Jul 12

Gestational Diabetes Top Tips

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By Simmone Lever
Specialist Gestational Diabetes Dietician

You may be halfway through your pregnancy, and everything is going well… You go along to the hospital, have that awful glucose drink, wait forever for the results, then get informed by the midwife you have gestational diabetes.

She tells you to prick your finger 4 times a day, record your blood sugar readings and write down everything you eat. She tells you to avoid junk foods, soft drinks and eat a healthy balanced diet (what-ever that means?) until you see your dietitian, which may not be for another 3-4 weeks. (Sigh.)

You get home and feel overwhelmed, confused and angry. You think “Why me? What did I do wrong?”. You feel worried about your baby and super emotional. Once you have had a cry, you turn to google. (Sound familiar?)

Now you are left feeling even more confused and unsure what you should be eating.

If this was you, don’t worry you are not alone. I see this all the time. From women just like you all across the world.

I want you to know gestational diabetes is not your fault!

Gestational diabetes can happen to anyone! In fact up to 50% of women with gestational diabetes have no previous risk factors (such as family history, age, weight, age, ethnicity), yet still get diagnosed.

Gestational diabetes is like a warning light that comes on in your car. During pregnancy our body is under a lot of extra stress. The gestational diabetes test is done in pregnancy to pick up any issues with your blood sugar regulation. Your body may be unable to pump out the large amounts of insulin needed to keep blood sugars stable or your body is having high levels of insulin resistance and isn’t working the way it should.

WHY DID I GET GESTATIONAL DIABETES?

For some women with gestational diabetes is due to placental hormones and weight gain making your body more insulin resistant. This means your body can’t seem to maintain normal blood sugar the way it could earlier on in pregnancy or prior to pregnancy. For others there was already an underlying insulin resistance issue such as pre-diabetes or type 2 diabetes prior to pregnancy.

So don’t feel guilty. You can’t rewind the clock or change your family history. Instead become curious. Learn how to nourish your body.

Work 1:1 with a specialist dietitian. You will discover how to make easy and simple swaps to your diet, lifestyle and supplement habits to keep blood sugars at the right level. However some women may need medication like metformin or Insulin, which is also ok.

The main goal with gestational diabetes is keeping our blood sugars in range. Doing that will keep you and baby healthy.

Here are 3 simple tips for you to get started!

1. Get enough protein in your diet!

Did you know that most women are not meeting the optimal protein amount in pregnancy? During the second and third trimester, aim for at least 100g of protein/day. This can be achieved by adding protein to each meal and snack. Doing this will also help keep your blood sugars stable, make you feel full and satisfied and help you meet the demanding nutrient needs in pregnancy.

TOP TIP: Start your day with eggs for breakfast. Include protein at snacks such nuts, seeds, edamame, Greek yoghurt. Then include protein like chicken, fish, red meat, bone broth, beans / lentils / other legumes at lunch and dinner.

2. Include the right amount and type of carbohydrates

You may have been told to cut out carbohydrates to help manage blood sugar levels. So you stop eating bread, rice, pasta, oats, potatoes and feel super restricted in your diet. However you may find this has the reverse effect. Cutting out carbs can cause our liver to dump out extra glucose / sugar over night resulting in a higher fasting blood sugar reading. Cutting out carbs can also make you feel low in energy, cause fatigue, constipation and make you crave more ultra processed sugary foods.

TOP TIP: Include around the same amount of wholegrain carbohydrate each day aiming for between 20-45g at your meals and 5-15g at snacks depending on your carbohydrate tolerance. To find out how much carbohydrate works best for you and how to include them in the right way in your diet work 1:1 with a specialist dietitian!

3. Take the right prenatal vitamins / supplements suitable for gestational diabetes.

A well-balanced diet, with unprocessed foods, fruits, vegetables, whole grains and plenty of water will give you most of the vitamins and minerals you need. However, in gestational diabetes your body will require increased amounts of certain nutrients to create an environment in which the baby can grow and develop healthily. Prenatal vitamins are supplements that contain those extra vitamins and minerals. Unfortunately, taking a chemist brand or over the counter pre natal supplement/vitamin is not enough.

