QUESTION: If you have gestational diabetes, should you feel shaky on a low-sugar, low-carb diet?
No, feeling shaky is not something you should simply expect because you have gestational diabetes. Shakiness can be a symptom of low blood sugar, especially if you use insulin, but it can also happen for other reasons during pregnancy.
If you feel shaky, check your blood glucose if possible. A reading below 70 mg/dL (3.9 mmol/L) is considered low and should be treated promptly.
Answer by Dr. Albana Greca, MD, MMedSc
Hi there,
I understand why this can be confusing. You are trying to keep your glucose under control for yourself and your baby, but at the same time you do not want to restrict your food so much that you feel weak or shaky.
The first thing I want you to do when shakiness happens is check your blood sugar rather than guessing that it is low.
Symptoms of hypoglycemia may include:
A blood glucose below 70 mg/dL (3.9 mmol/L) is considered hypoglycemia. If you are using insulin for gestational diabetes, your risk of having a true low blood sugar is higher.
With gestational diabetes, the goal is not to eliminate carbohydrates. Your body and your developing baby still need an appropriate supply of nutrients and glucose.
Very restrictive low-carbohydrate or ketogenic diets are not recommended during pregnancy. Instead, carbohydrates should usually be distributed across meals and snacks and chosen carefully.
I would rather see you eating sensible portions of higher-quality carbohydrates such as whole grains, beans, vegetables, fruit and other nutrient-rich foods than trying to remove carbohydrates almost completely.
The gestational diabetes symptoms, testing, diet and control guide explains how food, glucose monitoring and treatment are combined during pregnancy.
Pregnancy is not the time for an extreme weight-loss or ketogenic diet. General pregnancy nutrition guidance recommends at least about 175 grams of carbohydrate per day, but your individual meal plan should be adjusted according to your glucose readings, pregnancy needs, weight and treatment.
If you are repeatedly getting high readings after meals, this does not necessarily mean that you should keep cutting carbohydrates. You may need changes in the type, portion or timing of carbohydrate, or your diabetes treatment may need adjustment.
Pregnancy glucose targets are stricter than those used for many nonpregnant adults.
Your own maternity or diabetes team may give you slightly different targets, so follow the numbers they have set for your pregnancy.
If you check your glucose while you are shaky and it is below 70 mg/dL, treat the low rather than continuing to avoid sugar.
If you are awake and able to swallow, take approximately 15 grams of fast-acting carbohydrate, such as glucose tablets, glucose gel or a small amount of juice, and test again after about 15 minutes.
The 45–69 mg/dL low blood sugar action guide explains what to do when your reading falls into this range.
If your meter shows a normal glucose level while you are shaky, please do not keep eating sugar simply because of the symptom.
Pregnancy itself can cause weakness, nausea, dehydration, anxiety, changes in blood pressure and other symptoms that may feel similar to hypoglycemia.
Repeated shakiness with normal glucose readings should therefore be discussed with your obstetrician or diabetes team.
I would not want you to respond to gestational diabetes by becoming afraid of carbohydrates. The goal is controlled glucose with enough nutrition for a healthy pregnancy, not the lowest glucose number you can achieve.
Eat regularly, use appropriate portions of good-quality carbohydrates, monitor your glucose as instructed, and take insulin or other treatment exactly as prescribed.
If you are repeatedly becoming shaky, having readings below 70 mg/dL, losing weight unexpectedly, developing ketones, vomiting or struggling to eat enough, contact your pregnancy diabetes team promptly. Your meal plan or medication may need adjustment.
All the best,
Dr. Albana Greca