Gestational Diabetes. The Naturopathic View

Gestational Diabetes. The Naturopathic View

Pregnancy can be physically challenging. The extra demands on your body while it makes a bonny babe are considerable. Mostly your body miraculously and wonderfully meets all the challenges, but for a small proportion of women (2-10%), this doesn’t happen.

Gestational diabetes can be the result. For most women it’s an unwelcome surprise to be told they’ve developed diabetes in pregnancy. Doesn’t that only happen to women who gain too much weight? She may have been trotting along feeling perfectly healthy, passing all the milestones brilliantly, only to find that inwardly, her body has begun to struggle with one of the most important processes it performs. Turning food into fuel.
Overfed but starving

In a healthy state the body takes the food we put into our mouths, digests it into it’s smallest components, absorbs it from the digestive tract into the bloodstream and finally transports it to it’s final destination, into our cells. Here it is used to fuel the cell so it can do all of its various jobs. In short, this delivery of fuel keeps our cells working and us alive!

The body’s preferred fuel is glucose, so we have the amazing organ called the pancreas that produces something called insulin. Insulin’s job is to transport the glucose from the blood stream across the cell membrane and into the cells where it can be utilised. The cells ‘door’ needs to be ‘opened’ to let the glucose in. Like a VIP at an exclusive night club, insulin knows the magic word to get in.

In diabetes (type 2 and gestational) two main scenarios are happening. One is that the pancreas is simply not making enough insulin, and the other is when the cells become insensitive or resistant to the insulin. In effect the magic word doesn’t work any more. Both scenarios lead to higher than normal glucose levels in the bloodstream and the unwelcome side effects we associate with diabetes.

The fuel is of little use outside the cells, so in diabetes, we have too much fuel but at a cellular level we are starving.

When we are pregnant, there is an increased demand for many things, including insulin. This increased need puts a strain on the pancreas and some people’s pancreases aren’t up to it. About 50% of women who test positive for gestational diabetes were probably undiagnosed diabetic already. For others, pregnancy may have caused them to loose the taste for veggies and fish and instead they have been living on hot chocolate and cake.  In this case, eventually the body cells get sick of insulin knocking on the door and insulin resistance begins. Other risk factors are a history of diabetes in your family, being overweight or over 25years of age. As you can see there are many factors and some of them are entirely out of your control.
How do I know I have gestational diabetes?

At about 28 weeks of pregnancy you may be recommended by your midwife or specialist to take a polycose test. This test is designed to see how your body is coping with sugar and requires you to take 50gms of sugar in liquid form. Your blood is tested an hour later to see how well it has metabolised the sugar.  If your midwife sees glucose in your urine (which should be a standard test every visit) before 28 weeks, you may be sent to have a polycose test earlier in your pregnancy.

If your polycose test shows higher than normal blood sugar (above 7.8mol/ml) you will be recommended to take another test called a glucose tolerance test (GTT). This test is similar but you take 75gm of sugar after skipping breakfast and have your blood tested at 1 hour and then 2 hours after ingestion. From these results a diabetes diagnosis can be made or excluded and the need (or not) for medication decided.

It is worth noting that the polycose testing has a high false positive rate of 15-20%. So it is important not to jump to conclusions based solely on this.
Considerations for holistic mamas

There is some discussion and disagreement about the testing and interventions surrounding gestational diabetes.

It seems that pregnant women have higher than normal blood glucose levels from time to time without any negative effect. Certain pregnancy hormones suppress insulin, possibly because your baby needs a steady supply of glucose to fuel its growth and development. This glucose needs to be in the blood stream to reach baby. Because of this, some people dislike the use of standard testing and the subsequent intervention (insulin injections). They wonder, if higher blood glucose levels are normal, why intervene? There is also concern about the mega dose of sugar required for the polycose test and the negative effect this huge spike in blood sugar could have on baby (and of course the subsequent, even higher level of sugar in the GTT).

My advice comes down to preconception care. You should ask to have your HBA1c tested before you conceive to pick up on poor blood glucose metabolism. This is the new standard test for diabetes risk and if your result is above 39 I would get to work on reducing that number before you get pregnant. If that test is above 41 it is likely you have diabetes or that your risk of developing it in pregnancy is greatly increased. You may need pharmaceutical medication if it is quite progressed or if caught early, it can be managed well with natural solutions and the help of an experienced Naturopath, holistic Nutritionist etc. This is why I love working with women to prepare their bodies for pregnancy. It’s the best investment in your child’s future health you can make.

If you are already pregnant and faced with the routine polycose test, you do have the option of declining it. But I think you must take into consideration your particular situation.
Why test?

I recommend doing the ploycose test if:

There is glucose in your urine

You are overweight

You are a sugar fiend

There is a family history of diabetes

Your HBA1c test was above 39

You are having an abnormally high number of infections

You have not done any physical activity during your pregnancy

You have had a large previous baby (above 400gm)

You have had a previous still birth or unexplained neonatal death

You have been having excessive thirst or blurred vision

If you have some of the above precipitating factors it’s better to know what’s happening with your glucose levels rather than just hope it’s fine. While you are hoping, uncontrolled blood glucose could be effecting your baby.
The risks of gestational diabetes

Uncontrolled blood glucose in pregnancy can lead to:

A larger than average baby, which in turn can make a natural birth difficult and lead to interventions and complications.

Because the baby is usually larger, women are often advised to be induced for labour at 38 weeks.

