucumber, tomato and fricandeau.
11.30: a handful of nuts (about 30 grams), coffee with (lots of) milk, no sugar. As milk also contains some carbs, I have tacked it onto an 'eating moment'.
13.30: a tosti. 60 grams of bread, cheese, ham, fresh basil. Fresh tomatoes (no ketchup! Contains shocking amounts of sugar).
15.30: a snack: for instance a packet of wholewheat melba toast with brie, cucumber and tomato.
17.30-18.00: dinner. About 115 grams of potato, any (combo of) veg, meat. (I used to eat a lot of meat substitutes, but as these often contain a lot of carbs, in the form of filler like white rice, I now forego these for actual meat)
20.00: dessert, usually some fruit.
22.00: snack. For instance 30-40 grams of potato chips. Or Tyrell's vegetable chips!! Or some wholewheat melba toast with brie or cheese.

Pregnancy diabetes is doable
In conclusion, aside from the odd craving for something sweet, it's very well possible to live with pregnancy diabetes and still eat well. It takes some adjusting, and if I have a day full of appointments then there's some strict planning of eating and measuring involved. But it's certainly doable. I think I'd feel worse off if salt were off limits.

I've been told that due to increasing hormone levels I can get more resistant to insulin. But there's still room to adjust the diet. I've also been told that chances are very high that the pregnancy diabetes will return during a next pregnancy. And that my chances of developing Diabetes Type II later in life are now 50%. But let's just cross those bridges when (if) we get to them.

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