Reintroducing Carbs... Humor me!

[Cocosilk]

I'm finally biting the bullet and reintroducing extra carbs to see what happens after having had gestational diabetes and having eaten mostly keto and low carb for the past 6 months. (Now 4 months postpartum.)

I'm on Day 2 of extra carbs and apparently you need at least 3 days to full reawaken the pancreas from keto. Is that right?

I wasn't in ketosis constantly over this past 6 months though and have tried a couple of times to experiment with more carbs but got scared off when I started seeing 8s, 9s and 10mmols at the 1 hour mark...

But this time I really want to do it because I wonder if I've really been eating enough potassium foods while low carbing.

I am breastfeeding a 4 month old and have been having heart palpitations worse than anytime before. I wanted to rule out something lacking in my diet but am really suspecting the lack of sleep (and possibly low carb) is causing more cortisol to be released so actually anxiety about not being able to sleep enough is probably why I'm having heart palpitations.

In any case, I need to see how I really am going to react to carbs and in another week or so I already have the pathology request form from my GP to have a HbA1C, electrolytes and an ECG to check out my heart just in case.

In the meantime, would anyone care to humor me and tell me how diabetic these numbers sound for what little extra carbs I have eaten this past 2 days?

Bear in mind that on the morning of Day 1, I was in ketosis (trace - weak according to the urine ketostix) so perhaps that makes me less glucose tolerant than usual on this first day, but now, at the end of Day 2, I'm still not confident that I don't have a problem with glucose tolerance and insulin resistance.

The week prior to this, my morning fasting levels were good while I was eating keto / low carb: 4.4; 4.6, 5.1, 5.2, 4.7, 4.8 mmol.

The night before Day 1, I ate carbs at midnight to add some potassium to my diet after potassium counting the day before and falling well short of the 4700mg that I keep seeing is recommended... (How does anyone get that amount from food without overeating I have no idea!)

My fasting level on Day 1 was 5.1 mmol.

I ate a slice of sourdough rye bread with peanut butter and a glass of coconut water (sources of potassium apparently). 60 mins 7.4; 90mins 5.1 mmol. Seems okay, doesn't it?

Around lunch I had another slightly thicker slice of sourdough rye bread with half a cup of raspberries and about a tablespoon of banana followed by sweet potato pancakes that I was eating straight off the frying pan and would have just kept on eating but thought I should stop and measure when the first hour was up. Lucky I stopped... My metre told me I was 11 mmol... By 2h I was 8.6 mmol.

The rest of the day I ate low carb...

Day 2 Morning fasting 5.4 mmol. (Higher than usual and I find this has happened each time I added a few carbs back into my diet - that also made me go back to low carb before I stuck out the 3 days.) I'd also only had 4 hours sleep last night though. I was no longer in ketosis this morning.

Had 1 slice of sourdough white bread with peanut butter and a bite of banana.
60 mins 7.4 mmol
100 mins 6.2 mmol.
Seems okay again I guess.
2 hours and 40 mins later I was 4.6 mmol

Had a strange new thing for lunch - goat's liver! We bought a whole free-range freshly slaughtered animal so it was the first time I'd tried it. Nice! Milder then lamb's fry.
This was a low carb meal with a bit of a beetroot salad on the side. Numbers were fine.

Afternoon snack was a few sweet potato pancakes. Only measured 1h later. 6.9 mmol.

Had a nap in the afternoon and woke up with 4.3 mmol.

Then had 1 slice white sourdough with 3 cheeses, 1 dried apricot, pepitas and macadamia nuts.
1h 8.6 mmol
90 mins 8.2 mmol
2h 7.8 mmol

Seems high for that amount of carbs... I dunno.

Don't even ask what dinner was... okay, I'll tell you, but even though I thought I was adventurous (I mentioned the goat's liver?) well, my husband decided to make Goat's HEAD Soup... Brains and all.. I had trouble eating it. I love ox tongue and beef cheek, and the goat's tongue, the one bit I found in the pot, was really good! But he broke the head up into bits and pieces and mixed it all up in the soup so each bite was a surprise. The lips, or gums.... and something else that had the texture of snot... Oh man, I'm not going back for seconds. The goat's eyeballs are sitting on a small plate on the kitchen bench. Not sure what my husband plans to do with them... ha ha

Anyway, I digress...

