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Three Ways to Diagnose Gestational Diabetes

There was a good part of me that didn’t want to pursue a career as a dietitian. I didn’t want to be forced to teach incorrect information, put people on low-calorie, low-fat diets, and work in the medical system pushing the tired status quo.

Going against the grain is scary. It always is. But doing work that feels unethical just wasn’t an option (and never will be).

That’s why I was so pleased to learn there were other “real food dietitians” out there. Aglaee Jacob was one of the first I came across and she inspired me to stick to my guns and (trite quote alert) “be the change I wanted to see.”

I recently had the pleasure of talking with Aglaee Jacob and another awesome real food dietitian, Stephanie Greunke, who co-host the Real Food Mamas Podcast.

Their podcast explores natural pregnancy, undisturbed birth and healthy living for the whole family. So naturally, talking about my passion, gestational diabetes, fit right in with their message.

While we cover a lot, one of the key points we discuss are the three ways to diagnose gestational diabetes.

I get a lot of questions about how to diagnose gestational diabetes and what screening method is best. There are pros and cons for each screening method, but my unique background in both gestational diabetes public policy and clinical practice might give you a more complete perspective than what you’ve read elsewhere online. I break it all down in this interview.

Here’s a recap of what we cover:

  • Does pregnancy really “trigger” gestational diabetes or are there other things that can put you at risk? Is this something that was going on before pregnancy?
  • Does gestational diabetes go away after delivery?
  • Why I moved away from the traditional gestational diabetes diet and how my real food gestational diabetes diet is different
  • How the traditional gestational diabetes diet was formulated (including the carbohydrate recommendations)
  • How most research on high fat diets during pregnancy misses the point (and my thoughts on fat in a prenatal diet)
  • Three ways to diagnose gestational diabetes – what screening method(s) I recommend and why
  • The frustrating medical bias against women diagnosed with gestational diabetes and why it needs to stop
  • The three different types of ketosis and which one is dangerous during pregnancy (and why medical professionals freak out when they hear the word “ketosis,” but shouldn’t)
  • Top 3 tips for managing gestational diabetes

Listen to this interview on Stitcher or iTunes (episode 15)!

In other news, you might like to hear some updates from the gestational diabetes world:

1. For the first time ever, my real food approach to gestational diabetes will be used in a research study.  I’ve just finished recording my portion of the training program that will be part of a gestational diabetes pilot study through the University of Kentucky. The principal investigator, Rebecca Dekker, who you may know from her popular blog, Evidence Based Birth, sought my help on this project after reading my book. This is a HUGE milestone for women with gestational diabetes everywhere!

2. I’m excited to announce I’ll be interviewed for ReachMD this week, a highly trafficked website for medical professionals that offers a streaming radio station to help doctors and other providers stay abreast of the latest research (some of their programs offer continuing education credits, too!). It’s humbling and reassuring to see medical companies, such as this one, seek alternative opinions on gestational diabetes. Clearly, those in the prenatal nutrition industry have noticed that the conventional gestational diabetes diet doesn’t offer the results they’re looking for and are ready to think outside of the box. Bravo!

3. Finally, I’m very happy to announce the Real Food for Gestational Diabetes Course is growing quickly. We’ve got women from all over the world participating in the course and impressing the socks off their doctors with their fantastic results. If you want access to all of the practical tools, meal plans, troubleshooting tips (like how to lower your fasting blood sugar naturally), and an incredibly supportive group of moms, check it out HERE.

Here are two recent testimonials from happy participants in the Real Food for Gestational Diabetes Course:

Bulkin_HallieGestational diabetes was all new to me. I had only heard of one other person having had it before and she was obese before she got pregnant so I didn’t know that someone petite and healthy like myself would even be a candidate.

It was scary because there were so many unknowns but your course made it so simple. As soon as I completed your course & read questions and comments from others in the Facebook group, I realized how simple and easy it really can be to manage through diet alone. I am thankful for that now!

This course definitely put me at ease and made me realize that it is easy to eat well and monitor my numbers, keeping everything in check! The doctor is happy with my numbers and I am proud to say that I am successfully managing it with the help from your course and FB group. 🙂

I learned the best foods to eat & what to put on my grocery list, including some foods which I have never paid attention to in the past, the importance of incorporating more nutrient-dense foods, what foods to limit, and got an understanding of the medications just in case (which luckily I do not need thanks to eating a real food diet).

