Hyperemesis Gravidarum and Gestational diabetes
Hyperemesis gravidarum and gestational diabetes are a terrible combination to cope with. With hyperemesis food is your enemy then all of a sudden with gestational diabetes you need to make food your best friend.
If you find yourself being diagnosed with hyperemesis gravidarum AND gestational diabetes it can often be very worrying and concerning. Diet is now restricted to not drinking sugary fizzy drinks and foods which once where the top of the 'safe' list for hyperemesis may be high carbohydrate things which will raise your blood sugar levels. It is important to talk to your gestational diabetes specialist nurse or midwife, consultant and dietician regarding any concerns of trying to cope with both hyperemesis gravidarum and gestational diabetes.
What is hyperemesis gravidarum?
Hyperemesis gravidarum (or HG) is a medical term for severe nausea and vomiting in pregnancy. HG begins between 4 - 6 weeks of pregnancy. It usually improves by the 21st week but can make a reappearance at around 32 weeks briefly due to a surge in hormones. For many women it may continue for the entire pregnancy and can be a daily struggle to live through, making the most basic tasks impossible.
Diagnosing gestational diabetes when suffering with HG
For the majority, diagnosis of gestational diabetes is by a 2 hour 75 g oral glucose tolerance test (OGTT or GTT), between 24 - 28 weeks unless glucose is found in urine samples before this time, or if the patient has had gestational diabetes in a previous pregnancy.
The glucose tolerance test involves drinking 75g of glucose which may be in the form of a glucose syrup drink or original Lucozade and may be problematic to keep down for the duration of the test (2 hours).
If you feel that taking this test is going to be too difficult to take whilst dealing with the nausea and vomiting of HG, or if you are being screened in the first trimester where HG is more severe, then you should discuss this with your health care professionals.
Alternative ways of testing may be offered or advised, such as monitoring blood sugar levels with a glucose monitor over so many days. For more information on diagnosing gestational diabetes, please read more here.
Early diagnosis of Gestational diabetes with HG
Some ladies who have had gestational diabetes in previous pregnancies or those that show high glucose levels in routine urine or blood tests may be diagnosed at a much earlier gestation when HG may be extremely severe. This can be extremely difficult for those struggling with severe nausea, sickness and vomiting.
With early diagnosis of gestational diabetes (before 12 weeks), you may need to focus on HG then move on to good gestational diabetes practice when you feel a bit more stable. Before 12 weeks it is important to just try to get something, anything, from food or drink to help keep growing your little one. Once the 12 week scan is complete and baby is showing to be growing well, then you can try to move over to focusing on the GD.
Switching from HG to GD
Its very difficult to make the transition from HG to GD. You really need to dig the strength you don't have and power on. Switching from HG head to GD head is like climbing a mountain - the food aversions make it seem so difficult, but many ladies have done it and you can do it too. In fact once many get on the GD road, many find their HG slightly better and the nausea more bearable.
The good news is the vomiting usually slows down around the late teen - 20 weeks, even if the horrible nausea continues. Continue to take the HG medication until your totally sure you're able to eat without them.
With HG you may crave stodgy foods and sugar, but many find the nausea is easier without them. While you adapt your diet from HG safe foods to GD suitable foods, cut out the refined sugar completely until you find a good balance of what you can tolerate.
The '20 minute rule'
This may not be suitable for all, or be something that you want to try, but one method that has helped some ladies is the '20 minute rule'. This is where you eat and fight the sickness for 20 mins if you can, just to try get some goodness from the food before vomiting. You may have little or no control over this, or may feel that this will not benefit you, but this is something that some ladies with Hyperemesis Gravidarum and Gestational diabetes have shared with us in our Facebook support group as a way of trying to get some goodness from the food they've eaten.
HG to GD swaps
HG safe foods can vary from one to another, so it's best to read some detail on the GD diet and then work out what things from your HG safe food list you can swap or tweak to make GD friendly e.g. If you have survived on full sugar fizzy drinks, switch to diet, zero, no added sugar versions or fizzy water. If jacket potato is a safe food, then try it paired with lots of butter and cheese to help control the spike in blood sugar levels from the carbohydrate of the potato.
Smoothies are great for sickness and nausea. They give you the calories you need, but are kinder on the stomach. They're also kinder if you vomit, putting less stress on the body.
Any foods which are blended, blitzed, juiced or mashed are more broken down, sometimes with much of the fibre stripped away and so the glucose from them will be absorbed faster than the foods in their natural form and can cause rapid high blood sugars.
Fruit and fruit juice is high in fructose (natural sugar from fruit) and so it is best to use lower GI fruits such as lemons, limes, Granny Smith apples, berries, kiwi or a greener banana.