Does anyone know how to estimate your HbA1c from home tests? I mean, if I kept eating like this and saw 11s and 8s once or twice a day, that's not going to be a great result over months, is it? Or will the odd 4s keep the average in the okay range?

In any case, isn't 11 mmol already in the diabetic range if it's discovered randomly, or is that just classed as a glucose intolerance if it drops back to 8 mmol by 2 hours and if my fasting stays under 5.5 mmol?

I know these numbers are not optimal anyhow. I think I want to eat just enough carbs to stay out of ketosis mostly in case that's causing extra stress hormones to be released at a time when I am already under pressure, and to get more potassium from my diet from vegetable carbs, but the white sourdough bread is obviously not a good one. Especially not paired with any amount of fruit... not that it was much fruit really.

Thoughts?

 

[Mbaker]

I think your fasting on low carb is really good. I am not sure that you and sour dough work well together, maybe try some artisan version, made over several days with few ingredients (less than 5).

Have you tried butternut squash, not for everyone, but I do well on this. I have not heard of low carb raising cortisol, but lack of sleep definitely does. For the potassium I would get through a couple of teaspoons of lo salt on food (with a couple of squares of as dark chocolate as you can handle to also get the magnesium hit). I would drop anything that produces double figures post-prandial and personally anything that goes over 7 (I don't like seeing even a 6, but that's just me, others have a difference of view on this).

 

[Walking Girl]

Well for me, all carbs are definitely not equal. I see numbers like yours or higher with bread - any bread. Rice and pasta is also out. Beans, root veggies, berries, however, I can eat a lot and get great numbers. Perhaps experimenting with what carbs you eat is in order? Beans are high in potassium, btw...

 

[Sapien]

Each of us and our microbiome are different. I have seen multiple studies which show high variability in response to different foods with the same quantity of carbs for the same person and among glycemic normal people.

I can eat high fiber whole grain and seed bread and it usually barely effects me. Yesterday, I ate an almond butter sandwich with two slices and my blood sugar dropped.

Berries in combo with a meal or Greek yogurt hardly any effect. Frequently if eaten with dinner I also see a drop after dinner.

I eat homemade hummus 1/2 cup at lunch and dinner most days with a very small rise. But a cup of beans (at least without fat) will make my blood sugar spike. Sweet potatoes, which I love, are also a problem unless in very small quantity.

 

[Sapien]

This morning we had no eggs in the fridge so I ate an almond butter sandwich in addition to my typical breakfast (but today without the eggs) and surprise- same rise as my typical breakfast. Always a rise at breakfast unless I eat no carbs at all. (I once saw no change after two hard boiled eggs, but that isn’t much of a breakfast by itself.) My typical breakfast has about 20 carbs. Today with the sandwich it was 54 net carbs with the same rise to 6.1 at one hour that I usually get. Why I don’t understand.

Thick high fiber whole grain and seed bread. With white bread it would have been quite different.

 

[Sapien]

Well for me, all carbs are definitely not equal. I see numbers like yours or higher with bread - any bread. Rice and pasta is also out. Beans, root veggies, berries, however, I can eat a lot and get great numbers. Perhaps experimenting with what carbs you eat is in order? Beans are high in potassium, btw...

How do you prepare root veggies (e.g. sweet potatoes) and beans so that you can eat a lot? Naked or with fats? The only way I can seem to eat beans or potatoes is to keep the serving 1/2 cup or less. Hummus is the exception and that has the fat from the tahini.

 

[Member496333]

Thoughts?

If you can’t eat bread without spiking into double figures, then ‘reintroducing carbs’ is only going to make your glucose/HbA1c go in one direction. Up. I know very little about the aetiology of gestational diabetes, and I’m definitely not about to offer advice to a breastfeeding mother, but based on information provided, I can’t see this turning out how you’d like it to.

Just a hunch. Sorry.

 

[Walking Girl]

How do you prepare root veggies (e.g. sweet potatoes) and beans so that you can eat a lot? Naked or with fats? The only way I can seem to eat beans or potatoes is to keep the serving 1/2 cup or less. Hummus is the exception and that has the fat from the tahini.

