ARGH! Gestational Diabetes and Ketones

[mothergooseof4]

I always have gestational diabetes with my pregnancies.  In the past, I was able to control it with diet by following the recommendations of the dietician....which was typically 15g carbs per snack and 45g per meal. 

 

Well, now I am a decade older than my last pregnancy (31wks now), and I have followed a mostly autoimmune Paleo diet (Hashimotos), until I got pg.  Since then, I over did it on the gluten free carbs and have allowed myself nuts, eggs, and dairy again because it is too hard to stick to my normal eating habits while pg.  Meat just didn't sound good to me most of my pg unless it was in a pasta dish or on a sandwich.  So, by having gf bread I could do sandwiches and dairy/nuts got more protein back in my diet.  I failed my glucose tests miserably, and doc said I would be on insulin due to my extremely high numbers.

 

I have been able to control my glucose numbers with diet, by going back to my Paleo (not AI version) ways.  I have been eating meat, cheese, eggs, nuts, fruits, and veggies.  I have NOT been eating the amount of carbs my dietician recommended this time, though.  She wants me eating 15g per snack and 60g per meal.  I NEVER eat that many carbs in a meal.  Typical for me is one serving of carbs per meal, 15g.  Therefore, my body is really not handling that amount.  I would definitely be on insulin if I ate that amount.  I HAVE been able to eat 30ish grams if I make sure they are an extremely low glycemic carb, like beans, which I know aren't Paleo, but they are keeping my glucose levels down. 

 

Even though I have not been on my autoimmune Paleo diet, my thyroid is doing great.  My thyroid panel is done every four weeks, and have remained perfect without increasing my meds.  Since following my high protein, low carb lifestyle again, my glucose levels are staying under 120.  The problem:  My ketones are very high. 

 

After much research and reading that dehydration and lack of carbs are the most likely causes, I have been trying to eat more by eating every two hours and making sure that I include a serving of carbs every time.  I have also increased my water intake.  My glucose levels are still remaining stable, and I am getting in more food.  My ketones have dropped, but are still in the medium range.  It has only been two days, so I am hoping that they will improve.  My problem is that I feel stuffed and miserably full.  I am not hungry when it is time to eat again and often even still feel full and bloated from the last meal.  I am having a hard time forcing in all of this food.  No, I don't have an eating disorder when not pg...I average about ten pounds over my ideal weight and eat all of the time.  I am just really not hungry this pregnancy and just feel so stretched and bloated with baby and then a stuffed stomach.  And, baby is actually measuring over a week ahead of her gestational age, so she is growing perfectly fine. 

 

Any recommendations?  I really don't want to end up on insulin and I know that if I can't get my ketones down in my own way, my dietician will insist I eat more carbs, which will definitely end with a need for insulin. 

 

At the same time, I read that many docs don't even care about ketones anymore because they feel the research on ketones and pregnancy are inaccurate.  My endo actually said to me that she doesn't care about ketones as long as my glucose levels are normal.  But, that she leaves the ketone issue up to the dietician.  The dietician was really focused on it, so I know she will make an issue of it.  Should I even be worried about the ketones if baby is growing and my glucose levels are good?

 

Being pregnant at 40 has definitely been an adventure!

 

[Rosie_0801]

I chose not to care too much about the ketones when I had gestational diabetes. I can't think having them in the very high range can be ok, but I didn't care mine were medium. 

[mothergooseof4]

Well from what I understand the ketones thing as a result of low carb is not the same as ketoacidosis caused by out of control diabetes. 

 

I'm with you on the carb allowances being too high to control blood sugar.  That would not work for me.

Thank you.  I am small, 4'11" and about 114lb when not pg.  Sixty grams per meal is A LOT of carbs for me.  I think she wants me to be huge and on insulin by the end of this pregnancy!

 

ETA: I found that there is a difference, too.  My glucose levels are normal, so it is from low carb.  The dietician told me she wants to monitor ketones so that I am getting enough carbs.  Really!  On her plan I would be on carb overload!

