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Discussion in 'Gestational Diabetes' started by busydiabeticmum, Aug 18, 2019.
That's good to know, thanks.
For the avoidance of doubt, I am not directing you toward any way of eating. That is your choice. However, I am unaware of any hard evidence (clinical trials) showing that real ketogenic eating in humans is not suitable for pregnant mothers. If there were any evidence, I suspect eskimos and our northern hemisphere ancestors might have something to say about it. My personal belief is that you and baby would be better served by a real foods ketogneic diet than you would with a pizza and a Kit-Kat. But that is just an opinion, and not medical advice
Myself I'd be very wary about changing diet once pregnant.
Little delicate changes may be fine but no big upheavals in how you are eating. After all baby conceived ok on your current diet and you say you aren't starving yourself so therefore baby will Bloom. No excessive vitamin or minerals and baby should be taking whst he/she needs.
Are you losing weight since falling pregnant? As many specialist won't be happy with weight loss, at this time.
Specialists job is to get healthy mum and a healthy baby. Many use insulin to achieve that especially in second and third trimester. Baby eventually develops his/her own working liver after birth but in the womb relies on yours.
The dynamics change in the intertwined bodies.
A live birth has to be the priority in diabetic mums.
For me.... the specialist knows how best to achieve this in such special circumstances. Myself I wasn't prepared to experiment with any of my unborn babies.
I just wanted healthy babies.
Ps. My thyroid was assessed regularly too.
I was low carb when I conceived but added carbs because of sickness (low carb foods made me sick!) Baby wasn't growing well and I was putting on weight... almost 20kg and baby wasn't moving much... once sickness settled, I weaned myself off the high carb sugars and started eating healthier (I was eating pizza and rubbish just to satisfy the sickness) I started eating greens again... baby started growing massively and is now bigger back to the right size for her gestation, she has also increased movement... a lot, my weight gain has stopped but not loosing. I have only just been put onto insulin for the fasting (I messed that up with the carbs) and did have novorapid for breakfast but that doesn't seem needed anymore.
I agree fully that her health comes 1st which is why I'm asking this question and researching... but there doesn't seem like there is a firm yes or no answer as to what is correct... it seems individual... I noticed my bgl rising and knew that was bad, the diet in previous pregnancies on healthy living plate didn't help at all... the hospital I'm with is really bad but don't have a choice.
I think the main thing isn't the diet it's the worry of the effects of the stress on the baby.
I ate low carb foods without restricting the amounts for my first pregnancy, then ate high carb low fat when breastfeeding on advice from the clinic - baby was over 9lb when born and although contented at first became ravenously hungry, feeding every two hours day and night. I was almost comatose so I stopped eating carbs and went back to what suits me best - offspring grew to well over 6ft tall so I don't think it did him any harm.
Second pregnancy - a note had been made in my notes so low fat high carb pushed - with threats - and I was very ill with pre eclampsia until I went back to low carb, but a smaller baby, and when pushed again when breastfeeding, a few days later I had to stop feeding as I was so damaged by the screaming fury my baby turned into almost overnight.
Indeed. My post was about pregnancy.
"Dear *****, that,s fine re the novorapid, please eat some carbohydrates with your main meals as you are on insulin, we will see you Thursday when you see the obstetric team, with your up to date blood sugars, thanks, *****"
This is the message from today, I didn't take my insulin for breakfast because my bgl after eating is 4.6 without it... I asked if I could stop that as I didn't think it was needed with the fact I was well below the target of 7.9... I don't know why she is asking for the up to date sugars as they get them straight away (I have been put on the agamatrix jazz which sends them my results). I don't want to be rude and this is why I'm struggling with an answer... when I put in results I don't say what I ate it mention carbs, I quite literally said I had to wait for husband to bring test strips as I had ran out and so didn't want to take the insulin without being able to test. I tested when he came home with my prescription and gave them the result which was after eating and 4.6... I didn't comment on this one. Also I am only taking Lantus at bedtime for the fasting and at no other time... all other bgl are well within range and stable (ie not fluctuating)
@Resurgam each pregnancy is different, my last baby was wonderful and so easy with low carb, this one has been harder due to food aversion. But comparing my carb diet babies to my low carb baby there is a huge difference, the carb babies were all huge but not good eaters and are short, my low carb baby was my smallest but is now my tallest, he isn't 2 yet and is the same size as my 4yr old. This little girl is already quite big (hc and AC) but she was several weeks behind while I was on carbs and quite literally shot up and caught up when I went low carb.
I can only hope I am doing the right thing. Each pregnancy is different... one thing I have learned is to follow my instincts.
Whew! What a **** time of it you are having... I would like to suggest a different approach as the current one seems to be causing you great distress. Ask your care providers how they would respond if you had strict dietary restrictions based on your religious beliefs.. how would they manage your care? Would they (a) continue to harp on "you must eat X/Y/Z for the sake of your baby" despite your religious beliefs against doing so or would they (b) compassionately sit down with respect and problem solve with you? The correct answer is (b) of course.
In all areas of health care the right of informed choice and informed refusal based on the autonomy of the adult individual /emancipated minor are both the philosophical and legal backbone of modern care, you don't lose that right while pregnant. (unless you are unfortunate to live in some less enlightened parts of the world) The actions you describe are contrary to the standard of care in the UK and are of more concern than what/how/when you eat. Bullying, harassment in person and by phone are not ok at any time.
