Managing Gestational Diabetes: Diet, Lifestyle, & Meds
Chances are if you’re reading this you’ve recently been diagnosed with gestational diabetes (GDM). Whether you chose the standard glucola test with your OB, tried an alternative screening option with your midwife, or noticed a change in your body that makes you wonder if you have diabetes while pregnant, you’re probably wondering what the next step is.
You’re not alone in wondering what GDM is, how it may effect your pregnancy and baby, and what (if anything) needs to change in your pregnancy plan of care. The good news is that there is still SO much in your control and you have not done anything wrong or harmed your baby. You are choosing to take steps now to manage your blood sugar and understand what this diagnosis means.
But, you may be confused with the information available. Your OB might not have had the time to thoroughly answer your questions or a meeting with a dietician left you more confused than ever before. This article is meant to give you a direction for your questions and resources to help you manage an overwhelming topic.
So, let’s discuss what may happen after a GDM screening and diagnosis. The ways you can manage your blood sugars to give you and your baby a healthy remainder of pregnancy. If you’re looking for a detailed article on what GDM is, the risks involved, and how it may change your pregnancy, check out my article here.
Please note, this article is not medical advice and is for educational purposes only.
Some links in this article may be affiliate links. If you choose to purchase them, I may earn a small percentage at no additional cost ot you.
What is Gestational Diabetes
Gestational diabetes, also known as gestational diabetes mellitus, is defined as high blood sugar (hyperglycemia) first diagnosed in pregnancy. It may only show up during pregnancy, or it might be preexisting type 1 or 2 diabetes that has gone undiagnosed until now.
During pregnancy, the body requires more energy to grow a baby. As the placenta grows, it creates the hormone placental lactogen, which tells your body to decrease insulin production so more glucose nourish your baby. For most women, this doesn’t cause an issue, and your body can continue to keep blood sugar levels between 70 - 90 mg/dL (the normal range) despite the pregnancy-induced insulin resistance.
But for some women, their bodies cannot acclimate to the insulin resistance and struggle to keep blood sugars within a normal range; thus, they develop GDM.
Who’s at Risk for Developing GDM?
Though we do have some good research about GDM, there is still no known “cause” of GDM, but there are some known risk factors that can put a woman at higher risk of developing GDM.
Overweight or obese (particularly before pregnancy)
Family history of diabetes or GDM
Racial heritage of Black, Pacific Islander, Asian, Latino/Hispanic, or Native American
Age greater than 35
You previously had GDM
Your blood sugar levels are higher than normal but not yet diabetes (pre-diabetic)
High blood pressure
History of heart disease
Polycystic Ovarian Syndrome/Polymetabolic Ovarian Syndrome (PCOS/PMOS)
Previously had a baby greater than 9-10 lbs (This range depends on which source you cite).
With that being said, some women will have no risk factors and still struggle to maintain normal blood sugar levels while pregnant. Though GDM is a relatively new screening,it’s important to be screened, if you meet the risk profile or you feel the need to be tested. There are some risks to mother and baby if blood sugar levels are not within the normal range.
Risks of GDM
The risks of GDM show up with unmanaged blood sugars. Meaning, your blood sugar levels are both too high (hyperglycemia) and too low (hypoglycemia). Both can potentially cause harm to you and your baby.
The potential risks to mother and baby include:
Pre-eclampsia
Fetal high blood sugar
First-time Cesarean
Premature birth
Higher birth weight/having a large baby
Shoulder dystocia or birth injury
Newborn intensive care
Newborn respiratory distress syndrome
Newborn congenital heart defects
Newborn jaundice
Newborn low blood sugar
Newborn lethargy
Difficulty breastfeeding
Mother developing diabetes and/or heart disease later in life
The baby developing excess body fat and/or diabetes later in life
Though some of these risks can be worrisome, they are not set in stone for a mother diagnosed with GDM. If you are able to manage your blood sugars, you are likely to have a very normal labor and birth with the support team of your choice.
How to Manage GDM
GDM is managed in three ways: lifestyle modifications, dietary changes, and medication. The first line of defense is always lifestyle and dietary changes, with medication only if blood sugars cannot be managed without them.
The end goal of pregnancy is a healthy and whole mother and baby. Not just from an objective standpoint, but also on a spiritual, physical, and emotional level. So while you may need to make modifications to your diet or bring on insulin to stabilize your blood sugars, you should do so with confidence that you are making the best decision for you and your baby, not shame that you did or didn’t do something to make this happen.
So, get curious about the management options so that you can be confident in making the best decision for you and your baby.
Lifestyle Modifications
There are well-documented ways we know how lifestyle influences blood sugar balance. Some are very simple, like the order in which you choose to eat your protein, vegetables, and carbohydrates. While others take a bit more effort, like planning exercise around eating windows. But, all of them are absolutely within your grasp.
Incorporate light exercise into your daily rhythm, with the most benefit seen pre-meals
If you want to work out after you eat, keep your workouts short, around 20 minutes; a short walk post-meals can be very beneficial to blood sugar stabilization
Stress influences blood sugar balance, so make an effort to schedule in moments of calm and relaxation — like when praying or practicing birth affirmations.
Check your blood sugar regularly to assess which foods affect you — this may be different than what you heard from a provider or friend with GDM; each body reacts differently to food
These lifestyle modifications, though simple, can make a large impact on your blood sugar.
