Plan your celebration strategy.

I love Thanksgiving. I have great memories of the days of preparation and celebration that started with shelling pecans with my Great Aunt Leta for the cranberries and pie and culminated in hours of eating, when many a male member of my family headed back to the buffet for third and forth helpings.

But, things are a bit different now. Almost no body ends up with thirds on their plate. And for those of us with dietary concerns or diet-related health issues, enjoying the gluttony is a bit more complicated than a food coma. While pre-pregnancy, I would be fine with hitting a blood sugar of 300 on Thanksgiving, I'm not comfortable seeing numbers that big with a fetus in tow.

Finding a strategy to help you through the day while still allowing yourself to join in the epicurean fun is important. So here's what I'm going to do:

I'm planning to try to avoid unhealthful snacking during the day, sticking with fruit, yogurt and protein so I'm not starving, but not full. At dinner, I'll try everything, then go big with my one, true Thanksgiving love--Grandma Falk's Party Mashed Potatoes.

After that, before pie time, I'm going to strap on my tennis shoes and take a walk when my blood sugars are peaking. This is a strategy I use almost every day. I find that moderate exercise really helps my insulin 'kick in' so I come down from post-meal highs faster. And, if I get to it while those sugar levels are peaking, I don't end up with a low blood sugar like I do if insulin is already bringing me down.

Dessert comes after the exercise. This is also a good strategy for me. My body isn't too friendly with meals containing more than about 80 grams of carbohydrate, and it's not just me. Insulin to carbohydrate ratios can stop working when you get to levels this big. So, taking some time between dinner and dessert is an easy way for me to let my body deal with one cycle of eating before I start another.

Happy Thanksgiving everyone!

First Trimester: Baby is a sugar monster!

About 10 weeks into pregnancy, many diabetic women start to become more sensitive to insulin. Growing a baby and a placenta is hard work and a great deal of energy, a.k.a sugar, is required. Since you're responsible for making that sugar, you might need a little less insulin along the way.

After an initial increase in insulin to get those early-pregnancy sugars better under control, I needed a decreasing amount of insulin from weeks 10 to 12. I noticed this because I had lots of non-exercise related low blood sugars, especially in the afternoons, and in some cases my blood sugars didn't increase at all after meals. You like to see a moderate bump.

So, my endocrinologist and I toned down my insulin by about 10 percent in a combination of decreasing afternoon basal rates (or long-acting insulin if you're not on a pump) and reducing my insulin to carb ratio (the amount of insulin you take for however many grams of carbohydrate you eat) in the evening. My correction factors, the insulin amount you give if you have high blood sugar, also came WAY down, by more than half.

During this time, I recommend being extremely vigilant about those low blood sugars. My own blood sugar thermostat can usually catch symptoms of lows around 70 mg/dL... but the magic of pregnancy and its hormonal influence on the 'flight or fight' response pushed that well into the 50s. You will likely be asked to check some 3 a.m. readings to make sure you're not going low in the night when many people are unable to sense their changing blood sugars or wake up to treat them.

Around week 15, as the placenta and its 'evil' hormones kicked in, this insulin sensitivity trend began to reverse, and I was again upping afternoon and evening basal rates as well as jacking up my evening carb ratios. My endocrinologist said some women continue to be insulin sensitive until week 16 to 18 of pregnancy.

You'll get to hear a lot more about my love hate relationship with the placenta in coming posts. It is an amazing organ, as it better be since you spend half of your pregnancy growing it. But, since it's only looking out for maximizing fuel for baby, it presents some challenges for the diabetic mom.