Most of my recipes have some fat in them - lentil, bean and/or vegetable curries with coconut milk or cream. Refried bean, hummus, etc. Root veggies are mainly just roasted, oven or on the grill but always with a little oil. I eat a lot of raw carrots, but usually with hummus or tzatiki dip. I don’t aim for low fat though, my diet would best fit a vegetarian Mediterranean profile.

I have no idea why my BS hardly reacts to legumes and vegetables, but all I know is it doesn’t. I can eat some whole grains as well, such as quinoa, amaranth, buckwheat, but usually 2/3 cup or less.

 

[Cocosilk]

If you can’t eat bread without spiking into double figures, then ‘reintroducing carbs’ is only going to make your glucose/HbA1c go in one direction. Up. I know very little about the aetiology of gestational diabetes, and I’m definitely not about to offer advice to a breastfeeding mother, but based on information provided, I can’t see this turning out how you’d like it to.

Just a hunch. Sorry.

Yes, my exact concern... I wonder if I'll turn out to already have T2 or am I prediabetic and probably was before the pregnancy even started but was never checked..

I also wonder if the stress of sleep deprivation with 3rd baby (all under 5yo) is stress enough to rise my levels despite my hopeful attempts to keep them down... Although I was pretty happy with my numbers while low carbing.
I'll perservere through at least today with similar foods. If I'm still seeing 11s, that's probably going to give me my answer, isn't it? But even if I see postprandial 1h 8s that return to 6 mmol by 2 hours, that still won't be a great average if I go on with it, will it? Any idea what HbA1c I would have with numbers between 4s and 11s?

 

[Robbity]

Maybe I'm simple minded, but far as I'm concerned ketosis is natural and normal. and if you're keto/fat adapted then your body will process whatever fuel is currently available at the time, be it from a few carbs or from fats, and go in and out of nutritional ketosis all the time without problem. So I'm not sure why it should be a big deal?

If you're looking to add more potassium to your diet, there are various protein sources that are rich in potassium, e.g. some fish - trout, tuna, cod... and most of our very low carb vegetables and fruits are also an excellent source - e.g. broccoli, spinach, cucumbers, courgettes, mushrooms... A Goggle search will find them for you.

Robbity

(ETA: Bread, bananas, and dried apricots would all be a HUGE NO for me even on a fairly generous max 50g carbs a day)

 

[Cocosilk]

Maybe I'm simple minded, but far as I'm concerned ketosis is natural and normal. and if you're keto/fat adapted then your body will process whatever fuel is currently available at the time, be it from a few carbs or from fats, and go in and out of nutritional ketosis all the time without problem. So I'm not sure why it should be a big deal?

If you're looking to add more potassium to your diet, there are various protein sources that are rich in potassium, e.g. some fish - trout, tuna, cod... and most of our very low carb vegetables and fruits are also an excellent source - e.g. broccoli, spinach, cucumbers, courgettes, mushrooms... A Goggle search will find them for you.

Robbity

(ETA: Bread, bananas, and dried apricots would all be a HUGE NO for me even on a fairly generous max 50g carbs a day)

They are a huge no for me too I think. I had to try carbs again to see what would happen. I remain officially undiagnosed as I had a GTT 2 months ago and with these results was told I "might have glucose intolerance - come back in a year and test again"...
Fasting 4.4 mmol; 1h 12.1 mmol; 2h 6.5 mmol.

My own metre, which I was using during the test, had me at 13.8mmol at the one hour mark and 7 - 8 mmol on either side of the 2 hour blood draw. I heard recently that lab draw results often come back slightly lower than reality because, by the time the blood gets to be analysed, the still-living cells have chewed up a bit more of the sugar.
But my doctor told me I'm not diabetic - I should just take a statin for my cholesterol.... Hopeless.

I am on Day 3 today and I am convinced this is not looking good anyway so it'll be back to my low carb eating I guess..

The being out of ketosis thing was just to experiment to see if my heart palipations will go away. Breastfeeding and very low carb will see me in ketosis more easily than average (not just overnight but all day long) and I did read that eating like that can cause coritsol levels to rise. Probably only temporarily, but I'm also only experimenting for a few days to see if anything changes with these heart palpitations.

