Keeping an open mind

With diabetes, you can never positively tell what's going to happen. A banana and coffee for breakfast might get you to 140 mg/dL one day and 248 the next. You just gotta roll with it and be prepared.

Pregnancy also requires the ability to remain flexible. When your kid measures up at the 60th and 66th percentile of his or her peers during the first and second trimester, then jumps up to a shocking 84th percentile at week 32, delivery time frames and strategies, as well as blood sugar and diet controls might need to be adjusted quickly.

And so it went with me and Cletus the Fetus. Although (s)he remains in beautiful proportion, Cletus left her peers in the dust when it came to growth this last trimester. Five pounds 11 ounces with two months to go. My friends have delivered term babies smaller. So, instead of looking at an induction at 39 weeks, we've upped the schedule to 38. April 11th, let the cervix be ripe!

This is a little bit frustrating, obviously. My HbA1c was 5.6 the first trimester, 5.5 the second, and 5.4 so far this third. My control is awesome. My weight gain is awesome. My kid is just big. What can ya do?

Weight Gain

'Ten to fifteen pounds.' The doctor looked me straight in the eye and told me I should gain between ten and fifteen pounds. At my second appointment, I was already up five thanks to some Chinese food indiscretion and a heavy coat.

Surely she was joking. I later told my friend that 10 pounds was the equivalent of a 'bad vacation' and that it was likely my baby alone could weigh that much. However, at my next appointment, the doctor reassured me... they were dead serious.

Your pregnancy weight gain goals are determined by your pre-pregnancy body weight via your Body Mass Index. Here is some great information from the Mayo Clinic.

Gone are the days of eating for two. Exercise up to delivery and healthy eating are now expected parts of pregnancy. Know this, your health care provider will hold you accountable.

This is especially true for women with prior heath conditions. Have high cholesterol? Too much weight gain makes it harder to control. The same goes for high blood pressure and for diabetes. Increased body fat will exacerbate the insulin resistance all pregnant diabetic women cope with. Additionally, too much weight gain can lead to more difficult deliveries and make it harder to induce labor.

At 20 weeks, I've been able maintain my weight after the initial gain, I think largely because I continue to exercise regularly and didn't go crazy with dietary changes... by that I mean I have ice cream every OTHER day.

Scientists would say that I had already laid down the maternal fat stores needed during pregnancy (I am ALWAYS planning ahead), and so didn't need to gain fat like moms who start out at a normal weight.

Either way, it's easy to worry about too much or too little pregnancy weight gain. I frankly didn't believe I would gain any weight if I didn't change my eating habits... but the baby had other plans.

Blood Glucose Goals... Babies are tough customers

Although you've already been encouraged to keep rigorous control over blood sugars and document them daily through glucose logs and food and exercise diaries, once you're pregnant, diabetes control expectations skyrocket.

Here's a picture of what the recommended Blood Glucose goals for pregnant women look like, according to my doctors.

Fasting: (that's your first finger stick, right after you wake up)
Under 95 mg/dL

Pre-meals, similar to fasting:
100 mg/dL or less

1hour after you eat:
under 140 mg/dL

2 hours post meal:
under 120 mg/dL

Notice something different? Yep. Those are pretty significantly lower than your pre-pregnancy guidelines.

Women adopt many strategies to reach these goals. Some limit their carbs to under 45 grams per meal (a recommendation of my doctor) to make sure that they don't overload the system, but still get some of the carbs that are necessary for baby's good neurological development. For this reason, I was cautioned against going on a low or no carbohydrate diet, especially during the first trimester.

Other women continue to eat as they'd like, but really up the insulin. Given that diabetes in pregnancy is a fluid issue, women will likely have to reset their insulin to carb ratios and correction factors very frequently. I'm changing things on a weekly basis at this point, 16 weeks. More on that later.

I found that overeating or having a second portion of anything that wasn't salad or vegetable significantly raised my post-meal blood glucose values, especially after dinner which then carried over through the night. So, I now try to concentrate on putting dinner away when I'm full, with the promise of some dessert if I'm hungry later.