Did you know getting the right amount of vitamin D, or magnesium or collagen could all help you keep your blood sugar levels in range?

Here are a few questions to consider when choosing a prenatal supplement.
  • Are you using a synthetic or food based prenatal supplement? Food based supplements are much easier for our bodies to break down and absorb.
  • Are you taking your prenatal along side food and splitting the dose if you need to take a few to help the body absorb all the vitamins?
  • Does your supplement contain the appropriate form of folate L-methylfolate or 5-methyltetrahydrofolate? This is important as a lot of people are unable to metabolise folic acid! Look for a supplement that includes Choline (folates long lost cousin). This nutrient is just as important as folate for babies brain and spinal development.
  • Are you taking the right dose of Vitamin D, as this significantly impacts blood sugar regulation?
  • Are you getting enough Omega 3? Taking a supplement that contains DHA is essential to help with the formation of babies brain cells and protects babies brain from inflammation and damage).
  • Have you considered Probiotics? As having a healthy microbiome may result in better blood sugar levels.
  • Does your prenatal contain Magnesium? As this too can help with blood sugar regulation . Does it contain the right dose?

TOP TIP: Work 1:1 with a specialist dietitian to help you find the right prenatal for you as everyone will have different issues and requirements during their pregnancy journey.

If you have you recently been diagnosed with Gestational Diabetes, and feel overwhelmed and anxious get some support today! How would it feel to know you could join a 6 week individualised better blood sugars with Gestational Diabetes program that helps women have an easier and enjoyable pregnancy without feeling like they are on a diet?

You can check out my instagram page @gestationaldiabetesdietitian or book in a free 1:1 call with me to find out more about my services.

If you send me a email, you can grab a free copy of my guide 5 mistakes affecting fasting blood sugars!

Simmone Lewer, Specialist Gestational Diabetes Dietitian

Sep 21

Client Story: Maria

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Maria used the Pelvic Floor Confidence programme – a 4 month intensive of pelvic floor Pilates – to address the pelvic health issues she was facing.

Name:  Maria

 

Concern: Bladder urgency and did not trust ability to use the bathroom when convenient if out and about.

 

Success: Able to fit the programme around day-to-day life which has increased confidence when going out.

 

 

Before working with Grace…

 

I’ve known for the longest time that my pelvic floor was weak and that I needed some support. I had previously done some work on my pelvic floor but, honestly, progress had levelled off and I really wasn’t where I wanted to be.

I knew that ignoring the situation wouldn’t help and my pelvic floor problems wouldn’t go away or get better on their own, but I was concerned whether this programme would genuinely help or be much of the same content I had seen before.

 

 Maria’s Key Points

 

  • I love the way this program was able to fit around my daily activities, especially since I struggle find large blocks of time to devote to exercise.
  • The weekly schedules, goal setting and reminder emails were beneficial in making the content digestible and allowing me to work at my own pace. The regular coaching calls made the whole programme feel more personal.
  • The benefits from this program are wider than just pelvic floor problems – I am a lot stronger in my bum and legs, my posture is better, I am more flexible, and my breathing is more balanced (still working on that one, though!). It is a whole-body approach. Doing exercises little and often, working them into my routine, has added up to huge changes.
  • Grace has a huge knowledge and experience. You can absolutely trust her to understand your body and give you the best exercises to help overcome your individual problems.
  • The sooner you sign up and commit to working on the problem, the sooner you will see the benefits. Not all Pilates classes are necessarily appropriate for treating pelvic floor issues – I can confidently say Grace’s are. Just sign up. Do the exercises. You won’t regret it.

 

Would you recommend me and my services? If so, why and to whom?

 

I would recommend you to any woman of whatever age. Honestly, Grace is the best kept secret in St Albans! You don’t have to be a new mum to benefit from the program!

 

If you could suggest one thing for anyone interested in this programme, what would it be?

 

For anyone who hasn’t worked with Grace before or is new to Pilates, I would highly recommend a one. to one session with her to give yourself the confidence that the exercises are appropriate and that you are doing them correctly.

