about 4 years ago

At 28 weeks, I went and did the 1-hour gluclose screening test. I knew that I would be in the danger zone. First, my family has a history of diabetes. Second, the early months of daily throw up and midnight hunger pain caused me to switch from a previously more protein-based diet to a carb-based diet.

For the 1-hr screening test, no fasting was required. From the PTT BabyMother board, I knew that people would sometimes skip breakfast before they go for the screening so they have a better chance of passing. After all, to fail the first screening means that one would be subjected to the much more brutal, fast-required, 3-hr glucose tolerance test. But I didn't skip breakfast that day. I had a cup of milk and a dried pork bun for breakfast --- in retrospect not the greatest combination for a pre-test meal, went to the hospital, drank 50 grams of glucose, and got my blood drawn an hour later.

The normal glucose range for the 1-hr screening should not exceed 140 mg/dL. I was right on the mark, 139 mg/dL an hour later.

I was not going to see the doctor for another week, so I didn't know if that counted as "pass". Still, I knew that I was in the danger zone.

Searching for more advice from PTT and looking at the posts of expectant mothers who were diagnosed with gestational diabetes, I went ahead and purchased a blood glucose meter. Normally, if you had actual diabetes, gestational or not, the insurance would cover it. I paid out of pocket anyway. I was not satifised with a single controlled test. I wanted to know what my glucose levels were after actual meals I was eating.

The truth was way more revealing than the single screening test.

There were three days in that week in which I tested all my meals. They were as follows:

==== Day 1 ====

Fasting: 83 mg/dL (essentially, after waking up)
Breakfast: One whole wheat bagel w/ cream cheese & lox
--- 1 hr after breakfast: 170 mg/dL
Lunch: Greek salad + whole wheat bolognese pasta
--- 1 hr after lunch: 108 mg/dL
Dinner: Stir-fry cumin lamb, garlic sauteed spinach, 1/3 of a baked beet, brown rice, and a peach
--- 1 hr after dinner: 149 mg/dL

==== Day 2 ====

Breakfast: Egg thincake with a slice of cheese (a common Taiwanese breakfast)
--- 1 hr after breakfast: 113 mg/dL
Lunch: 12 pork dumplings
--- 1 hr after lunch: 166 mg/dL
Dinner: Lamb and chicken and veggie kabob with long rice
--- 1 hr after dinner: 121 mg/dL

==== Day 3 ====

Breakfast: Fiber One cereal w/ 2% milk
--- 1 hr after breakfast: 114 mg/dL
Lunch: Dim Sum (BBQ pork buns, sauteed veggies, pork ribs, sesame balls, etc)
--- 1 hr after lunch: 164 mg/dL
Dinner: Strawberry arugula salad + Pork ragu
--- 1 hr after dinner: 128 mg/dL

The ones marked in bold are those that surpassed the 140 mg/dL threshold. In other words, except for meals that I carefully controlled for carb intake (and those are usually the meals that left me not completely satiated), I was easily in the 160-170 mg/dL range.

A week later I went to my prenatal visit. Whether my self-reporting had anything to do with the doctor's decision, I don't know, but she ordered me to do the 3-hour glucose tolerance test. In other words, I failed the first glucose screening.

Even though the evidence was obvious from my home testing, I still felt sad. Like every other PTT expectant mother who failed the first or even the second test, I felt like I failed at being a person. I didn't consider myself to have the best (or the worst) eating habits and I knew I had a sweet tooth, but like everyone else I thought to myself "It can't be that bad". For every sugary indulgence I had, in my mind I negated it with the next healthy thing I ate, be it a salad, a tofu dish, or some hearty roast chicken.

But it was obvious that my diet was worse. I was eating more carbs and sweets because I got scared of waking up at night from hunger. I was exercising way less than I used to. When most folks gain no or drop weight in the first trimester and made up for the baby growth in the third trimester, I gained weight at a steady formula of one pound per week starting week 10. Every time I went for the prenatal visit, I gained almost exactly, in pounds, the number of weeks since I had last visited them. And up until the glucose test, the doctor/midwife/nurse just looked at the screen and said "Your weight gain looks fine". I know that was because medically, it was way worse to not gain weight, since underweight babies suffer from more complications than overweight babies.

I scheduled for the 3-hr glucose test immediately. I was told to not eat after 7PM the day before, show up at 8:30AM the next day, and expect to not have anything besides the disgusting 100 grams of glucose until noon. Well, I cheated just a little bit. I ate dinner at 7PM, but had a small serving of low fat yogurt at 9PM before I went to bed. I was more worried that I would wake up from hunger or be too dizzy the next day to go to the hospital. But I turned out OK. I didn't sleep very well, I was a little hungry, but I made it to the clinic the next day.

Here were the results:

Fasting: 90 mg/dL (normal range: 70-94)
1 hour: 177 mg/dL (normal < 180)
2 hour: 131 mg/dL (normal < 155)
3 hour: 139 mg/dL (normal < 140)

Two days later, the nurse called. I passed. Barely. So I technically don't have gestational diabetes, "But you know what this means ---", the nurse said, "Tight diet control."

Unfortunately it's not like a driving test. You passed barely and no one cares, you still have a drivers license. At some point the cutoff for calling what is gestational diabetes, just like the differentiation between overweight and obese, is extremely arbitrary.

And so I continued my journey of poking fingers an hour after my meals to see how I fare on the glucose meter. I was a little put off when I ran out of the 30 gauge needles that came with the meter and had to switch to the 33 gauge (more fine) needles. I wasn't able to get enough blood out of it with the 33 gauge, even when I set the needle intensity (how hard the lance pokes down on the finger) to maximum and poked twice at the same spot. Not funny. I wasted a lot of test strips on insufficient amounts of blood, and the test strips were the most expensive item. Apparently, no one else besides me have dinosaur skin, because Walgreens does not sell anything but the 33 gauge. I ended up finding the 30 gauge needles from a wholesale website specifically catering to diabetics. Oh well.

