If you have had diabetes in your pregnancy, whether you started the pregnancy with diabetes or became diabetic during the pregnancy, there’s a good chance that you will have to deal with diabetes in your future.
Up to 60 to 70% of women with diabetes in pregnancy go on to become diabetic, or they stay diabetic.
What happens after you have your baby?
After you have your baby, one of the first things you’re going to notice is that your glucoses come down immediately. Maybe not entirely down to normal, but you’re going to notice a change almost immediately after the baby is born. Different providers manage diabetes in different ways after delivery.
Usually we want to keep checking your glucoses fasting and two hours after your meals for at least a few days to see where these are going to settle out.
Many times your glucoses will come to normal right away. And if that’s the case, you can breathe a little sigh of relief. Have a little pie or whatever it is that you’ve been craving during the pregnancy.
After this, make up your mind to get back to work because you may not be done yet.
Next, you may notice that your glucoses have come down but maybe not all the way down to normal. But whether your glucoses are still a little elevated or they’re back to normal, you have to remember that your risk is still there.
Repeating your glucose test.
If you had gestational diabetes, you will need to repeat your glucose test. We usually wait a few weeks after your delivery. We then do a two-hour glucose test, which means you will get a fasting glucose, then drink 75 grams of glucose, and we test your glucose one hour and two hours after you drink it.
If any one of those values is abnormal, then my friend, you have diabetes.
If all three glucose values are normal, you pass the test and you don’t have diabetes. But wait! You’re still not done. Because even if you pass your glucose test after you have your baby, remember that your lifetime risk is still elevated. You don’t need to eat as strictly as when you were pregnant, but you do need to stay active and follow a basic lower carb, healthy fat and protein diet with lots of vegetables and fiber. Every year you will need to see your primary care provider and have a test drawn called a hemoglobin A1c.
The hemoglobin A1c looks at your average glucose over about a three-month period of time.
Don’t have a primary care provider? You need to find one. For many women, their OB-GYN is their primary care provider. If this is the case for you, they can do this test for you every year.
Remember that diabetes can be sneaky and it can creep up on you without causing any symptoms at all. So you have to be aware and keep checking every year. If your A1c is going up from the normal to the pre-diabetic or the diabetic range, then you have got to get serious again.
Pretend you are diabetic even if you aren’t. Food is medicine.
I always tell people that the best way to not be diabetic is to pretend that you are.
In other words, if you’re eating the right things, are staying active, and if you’re following a healthy lifestyle, that’s the best way to not be diabetic.
You will have options available after you have the baby that may not have been options while you were pregnant. There are more medication options depending on whether or not you’re breastfeeding, but the only true way to treat and cure Type 2 diabetes is intentional dietary management. Remember that to keep your glucoses low, you have to lower your insulin production. The way to do that and become more insulin sensitive is to not give your body a lot of carbohydrates or starchy foods.
Try the low carb healthy fat diet to naturally manage your diabetes.
What that means is you need to increase the protein, healthy fats, fiber, and leafy green vegetables while limiting things like potatoes, rice, bread, and pasta.
A great tip is to reduce portions of those starchy foods and eat them last, just like you’ve been doing during pregnancy.
This is a dietary approach called low carb healthy fat diet. We’ve been taught since the 1980s to lower fat in our diet. And we’ve achieved that in the US. If you look at graphs of our fat intake since about 1980, it has gone steadily down.
What should have followed is that obesity rates should also have declined. Surprisingly, that hasn’t been the case. We’ve lowered our fat intake and our obesity rate is higher than ever.
What we’ve found is that limiting fat doesn’t necessarily lower cholesterol, and it doesn’t reduce your risk of obesity. What really does the most damage is carbohydrates (sugars), which make you resistant to insulin. So you make more and more insulin, which promotes fat storage.
So you have to lower the starchy foods, simple sugars, and processed foods that don’t have a lot of fiber. Complex carbs like vegetables take longer for your body to break down and metabolize, so they fill you up.
Foods like instant rice, instant oatmeal, and instant mashed potatoes are nothing but starch, with a higher glycemic index than table sugar!
From here on you’ve got to limit processed foods and focus on eating things that are not going to affect your glucose and insulin levels as much. Focus on eating healthy fats like nuts and avocados, and use olive oil and coconut oil to cook with.
You should also consume more fat and protein than you might be used to. If you’re not a vegetarian, eat plenty of meat, fish, and eggs. Those are foods that are going to keep your glucose from bouncing around.
When and how often should you eat?
The same principles apply as when you were pregnant, but now you might be able to try things like intermittent fasting. This is not recommended in pregnancy because your metabolism is different.
After you have your baby, even if you’re nursing, missing a meal is not going to make or break you as long as you’re staying well hydrated and eating a balanced diet.
Sometimes reducing your feeding window may help stabilize your glucose. For example, instead of eating three meals and three snacks every day, try having two or three healthy well-balanced meals and extending the amount of time between evening and morning meals. For example, don’t eat anything between dinner at 7:00 or 8:00 pm one day and then break your fast around 11:00 am or lunch the next day. Extending your fasting window helps lower insulin production.
And that in turn helps make you more insulin sensitive which is going to lower your blood sugars.
Every woman is unique and has unique dietary needs. Be sure to work with a registered dietitian or dietary counselor to get a clearer picture of what your body needs.
Make healthy movement a part of your everyday routine.
Don’t forget to make healthy movement a part of your everyday routine, at least 30 minutes a day, every single day if you can do it.
You don’t have to go to the gym. You don’t have to have any special equipment. If you can get out and walk with your baby every single day, walk the dog, or find some regular fitness time, it will not only help lower your blood sugar, it will be great for your mental health. If you can do this for 10, 20, or 30 minutes every day, you’re going to lower your lifetime risk of diabetes.
And also remember that weight-bearing is important. If you add muscle, you will burn more fat because muscle uses more energy than fat.
So even if you put on a few pounds of muscle, it’s going to be much more efficient at burning fat, and that’s going to help your metabolism!
A word about future pregnancies.
If you have had diabetes with one pregnancy, you’re much more at risk for having it again with your next pregnancy. Before you plan another pregnancy, try to reach and maintain your ideal weight. If you started this pregnancy over your ideal weight, or if you gained a lot of weight with the pregnancy, work on that before you have another baby. And if you stay diabetic after pregnancy, if you can get your A1C down to six or below, you’re going to have a healthier future pregnancy.
If you have elevated blood glucoses at the beginning of pregnancy, the risk is higher for birth defects for your baby and health problems for yourself. So get healthy before you have another baby.
To wrap this all up, your body has served you really well with this pregnancy. It hasn’t failed you. It has done a fantastic job. And now here you are with a baby. Love your body and take care of yourself. Remember that diabetes is potentially reversible. You just have to keep behaving the way a diabetic should. Most of the time, you want to focus on healthy fats and proteins, and limit the amount of starchy foods that you consume.
And finally, remember that anytime you want to, you can take a break. You can have food that you enjoy that may not be considered “healthy.” These foods are special because they’re only every now and then foods. If you eat them every day, they’re not a special treat. So stick to just once a week or once a month, so those foods stay special because you worked for them.
Don’t forget, you’ve got this! You’ve been strong all through your pregnancy. You may have slipped up a few times as do we all, but you’ve totally got this and you’re going to do a great job as a mom.
If you have any questions about gestational diabetes or how to manage your diet after gestational diabetes, please leave me a comment below!