Low carb in pregnancy with type 2?

[Deediabetic]

Hi all

I was diagnosed as a type 2 at the end of June with a very very high hba1c. I've worked hard to get it within normal non diabetic numbers by going very low carb, exercising and losing a lot of weight. I had an appointment a few days ago at a local hospital in my area that has a a specialist unit that deals with pregnancy and delivery for those who have diabetes. It was a consultation and information session where I met with a diabetes midwife, a physician and a dietitian and if I get pregnant I would be under their care and have my baby there.

They were all very happy with my progress and my numbers and I feel relieved that this service and unit exists to help us through the journey to become parents. They gave us the green light to go ahead and start doing the baby dance to get pregnant! However they did tell me that they are happy with me going low carb when non pregnant but that I will need to eat two servings of carbs per meal once pregnant as carbohydrates are important building blocks for a developing fetuses brain and that studies show low carb can be detrimental to a baby's development. Eating what they term as two serves of carb per meal essentially equals eating 30 grams of carbs per meal and 15 grams per snack. That basically equals eating over a hundred carbs a day. I know by testing my bgls that anything over 20g of carbs in a sitting generally spikes me into high bgls. I get that pregnancy is naturally a state of poor insulin regulation for every mother irrespective of whether they are diabetic or not. I know I'll be having to inject insulin from the second trimester of a pregnancy.

I know high blood glucose can be harmful to a baby and because of the real lack of studies in real human pregnancy with low carb/ keto lifestyle, I am at a crossroads yet again on whether to ignore the medical advice regarding eating so many healthy low GI carbs during pregnancy. I went against their advice on the eatwell plate and took my hba1c from 13.3 to 5.6 in four months. As a result of that, all the medical professionals I've seen since my diagnosis look at me like I've done something amazing and like I'm an anomaly. (Which i guees i am because you cant set types 2 up for success if you keep pushing a diet high in low GI carbs). I'm questioning their advice on this too regarding pregnancy and eating more carbs. Don't know which way to go but I'd love some perspective from those of you who are type 2 gurus or those of you have had a pregnancy as a diagnosed type 2.

 

[DEBBIESCOTT]

I’m sure people will be along later with some great advice for you,
I developed gestational diabetes, midwife gave me urine test strips & told me to contact her if glucose showed (doesn’t show till 10)
I was given a consultant appointment for 6 weeks time, I was already in hospital in labour at that time, my son was born 6 weeks early at 8lb 5.5 oz
I didn’t eat any obvious sugar in this time but 24 years ago I suppose they didn’t know about low carb, when he was born a nurse came round & told me I wasn’t safe to be left at home with a new born & a 3 year old without insulin, I refused & managed for 24 years before any meditation (oral only).
I wish I could be more helpful, think it’s the end result (a healthy baby) that is the most important thing & you need to be healt too, hope you get some really good advice
Take care

 

[OB87]

I was recently pregnant (baby 3 weeks old) and with the tiredness and sickness in pregnancy I did have to increase my carbs as it was all I could handle really. Though blood sugars didn't get worse I was really surprised. I think low carb is OK but if you do need to increase your carbs you could have a smaller portion , pair it with fat and protein and go for a short walk after. That's what I did and worked out OK. You will have to monitor your blood sugars. Good luck

 

[Daibell]

I'd love to see the research that says you need these carbs with every meal when pregnant; I suspect it's very weak. You must do what you think to be right but be aware the body can derive glucose from fats and proteins and your BS is one measure that you have glucose in the blood. If BS goes low then you do need to increase the carbs.

 

[Deediabetic]

I was recently pregnant (baby 3 weeks old) and with the tiredness and sickness in pregnancy I did have to increase my carbs as it was all I could handle really. Though blood sugars didn't get worse I was really surprised. I think low carb is OK but if you do need to increase your carbs you could have a smaller portion , pair it with fat and protein and go for a short walk after. That's what I did and worked out OK. You will have to monitor your blood sugars. Good luck

Thank you so much for taking the time to reply. I've heard that carbs are what most pregnant women can stomach to eat especially during morning sickness. They told me that I need to have tight blood glucose control during pregnancy but it seems like eating 30 grams of low GI carbs at every meal would create the opposite of tight blood glucose control. Your idea of walking a little after a meal sounds like a good plan to help keep my bgl in check especially if eating a few more carbs than I do now is what I can stomach to eat during pregnancy. I notice that doing exercise helps lower my bgls. Thanks again and congrats on your little one!

 

[Deediabetic]

I'd love to see the research that says you need these carbs with every meal when pregnant; I suspect it's very weak. You must do what you think to be right but be aware the body can derive glucose from fats and proteins and your BS is one measure that you have glucose in the blood. If BS goes low then you do need to increase the carbs.

That's why I'm questioning the advice given because I know that your body has back up systems in place to derive glucose from fats and proteins. I also know babies are very good raiding whatever nutrients and minerals they need from their mothers. The research into low carb and the effects on pregnancy and a developing baby is actually minimal because it is unethical to conduct studies and expiraments on pregnant women. The conclusions stated were drawn from mice and a study on pregnant women who were on keto because they suffered from severe epilepsy and used keto to manage seizures etc. The thing is with that study, some of the women were also on strong medicine to try help with the epilepsy and seizures. So was it the medication or the diet that really made them draw the conclusion that keto/ low carb affects the development of a fetus?