In reality, I probably just need more sleep but can't easily get it with a baby, a 3yo and a not yet 5yo in the house when we've all been down with a virus this week

 

[Cocosilk]

This morning we had no eggs in the fridge so I ate an almond butter sandwich in addition to my typical breakfast (but today without the eggs) and surprise- same rise as my typical breakfast. Always a rise at breakfast unless I eat no carbs at all. (I once saw no change after two hard boiled eggs, but that isn’t much of a breakfast by itself.) My typical breakfast has about 20 carbs. Today with the sandwich it was 54 net carbs with the same rise to 6.1 at one hour that I usually get. Why I don’t understand.

Thick high fiber whole grain and seed bread. With white bread it would have been quite different.

Do you return to your fasting base after 2 hours when you eat bread?

I just measured my results on Day 3 of eating this sourdough white bread my husband made (he normally makes rye or spelt and I don't spike quite as high with that). Again I had peanut butter and a bit of banana and I drank a glass of goat's milk with it.

My fasting this morning was 5.2 mmol when I first got up.
An hour later I still hadn't eaten and it was 5.4 mmol - typical now that carbs are back. During low carb weeks it was going backwards with the help of breastfeeding taking some of the sugars out. This morning my baby is sick and didn't feed well so the sugars were all mine...
1h 7.2 mmol
2h 6.0 mmol.

To me, not returning to base is a pretty big warning here. So even if the numbers didn't get that high, why not back down in the 5s by 2 hours?
So my verdict to myself is that I will assume I still have glucose intolerance and not wait for a year to be told I have full-blown T2...

 

[Sapien]

I didn’t test at 2 hours today. I generally don’t drop back to pre-meal fasting at 2 hours. That usually takes about 3 hours.

I try stay in the 5’s, including maybe a peak just over 6 at breakfast. Lunch almost alway peaks lower than breakfast. Frequently I am back in the 4s before dinner. After dinner I am usually in the low to mid 5s. In the morning I wake up usually in the 4s, but only a few times below 4.4. I’ve only dropped below 4 after eating carbs and then exercising.

For me it is any reading over 6.1 after eating that concerns me. Then I test to see how long it takes to come down. If it is 6 or below I have stopped testing again. (I would if I tried pizza or pasta again. Fat and carbs. Those seem to peak later.)

I pay attention to the fasting number mainly because it would seem to reflect the level of homeostasis that my body (liver / pancreas) is used to.
I wish I could bring that down well into the 4s.

I don’t want to experiment too much with eating more carbs until/unless my body gets used to a lower baseline glucose level.

 

[Cocosilk]

Can

I didn’t test at 2 hours today. I generally don’t drop back to pre-meal fasting at 2 hours. That usually takes about 3 hours.

I try stay in the 5’s, including maybe a peak just over 6 at breakfast. Lunch almost alway peaks lower than breakfast. Frequently I am back in the 4s before dinner. After dinner I am usually in the low to mid 5s. In the morning I wake up usually in the 4s, but only a few times below 4.4. I’ve only dropped below 4 after eating carbs and then exercising.

For me it is any reading over 6.1 after eating that concerns me. Then I test to see how long it takes to come down. If it is 6 or below I have stopped testing again. (I would if I tried pizza or pasta again. Fat and carbs. Those seem to peak later.)

I pay attention to the fasting number mainly because it would seem to reflect the level of homeostasis that my body (liver / pancreas) is used to.
I wish I could bring that down well into the 4s.

I don’t want to experiment too much with eating more carbs until/unless my body gets used to a lower baseline glucose level.

Can I ask what your levels were like upon diagnosis? Was it a HbA1c or a OGTT?

 

[Daphne917]

Yes, my exact concern... I wonder if I'll turn out to already have T2 or am I prediabetic and probably was before the pregnancy even started but was never checked..

I also wonder if the stress of sleep deprivation with 3rd baby (all under 5yo) is stress enough to rise my levels despite my hopeful attempts to keep them down... Although I was pretty happy with my numbers while low carbing.
I'll perservere through at least today with similar foods. If I'm still seeing 11s, that's probably going to give me my answer, isn't it? But even if I see postprandial 1h 8s that return to 6 mmol by 2 hours, that still won't be a great average if I go on with it, will it? Any idea what HbA1c I would have with numbers between 4s and 11s?

@Cocosilk everyone is different. I average between 100 - 130g per day and manage to keep my BS under control but there are some things that I still cannot eat such as Scampi without raising my BS to 9 after 2 hours so tend to avoid. I can eat bread - albeit high protein but not wraps - although I haven’t tried them for a while so may experiment again although I can take them or leave them so may not bother. Rice is another food which I do like but am wary of but a small portion of reheated pasta in fine. I have a list of foods that I know I can eat and which I should avoid.

