Intuitive Eating with Gestational Diabetes

Today I wanted to discuss something that I feel like doesn’t get discussed enough. Often, when someone starts digging into intuitive eating, everything makes sense until you start thinking about intuitive eating in the setting of illness or disease. I mean, that was my first question too, especially because I work with pregnant women with Gestational Diabetes. How in the world can you tell someone to eat what they want when they want, when their body is having a hard time doing what it is supposed to do?


As I’ve done more and more learning about IE and continued to work with those with GDM, I’ve been able to answer that question. A little bit. I want to preface this with the fact that I am still learning. This is what I’ve witnessed and learned so far, and see to be the most beneficial for my patients, and I want to share for those out there who are living with a diagnosis that makes intuitive eating a little harder.

Being diagnosed with gestational diabetes can feel really confusing. You may feel betrayed by your body, at fault, embarrassed, or ashamed. And then, to be told that you now have to follow a diet + schedule, as well as prick your finger 4 times a day…well, at this point you may feel downright overwhelmed and frustrated.

I believe that weaving intuitive eating into your GDM care plan is the best and only way to feel like you aren’t completely restricted, and to feel like you’re still in charge and know what’s best for your body. Because you are, and you do. Instead of viewing it all as a restrictive diet + demanding schedule, view it as an opportunity to work with your body for the best outcome.  


Here are my suggestions for intuitive eating while having Gestational Diabetes:

1. Pay attention to how low blood sugar and high blood sugar make you feel

Most people would agree that having high or low blood sugar doesn’t feel good.

Hyperglycemia/High Blood Sugar

You can be told over and over again of the negative consequences of having high blood sugar, but sometimes that just isn’t enough motivation to work to get your blood sugar within normal ranges. Instead, consider taking the time to do a self-check after you see a high number on your meter. How did I make the decision to just eat what I ate? Was I feeling over-hungry, or stressed about what to choose to eat, or like giving up and eating whatever I wanted? Did I feel satisfied after my meal? Where was I on the hunger/fullness scale? How do I feel now?

I’ve noticed that when patients are more aware of how the high blood sugar made them feel, they are less likely to want to engage in the behavior that caused the high blood sugar again.

Hypoglycemia/Low Blood Sugar

Many times, eating frequently is something that is difficult for people to get used to. However, eating every few hours really helps your body regulate blood sugar. We encourage patients not to go more than 10 hours without eating, because this can cause their blood sugar to go too low. When it gets too low, the body overcompensates by releasing stored glucose, and this then results in high blood sugar. Because of this mechanism, snacks between meals and before bed are super important.

If you see that your fasting blood glucose is trending high every day, instead of feeling frustrated at the “bad number”, ask yourself some questions. How many hours has it been since your last snack or meal? Did you wake up in the middle of the night feeling shaky or nauseous? Did you feel good when you woke up? Were you over-hungry? Did that result in you over-eating at breakfast? How did that feel?

If you are having difficulty eating snacks because you aren’t used to it, some helpful questions may be: Do you feel low on energy between meals? Do you feel shaky? Do you often finish a meal feeling stuffed, or overeat carbohydrate-rich foods?

Paying attention to how you feel when your blood sugar is out of the normal range may help you see the value of working to help it fall within the normal range, and help you get in touch with your body and it’s cues.

2. Take the focus off of the blood sugar number

So...I just talked about the blood sugar number…and now I’m telling you to take the focus off of it? I know, but bear with me. Really, these first two suggestions are essentially the same thing – the number is a useful tool, but what is going to be most helpful is listening to your intuition and exploring your motivation.

In the beginning, it can feel really disheartening if you are trying your best and your blood sugar is still trending high. Rather than going through their logs and pointing out every high number, I try to work together with the patient to find victories, no matter how small. Even if the number is still high, that is not a reflection of whether or not you take a step towards intuitive eating that meal - did you feel less hungry after said meal (ate sufficient amount of pro + carb + fat)?

When you ate your nighttime snack, did you notice that you didn't wake up in the middle of the night shaky and nauseous? 

Maybe other mealtimes need some work, but did you finally find that breakfast that satisfies you, helps you stay full, and results in a normal blood sugar number?

Tunnel vision will only result in a feeling of failure. Focus on the big picture, and celebrate every victory!


3. Think about your goals

Would you be open to using medication to aid your body in controlling blood sugar, or is this something you are wanting to avoid?

Sometimes this is out of your control, and that's completely okay. But if your goal is to avoid medication, there may be small steps that can help you reach your goal. If you really want to eat a specific food that normally causes high blood sugar (for example…gotta have a piece of cake at your baby shower!), there are steps you can take so that you can still have this food, but also avoid the discomfort of high blood sugar. You can choose to add some sort of movement after the meal, or choose to eat a small portion of the carbohydrate-rich food, and then choose other foods low in carbohydrates to help you feel satisfied.

If you find that you are trying your best and your blood sugar is remaining really high, or trying at all is causing incredible stress to you and your body, that's not good for you or baby either. Sometimes choosing to start insulin is the best thing you can do for your mental and physical health. This is something else to intuitively think about. 


4. Pay attention to hunger and fullness cues

An intuitive eating basic! Overeating or undereating can both result from feeling hangry yet stressed about not knowing what the best decision for a meal is.

Sometimes you may feel so frustrated or “done” with the rules and schedule and choose to overeat, or specifically overeat carbohydrate-rich foods. This happens and that’s okay. We are all human! But I encourage self-reflection and discussion about how overeating made you feel.

As I’ve mentioned previously (honestly, this all ties together), being in tune with your hunger and fullness cues can help you avoid some yucky feelings associated with eating too much or not enough.

5. View it all as a learning experience and take the focus off of perfection

Checking your blood sugar after each meal can absolutely feel like being graded for your actions. It can be incredibly triggering. Instead, it may be helpful to view the meter as just a tool to help you feel your best. If you see a high number, evaluate with curiosity your last meal. Similar to #4, think about those hunger cues and ask yourself questions to figure out what happened in that meal. Then, move on and approach the next meal or snack like a blank slate. It also may help to just view it as truly interesting. Look at the way your body is working right now, pay attention to the way food and movement affect your body, mood, and blood sugar. It’s pretty fascinating!



Intuitive eating absolutely has a place when it comes to management of diabetes, and can help you feel like you still have control in an environment where you may feel very controlled by others. Remember, everyone on your care team is there to help you and your baby have the best outcomes. If this doesn’t feel true for you, you always have the right to ask to switch doctors/nurses/dietitians.