 

 

Nov 20

Complete loss of bladder control after childbirth

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Are you struggling with bladder control after having your baby? The bladder can have a bit of a rough time during labour. It can be ignored and not emptied and subsequently overdistended or stretched. It can be pushed and squashed by the descending baby, it can be filled due to IV fluids, affected by hormones and medication and it can be irritated by a catheter or surgery. As a result of all this, some women present with a complete loss of bladder control after childbirth and this can cause a lot of distress at a time when emotions are already high and exhaustion is present.

Three main types of urinary incontinence

There are three main types of urinary incontinence that may occur immediately postnatally.

Stress urinary incontinence (where urine leaks due to the inability to compress and shut the urethra during an increase in abdominal pressure – such as with a cough), urgency urinary incontinence (where urine leaks in response to an overwhelming urge to reach the toilet) and overflow incontinence.

1. Stress urinary incontinence is very common in the postnatal population – it is thought around one third of postnatal women experience stress urinary incontinence. Often (but not always) it is due to a weakening of the pelvic floor and an inability of the pelvic floor muscles to generate the required, or timely, force closure of the urethra. Urine subsequently leaks during a raise in intra-abdominal pressure, such as with a cough, sneeze or jump.

2. Urgency urinary incontinence is also very common postnatally. This is where the urge to urinate overrides the ability to maintain control and urine escapes. The bladder lining has become more sensitive and overreacts to the filling bladder.

3. Overflow incontinence occurs when the bladder is not emptying properly. Postnatally this is called Postpartum Voiding Dysfunction (PPVD). This may happen due to an obstruction eg postnatally a swollen perineum following a tear or episiotomy or because of overdistension of the bladder which prevents complete emptying and results in regular urine loss.

Overflow Incontinence can occur postnatally and is a warning sign for Postpartum Voiding Dysfunction. This is when a postnatal woman is unable to fully empty her bladder. This may be very apparent – she just can’t wee, or less so – she is managing to pass urine but it is slow, hesitant, small in volume, she keeps having to go back to do more and there may be regular incontinence.

Either way, this is not good news for the bladder. With this condition the bladder is at risk of overdistention (overfilling and stretching) which can lead to a chronically dysfunctional bladder down the line.

PPVD is more likely in those women who have had an instrumental birth, such as forceps, an epidural, a prolonged labour, first-time mums, caesarean section and/or perineal trauma.

After delivery of a baby, the bladder is usually monitored to ensure the woman passes urine within 6 hours of delivery or 6 hours after catheter removal. The volume is measured to make sure it is an appropriate amount (normally over 150ml). If there is no urine or only a very small amount within 6 hours, the woman may require an in/out catheter to drain the urine and is then monitored further. Occasionally an indwelling catheter is required for 24 hours or longer to protect the bladder from overfilling and allow it to recover. The exact protocol is dependent on your local care provider.

What you need to do if you suffer from a complete loss of bladder control after childbirth

The good news is that the bladder, perineum and pelvic floor are normally all great at getting better. For PPVD it is important that you flag up any concerns to your Midwife or Doctor as soon as possible as you will need to be monitored and checked regularly. You may require timed voiding (going to the toilet at a set time) moving forwards and subsequent help and advice.

For stress urinary incontinence and urgency urinary incontinence there is much conservative treatment that can be accessed easily through the NHS or Privately. Ask for a referral to a Women’s Health Physiotherapist. Here you will be assessed and guided through the appropriate muscular rehabilitation, given advice about fluid and bladder control techniques, advised on how to move forwards with general exercise and taught perineal care as appropriate.

Although postnatal incontinence issues are common, they are not normal and as such should not be ignored. If you’re suffering with a complete loss of bladder control after childbirth, make sure you seek treatment. There is a lot that can be done with excellent success rates. If you have any questions, please do not hesitate to email me at erica@hertfordshirewomenshealth.co.uk.

You can also read our blog post on what you can do to improve your pelvic floor if you’re struggling with incontinence after childbirth.