I also looked to the PTT posts for help. For the expectant mothers diagnosed with gestational diabetes and were forced to have counseling with nutritionists, what did they eat?

I learned quite a few useful tips from them:

  • Low GI doesn't always mean low glucose level. If it's carbs, it's carbs. Brown rice, buckwheat, whole wheat, grains, will still spike your glucose level. The only way you can control it is to reduce the amount. The mothers found that, as a general rule, about half a fist size of rice/grain is the most they can have.

  • Non-starchy vegetables are always all you can eat. No one eats that much spinach or kale anyway.

  • Fruit juice or sugary drinks are always OUT. That's a no-brainer.

  • Fresh fruit, low or high GI, are all dangerous when consumed with one of the main meals. They should generally be put as snacks, 2-3 hours away from main meals.

  • Protein is fine. Tofu, fish, meat, are all fine.

  • Eat smaller main meals and put 2-3 snack times in between them. This means eating up to 5 or 6 times a day.

  • Once you have established a "safe meal" that does not spike your glucose, you can save yourself from poking your finger afterwards. This will reduce the amount of test strips you consume and your fingers will be thankful.

After almost two weeks of further self monitoring, I have found a few "safe meal" combinations that seem to work for me.

==== Safe option #1 for breakfast ====
Fiber One cereal with 2% milk. Can add up to 10 pieces of dried cranberries. This cereal also has the highest amount of dietary fiber I have seen (14g per serving). Even the Flax Plus Raisin Bran cereal, which has the highest dietary fiber per serving at my local WholeFoods, has only 8g. The fibers have been keeping me away from one of my greatest fears in pregnancy discomfort.

Post meal glucose: 95 - 110 mg/dL

Possible addition: adding two scrambled eggs (scrambled w/ butter) and half a slice of American cheese will elevate this to 116 mg/dL, which is still good. Praise be to dairy!

==== Safe option #2 for lunch & dinner ====
Greek or house salad, with vinaigrette dresssing
Any kind of meat sauce with whole wheat or regular pasta

I thought the pasta would undo me, but it was actually OK. It didn't matter if it was regular pasta too. I think this is because the dishes I ordered didn't put that much pasta in. And they were delicious.

Post meal glucose: 110 - 130 mg/dL

==== Safe option #3 for lunch & dinner ====
Grilled meat (beef, chicken, fish)
Sauteed non-starchy vegetables (I really like spinach)
Cooked beans

Post meal glucose: 110 mg/dL

I don't like beans. I don't like beans. I especially don't like savory beans. I was brought up on red beans being sweeted up and served in pastries. But where I live now there is actually a lot of amazing Mexican/Latin American food that serves meat with beans. Just kick out the rice and this is a super healthy meal. I guess I will learn to love savory beans.

==== Safe option #4 for lunch & dinner ====
For Chinese dishes, this is what I have found to work: meat/tofu (as long as not fried) as fine up to one serving, non-starchy veggies are all good, I can have rice (white or brown) as long as it is no bigger than somewhere between 1/2 - 1 of my fist size (I have small hands, btw)

==== Snack options ====
Here are some of the snack options, usually eaten 2-3 hours after lunch and right before I sleep.

  • Plain greek yogurt (unsweetened, no jam, fruit, granola, no nothing)
  • One small piece of low GI fruit or 1/2 piece of high GI fruit
  • Raw broccoli w/ hummus + petite sweet bell peppers

Yesterday was my best day. I was under 120 mg/dL for the entire day! Granted, I did not record my post-snack glucose level since I was running outside all day long. But my post breakfast, lunch, and dinner glucose was 116 mg/dL, 116 mg/dL, and 117 mg/dL. The dinner was a bit harder to judge, since we ate at a fancy Japanese restaurant and it was a 2-hour meal. I had one bowl of miso soup, 5-6 pieces of sashimi (no rice), 2 pieces of nigiri (has rice), 1-2 bites of grilled fish and chicken, and at the every end ate a small slice of birthday cake. I was OK with going over for the birthday cake, but looks like I was OK because I ate very little carbs beyond that. And I was happy, it was a delicious cake.

The scale I have at home is somewhat inaccurate, so even though it seems to indicate I have no gained weight since my last prenatal visit two weeks, I won't know for sure until I go for my next visit on Tuesday. We shall see how I fare. My main concern was that I did not want to starve myself which may lead to excess ketones in the urine. I don't feel like I am starving, since I supplement my now low-carb meals with additional snacks. My total food intake, on paper, appears to be only a little less from what I was eating before the glucose test. I am a little unsatiated after main meals, but I have also discovered that this is often because my food digests slower these days, so I always have a delayed satiation response after meals. I don't feel more tired. I feel just as energized as I was a few weeks before. I sleep well and get up at a regular 2 times per night to pee. The final small piece of evidence that I might be doing the right thing, is that before my diet control, I would feel a slight mix of heartburn/chest discomfort, after meals and before sleep. This is not unusual for pregnant women, but they went away after my diet control. Perhaps before I was consuming food too much and too fast and with my organs being squeezed into tigher space, I was suffering from indigestion.

But now that I think about it, I'll probably head to the pharmacy later to get ketone test strips. I guess the experiment continues. I have also (sort of) mentally accepted that if all fails, that if there is nothing I can do through diet control to achieve healty food intake and healthy glucose levels, I will accept medication. But I think I won't have to go there. Till my next visit on Tuesday, then.

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