A gestational diabetes workout plan!

A client told me tonight that she has been newly diagnosed with gestational diabetes. NOOOOOOOOO!!!

She has been attending my class for the last few months, although because of her busy schedule hasn’t been coming every week.  So, for her, and for all the women of the world who have been diagnosed with gestational diabetes, I’ve developed a great workout plan that you can do at home, to help you control your diabetes and hopefully avoid this….

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19 pound baby at birth!

As I discussed with my client tonight, exercise and diet are only part of the picture for gestational diabetes.  Often, unfortunately, there is a genetic component that can make it totally unavoidable… but we can still do our best to control it and fight it!

In regards to exercise and gestational diabetes, you must be supervised through this time by your healthcare provider, so please check with your doctor before you begin any new exercise regimen (including the one I’ve developed below).

First exercise – talk a… walk.

It sounds BORING, but walking after a meal can help control blood sugar levels.   A 10 minute walk after breakfast, lunch and dinner instantly places you at 30 minutes of walking a day… the guidelines recommended by ACOG. If you can’t do breakfast, lunch, and dinner, try a 10-15 minute walk after at least one of these meals.  DO IT!

Now for the more dynamic part of my workout plan for those of you with gestational diabetes.  Resistance Exercises!  But, before you reach to click off the page because you are so exasperated with the thought of having to do weights at a gym, resistance exercise includes using your own body weight (ever increasing in pregnancy!) for resistance. It is easy to do at home! Resistance exercise builds muscle in your body and helps to enhance insulin’s ability to be absorbed into muscle in pregnancy, which allows your muscles to gobble up more of that sugar in your blood stream, lowering your blood sugar levels!  Whoop, whoop!

Here are some that I recommend that you can easily do at home

1) Squat.  A wall squat gives you a little bit of support, and if you have a ball, use it!  When you come into the squat, make sure your legs don’t go any further than parallel with the floor, just like the woman in this photo.  Here is the routine I do in my prenatal aerobic exercise class.  3 sets of 8 squats really slowly (count for 4 down, 4 up).  3 sets of 8 faster squats.  Then squat and hold for 8 slow seconds, 4 times.  This will quickly build up the muscles in your lower extremities… and is a great position to prepare you for labor.  Squatting is a great position in labor, as it is gravity assisted, and who doesn’t need a little assistance in labor??!!

2) The monster walk.  Monster Walk Backward for Strong Hips(I so wish this photo was of me… this woman kicks butt!  Oh, and so will you, if you do this exercise!)  This one is a great one to strengthen your hips and gluteals, some of the biggest muscles in your body.  Get them stronger, and your insulin resistance will be challenged!  Squat down, keep down, and walk from one end of a room to the other.  Just like in this picture, add a band for increased resistance, which will make your muscles even stronger.  Go to fatigue (until you just can’t do anymore!)

3) Calf raises.  Got a step?? Then you’ve got a way to exercise those calf muscles eccentrically, which means making those suckers REALLY STRONG! Now, before you get going with these, please be warned that these can really hurt!  Trust me, I tried.  Having a slightly sore calf muscle, I saught out a running physical therapy expert and he suggested I start doing eccentric calf exercises, single leg, 2 sets of 25, twice a day.  That is 100 per calf a day, or 200 total.  So, being the willing participant, I was diligent, and I’m not kidding, the next day, I could barely walk.  Please, ease into them!

An eccentric calf exercise is lowering your calves below the step.  That’s all it means.  Also,  perform these with straight legs and then with bent legs. Doing the heel lowering with a straight leg exercises the big, top muscle, known as the gastrocnemius, and the exercise with the bent leg exercises the deeper muscle, the soleus.

Here are Angie’s progressions:

  • start with both legs, one set of 25 a day… if you are not too sore the next day
  • do both legs at the same time, 1 set of 25, twice a day… if you are not too sore the next day
  • progress to both legs, 2 sets of 25, twice a day (so now you are at 100 a day).

Once you can complete that progression without too much soreness in your calves, progress to single leg eccentric, which means goes up with both feet on the ground, and lowering your foot below the step with just one leg.

  • start with single leg, one set of 25 a day… if you are not too sore the next day Full-size image (51 K)
  • progress to one set of 25 a day, twice a day… if you are not too sore the next day
  • progress to two sets of 25 a day, twice a day

And you will have CALVES OF STEEL!  Do it.  Until I make my own video of this, which I will, here is an example of this exercise with single leg.  Do with knee straight, and bent.

4) Push-ups.
 If you can do them like this, then you are awesome.

 

 

 

If you can’t do them like that, then the girly push-ups are good too.

 

 

 

And if those are too hard, then wall push-ups are a great place to start.

Wherever you are at, do 3 sets of 8.  If it hurts your wrists, stop.  

 

 

Do these exercises, and you’ll build muscle and help yourself with the fight in controlling gestational diabetes.

Hammer time – don’t touch it!

Hammer toes… what the?