 

[Deediabetic]

i am 12 weeks pregnant with GDM and my doc has advised me insulin for controlling fasting..rest sugars are fine and i get stable readings with my blucon only if i stick to 50-60g carbs per day..the moment i eat anything extra my sugars shoot up and my alarms start beeping

Thank you for your reply. They told me I could come off the metformin as I was no longer in even pre diabetic range and managing it with diet, weight loss and excercise. They said thar however as I was considering pregnancy that maybe to continue with one metformin tablet per day and keep taking that through to the end of my first trimester where I would then switch to insulin.

I'm eating about the same amount of carbs as you are currently. Generally between 30g and 60g most days. To be honest, I don't think the specialists diabetic midwifery unit I went to for diabetic counseling see a lot of people who are type 2 that have pushed their numbers significantly below the hba1c number of 7 (53mmol/mol) which is the requirement for them to recommend as safe to try get pregnant. Every new person I saw as part of my consultation kept asking how I was diagnosed because of my current hba1c and wondering if I was wrongly diagnosed until I told them my first hba1c was 13.3 and my second 6 weeks later was 7.3 and my last one taken 7 weeks after that was 5.6. When they saw the pattern they realised it wasn't an error and that my weighloss, diet and exercise regimen was what had contributed to those numbers.

 

[ianf0ster]

Hi @Deediabetic We can't give specific medical advice, but I suggest that consider eating what you need in order to control your Blood Glucose rather than what somebody was taught.
Why do I think it's safe to do this?
1. Breast fed babies are on a Keto diet. Surely if the baby's brain needed carbs form a dietary source then either the human race would have died out long ago, or human breast milk would contain much more carbs.
2. This sounds similar to the situation in South Africa where the medical establishment prosecuted Prof Tim Noakes for saying it was safe to ween a baby onto a Banting (which what they call a low carb / keto way of eating). It was a long drawn out case with 'big guns' against him, but he won his case and in fact showed that what he'd proposed actually met with their own published guidelines!

 

[OB87]

Thank you for your reply. They told me I could come off the metformin as I was no longer in even pre diabetic range and managing it with diet, weight loss and excercise. They said thar however as I was considering pregnancy that maybe to continue with one metformin tablet per day and keep taking that through to the end of my first trimester where I would then switch to insulin.

I'm eating about the same amount of carbs as you are currently. Generally between 30g and 60g most days. To be honest, I don't think the specialists diabetic midwifery unit I went to for diabetic counseling see a lot of people who are type 2 that have pushed their numbers significantly below the hba1c number of 7 (53mmol/mol) which is the requirement for them to recommend as safe to try get pregnant. Every new person I saw as part of my consultation kept asking how I was diagnosed because of my current hba1c and wondering if I was wrongly diagnosed until I told them my first hba1c was 13.3 and my second 6 weeks later was 7.3 and my last one taken 7 weeks after that was 5.6. When they saw the pattern they realised it wasn't an error and that my weighloss, diet and exercise regimen was what had contributed to those numbers.

They told me I would need insulin later on as well but I didn't need it, I just stuck to the one metformin tablet like I did pre pregnancy. I spent weeks worrying about insulin but it's not a given you will need it so don't worry. My blood sugars were stable and my hb1ac in August was 31, I've got another one booked for Wednesday this week. You will need to stick to the targets but it can be manageable.

 

[Deediabetic]

They told me I would need insulin later on as well but I didn't need it, I just stuck to the one metformin tablet like I did pre pregnancy. I spent weeks worrying about insulin but it's not a given you will need it so don't worry. My blood sugars were stable and my hb1ac in August was 31, I've got another one booked for Wednesday this week. You will need to stick to the targets but it can be manageable.

Thank you so very much. They made it sound like it was a given that I will need to do insulin from my second trimester. I will work hard at keepimg my bgls in check and hope my body plays ball and I can avoid insulin if possible. If I have to take it, I'm fine with it but I'll still try my hardest. If I you don't mind me asking, were you following keto or low carb before pregnancy at how long had you been getting non diabetic numbers by way of hba1c before getting pregnant?

 

[OB87]

Thank you so very much. They made it sound like it was a given that I will need to do insulin from my second trimester. I will work hard at keepimg my bgls in check and hope my body plays ball and I can avoid insulin if possible. If I have to take it, I'm fine with it but I'll still try my hardest. If I you don't mind me asking, were you following keto or low carb before pregnancy at how long had you been getting non diabetic numbers by way of hba1c before getting pregnant?

I was diagnosed in Sept 2020 and got pregnant in Feb 2021. My hba1c at the time was 40 ( was 76 when I was diagnosed) I had a private one done to check if I was in normal range. When I was diagnosed I reduced carbs to 100g a day roughly but I didn't cut them out completely. I was only 32 and knew I needed something that I could realistically stick to long term. I usually had a low carb breakfast and lunch and more carbs in evening when I ate with my family. Before I got pregnant I lost 3 stone and I think that really helped. When I became pregnant, I actually found my blood sugars improved which I wasn't expecting. My blood sugars were mostly normal throughout I had the odd highs but it was when I ate things I shouldn't. Overall the clinic were really happy with things, I didn't need to increase any meds, baby was healthy and a normal weight. I was induced at 38 weeks though but that is just guidelines. At the beginning of the year I was seriously doubting whether to have another baby as I was so scared of it all but it worked out OK. The clinic wil keep close eye on things. I couldn't face eggs when pregnant which as a vegetarian were a big part of my low carb diet. You will have to test after an hour which I really liked, I'm going to continue testing at an hour