I like how you broke everything into modules and bite size pieces. It was not overwhelming and it was very easy to follow! I loved that you focused on exactly what to eat and what not to eat as examples, the reassurance helped!

I have already shared this on a mommy page because others were freaking out about failing their 3 hour test and I told them how much of a life saver this was for me! Hallie Bulkin, North Bethesda, MD”


Maria ParrishWhen my first glucose test was inconclusive, I was very scared. I felt very unprepared about GD. There was plenty of information online but not a lot provided solutions and programs to make it easy. That’s when I found this course and book, and I am so happy I did!

Lily does a thorough job providing a simple guide for pregnant women on what to eat and how to make it using READ FOOD! There are not many books nor information online that explain WHY it’s so important to eat certain baby nourishing foods that are low sugar.

Compared to the book, this course was even more informative and provided more tools for dealing with GD. I had all the extra support I needed to feel confident in managing this on my own from worksheets, sample menus, and of course, the support group. This is an essential course for anyone looking to learn and live with GD or just learn how to eat right during pregnancy.

Thank you Lily for doing this! You helped me more than I can say. Blessings! Maria Parrish, Concord”

Until next week,

UPDATE: If you’d like to read my experience with the glucola and gestational diabetes screening, read this post.

Manage gestational diabetes without fear.

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Lily Nichols is a Registered Dietitian/Nutritionist, Certified Diabetes Educator, researcher, and author with a passion for evidence-based prenatal nutrition and exercise. Her work is known for being research-focused, thorough, and unapologetically critical of outdated dietary guidelines. She is the author of two bestselling books, Real Food for Pregnancy and Real Food for Gestational Diabetes.


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  1. Lily, thank you so much for this interview. I’m getting close to the point in my pregnancy where they want to test me for gestational diabetes and I was stressing about my options (gestational diabetes runs in the family – both my mom and aunt had it), so this really helped answer my questions. I’ve heard such mixed advice about getting screened for gestational diabetes and what test is best – so many of the “experts” in the blogosphere just give a black and white answer instead of going through all the pros/cons of each test. I’m feeling much more confident with my decision. THANK YOU!

    And you can bet if I get diagnosed, I will be joining your Real Food for Gestational Diabetes Course. I want to do everything I can to have a natural pregnancy and birth! 🙂

    • Glad you found it helpful, Britteny!

  2. Hi Lily, I am also a dietitian and am loving your information about GDM. I was wondering if you could post a citation or link to the article about women who have a hgb A1c in the prediabetes range and having a 98% chance of testing + for GDM with an OGTT.

    Also, this is a bit off topic, but do you subscribe to individual journals or pubmed to gain access to research articles? I find it difficult to do research since graduating without the schools subscription to the databases.

    • Sure, Courtney.
      Hughes, Ruth CE et al. “An Early Pregnancy HbA1c≥ 5.9%(41 mmol/mol) Is Optimal for Detecting Diabetes and Identifies Women at Increased Risk of Adverse Pregnancy Outcomes.” Diabetes Care (2014): DC_141312.

      You’ll find every last detail is cited in my book, Real Food for Gestational Diabetes. I have some connections in the research world, so I’m able to get full text articles, but keep in mind many articles are public access.

      PS – If you’re interested in further training, I’m developing a continuing education program on gestational diabetes and real food prenatal nutrition for dietitians and healthcare practitioners.

      • Thank you for the reference. I would definitely be interested in participating in a continuing education program that you create.

  3. Lily, you suggest home monitoring as an alternate to the in-lab glucose test. How can monitor at home? Could I simply buy a kit at the pharmacy?

    • You can purchase supplies over the counter or request a prescription for a glucometer and test strips from your care provider. Basic instructions for home blood sugar monitoring are found in my free video training on gestational diabetes.

  4. Hello,
    What is the name of the episode on the podcast? I can’t seem to find it!

  5. Hello,
    What is the name of the episode on the podcast? I can’t seem to find it! Thank you!

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