Counting Carbs

On Thursday afternoon I had my first consultation at the Diabetes/Endocrinology Center in Scarborough. Nick came with me, to make sure I paid attention to the dietary recommendations, and because he’s really the better cook between the two of us, so we thought it important that he be there to know what I should be eating. There were only two other women in the class with us. Both were rather large women, and had they not been in a gestational diabetes class, I would not have realized that they were six months pregnant. Neither had a discernable baby bump. One of the women came to the class late, scraping the bottom of a cup of chili from Wendy’s.

The class was much more informative than either Nick or I were expecting. The instructors gave very specific guidelines as to how many grams of carbohydrates can be consumed at each meal (45gm) and snack (15gm). I was also given a glucose testing meter, and have been instructed to check my blood four times per day. Testing my blood consists of pricking my finger with a tiny needle, called a lancet, then placing the blood drop on a small plastic receptor strip that is inserted into a glucose meter. I check my blood upon waking (the fasting level) and two hours after every meal. My first reading, two hours after my usual breakfast of whole grain cereal and soy milk, was too high. Every other reading of the past four days so far has been normal.

I stopped eating cereal, and replaced it with a breakfast of yogurt and frozen blueberries, and a fried egg and cheese on a sprouted wheat English muffin. Delicious and filling, and seems to keep my post-breakfast levels lower. The meal plan they recommend is really not so different from what I usually eat—I just have to watch my carbohydrate intake, and limit sweets. Last night for dinner, I made whole wheat penne with chicken, broccoli, and parmesan, and two hours later for dessert had an organic ice cream bar dipped in chocolate with almonds. Both are perfectly acceptable on the meal plan. Neither spiked my blood sugar levels. The trick is to count carbs and space out meals and snacks every two to three hours so that my blood sugar never has a chance to dip too low or get too high.

I’m feeling less guilty about how this happened. I realize now it’s less a problem of my diet than the fact that my body simply isn’t producing enough insulin during this period of pregnancy. The placenta blocks the absorption of insulin into the bloodstream, meaning there is more glucose traveling through my blood, and not getting into my cells, where it belongs. All I can do to counteract that fact is watch my intake of carbohydrates, so my glucose levels don’t get too high, and exercise more to burn off whatever extra glucose is leftover. Between counting carbs and walking more (I walked for two hours yesterday while doing errands), I think I’ll get this under control.

Owning Up

I thought I was reasonably healthy. I read labels, scrupulously avoid high-fructose corn syrup, and whenever possible try to eat minimally processed foods. I eat organic, whole-grain cereal with soy milk every morning. I eat red meat sparingly (once or twice a month), and I snack on things like oranges, almonds and yogurt.

But I have some bad habits. I crave chocolate almost every day at 3pm (strangely, this only happens during the workweek, not on weekends), and indulge my sweet tooth with a chocolate or two, or a few cookies. I love French fries, and would get the fries at Duck Fat at least once a week if I could, but tend to resist so that I have them only once or twice a month. And if I have chocolate ice cream in the house, I will eat it. But then again--I can buy a pint of Haagen Dasz and make it last for a week--and I am pregnant, people! So I think my dietary habits, while by no means perfect, are not horrible.

Yet, last week, I was diagnosed with gestational diabetes. The good thing is that by making changes now, in the next two weeks, there should be no ill effects on the baby. What can happen is that babies can grow excessively large when the mother has gestational diabetes, necessitating a C-section. The babies can also have problems with their own blood sugar, and they are more likely to grow up to be obese and to develop Type II diabetes themselves. (Type II is also called adult onset, or late-onset diabetes.) Gestational diabetes usually disappears in the mother about 6 weeks after giving birth, unless the tests in pregnancy merely caught a previously undiagnosed case or the disease.

The frightening thing is that I THOUGHT I was being healthy, until I got the results of this test back. I know I ate a lot of extra treats over the holidays—homemade toffee, chocolates, cakes, pies, cookies, etc. etc.—and compounding the effects of this candied cornucopia was my lapse into a completely sedentary lifestyle beginning about two weeks before Christmas. I generally like to walk, whenever feasible, but with all the snow we got here in Portland, walking around outside was extremely difficult. There is no city ordinance enforcing people to shovel their sidewalks, so a day or two after a snowfall, the sidewalks in our East End neighborhood would be about three inches of treacherous ice thick. Forget about the beautiful walking paths along the Eastern Prom—they were still buried in snow. Those conditions, plus the early darkening of the sky, relegated my walks with Nick and Ting-Tong to weekends only. And even then, I’d find myself exhausted after short routes around the neighborhood.

