Having a hard time with diet

I’m having a difficult time figuring out how to eat to keep both my fasting and postprandial blood sugars within range and also have energy and not feel like I’m starving. I have T2-ish diabetes and I’m 14 weeks pregnant. I tried LCHF for a while but I always feel really awful on it and it raised my fasting numbers so they were too high, but not high enough for my Endo to prescribe longer-acting insulin. My post-prandial numbers were fairly stable though, typically 120s. Because my fasting numbers were too high and I was having a hard time functioning, I raised my carbs to ~100g/day and started taking Humalog when I eat carbs and my insulin resistance has gone way down. In order to keep my fasting numbers below 90 though, I had to cut way down on fat, particularly at dinner, and can’t eat anything after dinner. Dinner has to be pretty much only non-starchy veggies. It’s really hard to eat low fat, low-ish carb though, is there a way to do this without being hungry constantly?

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First off, I love your name!!! :grinning: Tomatos are my fav food!

I do not have gestational or T2 diabetes, so I may not be much help (just T1). However, I’m a little confused about eating low fat and low carb at dinner.

For me, fat is a bigger problem when I’m eating more carbs because it lengthens the digestion of carbs. Is it possible for you to eat more of your carbs at breakfast and lunch then eat more fat/protein with little carb at dinner?

I’ve spoken with friends who had gestational diabetes, and they said that they benefited from a snack at bedtime like peanut butter or cottage cheese - low carb. Or maybe different kinds of nuts?

In my somewhat uneducated opinion, it seems more important that you and the baby are getting the nutrients you need and that you’re staying in range. If that requires long-acting insulin… then the doctor should prescribe it.

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My fasting number is higher if I eat a bedtime snack or a dinner with more fat/protein. That was my Endo’s suggestion. My worst fasting numbers, over 100, are when I have higher fat days particularly later in the day, even if I ate <30g of carbs. I don’t know why fat is a problem for me.

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Congratulations on your pregnancy!

I was pre-diabetic before pregnancy and had gestational diabetes as soon as I became pregnant, so I know the difficulties in figuring out what to eat and keeping the BG level under the target all while trying to nourish the baby growing inside you! Are you currently being seen by an OB specializing in gestational diabetes (like maternal fetal medicine physician), and dietician specializing in gestational diabetes? If not, I highly recommend it. I was under the care of my endocrinologist, maternal fetal medicine specialist and dietician throughout my pregnancy and I was able to control my BG throughout the pregnancy and now have a healthy 4 month old.

One of the things I noticed is that you currently only consume 100 g of carbs a day. I was told to consume 175 g/day to ensure that the baby gets enough nutrients. Basically, 30-45 g of carbs for breakfast/lunch/dinner, and 15-30 g for snacks in between meals. If you eat dinner early and go to bed late, then also snack before you go to bed. I was told not to let more than 2 hours lapse between meals.

Based on what you’ve written here, it looks like you do need longer-acting insulin since you pretty much need to be on a strict low carb diet to stay under 90 for fasting BG.

Here are my recommendations based on my experience. Hopefully they work for you, too:

  1. Walk. Walk after you eat, within 15 minutes of finishing a meal. You don’t have to walk a lot, 15-20 minutes is sufficient. This helps your muscles take up more glucose so you can eat a bit more carbs. Walking kept my fasting BG down. If I didn’t walk, I occasionally saw fasting BG in the 90’s. When I walked, the numbers were somewhere between 65-85.

  2. Eat lean protein foods like fish and chicken. And eat cheese. I ate cheese with fruit. Nuts like almonds are good too.

  3. Meal kits, maybe. I like meal kits (blue apron, sun basket, hello fresh, etc) because I can easily find menus that are high in protein and low in carbs.

Good luck!

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My last pregnancy I saw an MFM, but this time they are treating me as normal person so far so I see an OB or NP once a month and my Endo every 10 weeks, with weekly e-mails. Last time it was easier to manage though, my diabetes has definitely gotten worse this pregnancy. My current Endo is pro-LCHF and doesn’t believe that carb minimums are backed up by the literature. He wants to wait until my fasting is consistently over 100 to prescribe NPH, so I’m in a phase where I’m too high, but not high enough for meds.

I already walk and hike a lot, and it doesn’t seem to make any difference in my fasting numbers. I’m not particularly insulin resistant though, and my fasting insulin is actually low.

I eat a whole food, plant based diet. I’m Type 1 and I have much better control when I do not eat meat and dairy. I concentrate on fruits, vegetables and starches like sweet potatoes and brown rice. The fat in meat and processed foods make it difficult for insulin to work correctly and keep sugars under control.

Do you have any tips for staying in range while eating fruits and starches with insulin? I’m finding it tricky to stay under 130 at an hour without going low at 2 hours.

There are different ways of aligning your eating with your insulin curves.

With fast-acting insulin like novolog or Humalog, the insulin doesnt peak until around 1.5 hours after you take your dose. However, your food may digest faster than that which could result in a high. You can get around this a bit by taking more than you need (injecting when you eat), but you’re going to end up with lows 3-5 hours later because, technically, you took too much.

To avoid this, you can prebolus awhile before you eat (inject 15, 30, or 45 minutes before eating). The amount of time you want to prebolus depends on your blood sugar when you inject, how quickly insulin begins acting for you, and what you plan to eat.

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