Diet Modifications
Standard guidelines for diabetes mangament may still include too many carbohydrates to stabilize your blood sugars. They recommend eating whole grains, starchy vegetables, beans, pasta, etc. all in the name of high fiber/high vitamin content. But, Lily Nichols, RDN, the leading dietician who works every day with pregnant woman, suggests a much different approach. She suggests a low-carb diet for women with GDM, high in animal-based protein,nourishing fats, and non-starchy vegetables. She has worked with hundreds of pregnant women over the years and seen incredible results.
If you’d like to read more specifically on a low-carb diet to manage GDM, Nichols’ book, Real Food for Gestation Diabetes, is a treasure trove of research and practical guidlines, I highly recommend it for a deep dive into this subject.
Additionally, the following diet modifications are crucial for blood sugar balance.
Always consume carbohydrates with protein and fat
Eat the protein and fat component of the meal before the carbohydrate portion
Consume the majority of calories in the first two meals of the day, concentrating any carbohydrate intake there, before dinner
Snack smartly to keep blood sugar levels stable and prevent low-blood sugar (hypoglycemia), which can make carbohydrate cravings stronger
Avoid high calorie/high sugar drinks
Once you get into a rhythm of what foods balance or spike your blood sugar, you’ll quickly get the hang of meal planning and snack options. It’s very likely that these dietary modifications will make you feel better, have more energy, and feel more balanced.
Pharmaceutical Intervention
If lifestyle and dietary modifications are not enough to balance blood sugars, your provider may recommend a medication to help, either metformin, glyburide, or insulin, with insulin being the most commonly prescribed. But please, don’t think that this is a failure. You have likely made leaps and bounds with your controllable adjustments, and your body is simply asking for more help.
Low-carb Snack & Meal Ideas for GDM
As mentioned above, the standard recommendations for GDM management may not be enough to maintain stable blood sugars. Dr. Lois states, “Honestly, 175 grams of carbohydrate (the standard recommendation) is ridiculous! Women should be going as low as it takes to keep their blood sugar regularly under 90 mg/dl (5 mmol/L).”
You’re only going to know what works best for your body by trial and error. So check your blood sugar regularly, tune in to how certain foods make you feel, i.e. more engergized vs. more sluggish, and if your modifications aren’t enough seek out an expert schooled in evidence-based GDM care, not simply the status quo at your local OB office.
Keep your meals and snacks simple. Check your ingredients for added sugars and starches that may spike your blood sugar. Try to stick to whole, nourishing foods that aren’t filled with empty calories.
Snack Ideas
Low carb snacks – hardly raises blood sugar, if at all
Nuts of any kind
½ c plain Greek yogurt + a ¼ c of mixed berries
Beef or turkey jerky or sticks like these
Cheese – cheddar, jack, or string cheese
¼ cup of berries with unsweetened whip cream
Guacamole with celery and bell pepper
Hard boiled eggs
Cherry tomatoes, mozzarella, fresh basil, drizzled in olive oil and vinegar
1 oz of dark chocolate and handful of nuts
Cottage cheese and ¼ cup berries
Moderate carb snack ideas – raises blood sugar a little bit
Apple and a small handful of nuts or string cheese
½ banana and peanut butter
½ cup pineapple and cottage cheese
½ cup fruit flavored greek yogurt
½ cup hummus and feta cheese with carrots and celery
Smoothie with ¼ cup berries, ½ cup greek yogurt, 1 tbs of chia seeds, and almond milk (fewer carbohydrates than cows milk, use at your discretion)
Low- carb meals
Salad with pine nuts, goat cheese, grilled chicken, and balsamic vinegar
Grilled chicken breast with pesto and parmesan cheese and a spring mix salad
Steak topped with garlic and butter with roasted broccoli
Grilled chicken with ½ cup sweet potato fries
3-4 oz grilled lemon pepper salmon (wild-caught), Asparagus, sautéed in butter, Riced cauliflower topped with fresh chives and butter, 1 cup strawberries
Crustless quiche filled with bacon, cheddar cheese, broccoli, and cherry tomatoes
3-4 oz grass-fed beef meatloaf and roasted brusel sprouts
The above ideas should be enough to get you thinking about what low-carb eating looks like. If you’re not used to eating an animal based diet or you’re concerned about the cost of eating more animal foods, I can tell you first hand that eating this way is more cost effective in the long run because of the satiety you will feel after each meal. You will not be tempted to eat a $5 bag of chips in one sitting when you’ve just consumed over 100 g of protein in a day. Again, if you want to dive deeper into Nichols’ work, check out her book here.
Managing Gestational Diabetes Does Not Need to Overwhelm You
If you only take one thing away from this article it’s this: there is so much you can control, even if you are diagnosed with GDM. Please, refrain from beating yourself up and thinking on all the things you “could have” done to prevent this. Rather, take charge now of your nutrition and lifestyle choices to give your body the best support you can. And if you need more support from pharmaceuticals, you can rest easy knowing you did everything in your power to stabilize your blood sugars and your body simply needs more help. Thank God for modern technology that can support mothers when they need it.
I’d love to know what you think of this article, leave a comment below and don’t forget to share with any friends who may glean from this information as well.
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