My endo encourages adding more carbs

A little background first: I’m 6 months pregnant. I found out I was Type II in Aug '09. Since the pregnancy, I’ve been under the care of a great endo. She put me on Lantus (nights only - 18 units) to keep my bg under strict control. I had previously been managing through diet/exercise alone.

I had my monthly endo appointment today. I finally gained 2 lbs today (first time gaining in all of my pregnancy). She asked what my carb limits are & I told her - 20g per meal (3x/day) with 15g per snack (2x/day). So around 90g per day give or take 10g. She encouraged me to eat up to 30g per meal. Says she doesn't want my OB/GYN to yell at me for not gaining enough weight.

And my in-office A1C tested at 5.2% (was 5.6% in Jan).

Maybe I'm being too strict with myself? Anyone else with the same situation?

hi there - it sounds exactly like the program I am on. I’m working with Sansum Diabetes Research Institute in Santa Barbara. They have had great results with those low carb numbers = healthy babies! Good luck and keep us posted!

I have no experience with this because I am only trying to get pregnant. However, I’m curious about what your meal options are. For those carb guidelines, would you mind giving an example of your daily food intake. I’d like to see what my choices look like and hope to get more ideas.

I was told to eat between 2-3 servings of carbs per meal (a serving is 15 g) and 1 to 2 per snack. Each meal should have three food groups at least and each snack should be a carb and another food group. So I think the range you have is fine especially if you have good blood sugar control and it sounds like you do.

Don’t ever let anyone tell you you’re not gaining enough weight in pregnancy. If babe is fine and you feel good, no worries.

Hi Annette. Most weekdays for breakfast I eat a hardboiled egg, a slice of cheese, and a piece of fruit (apple, pear, or orange). I’ve started adding a slice of toast too since my endo has suggested adding more carbs. For lunch, I’ll have chicken tacos (I can do 2 with very little effect on my bg), or a sandwich with sandwich rounds (new kind of bread that was recommended - works great for burgers too), or a salad with some kind of protein (chicken, turkey, beans). I eat 2 snacks (morning & afternoon) that consist of any of the folllowing: nuts, turkey jerky, half a blueberry-bran muffin (my snacks all tend to come from Trader Joe’s), crunchy-salted green beans (they’re in the chips aisle at TJ’s), or edamame. For dinner, about the same as lunch - recent favorite are turkey burgers with those sandwich rounds. Or sometimes, I’ll just scramble a couple of eggs and have toast & turkey or chicken sausage. Sometimes, I even sneak a scoopful of low-carb ice cream for dessert. My fasting bg tends to stay in the 70’s & 80’s and 1 hr after meals under 120. I hope this helps!

Hi, I have a five week old baby, so I just went through a diabetic pregnancy.

My CDE, my OB, my endo, and my high risk OB all said the same thing - don’t cut your carbs too far back during pregnancy. This is a safe time to be consuming them. It’s not only the primary source of nutrition for the fetus right now, but we are also more prone to developing ketones during pregnancy as our bodies siphon off every carb resource they have to the growing baby, leaving us with even less to burn and burning our fat stores - which would explain their concerns about healthy weight gain as well as ketones. My perinatalogist told me at every visit - do NOT cut your carbs and do not be afraid to take the big insulin doses you need to cover them.

90g of carbs a day isn’t red-alert-dangerous or anything, but it is decidedly less than they’d like to see you consuming. I developed off-the-chart ketones one evening during week 20 and one of the endo’s theories about why was that it was “starvation ketosis.” I’d had only a 28g sandwich for lunch and very little to drink all day. So it could also have been dehydration ketosis. (I admit that I was afraid of the insulin I was having to take for larger meals - my insulin-to-carb ratio (fast acting insulin, of course) was down to 1 unit for every 4g of carb.)

Of course, I’m speaking as a type 1 diabetic on an aggressive insulin management regimen. I would follow the docs’ advice though. If you’re on a carefully managed program like Sneetch is, then go for it, but if your docs are suggesting you eat more right now, you might consider it.

Thanks so much! I appreciate it.

Thanks Melissa (and congratulations on your new baby)!

I confess that I’m in the same boat you were - afraid of having to use insulin for carb-loaded meals. I use that insulin maybe once a week now. My endo said not to be afraid to use it more frequently. Since I’m still new to living with diabetes, I’ve changed the way I think about food and have become hyper-vigilant about my diet (yeah, I guess it’s the control-freak in me). I guess I’m afraid I’ll develop bad habits over food because of this pregnancy. I’m still trying to find that balance and maybe being overly cautious. I’m a T2 and have only started insulin due to the pregnancy. My endo suspects that I won’t need insulin after the pregnancy but might be able to manage with just pills. I’m hoping I won’t need meds of any kind since I’m not too thrilled about having to medicate daily. Appreciate the advice - thanks again.

What kind of low carb ice cream do you eat?
What kind of wrap/tortilla do you use for your chicken tacos? And where do you get the sandwich rounds (brand)?

I am recently diagnosed with Type 2 diabetes (after having gestational diabetes in my pregnancy 4 years ago). We have been trying and doing fertility for 2 years without knowing I was diabetic, but after finding out about the diabetes I am scared to death to get pg. I was told that if I did get pg that I would automatically be put on insulin, right now I am controlling my BS with diet/exercise. So I am curious to know more about the insulin during pregnancy…you only take it at night? How has it been? You sound a lot like me I am very controlling a bout my diet and blood sugar as well. Congrats on your pregnancy btw!!

Breyer’s makes a low-carb vanilla ice cream that’s pretty good. I’m not sure if you have this brand on the East Coast but if you look in your local supermarket freezer - I’m sure you’ll find a brand that is low-carb or at the very least no sugar added that has less carbs than normal ice cream. I like topping my ice cream with fresh blueberries or low-sugar preserves. For tacos, I like using thin corn tortillas for the tacos (the regular thickness corn tortillas have 1-2 g more carbs that I’d rather not waste, hence my preference for the thin tortillas). But I have also tried low-carb tortillas (though anything branded “low-carb” tends to be more expensive) with success. The sandwich rounds are like a pita/bun hybrid & I buy them from our local Entenmann’s bread outlet. The brand I use is Oroweat. I think they might also be referred to as Deli Thins and Pepperidge Farms might also make some.

Thanks for the congratulations - it has been well worth it! We have a son - 7lbs 15 oz & 21.5" long - that was born on June 21. Because of the D, they did have to induce me at 39 weeks, but my midwife was very understanding of our wishes for as natural a delivery as possible (which it was).

I, too, was scared throughout most of my pregnancy that I wasn’t doing things right. However, with my team of doctors, not only did I have a very healthy, full-term baby delivered, but I also had no complications during labor/delivery and within a week, was back in my pre-pregnancy clothes (I’m actually 20# smaller now than when I first found out I was pregnant). Yes, the insulin was only taken at night (slow-acting Lantus pen). My endo also gave me a fast-acting insulin (Novolog pen) to take when I knew I was going to have a carb-heavy meal (like pizza). I did use that occasionally, but didn’t rely on it. My next visit with her isn’t until August and in the meantime, I’m completely off insulin and am not taking any meds. I’m not fully healed from the delivery yet so not able to fully exercise, but am still watching my bg and keeping up with my eating habits (I’m breastfeeding). I got the okay to start upper ab exercises next week so looking forward to getting back into shape again.

Good luck with your fertility treatments (I would also recommend acupuncture if you haven’t already tried it) and don’t let the D hold you back! You already sound like you’re doing a great job controlling it. Having D doesn’t mean anything is wrong with us - it just means we have to be a little more creative in how we handle our food choices.