If baby is exposed to continually to high blood glucose levels in the womb, it may have difficulty maintaining those levels and their blood sugar may drop dangerously, immediately after birth (once the umbilical cord is cut).

For these reasons I think it’s imperative to know about your blood glucose levels.
Things to think about

Testing

If you are opposed to the whopping dose of sugar that comes from the polycose or the GTT test, you can buy a glucose meter and monitor your levels yourself. They are available from most pharmacies and come with instructions. Monitor and document the reading after each meal for several days a week.

Natural medicine

There are some herbs (Gymnema sylvestre and Humulus lupulus) which can have a very positive effect on blood sugar balance and also a nutrient called Chromium that helps with the cells sensitivity to insulin. These and a few others can be great adjuncts to dietary changes. For the best management it’s best to work with a professional and to monitor your blood levels daily at home.

Diet and Lifestyle

I have put together a sample menu to give you some idea of the type of diet that will help. Exercise (moderate but consistent) is very important for a couple of reasons. Firstly, it will help to keep your pregnancy weight gain healthy, and secondly, exercise in itself helps your cells to be more sensitive (less resistant) to insulin.

As a final note I want to say that most women with gestational diabetes have healthy pregnancies and healthy babies. Diet and exercise, along with good monitoring is often all you need!

 

 

 

 

           

	Breakfast	Snack	Lunch	Snack	Dinner
Sun	Green omelette (see recipe) with 1 pc wholegrain toast or Essene bread	Herbal tea/water 1 piece of fruit and, 10 raw almonds or other nuts	1 cup Beetroot salad (see recipe) I serve chicken or fish and 1 cup quinoa or brown rice	Herbal tea or water Veggie sticks and cottage cheese (cold and within 2 days of opening the pack)	Fresh fish with steamed broccoli and silver beet or salad greens and 1 cup brown rice or baked kumara Remember to soak your breakfast now
Mon	½ cup wholegrain oats with ½c  mixed raw nuts and seeds, 1 teaspoon flaxseeds, ½ c water SOAKED OVERNIGHT Serve this with ½c fresh fruit and almond or rice milk to taste	Herbal tea 1 piece of fruit and, 10 raw almonds or other nuts	Cooked salmon – grilled or baked/poached with green salad and 1 cup quinoa or brown rice	Natural peanut butter or Almond butter on celery sticks (3 tsp)	Fresh salmon, cod, or terakihi with grapefruit or lemon and salad greens or fresh steamed vegetables – green beans, broccoli, peas, onions. Serve on a bed of brown rice
Tue	Green omelette or soaked oat recipe or, Natural peanut butter or almond butter on wholegrain toast	Almond butter on 2 plain rice wafers, or 1 piece of fruit and 10 almonds	Cooked salmon with green salad and 1 cup mixed bean salad. Rice mountain bread wrap x 2-3 packed with greens, avo, and a protein choice	Herbal tea 1 piece of fruit and, 10 raw almonds or other nuts	Homemade soup such as broccoli or your favourite. Keep blood sugar levels stable by adding some kind of protein such as chicken and only having 1 pc bread
Wed	Green omelette or soaked oat recipe or Natural peanut butter or almond butter on wholegrain toast	Herbal tea or water Veggie sticks and cottage cheese	1 cup Beetroot salad (see recipe) I serve chicken or fish and 1 cup quinoa or brown rice	Herbal tea or water 1 apple and 10 almonds	Steak, scotch fillet or lamb with gigantic green salad or steamed vegetables and baked/mashed kumara
Thur	Green omelette or soaked oat recipe or, Natural peanut butter or almond butter on wholegrain toast	Herbal tea 1 piece of fruit and, 10 raw almonds or other nuts	Green salad with tinned salmon on wholegrain toast or, Rice mountain bread wrap x 2-3 packed with greens, avo, and a protein choice	Almond or natural peanut butter on 2x plain rice wafers, or corn thins	Cold meats such as chicken or roast lamb/beef with green salad and 1 cup of roast veggies Or with steamed broccoli and silver beet or salad greens
Fri	Green omelette or soaked oat recipe	Almond butter on celery sticks (3 tsp)	2/3c cannelini beans with green beans, sliced red onion, ¼ c feta, green salad and crunchy wholegrain croutons. Balsamic and olive oil to taste	Herbal tea or water Veggie sticks and hummus tuna mix (1/4 cup)	1 cup Beetroot salad with a serve chicken or fish and 1 cup quinoa or brown rice
Sat	Green omelette or soaked oat recipe or, Mushroom scramble and 1 pc wholegrain toast	Herbal tea or water Veggie sticks and cottage cheese	Rice mountain bread wrap x 2-3 packed with greens, avo, and a protein choice	Herbal tea or water 10 raw almonds and/or walnuts, and a few raisins (10)	Fresh salmon, or white fish salad greens or fresh steamed vegetables – green beans, broccoli, peas, onions, carrots etc. Serve with 1 cup brown rice

 

Green Omelette Recipe

Stir fry some veggies in coconut or extra virgin olive oil. The best ones are onion, garlic, broccoli, capsicum, green beans, finely sliced kale and mushrooms. When nearly cooked add some organic eggs (1 yolk and 2 whites for each person) and a sprinkling of goats feta.  Just before it has cooked, throw in a handful of chopped spinach and serve when mixed through. Delcious!

 

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