[mothergooseof4]

I chose not to care too much about the ketones when I had gestational diabetes. I can't think having them in the very high range can be ok, but I didn't care mine were medium. 

I am considering this and just telling her all is well when I send in my levels each week.  I have been eating closer to the amount of carbs she wants me to, just in smaller amounts spread through the day.  I cannot eat 60g at once.  My glucose would be 200 an hour later.  But, doing 15-20g at two hour intervals is keeping it normal.  And, my ketones have dropped significantly just since last night, so my method seems to be working.  I am just miserably full, and it is time for another snack already!  

[AK_Mom4]

This is a rough time for you.  You have my complete sympathy - been there, done that - even to the nutritionist freaking about ketones.  Medium-to-medium high was the best I got when pregnant with DD12.  I ended up on insulin after I came in for a two week check up at 32 weeks and had dropped 8 pounds.  Insulin isn't the worst thing in the world (by far!) but if you can avoid it then that's a good thing.  You just have to watch that the calorie count doesn't get too low while eating low carb.

 

Have you considered drinking some of those snacks?  Something like Glucerna, where you have a really accurate measure of how many carb and calories are in the drink.  Sipping might make you feel less bloated and full because liquid digests faster in the stomach. 

[mothergooseof4]

I find sticking to around 20 carbs per meal very doable.  I didn't feel deprived and it still worked for me.  40 might be a compromise for a person who has a tough time with 30.  But 60?  How on earth is that low carb?  I probably do that without trying.

I don't think their goal is low carb.  They want me to eat all of that food, and if my glucose levels are high, then go on insulin.  I think it is crazy.  I get my calories in, probably more than they can imagine because I eat lots of fat...healthy ones.  But, I never eat 60g of carbs in a meal unless it is a deliberate splurge meal.  

 

I think I will try spreading my meals/snacks out to three hours tomorrow and see if my ketones keep dropping.   After two days of tiny meals every two hours, I am so full I feel like a whale.  I don't want my dinner and feel like I will barf if I have to force down more food tonight.  I was probably not eating often enough, which is why I was spilling large amounts of ketones, so I will make sure not to skip snacks and will eat breakfast first thing in the morning.  I was skipping my bedtime snack and then not eating breakfast for a couple of hours after waking.  

[mothergooseof4]

This is a rough time for you.  You have my complete sympathy - been there, done that - even to the nutritionist freaking about ketones.  Medium-to-medium high was the best I got when pregnant with DD12.  I ended up on insulin after I came in for a two week check up at 32 weeks and had dropped 8 pounds.  Insulin isn't the worst thing in the world (by far!) but if you can avoid it then that's a good thing.  You just have to watch that the calorie count doesn't get too low while eating low carb.

 

Have you considered drinking some of those snacks?  Something like Glucerna, where you have a really accurate measure of how many carb and calories are in the drink.  Sipping might make you feel less bloated and full because liquid digests faster in the stomach. 

My calories are probably way above normal since I eat a lot of fatty meats and cook with coconut oil and butter.  Apparently this ketone thing is directly related to carbs.  

 

I will look into Glucerna.  I require gluten free and prefer no processed foods.  Hmmmmmm, perhaps the health food store has a more natural version.  Good idea, though.  Maybe sipping something like this would keep me from feeling stuffed all of the time.  Or, I might try smoothies with egg protein and fruit.

[mothergooseof4]

I don't get why Glucerna is considered a diabetic product. for an 8 oz drink it's 23 grams carbs and 6 grams sugars.  How is this for diabetics?!

Yeah, that is a lot.  But, I think putting a diabetic on a diet plan with tons of carbs then shooting them full of insulin is crazy, too.