 

[Cocosilk]

@Cocosilk everyone is different. I average between 100 - 130g per day and manage to keep my BS under control but there are some things that I still cannot eat such as Scampi without raising my BS to 9 after 2 hours so tend to avoid. I can eat bread - albeit high protein but not wraps - although I haven’t tried them for a while so may experiment again although I can take them or leave them so may not bother. Rice is another food which I do like but am wary of but a small portion of reheated pasta in fine. I have a list of foods that I know I can eat and which I should avoid.

How are you morning fasting levels nowadays? Can you keep them under 5.4 mmol as a general rule and still manage to eat small amounts of rice and pasta?

 

[TriciaWs]

So potassium rich foods include: grapefruit, spinach, mushrooms, yogurt, courgettes, broccoli, cucumber (organic is better?), most nuts. avocado, beetroot, tomatoes.

I'd try some spinach, walnut and beetroot salad, a tomato sauce heavy on mushrooms plus a protein (chicken or salmon?) served with courgette noodles , and half a grapefruit (I find a whole one will spike me a little).
Both flaxseed and chia seeds are good - I make a porridge with a little oatbran, loads of milled flaxseed and some chia seeds for breakfast, with nut milk.
Or maybe a green smoothie with loads of leafy greens and almond/cashew nut milk?
And try making cashew nut milk if you can't find it locally, it is very easy. I buy large bags of broken pieces online to cut the cost.
And don't forget a little 85% chocolate ...

As you must be very busy, batch cook the tomato/mushroom sauce and freeze portions?

Also make sure you are balancing your potassium with sodium.
https://www.hsph.harvard.edu/nutritionsource/potassium/

 

[Cocosilk]

So potassium rich foods include: grapefruit, spinach, mushrooms, yogurt, courgettes, broccoli, cucumber (organic is better?), most nuts. avocado, beetroot, tomatoes.

I'd try some spinach, walnut and beetroot salad, a tomato sauce heavy on mushrooms plus a protein (chicken or salmon?) served with courgette noodles , and half a grapefruit (I find a whole one will spike me a little).
Both flaxseed and chia seeds are good - I make a porridge with a little oatbran, loads of milled flaxseed and some chia seeds for breakfast, with nut milk.
Or maybe a green smoothie with loads of leafy greens and almond/cashew nut milk?
And try making cashew nut milk if you can't find it locally, it is very easy. I buy large bags of broken pieces online to cut the cost.
And don't forget a little 85% chocolate ...

As you must be very busy, batch cook the tomato/mushroom sauce and freeze portions?

Also make sure you are balancing your potassium with sodium.
https://www.hsph.harvard.edu/nutritionsource/potassium/

Thanks for the tips! I have been looking up potassium-rich foods and trying to get them into my diet. Some of the best ones are also very carby, like dried apricots with over 1000mg per 100g, but 63g of carbs per 100g means I would only have one or two at a time... I think one dried apricot weighs about 5g.

For dinner this evening I had fresh salmon. I didn't have time to make the salad I wanted to - beetroot & broccoli with avocado, cucumber and sesame seeds so I just ate a handful of peptitas (around 800mg of potassium per 100g) and made a drink with 1/4 teaspn of Lite Salt (27g of potassium per 100g - roughly 500mg of potassium per 1/4 teaspoon if my maths is correct...), plus the juice of a lemon and half a glass of coconut water (220mg of potassium per 100g). I think lemons and grapefruits have a similar amount of potassium.

I've had my square of 85% dark chocolate today - I mix it into a glass of hot goat's milk since I'm trying not to have tea or coffee at the moment - it makes a nice hot chocolate (if you can have milk that is). Did you know milk has as much potassium, or slightly more, than coconut water? And coconut water is advertised here as some electrolyte elixir... Really they both have similar amounts of potassium and carbs too, just milk has the fats and potential to cause allergies in those who are sensitive.

Mushrooms will be on the menu soon - we have a ton in the fridge and I just haven't had a chance to cook them.

Spinach I love too. I have it fresh in salads and frozen spinach I heat up with garlic and butter.