I would suggest that you stay polite and calm, thank them for their advice and state that you have considered it carefully and wish to proceed as follows & then hand them your written care plan. (make several copies) Keep it simple, bullet points and with a short preamble that your own & your child's optimum health are your first priority. Bring an advocate to each visit and continue to expect competent, compassionate and evidence based care. If you continue to experience bullying, work your way up the administrative chain of command. Most hospitals have patient advocacy or ethics committees that may be able to help you.
I wish you the best of luck in resolving your issues. (BTW also a recently retired midwife)
Thanks for your reply, I have refused fragmin on these grounds, I asked for an alternative but there wasn't one and was advised to drink plenty of water and exercise! I was shocked because that should be the 1st thing they advise... they are still trying to get me to take fragmin! They tell me I'm going to get a blood clot and die, but then in the next sentence they're telling me I could bleed to death after I give birth... it is illogical to me that I take something to stop my blood clotting if I know there is a chance I could bleed to death... (FYI they only say this because I have more than 3 children.) The other hospital didn't offer fragmin because they said it wasn't needed for my care, they also supported my diet and taught woman to eat low carb in a group session and really celebrated with me the fact that I was doing well. Unfortunately I only have myself to advocate, my husband is needed to take care of the kids and I don't really have anyone else. He's going to come tomorrow just because it's getting ridiculous. Hopefully they will back off a bit.
I have just been checked, I had +4 ketones in urine and they were concerned so I made this statement... they checked my blood ketones and it's high... 2.2mmol bgl 4.2mmol...
Sounds pretty perfect to me.. Nice low BG and reasonable ketones.
They're saying it should be below 0.6... they are bringing me in tomorrow to redo, they want me to add carbs and raise insulin to combat carbs... Dr did say that midwife mistook the "acidic" environment as ketoacidosis which he said I wasn't as I wasn't on enough insulin even for euglycemic diabetic ketoacidosis (I did ask if it was this too) I have no symptoms and even the drs thought I looked well enough to go home... I have no idea what's going on, they have decided to do another one now and I still don't know if I will be here tomorrow as well!
We'll they admitted me! That diabetic midwife put her foot down and undermined the Dr who told her she was wrong! I really don't know what to do... I even agreed to add carbs!
That is just plain and simple bullying - dreadful behaviour and far overstepping the mark.
How are you doing? This sounds like such a stressful situation when you should be enjoying this healthy pregnancy in which you are growing your baby well by eating high quality foods. It sounds as if you've had a bad time with previous pregnancies so it must be hard to trust your team although you do need them for at least your basic care. I always found midwives were terrified of diabetic preganancies and don't always realise how terrifying it is to be told about the risks of macosomic babies etc.
I wish I'd known about keto when I was pregnant (might have avoided NICU twice when the babies crashed from having high bgs in utero) and am routing for you and your baby to keep going with what works for you in the absence of any evidence that your baby is being damaged e.g. bgs are normal so you're not in ketoacidosis plus your baby is growing normally. Understandably there is rarely evidence of safety of keto diets in pregnancy just because of the perceived risk of any such trial would make it unethical. I suppose your team are trying to promote your safety such that they can cover their backsides but surely growing a massive baby via the exogenous insulin/carbs combo makes no sense unless you were underweight and your baby was not thriving.
All I can do is send you a massive hug. If you have to eat carbs it would be good if it could come from green veg, salad, berries but you are unlikely to get much of that in a hospital. Dont know if your OH can bring you in some stuff but I guess he’s so busy looking after the other children unexpectedly its not easy. Since the midwife and (presumably obstetric doctor) disagreed I wonder if you should insist on passing up the paygrade and have Endocrynology doctor pay a visit. I find it hard to believe stodge is good for any growing foetus. I hope you get home asap and of course try not to stress if you can.
@NicoleC1971 and @PenguinMum thanks, I really don't know what to do, they have put me in a labour and delivery room... I saw a midwife who isn't looking after me and didn't know what's going on, I told her and also said I was feeling anxious, I was telling them since I got here (1:40pm) that I hadn't had lunch yet... I am absolutely starving. Anyway they insist I drink loads of water but I'm not thirsty at all, the midwife I saw said she would get drs a.s.a.p due to my high anxiety (being in the same room I almost lost my son in) that was over an HR ago. I have spoken to my husband and I'm seriously considering discharging myself, dh says not to cancel all my appointments which I really feel like doing right now. I am locked in so can't just walk out... it really does sound like a prison at this point, they did however offer me a slice of toast!!! I said I want to go home and eat my dh bought me asparagus, Brussels sprouts, broccoli and I have some smoked salmon... I am drooling just thinking of it... doubt this will get my ketones down either... FYI Dr said not ketoacidosis or euglycomic diabetic ketoacidosis (I know I spelt it wrong) as I'm not showing the symptoms for either and look well enough to go home, he also says because I'm on such a low dose of insulin (10 units of Lantus for fasting which I don't have with me) that it's impossible for it to be this and more due to diet. I did say I would add carbs and raise insulin if that's what's best for baby, baby is growing nicely and fluid is no longer elevated... just waiting to see what the plan is as I don't even want to touch this bed which isn't for sleeping in but delivery!!! Also been listening to woman in labour and I'm really not wanting to be here!!!
Are they checking your ketones?
as part of the package of research and good quality papers for them to read from the past 5-10 years there is this one:
I'm so sorry to hear about your stressful situation. Don't really know what to say to help. So, the only thing I can offer is a really big hug.
If you're on a ketogenic diet (very little carbs), you're supposed to be in ketosis = have ketones! Hence the name keto diet.
Ketosis is definitely not ketoacidosis, something some people around you seem to overlook.
Wishing you well!