Diabetic Pregnancy: Nutritional Counseling, Carb Counting, Meal Planning

Kelsey Bonilla Health Guide
  • 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.

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    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.


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    I was a little shocked, to tell you the truth. Here I was proud of my 5-pound weight gain because I have been swimming a lot, hence losing excess fat while the baby was developing normally, and she decides to lecture me on my pre-pregnancy weight?


    Both my husband and I were put off, especially when she pulled out the BMI chart. I've read a lot about the body mass index and how it unfairly categorizes athletic individuals as overweight because muscle weighs more than fat, thus throwing off the height-to-weight ratio. In fact, that very morning, we'd heard this discussion on "The Today Show." I meekly explained that I had a muscular build, and thus I didn't see my pre-pregnancy weight as being unhealthy. If I hadn't been so stunned, I would have asked how that was even relevant at this point!


    The reason this post is only part one is because I actually learned a lot from the dietician appointment. In fact, maybe one of the most important lessons of my pregnancy began at this meeting. However, the delivery left much to be desired, and I had to swallow my pride a lot to sit through the session. Obviously, mine was just one experience and most dieticians or nutritionists will not come across this strict and unyielding.


    Stay tuned later this week when I'll explain the valuable information I was able to mine from this session with the dietician. You know it had to be good for me to find it among all the criticism!

Published On: August 30, 2007