I gave some information about gestational diabetes and explained my diagnosis procedure in my previous post Pregnancy Diabetes (Gestational Diabetes) (info, diagnosis)

My gynecologist referred me to dietitian for an appropriate diet. When I mention a diet, never thing about something like you do for losing weight, staying hungry diets. It was an eat and drink all the day diet. I was hardly finishing my 6 meals (3 plain and 3 snacks). 

Gestational Diabetes Diet
My dietitian prepared a diet appropriate for my weight which I was supposed to eat every 3-4 hours.

Basic aim was to interfere with sudden blood sugar changes. Only completely restricted food was white sugar (and other complex sugars like honey). I had a lot of bran-bread to eat. She gave me an interchange list for breads (like for soups, rice, pasta, etc.), however it was not advised to eat too much white carbohydrates. I had 3 portions of fruits to eat and I could pick whichever I'd like, being careful with portions. She told me that i need fats, so I did not need to buy light milk or meat products. However, she advised me not to eat too much fries and butter, since they have no use to anybody (she told me that i could eat Becel rather than butter).
I measured my blood sugar (with empty stomach and 2 hours after meal)following the diet for one week. If diet wouldn't work for controlling my blood sugar levels, i would need insulin injections. My blood sugar levels were fine and I continued with the diet until I gave birth to Ilgaz.

Blood Sugar Monitoring /Glucose Meters
I was supposed to measure my blood glucose levels weekly. You can get your blood sugar monitored in pharmacies for 5 TRY. They use simple devices measuring with only one drop of blood from your finger. It seemed more feasible and convenient to get one device for myself. I bought one from Dogubank (Sirkeci, Istanbul). It was 90 TRY in total for device(30 TRY including 10 test strips), 50 extra strips and lots of needles(200 I guess). There were many brands with different prices. It is a shame and of course a marketing strategy that, strips are not standard. I mean, you have to buy same branded strips with the device you have. It is wise to choose a known brand in order to find strips everywhere. When you exclude the device, every measurement was costing only 1 TRY. I had the chance to prick fingers of every member of the family. You can organize bets on blood sugar levels for fun. The lowest blood sugar level gets the biggest piece from birthday cake :)

Healthier pregnancy and baby with gestational diabetes
You can end up with a healthier baby with gestational diabetes, and also reduce the side-effects of pregnancy. While my dietitian preparing my diet, she took care about all pregnancy needs together with my blood sugar problems. I was having all my calcium, vitamin, mineral and protein needs with a perfect routine. For some nutrients (like calcium), if yo do not get enough, baby will get it from you (bones). All my meals were scheduled, this helped me with organizing myself much better. With the help of this routine and also motivation to keep my blood sugar level steady, I exercised regularly until my doctor tells me to stop. These exercises had tremendous use protecting energy, balance during pregnancy and had a lot of help for my labor (i will write another post on exercise issue). My weight gain was ideal with the help of diet and exercises. It was no way possible for me to be so careful with my diet and organize my pregnancy time perfectly.

Worries
I searched about the issue as soon as I took the test results, like I always did for any question in my mind. I felt terrible reading that I could harm my-own baby. I called my doctor and asked "This is something bad and serious, isn't it". He answered as "Yes it is serious , but we can control it". I was feeling better seeing low results of first set of tests. It is very convenient having the test device at home. I made a lot of tests until my next check-up to comfort myself. My doctor told me that everything is as it should be at my routine check-up, than I stopped worrying.

Forbidden Donut
When something is said to be forbidden to eat (especially when you are pregnant), it doesn't feel very good. Sweeteners are not recommended during pregnancy, since their effects on fetus are not known. When you can not have white sugar, and other sweeteners, it means you can not have any desserts. However it is for a limited period, and is a sacrifice(you do a lot of them anyway) for your baby. I was making the list of desserts to eat following delivery. Now chocolate and biscuits are usually enough for me, I have the sweetest of desserts with me all day.

Even though we have a lot of people with diabetes, it is not easy to be one in Turkey. We have very limited diabetic products on supermarkets. When you look at ingredients, almost everything includes sugar. I remember feeling bored from following diet when I was 8 months of pregnant. I went to the supermarket, looked all the shelves to find snacks and different food that will fit to my diet. I bought many salty snacks, and found a product which saved rest of my pregnancy. It was a 100% fruit made jar from different fruits, and how strange, it was shelved with regular jars(not with diabetic products). According to my calculations, 20 grams of it was equivalent to 1 portion of fruit, which was enough to thickly cover one slice bread.

Dessert Recipes
Jelly the Belly (equivalent to 1 slice bread, 1 slice cheese, 1 portion of fruit)
Cover a slice of corn bread with Labne* and 100% fruit jar

Yummy yummy (equivalent to 1 slice bread, 1 slice cheese, 1 portion of fruit)
Slice half banana
Boil, peel and slice 2 chestnuts, mix with bananas
Mix labne* (app. 30 grams) with some milk to get a cream, pour on top of ingredients
Decorate with grinded nuts

*Labne: Labaneh, a kind of spreadable cheese, it is like yogurt

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A few years ago, I thought I was under risk of diabetes (my father had diabetes, I was thirsty all the time, etc.). I have gone through some tests. Results were not over but closer to the upper limits, so my doctor advised me for yearly check-ups (but i didn't).

When I was about 24 weeks of pregnant, my doctor explained gestational diabetes and asked for a blood sugar test for diagnosis. In so many possible side-effects of mysterious pregnancy, I was certain that i would have this one and yes, I had.