Avoid sweeter and exotic fruits which are high in fructose such as melon, pineapple, mango, ripe bananas, peaches, grapes, oranges etc.
If milk causes nausea then swapping to almond, soya or lactofree milk may be beneficial.
Adding peanut butter, nuts and seeds such as milled flaxseed to smoothies will help to keep lower and stabilised blood sugar levels.
Vegetables are also great for adding to GD friendly smoothies, especially greens such as spinach and avocado which is also packed with good fats.
Hydration is very important with both HG and gestational diabetes and so try your best to stay well hydrated. Sips of water throughout the day are beneficial, eating ice cubes or home made no added sugar squash lollies. If water makes you sick then try fizzy drinks that do not contain sugar. For many ladies suffering with severe vomiting, it may mean being admitted to hospital for IV fluids.
Vomiting raises blood sugar levels
If you're sick don't be alarmed to see high numbers on your monitor. It's known that being sick raises blood sugar levels so if you are sick, note it in your diary when recording your blood sugar levels. After you vomit, try to eat a snack straight away as many ladies feel some relief after vomiting so it gives you a chance to eat something and this will help stabilise your blood sugar levels.
Foods which may be suitable for both HG and GD
What is tolerable to one Mum with HG may taste like poison to another. We have tried to create a list of commonly safe foods to help give some examples.
Foods which are unrefined complex starchy carbs are important for providing energy. To keep blood sugar levels lower, you need to add protein and fat to these high carbohydrate foods so that it slows down the release of glucose into the bloodstream e.g. jacket potato with butter & cheese, or toast with peanut butter:
- oatcakes or wholegrain crackers
- Ryvitas or wholegrain crackerbread
- Nairns oat biscuits
- Burgen Soya & linseed bread, Lidl high protein rolls, wholemeal sandwich thins
- wholewheat pasta
- Basmati or wholegrain rice
- Digestive biscuits
- salted potato crisp
- salted popcorn
- Jacket potato
- Granny Smith apple
- Greener bananas (greener bananas contain much less sugar than ripe ones)
- Creamy or high protein soups
- Salad with protein (meat, chicken, Quorn etc.)
- Full fat yoghurt
- No added sugar or sugar free jelly
- No added sugar delight or angle delight
Women with gestational diabetes may suffer with ketones present in their urine samples. It is common for women suffering with HG to also have ketones present in their urine and so having the two complications will most likely mean that ketosis is unavoidable. For many ladies suffering with severe ketosis, this may mean being admitted to hospital for IV fluids. Read more about ketones here.
Metformin for HG sufferers
Metformin is an oral medication that may be prescribed to lower blood sugar levels. It is very common to get side effects from metformin such as stomach cramps, diarrhoea, nausea and vomiting. Some women suffering with hyperemesis gravidarum and gestational diabetes have reported that using Metformin has actually helped their HG symptoms, but many have concerns over taking a medication which they feel may worsen their HG. Discuss any concerns you have with your diabetic consultant or midwife who may be able to help you.
If you need additional help with lowering blood sugar levels and do not feel Metformin is suitable for you, then please be aware that in the majority of cases, insulin will be offered as an alternative.
Insulin for HG sufferers
There are no reported side effects reported from the use of insulin for HG sufferers. The biggest problem with insulin for anyone who is regularly vomiting is that rapid release insulin works with the food eaten at the time injected and if you vomit following eating, there could be concern of having a hypo. Hypos can be managed and controlled, but you should discuss any concerns with your health care professionals. Your diabetes team will best to advise and support you with which course of treatment suits you best.
Medications for HG affecting blood sugar levels
You should check with your health care professionals if the medication given for helping your HG will impact your blood sugar levels. Steroids are known to raise blood sugar levels and so if you are advised to take anything with steroids you should discuss this with your diabetes team.
Links between hyperemesis gravidarum and gestational diabetes
No links have been found between these two conditions during research.
Help and support for hyperemesis gravidarum sufferers
Facebook groups and pages:
Hyperemesis gravidarum affects the positive GDM screening rate in the first trimester
There was no significant association between HG and the various perinatal outcomes tested
Hyperemesis gravidarum is not associated with adverse pregnancy outcomes.
This page was written with information and help from members suffering with hyperemesis gravidarum and gestational diabetes in our Facebook support group and Genna, founder of the HG Warriors. In particular I would like to thank a dear friend (Susan) who has suffered 4 HG pregnancies, 3 of those being HG and GD pregnancies. Susan you are a true hero, how you coped I do not know. Your strength and courage is amazing and you have a beautiful family to show for it. Thank you for your help and support.