Food for Thought

I had my much-anticipated appointment with the dietitian today and it was definitely worthwhile.

As I have mentioned in previous posts, my diet has basically fallen apart over the course of this pregnancy. Between treating the ever-present lows, soothing my nauseated stomach, and catering to my temperamental digestive system, I have thrown all of my diabetes-friendly diet techniques out the window in favor of foods that are comforting, easy to digest, and quick to raise a 24 mg/dL blood glucose. Out the window went my fiber-rich whole grains, fruits, and vegetables. In their place, I am living on juice boxes, white pasta, white bread, and gummy candies (my newest craving.)

But I am into the fifth month now, and that placenta must finally be doing it’s thing because the spikes after my meals are higher and more stubborn. And the lows, while still severe, are fewer and farther between.

The dietitian asked me to keep a food log for three days and to bring it along to the appointment. I was embarrassed with what I had to show her. Besides my carb-laden meals, I also documented an alarming number of trips to the vending machine for things like donuts and Rice Krispies treats. Yikes.

Luckily, she was one of the “good dietitians” — you know, the ones who realize that we live in the real world with real world temptation and real world schedules. She did not try to beat me up over my bad choices, and instead offered a few suggestions for how I could do better.

She put together a pregnancy meal plan based on the old-fashioned exchange system  and it is very reasonable. But the suggestions for better choices were probably the best take away. For example, I am struggling with a ravenous appetite in the mornings. It starts when I wake up and doesn’t die until after lunch. Mid-morning is when I spend most of my time at the vending machine … hello donuts.

Instead of donuts, she suggested a sandwich. Or, if I just can’t give up the donuts, half of a sandwich and half of the package of donuts. That is a pretty basic idea, and  I probably could have come up with it myself, but it sure helps to have the reassurance from an “expert.” Plus, it really helps that she did not try to tell me that I absolutely could not have the donuts. Because the craving center in my brain has been on fire lately and there is no telling what I will feel like I “need” to devour next.

We also talked about my ketone issues. Like the High Risk OB, she thinks I can get away with moving the 2AM snack to before bed, but she disagrees with him about the protein. She thinks I need the protein to keep my energy level up overnight to prevent going into “starvation mode.” I tend to think she is right, and proteins are starting to sound better now, so I think I will take her advice. She suggested string cheese and a box of juice for my pre-bed snack because it is quick and easy and has the requisite number of protein and carb exchanges. I think I will give it  a try.

Sidenote: My Endo thinks that moving the 2AM snack to before bed is a recipe for disaster. I have not been able to test this change yet, because my BGs are bottoming out every night at 3AM, so I’ve had to eat then anyway. Hopefully I can get him to change my basal rate and then I can give this snack time change a try. Just goes to show you that even the experts disagree on these things!

Another idea she had was with my boluses. In the past, I have used the dual wave bolus to offset my slow digestion, but recently, I haven’t needed it. She suggested that I experiment with the square wave instead of the dual wave when I eat a higher-fat meal. She said to start with a duration of an hour or so and see how it goes. I have noticed in the last couple of weeks that my digestion is really slowing down again … another of the side effects documented in the book … so I think this could be really helpful, too.

All in all, I am really glad that I finally found a dietitian. She made some good suggestions that I think I can use to improve my diet and she gave me the tools I need to make better decisions. Perhaps most importantly, though, she has given me the information I need to at least partially relieve my diet-based anxiety. Whew!

What’s for dinner?

This question is the hardest one of the day. As a result of my recent morning sickness, which is thankfully finally starting to subside, nothing sounds good.  Couple that with my complete exhaustion, and the digestive distress that pregnancy has brought along with it, and dinner time has become one of the most difficult times of the day for me.

My husband is probably nodding in agreement right about now. Normally a pretty basic guy when it comes to dinner, he favors a no-fuss, simple-to-prepare and simple-to-eat menu. If it weren’t for me, I think he would live on bologna sandwiches (complete with squishy white bread, American cheese, and ketchup) and SpaghettiO’s. Most of his suggestions sound less than appealing at this point in time, but he has been a real trooper, continuing to suggest ideas that I continue to turn my nose up at.

Luckily, he has been more than helpful in the kitchen, pretty much taking over all of the food preparation and clean-up duties. This is no small feat for a man who prefers not to make meals that require more than one utensil to prepare. Have I mentioned how great he has been through all of this?

Additionally, I have had to nearly abandon most of my normal, diabetic-friendly foods. Fiber is a no-no for my newly sensitive digestive system, so I have had to cut out most of the whole grains and strictly limit my vegetable intake. So much for my vow to eat lots of veggies throughout my pregnancy. I am reduced to low fiber fruits as well (think grapes, not apples). Even a modest amount of fiber leaves my stomach feeling like it has a lead weight in it, while at the same time, resulting in bloating and smoother-than-preferred results on the other end. Luckily, my blood sugars are still running on the low side, so I have not had to rely on the fiber to offset my insulin resistance. Yet.

Acid is also an irritant thanks to my new heartburn and acid reflux issues. That limits my intake of tomatoes and all tomato-based sauces, and acidic juices and fruits like oranges and pineapple.  And I really miss my spicy foods. Bye-bye chicken wings, salsa, hot pickles, and Tabasco sauce.

Milk products and most proteins are also causing me grief in the nausea department, although I have had some success with Carnation instant breakfast mixed with skim milk.

So what’s a pregnant diabetic to do? I’m growing tired of boxed macaroni and cheese, white pasta (sometimes with a small amount of mild spaghetti sauce,) and white toast, English muffins and bagels. Besides, Baby is not exactly getting a well-balanced diet out of these selections. Thank goodness for prenatal vitamins, I guess.

Does anybody have any easy-to digest dinner ideas that are quick and easy to prepare? My husband would be oh-so-grateful for your advice.

Digestive Woes

Ugh. Who would’ve thought that pregnancy would lead to such drastic digestive issues? I think I’ve experienced them all…

One minute it’s constipation. The next it’s diarrhea. Complete with gas, cramping and pain. Then it’s indigestion, burping, and hiccups. And then there is the on-again-off-again nausea. And to think most of it will probably only get worse from here.

I assume this is associated with my everyday digestive struggles which were most recently diagnosed as “probably a little bit of gastroparesis, a little bit of IBS, and a little bit of constipation.” Really. That was the professional diagnosis from the most respected gastrointestinal specialist in the area. Even more impressive, he said there wasn’t really anything he could do to help.

Nothing seems to help the intestinal issues, but the nausea does get better if I eat snacks every couple of hours.

The struggle, of course, is to find something healthy to eat for that snack that doesn’t make my stomach turn. Most proteins sounds just repulsive right now. And if it’s not covered in salt, it doesn’t exactly sound good. So I am eating a lot of pretzels and crackers. Not exactly the best meal for a diabetic with insulin resistance, right?

Speaking of insulin resistance, my basal needs went through the roof yesterday. It is amazing how fast these things change. I am using a 130% temp basal rate this morning, and still struggling to stay in range.

In other news, I’m hoping to try out a new yoga class tonight. I am not very good a sticking with an exercise routine, but I am going to really try to keep with it during this pregnancy. I have fought insulin resistance and “flab” for the last couple fo years, and I am concerned that the hormones and cravings of pregnancy could put my weight over the edge.