Here is a medical drawing of hammer toes…

Have you really looked at your feet, I mean, really looked at them.  What are your toes doing?  This is a scary endevor, but one we must all embark upon if we are to venture through life pain free…

So, drum roll please…. Here is a picture of my feet (well, my left foot)

and I wonder why I’m having foot pain??!! The bottom of my feet (my metatarsals) are really sore, and my toes number 2 and 3 are numb, and have been for more than a year.

The saddest part of these hammer toes is that I only just realized that I have hammer toes (among other issues with my feet), and they have been sore for over 2 years now!

You will also notice the scratch on my big toe. That is a love scratch from my new kitten, Mittens, ahhh, she is so cute!  Anyway…

It is time to get to the bottom of this bottom foot pain, and this DOES have something to do with pregnancy, because all you pregnant women out there, you all have feet, and we all need to be pain free in our feet, and many women have more foot pain in pregnancy then when they are not pregnant, so we are going to go on a journey together. Breathe. That was a huge run-on sentence!

NO MORE FOOT PAIN! But maybe more run-ons…

But, you ask, where is this physical therapist with sore feet going to start?  I just bought these happy feet, and I’m really hoping they are going to make my feet really happy!

And I read Katy Says.  You all should too!

More to come.  Please e-mail me or comment with questions about YOUR foot pain.

Insulin resistance, pregnancy, and gestational diabetes – a short explanation

This blog post explains the role of insulin and glucose in our bodies.

But what about pregnancy and insulin?  Something pretty amazing happens when you become pregnant (besides the facts that you are growing eye balls, and finger nails, oh and that a heart starts beating inside you that isn’t your own… besides those small details).

In a normal pregnancy, insulin resistance increases at the level of the muscle (1, 2).

Don’t you think that is amazing??  Ok… let me describe why that is so cool.

by J I N N e e Răng Thỏ :x on flickr
mmmmm, sugar!

Pregnancy is so special, that even your muscle cells know that your baby is the priority now, and sacrifices glucose for the baby! Having an increase in insulin resistance means it is harder for insulin to bring glucose into muscles when you are pregnant. In other words, not as much glucose is hopping out of your arteries and into your muscles.   This is what you and your baby want, as more glucose in your blood goes directly to your placenta, as a yummy food for your baby.  Your baby needs glucose to grow properly. Continue reading

The physiology of insulin – a little pictorial explanation. It’s funny!

Have you ever wondered, really wondered, what is all the fuss about insulin?  I mean, why is it so important, and what does it do anyway?

Here is my little pictorial explanation of insulin and it’s pathway with muscles.

But first, what is insulin?  In Angie’s words (that’s me), insulin is the substance that takes sugar out of your blood and allows it to enter your muscles (and other places, like fat). But don’t take my word for it, click here for more explanation about that.

Imagine insulin is like the cool guy, cruising along streets (arteries),

Insulin = cool guy

by matt512 on flickr
Cool Guy

Um, no, not so cool, let’s try that again…

Insulin = cool guy

by Iomo54 on flickr
Cool guy take 2

that’s a bit better… Continue reading

Perineal Oil – made a little easier for you!

I quote from one of my favorite books, “The Birth Partner” by Penny Simkins, regarding perineal massage and oils.

Lubricate your index finger with wheat-germ, any other vegetable oil that you have in your kitchen, or water-soluble jelly.  Do not use baby oil, mineral oil, or petroleum jelly, as they tend to ry the tissue; vegetable oils are better absorbed.  To avoid contaminating the oil in the container, squire a little over your finger instead of dipping your finger into the oil

 

As my mission is to empower women into health in pregnancy, and I am attempting to provide information to help reduce tearing and pain, I have also whipped up a perineal oil, to make things a little more simple for women who don’t feel like delving into their kitchen supplies.

A 1oz bottle of a blend of sweet almond, fractionated coconut, and geranium oils, in a dropper bottle for easy and clean application.  Partner or yourself can drop one dropper filled of oil onto fingertips, and begin the massage… and the oil can be kept on your bedside table, not in your kitchen.  There is enough oil so that you can have a daily supply for 4 weeks, the time needed from beginning of perineal massage to birth!

Massage can also be a very helpful tool for postpartum healing.

I ship this little vial of goodness all over the USA, and can ship it internationally, too.  Click here to purchase!

 

Perineal Massage: There’s the rub!

by Ko:(char *)hook on flikr

Top gift for expectant mothers??!! I know, I know… you think it is a massage or a spa day, but you are WRONG! How about this… a perineum massage handout with perineal oil to boot.  Oooh, oooh, sign me up!

What exactly is a perineum, anyway, and why should you be massaging it when you are pregnant?

The perineum is the skin, muscle and tissues that lie between your vagina and your anus.  It is the place where doctors cut you if you are going to have an episiotomy, and it is also the most likely place a woman tears if she gives birth vaginally without an episiotomy.  And yes, you want to tear, rather than be cut, but more on that later.  But yes, you want to be intact, rather than tear, and that is where perineal massage comes in.

A Cochrane review, which is “internationally recognised as the highest standard in evidence-based health care” investigated “the effect of antenatal perineal massage on the incidence of perineal trauma at birth and subsequent morbidity.”  Whoa.  Say what?  Basically, they wanted to know if massaging your va-gi-gi when you were pregnant helped with tearing, episiotomies and pain after birth.  And what did they conclude, these gurus?