I have only once made corgette pasta and used some fresh tomatoes when we had them growing in the garden. I loved it, but haven't thought to make it again. We did have too many tomatoes coming in a few months ago and my husband was making so many pasta sauces that I got diarrhea from it a couple of times and haven't wanted a tomato since! Even my salads have been without tomatoes since then - I have red capsicum, cucumber, raw cauliflower and avocado instead. Only just started having beetroot this past week. I forgot how yummy they are!

Does oat bran spike you less than regular oats or steel cut oats? I tried having steel cut oats a few weeks ago but saw 8mmol and thought I'm a bit sensitive to them now. I ate oat porridge every day for years until my second pregnancy and realised it's actually one of my major triggers for heartburn, so I just stopped eating it all together, even though I love it.

My breakfast now is a predictable scrambled eggs with cheese (we are exploring a new range - had Gouda and Blue Castello this morning), along with smoked salmon (sometimes it's bacon), avocado and my husband's homemade sauerkraut.
Recently we've started making chicken liver pate so I'll have a spoon of that on the side too.

My snacks are usually macadamia nuts or walnuts, pumpkin seeds, sunflower seeds, maybe one dried apricot or a half cup of raspberries or small bite of banana.

I don't bother with the nut milks because I eat too many nuts and also use almond meal to make pancakes and bread substitutes. I think I'll be overdoing if I use nuts for milk as well. At the moment I seem to be able to drink goat's milk and don't notice if it's causing me any problems (not to mention I love the stuff!). My husband made a goat's milk yoghurt recently too and it was delicious!

As far as cooking goes, I'm lucky that my husband is in the kitchen more than I am at the moment (in fact I think he always has been!). He makes the sourdough breads (which I'm slowly not really tolerating so well anymore, esp not the white one he made recently - but rye and spelt are not too bad if I have just a small slice). He also does all the slow cooking - like osso bucco, or ox tongue soups. They are dead easy but just take hours to cook. He'll just do a meat and onion base and I add vegetables later if I want them. Cutting up the vegetables is what takes all the time though, isn't it?

 

[Daphne917]

My F

How are you morning fasting levels nowadays? Can you keep them under 5.4 mmol as a general rule and still manage to eat small amounts of rice and pasta?

My FBS varies between 5.2 and 5.8 with the occasional 4.8. Provided I keep the portions relatively small I’m ok with reheated pasta and rice.

 

[Sapien]

Can

Can I ask what your levels were like upon diagnosis? Was it a HbA1c or a OGTT?

My A1c was 5.0% but I had a fasting blood glucose of 5.8 on one lab test. (5.1 and 4.7 on two other tests this past year). No diagnosis. I decided to get a meter and check for myself.

I found that my fasting are were usually around 5 on waking up but rose sometimes over 5.5 after an hour or so still fasting. (I definitely have a dawn phenomenon going on)

I tested after meals to see how high my blood sugar went. Most of the time it didn’t go past 7.8 with lots of carbs - potatoes,sweet potato, oatmeal, beans, etc. (I generally did’t eat much in refined carbs except whole grain bread) I got some surprises that trouble me - two readings up to 9.4 at an hour and two others over 7.8 at one hour but below 7.8 two hours. Those I ate more carbs than normal as a test. Spikes like that aren’t healthy and I want to avoid them.

Since reducing carbs, my fasting are usually in the 4s and were trending down, but the trend down seems to have stalled.

I may have insulin resistance or a weak pancreas. My doctor refused to order a fasting insulin or c-peptide. I am relatively thin and have a small waist. If someone told you that I am diabetic, looking at me you would guess type1 rather than type2.

There is this big grey pre-diabetic area between healthy and diabetic. Healthy with fasting under 4.8 and post-prandial always under 6.7. “Normal” with fasting under 5.6 and post-prandial under 7.8. Pre-diabetic is over normal up to 6.9 fasting on 11.1 peak.

I have definite signs of pre-diabetes but I don’t have extra weight to lose. Actually gaining back some muscle I have lost would probably help if the issue is insulin resistance rather than lack of insulin. Eating low carb is giving me consistently normal, even close to healthy, blood sugars. Not as low as I would like though.

I certainly would like to eat more carbs without my blood sugar reacting unfavorably. I now always have in the back of my mind - what will that do to my blood sugar?