MY GLUCOSE TRACKING EXPERIENCE WITH A CGM

Following on from my last blog post, instead of doing the OGTT, I chose to track my glucose with continuous glucose monitor (CGM). In support of this, my GP also tested my HbA1c in first trimester, which can be a predictor for glucose issues later on (which was normal). I do see purpose in tracking blood glucose and understanding your tolerance in pregnancy. Good blood glucose regulation matters! What pains me is the number of women who might be incorrectly diagnosed with GDM based on a marginally high OGTT reading (usually only the fasting reading) and then they are subject to additional appointments, having to change their diet (with totally questionable recommendations!), and further down the line are at risk for early induction of labour due to the fear of a ‘big baby’. The repercussions are astounding and can be unnecessary. There is also the question of whether OGTT results gave a false negative and actually there might be some issues with blood glucose regulation in pregnancy. It goes both ways!

Yes there is the argument that macrosomia can result from poorly managed blood glucose—and I am not refuting this in women who do have GDM and need management. However, since the introduction of the new ranges for OGTT in Australia in 2010, more women (most likely incorrectly diagnosed with GDM who have been over meticulous with glucose control in the later stages of pregnancy) have been at risk of having small for gestational age babies. This is wild! Some really great questions are raised by the midwives over at both the Midwives Cauldron and The Great Birth Rebellion. 

Continuous glucose monitoring (CGM) 

Personally, I have chosen to use a CGM for assessing my body’s response to my usual diet, as well as ‘challenging’ my glucose/insulin response with some higher sugar meals. Research supports the benefits of CGM in pregnancy for both diabetic and non-diabetic pregnant women. What’s really great about this is that I can make real-time changes and adjustments that will be supportive of both mine and bub’s health for the rest of my pregnancy. I see spikes and lows that would otherwise not have been picked up from manual tracking, nor the single snapshot test of the OGTT.

I have noticed I am actually more akin to blood glucose lows and so especially with exercise I have to be cautious with the timing of my meals. If I have a high sugar meal, my glucose spikes and drops rapidly, with a low usually shortly after. This is definitely something I want to avoid. 

My blood glucose never really went above 7mmol/L at any time (except after sourdough with jam where it went to 7.8mmol/L and when it went to 9mmol/L after a Banh Mi, which was my highest reading and slowest decline back to normal—safe to say, I will not be having any more Banh Mi rolls in pregnancy!!). Both of these readings came back down to normal limits within the 2 hour mark*. 

From what I have learned, I will now be more cautious of having too much sourdough bread (I was only really trialling it, usually I have GF sourdough by Strange Grains which does spike glucose as well, but not as much), still cautious with rice after learning last year this was my spikiest food, and knowing that fruit is one of my besties with a meal for supporting sustained glucose levels of there is enough protein/fat. I also might need to have a bit of cut up orange after about 20 mins of exercise to get me through the end of my session as my blood glucose starts to go <4.0mmol/L. I totally see relevance for the half-time cut oranges at netball now!

I know I need to have a good dose of protein in each meal/snack to keep glucose from spiking. This is more of a factor than when I tracked last year non-pregnant. And of course this is what I have found most tricky in pregnancy, as I am sure any other pregnant woman can relate!

I want to highlight that we are all so different. What works for me, may be different for you. This is why I am such a proponent for CGM. Test out your usual diet, make some tweaks, and then better understand how you can keep things regulated. I’ve felt much better on days where my glucose is steady than on days when glucose is all over the place.

WHAT WE CAN DO

If you are indeed struggling with glucose management in pregnancy, are worried about doing the OGTT and want to prepare, or you would prefer to do some tracking with a CGM, working with a pregnancy-specific naturopath is a great way to prep and analyse results in a safe environment. We have so many tools up our sleeve to support glucose regulation in pregnancy. Know there is much you can do to regulate blood glucose without under eating or undernourishing in the later stages of pregnancy. One of my favourite resources is Lily Nichols, who is very pro glucose regulation in pregnancy (bust some myths and read her book).

In summary,

If anything, pregnancy is a time when we don’t particularly feel ourselves and so regulating blood glucose can have a huge influence on how we feel. This isn’t just about diagnosing GDM. Spikey glucose over the course of the day is bound to push us to our emotional edge, have us feeling hangry/jittery at times of a low (or nauseous!), and potentially more anxious or uptight at times of a high. I query the relevance of the OGTT for well, healthy women and rebut any diagnosis of GDM where it was only the fasting glucose that was ‘high’, especially when marginal. There can also be false negatives, so keep that mind. I much prefer seeing the whole picture and getting a bit more info than just one standalone test, but maybe that’s the naturopath in me.


*Expected glucose levels according to Australian standards:
- Fasting levels <5.0mmol/L
- 1 hour post meal <7.4mmol/L
- 2 hour post meal <6.7mmol/L