Antenatal perineal massage reduces the likelihood of perineal trauma (mainly episiotomies) and the reporting of ongoing perineal pain, and is generally well accepted by women. As such, women should be made aware of the likely benefit of perineal massage and provided with information on how to massage.

 

Did you hear my cue?  Provide with information!  Hey, I’ve got the information… let’s talk about it, and better yet, my mission is to ensure every pregnant woman is massaging at 36 weeks pregnant onwards… let’s get down to business!

Click here for the best little handout ever on how to do perineal massage, courtesy of American College of Nurse-Midwives. Print it out, hang it on your bedside table, and get to work!  The handout says 6 weeks before birth, I say you can start at 36 weeks pregnant (based on the literature), and the handout also says for 10 minutes… I say 3-5 minutes and I’d call it good (again, based on the literature.)

But for a brief summary:

1) Be 36 weeks pregnant

2) Oil up.  Either partner or yourself should use a little oil.  You don’t need anything fancy, just some olive or almond oil.  But, if you don’t want to raid your kitchen for bedroom activities, I sell a special perineal oil for this very activity!  Click here if you want to learn about it and buy it.

3) Insert fingers or thumbs into vagina, and press down toward your butt hole (otherwise known as anus).  You get the idea from this picture, right??!!

Pressing down toward bottom

3) Rub back and forth along the back of the vagina for 3-5 minutes.  Notice my full concentration while performing this task!  :)

4) Do this on most nights until baby is born

5) Have less pain and trauma to your perineum.

That’s all I have to say about that.

 

Preeclampsia, exercise and pregnancy: A systematic review

by comedy_nose on flikr

Preeclampsia is a fancy way of saying high-blood pressure in pregnancy.  But what is all the fuss about?  Why do providers check your blood pressure at every prenatal visit (and if they are not, they should be!) and what is happening if you do have preeclampsia?  Basically, preeclampsia is the leading cause of maternal morbidity and death, especially in developing countries (1), which kind of sucks, because when you are having a baby, you want to be around to see the baby.  So, pretty important topic, right?

Well, some researchey dudes in Brazil (1) decided they wanted to know once and for all if exercise can help reduce the risk of preeclampsia in pregnancy.  So, they got their little fingers typing into all sorts of databases, and started searching all the pregnancy and exercise literature in all the world… that is to say, they did a systematic review.  They found 231 articles, 217 which were excluded because the articles didn’t address the topic they were interested in, so world wide, they had 17 research papers to examine. Continue reading

A closer look: Glucose tolerance at 24-28 weeks pregnant is improved in women who exercise

Everybody knows that gestational diabetes is not a good thing to have when you are pregnant.  It isn’t good for mama, it isn’t good for baby.  Basically, it means BOO for everyone. (And if you want to learn more about the pathways of insulin, which is responsible for the glucose in the blood in gestational diabetes, through a funny pictorial I created, click here)

By Joint Base Lewis McChord on flickr

Let’s take a closer look at a trial that was published last year. Then maybe after you know the facts, pregnant ladies who are exercising may look a little more excited than the women exercising in this photo, because you will know how awesome it is for you and your baby… but HEY, at least they are doing it!

 

Continue reading

Running in early pregnancy

I heard a fabulous pod cast by Another Mother Runner (awesome website and community… whoop, whoop to Sarah and Dimity), called Lady Doc.  The obstetrician speaking stated that at about 28-29 weeks many runners stop running due to the relaxin levels and the growing baby.

I just wanted to clarify one little point for all the newly pregnant mamas out there, trying to run…the thing is… before you even obtain “large and in charge” status with a huge mama tummy…before your jeans are even getting a little tighter on you… before ANY of that happens, in fact, more or less at conception, your hormones go CRAZY! (and that IS official medical language!)  Most importantly for running, relaxin is SURGING.

Relaxin in pregnancy peaks at around 12 weeks. This hormone is responsible for making all your ligaments nice and loose, so your baby can move through your pelvis during labor. 12 weeks is before the baby even starts to move out of your pelvic region, so before you start showing.  Due to these high relaxin levels, you may actually feel uncomfortable running, despite not even physically being able to see that you are pregnant.

You need to listen to your body, it is that simple.

NYC running mama

Here is a BAMR (bad ass mother runner, and I mean, really bad ass, with a marathon personal best of 3 hours and 20 some minutes. Hello?!) blogger, NYC running mama, (pictured).  She blogged her whole pregnancy running experience, which is awesome because now we can all learn from it!  Check out this quote regarding her experience at about 8 weeks pregnant (and this is someone who was running 6x/week, up to 50 miles a week):

But by week 8, I started to feel extremely tired, out of breath, and achy when I was running.  I constantly felt like I needed to stop and walk – so despite not wanting to, this is what I did.  I began doing a run/walk interval (running 1-2 miles, then walking 1/2 mile). I’ve never been a walker so I was surprised to find I actually enjoyed it! However, I was extremely discouraged – I really missed being able to run for more than 10-15 at a time and was worried that my plans to run throughout pregnancy were lost.

Continue reading