 

After the past couple of days of feeling miserable, I am done stuffing myself.  Last night I was so full I delayed my dinner until late, then just ate that at about 8:30pm.  I woke up during the night feeling nauseous.  I am never nauseous during pregnancy.  I think it was from stuffing myself for two days.  The thing is, when I added up my carbs for the day, it came out to approx 160g.  The dietician wants me at a total of 215g per day.  I think I would explode if I ate that much.  Plus, I would be on insulin.

 

So, this morning I did some research and read what Robb Wolf had to say about gestational diabetes, ketones, etc.  I think I will focus on my glucose levels, which I have been controlling with MY diet plan.  I eat clean, healthy foods.  I had been omitting my snacks and delaying breakfast, so I will make sure to include those.  Otherwise, I am not forcing myself to eat a bunch of carbs that I feel are unhealthy for me, then end up on insulin because of it.  Sure, if a normal amount of carbs starts making my glucose levels spike, I will do what is healthy for the baby.  I know cutting carbs too drastically is also not healthy.

 

So, so far today I have had: (I have given up my purely paleo ways lately, but still do low carb)

 

7am paleo wrap(eggs, almond flour) with almond butter 

10am scrambled eggs (2) with cheese and fresh berries

1pm chicken salad with real mayo, walnuts, apples, pineapple, and raw veggies

4pm homemade snack bar with nuts, dried fruit, and honey

I plan to have meatballs, cheese cubes, and fresh fruit and veggies for dinner, then probably a bowl of paleo mock oatmeal at bedtime.

 

All of these meals/snacks keep my glucose levels normal when drawn one hour after eating.  At three hours, I do not want food, but can eat without feeling as if I will explode.  So far today, my ketones have remained in the mid range.  I think I am okay with this, but am hoping that a few more days of making sure that I don't have the long fasting periods that I was guilty of will bring them down to at least a low level.  I keep reminding myself what I have read and the fact that my endocrinologist actually said that she isn't concerned with ketones.  It is the dietician that insists that ketones mean that I need more carbs.  I will also be seeing my chiropractor, who has treated me successfully with natural alternatives for other ailments that med docs were unable to help me with and see what he has to say.

[mothergooseof4]

Just wanted to add a funny story.  I posted a year or so ago about my success with my autoimmune paleo diet.  I had blood work done, and as usual, my cholesterol panel was horrible.  I went on a strict AI paleo diet immediately.  Six weeks later, after eating half a pound of bacon most days, tons of red meat(and other meat), lots of healthy fats, and lots of fruit and veggies; my cholesterol had dropped thirty points, LDL was almost normal and triglycerides were normal for the first time ever.  

 

I told this dietician about that experience when I was explaining how I eat to her.  She said it was coincidence, and that I needed grains. She insisted that I couldn't be eating those types of fatty meats and other fats, yet lower my cholesterol.  Ha!  I had been trying to improve my cholesterol panel for over five years with their methods.  It didn't work for me.  They wanted me on cholesterol meds at age 35.  I refused since my mom had been on them since her mid forties.  They resulted in her tests being normal.  She died at 55 of her first heart attack......her heart had been weakened by the meds.  No thanks!

 

And a whine, I typically gain less than 15lbs during pregnancy.  I am small and eat mostly healthy and exercise.  When I see other women gain a lot of weight, it just doesn't seem fair that I am the one with GD.

[wapiti]

It sounds like you're much better off doing your diet your way rather than following the dietician's recommendations.  I'd either skip the dietician at this point if possible or ignore her or ask your OB to switch to one who knows more.  I realize that the medical establishment hasn't come around to this other way of thinking on diabetics eating low carb, but at this rate it's going to take decades.  (FWIW, when I had GD, my dietician's carb recommendations were the same as yours.  I vaguely recall not being able to eat as much as she said.  If I had to do it over again, now that I'm into LCHF, I'd definitely do it your way!)

[kitten18]

How are they measuring your ketones? The only accurate way is using blood and that's expensive and not done very often.

 

I would eat what was needed to keep your blood sugar numbers good and not worry about the ketones.