Summary of information i gained:
A kind of diabetes called gestational diabetes develop in some women during their 24th to 28th weeks of pregnancy. It's like having type II diabetes for a limited period, and seen mostly in women who are under risk of diabetes (like having a close parent with diabetes) and who increased too many weights during pregnancy. It usually goes away following delivery, however it should be taken as a warning for developing diabetes later in life.

If it is not under control, it has some important risks for the baby. Sugar is supplied from mother's blood, but insulin does not pass from placenta, it is produced in baby's-own body. Insulin is the hormone produced by pancreas as you eat sugar, and moves sugar from blood to cells. If mother has high blood sugar, baby will be supplied with extra sugar, and eventually will produce extra insulin. With the help of this extra insulin, more energy than needed will be stored in baby's cells. This may result in a fat baby, which may cause difficulties during delivery for both mother and baby. Moreover, it is increasing the risks of obesity for baby during her childhood. Another important risk for the baby is hyperglycemia in newborn period. Baby may continue producing high levels of insulin, but will not be supported with that much sugar from breast milk. This may lead low blood sugar levels in baby as a newborn, which may have hazardous affects like brain defects.

Seems pretty bad, isn't it? As i mentioned, it is not good if it is not controlled. It was taken under control for me with the help of my doctors, and i ended up with a perfectly healthy boy, weighting 3095 grams. And if you follow medical advices carefully, it even has some advantages for you and baby which i will explain in the following post.

How was it diagnosed?
My doctor asked for a blood sugar test during my routine check-up at 24th weeks of pregnancy (it can be done between 24th to 28th weeks). My blood sugar was measured before and 1 hour after drinking a solution, which includes 50 grams of glucose. Although the result was positive, my doctor told me that it does not necessarily mean that i had gestational diabetes. He asked 100 gram oral glucose tolerance test (OGTT) correspondingly. Unfortunately, result of this test was also positive, and my diagnosis was complete.

Oral glucose tolerance test (OGTT)
I went to the laboratory with empty stomach. I gave blood and urine samples. I drank 100 gram glucose including lemonade(extremely sweet). And they took blood and urine samples from me three more times in the following three hours. You are not allowed to eat anything during this period. You are not allowed to leave the laboratory, not that i felt like walking around. Staying with empty stomach for 3 more hours after drinking such a sweet thing made me feel dizzy and tired. I just sit on the coach and looked at pictures of magazines. I wanted to have a nap but they didn't allow me to sleep either. If you are going to have an OGTT, do not go to the lab alone (at least do not leave alone), pick a laboratory with a comfortable coach and nice staff. It would be wise to take something to eat (not sweet, for sure) as soon as you gave your last sample. Since it takes many hours and a strict follow-up (they have to keep a hungry prego awake :)) you need to have an appointment in some labs to have an OGTT (ex.. American Hospital's lab in Istanbul, Nisantasi).

My gynecologist referred me to the dietitian for an appropriate diet. If the diet wouldn't be enough for controlling my blood sugar levels, i would need to use insulin injections... to be continued 

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Graduate from college, get a master's degree(postpone military service*), get a job, get married, serve in the military, buy a house, spend some time and money for yourself. We delay parenthood with plenty of reasons. Once we make the decision, we want that baby right away. We take the necessary actions, and wait for the next period impatiently (i ment going to a doctor, buying a health insurance, etc. with "actions" :)). Take a test even before you miss your period.

But which test to take? How do these tests work?

A pregnant women produces a hormone (human chorionic gonadotropin / HCG) in her body. This hormone can be detected in her blood, and then in her urine as the pregnancy progresses. Laboratories provide both blood and urine tests. Home pregnancy tests (HPT) for urine are available in pharmacies.

Blood Tests
Doctors like blood pregnancy tests. Result of blood test is a quantitative hormone level. This hormone level is useful for interpreting the week of pregnancy. Doctors also ask for this test when you are under risks like miscarriage or ectopic pregnancy. Laboratories in Istanbul usually provide your result at the same day. Despite its advantages, blood test is more expensive than urine tests. Driving to a laboratory and leaving with a hole in arm is not very convenient.

Urine Tests
HPT's are sold as small test tubes. Some have a urine slot next to the test area. It is necessary to put a few drops of urine into the slot with the dropper included in test packages. A small pen is saturated with urine and placed inside the test tube in other type of tests. At least one line will appear on the whitepaper-like area, which is control line, indicating that the test is working properly. Second line area is covered with a chemical reacting with HCG and changing its color. Therefore, the result is positive if a second line shows up. Instructions will tell you to wait for a few minutes before reading results. According to my experience the second line is seen as soon as the paper is saturated with urine when you are pregnant.

Faint second line
A faint one will indicate the existence of pregnancy hormone, but with a low concentration. This can happen in conditions like early taken tests, miscarriages. You can repeat your test a few days later, or take a blood test if you want to make sure.

If you have a negative test and a late period, you need to call your doctor. Such a phone conversation will the most probably result in a holl in your arm.

HPT 's are sold in a large price range from 3 to 30 Turkish Liras. Working principle of the HPT is pretty simple, so I can't see a point buying an expensive test. For  laboratory urine tests, i think they can only be useful for reducing risks in emergencies. Like you went to the emergency, and doctors suggest you a medicine that you shouldn't take when you are pregnant. It is best to have a blood pregnancy test, if you are looking for accuracy.

Waiting for the result is pretty stressing even if it is for a few minutes.  Conceiving days in a month is so few that, you will feel like looking at lottery results when you look at your test. It is best to be prepared from the beginning and buy your tests with wholesale :)

* Military service is obligatory in Turkey, and can be postponed by studying at the university. This rule has a great role in Turkish men's level of education :)

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