I also stopped doing any stretches or formal yoga routines. The reason for that wasn’t clear to me, until I found out (also last week) that I’m also anemic, which explains my low energy and motivation for doing any exercise in the first place. So put the two together—the exhaustion and worn-out feeling of anemia, and the high blood sugar levels—and I have been feeling completely tired, overwhelmed, and exhausted lately. Sometimes my exhaustion manifests itself in uncontrollable crying jags that seem to come out of nowhere. Other times I feel weighed down by inertia.

Last night, Nick made me a healthy meal of broiled salmon, brown rice, and corn-crab chowder. It was delicious, and there’s no doubt it meets the requirements of my new healthy diet. But I wonder about the rest—the bean and cheese and rice burritos, vanilla yogurt, and even the soy milk I drink every day. Are they too high in sugars and carbs? Tomorrow I go for a consultation at a diabetes center, where I will be put on a meal and exercise plan. I never would have thought I’d need to be told how to take care of myself, and I feel both embarrassed and guilty. But I also feel indignant: Eighty to 90% of cases of Type II diabetes are found in people who are overweight or obese. At 6 months pregnant, I’ve gained 20 pounds, which my doctor assures me is right on target. I do have a family history of diabetes, which I only just learned about last summer, so that might explain some of this. As soon as I found out that I had gestational diabetes, I stopped eating anything with sugar in it, and was disappointed to find that three days later I’m still as tired and drawn out as I was before.

I guess this is just one more thing I can’t control with a few days’ notice, along with my growing belly and breasts, my decreasing bladder capacity, and my lessening ability to get a good night’s sleep. I think one of the hard things about having a baby later in life is that as an adult you get so set in your ways (especially as a formerly single New Yorker who did whatever I wanted, whenever I wanted) that it’s hard to relinquish the control I’ve so carefully cultivated over my life and body during this last decade of being single, footloose, and fancy-free. The baby’s not even born yet, and already I have to account for my actions, even as I’m still navigating the in and outs of learning how to live with a man I’m also accountable to.

This is all new to me, and it’s all happening at once.

Week in pictures

Not a lot has been happening around here. The first full week back at the office in a while was slightly tortuous, so much so that I couldn't even drag myself in by the time Friday rolled around. Luckily, I'd brought home some files and was able to work from home before my afternoon doctor's appointment. I probably got just as much done in a morning of intense concentration as I usually do in a whole day in cube-land trying to fend off unwanted conversations from Chatty Cathy and trying to ignore the feet stomping and sighing and shouting over the top of my cubicle that comes from my neighbor, CB.

CB drinks nothing but diet soda (she claims to get her water from the ice that melts in her giant igloo/thermos that she keeps filled with Diet Coke all day). She just spent an entire week home with some sort of illness that left her dehydrated and vomiting. By Thursday, we began to notice a strong odor in cube-land. The financial manager who directs the other women I share space with had them call maintenance. I wasn't there for this part, but apparently the maintenance crew pulled open vents and looked behind every nook and cranny, expecting to find a dead rodent. Ultimately, it was Kathy from California who found the offender: a chicken sandwich, sitting in a bag under CB's desk. It had been there for a full week, including the previous weekend. Just, please, get me out of there, now.

Ok, now for the pictures. I don't know if you can tell from this first one, but we had some cold weather recently:
Wiley tried to bundle up in my maternity sweater:
I FINALLY finished my mom's scarf, and even mailed it off to her the same day:
The Penney Ugland came to visit:
And Thumbs got comfortable in her new pad:
Do NOT try to rouse her:

Practice Run

My nearly two-year-old niece Eve came over early on Sunday morning for a visit while her parents were busy with other obligations. Nick and I took her on a walk to the coffee shop, where we got her a cup of hot chocolate and shared a bagel with her. I think she felt really cool, hanging out with the big kids. Afterward, as we waited outside the shop for Nick, I rested my foot on a snowbank, and Evie did the same. Her foot was at a really awkward angle, and it couldn't have been very comfortable, but I think she just was just getting in the spirit of being a big kid.