Pregnancy Tracker: 21 weeks

Size of the Baby: The size of a large banana!

Biggest Obstacle: Getting enough rest

Just over a week ago, I attended my first dietician appointment in about 12 years. My diabetes and pregnancy care team had been encouraging me to see their nutritional counselor, so I finally made an appointment. Immediately after our incredibly successful anatomy scan, my husband and I set off for the dietician's office.

As a diabetic who was diagnosed just before carbohydrate counting became the preferred method of insulin calculation, I am familiar with the old "meal planning" technique and all of the inflexibility it entails. The last time I'd visited a nutritionist or dietician, we had discussed meal planning and food exchanges. So, perhaps I was a bit negatively biased against the whole idea of seeing a dietician again. On the other hand, everything has been going so well with my pregnancy, both in terms of my blood sugar control and the baby's development, and I was feeling good about my diabetes management lately.

Dennis and I sat down next to the dietician and she began explaining her general approach to nutritional counseling for pregnant women with diabetes. Right off the bat she admits that she's used to dealing with gestational diabetics, and does not see a lot of soon-to-be-moms with type 1. I handed her some of my recent log sheets, which includes a fairly detailed food diary.

When she saw a dinner entry containing 75 grams of carbohydrate she exclaimed, "Wow, that's a lot of carbs for dinner!"

The chip on my shoulder grew with each judgmental question she posed: "Where was your fruit this day?" "Did you have any protein with that snack?"

"Oh, a chocolate chip granola bar, that doesn't have much protein, unless you smeared peanut butter on it. Did you add peanut butter?"

I gritted my teeth and answered, "Nope, no peanut butter."

As her litany of questions and my meager rationalizations flew back and forth, I found myself thinking, "Man, my A1c is 5.0... I must be doing something right!" The dietician was well aware of my latest blood test, and to my chagrin, did not seem impressed by it.

Once she put down my logs, we discussed weight. She asked me how much I weighed before becoming pregnant, to which I answered: 146 pounds. I then stepped onto a very sophisticated looking scale to see my current weight: 151 pounds. At 19 weeks and 3 days pregnant, I'd gained a total of 5 pounds. At first, I thought she might criticize that increase as being too small. After all, most of the books recommend a 10- to 14-pound weight gain by the midway point.

Instead, the dietician questioned me about my pre-pregnancy weight. At my height, she considered 145 pounds to be the "high end" of my healthy weight range. She explained that it was very important I lose all of my pregnancy weight and get back down to something like 135 to 140 pounds after the baby's birth.