Diabetic Diet: Protein Delays Blood Sugar Release buying Time for Insulin
Pregnancy Tracker: 21 weeks, 3 days
Size of the Baby: 10.5 ounces
Biggest Obstacle: I'm tired because we're moving this weekend!
Although much of what the dietician had to say was difficult to hear (and fairly demeaning), I retained some very important information from that session.
Basically, her first major message to me was: "less carbohydrate, more protein." That explains the dietician's concern about whether I smeared peanut butter on my granola bars! Protein delays the release of glucose into our blood streams. So, if I have some protein at each meal and snack, my blood sugar should not spike as quickly. This allows the insulin to get working in time to catch the spike, so that my postprandial readings can stay below 140 mg/dl.
The second big lesson was "consistency." Many long-term diabetics were thrilled to start the pump because it freed us from rigid schedules of meal planning and snacking required by long-acting insulin. If we want to eat pizza, cake, pasta or other goodies, we can now, with much fewer high readings. So, when the dietician suggested limiting carbohydrate amounts for each meal, I initially resisted. I explained, "With the pump and carbohydrate counting, I don't have to be held to a schedule for my meals and snacks."
However, she enlightened me to a new reason for using a meal plan. As pregnancy progresses, insulin resistance kicks in quite severely. By eating the same number of carbs at the same times each day, we'll be better able to predict and adjust to my changing insulin needs. In this way, I will hopefully stay ahead of my insulin resistance and not have a lot of high readings, which are bad for me and the baby.
Light bulb moment!
Ah, this schedule for my eating would not be restrictive; it will actually free me from worry and concern by eliminating a variable from the diabetes puzzle! Now, I won't have to ponder whether a high postprandial reading was due to an inaccurate carbohydrate count, an ill-advised higher carb meal, or a genuine need for more insulin. It will be more obvious when my insulin needs increase, because the carb values of my meals and snacks will stay consistent.
The actual meal plan that I'm working with breaks down into these carbohydrate amounts:
- Breakfast: 15 grams
- Morning snack: 15 grams
- Lunch: 45 grams
- Afternoon snack: 15 grams
- Dinner: 45 grams
- Bedtime snack: 30 grams
That's not a whole lot of carbohydrate! In order for this plan to be filling, protein will have to play a major role. Thus, I'm eating eggs for breakfast regularly -- typically egg salad on one slice of high-fiber bread. It's quite tasty and produces beautiful postprandial numbers and nice steady blood sugars throughout the morning.
This plan also includes other restrictions, which seem a little inflexible, but work. For instance, I'm not supposed to have my beloved milk at breakfast. However, with only 15 grams of carbohydrate allotted for, a cup of skim milk would fulfill the entire meal anyway! Also, fruit should be avoided in the morning hours because of that delightful dawn phenomenon that makes morning blood sugar spikes all too common.
As the carbohydrate breakdown indicates, it's really the morning hours that cause problems for pregnant women with diabetes. I've certainly found this to be the case! My carb ratio for breakfast and lunch is quite a bit higher than my ratio for meals and snacks in the afternoon. In fact, I've had several lows the past week, all before dinner, obviously from the buildup of insulin I delivered earlier in the day.
So, those were my insights gleaned from the dietician appointment. There's another level to this carbohydrate reduction idea that I've been mulling over, but I want to run it by the doctor before I start advocating it. I have another appointment with my O.B. today, so we'll see what he has to say!