Therapy, Toast, and Testing My Blood Sugar: An Anti-Diet Take on Gestational Diabetes from an Eating Disorder Therapist & Certified Perinatal Therapist

Rachael McLaughlin
3 days ago
5 min read

Written by: Rachael McLaughlin, LPC, PMH-C

Hi! I’m a certified perinatal mental health therapist and an eating disorder specialist. I spend my days helping people make peace with food, feel safe in their bodies, and unlearn the rules diet culture whispers (or screams) into their ears. I talk about intuitive eating like it’s a love language. I’ve cried with clients over bread. I believe, with my whole heart, that your body is not a problem to be fixed.

So, naturally, when I got pregnant and was diagnosed with gestational diabetes, I thought: Well, isn’t this just rich? (But, like, sugar-free rich . . . per the medical instructions.)

Let me back up. This isn’t my first pregnancy rodeo—my first was during the height of COVID, and that came with its own flavor of chaos (pandemics, anyone?). So, naturally, I had been looking forward to this pregnancy being restriction-free. You know, the one where I could leave the house when I wanted to, eat what sounded good, and enjoy prenatal care that wasn’t filtered through an N95 mask.

The Surprise Nobody Wants at Their Baby Shower

Getting diagnosed with gestational diabetes felt like a punch in the pancreas. Not because I thought I had done something wrong—I logically know better than that. But because the system around this diagnosis can feel so laced with shame, blame, and wildly outdated advice, it had me blinking at my provider like, “You want me to do what now? Did I cause this?”

As someone who supports clients in healing their relationships with food, I was made instantly aware of the tightrope walk ahead: between evidence-based medical care and the deeply disordered nutrition advice often given to pregnant people with gestational diabetes (GDM). The recommended “meal plans” looked like someone dusted off the 1995 Weight Watchers handbook and slapped a fetus on the cover. Limit carbs. Eat at exact intervals. Don’t eat fruit in the morning. (Fruit! In the morning! The audacity!)

Now, don’t get me wrong: Gestational diabetes deserves care and attention. It’s very real, and managing blood sugar matters for both the birthing person and baby. BUT the way the medical world talks about it? The midunderstandings from the rest of society? That’s where I raise a gently arched, sarcastic eyebrow.

When Intuitive Eating Meets a Glucose Meter

Here’s where it gets complicated: I’m deeply aligned with intuitive eating, weight-inclusive care, and body autonomy. I support clients in listening to their bodies, honoring hunger and fullness, and moving away from rigid food rules. So how exactly do I mesh that with being told to eat every two to three hours, avoid pairing “too many” carbs together, and keep my fasting numbers under a specific (and somewhat random-feeling) threshold?

The truth? It’s messy. Sometimes I'm eating because it's time and not because I’m hungry. Sometimes I am hungry, but the only thing that sounds good is a grilled cheese and french fries—and, instead, I’m staring at a hard-boiled egg and a few peanuts. The thing about gestational diabetes is that the recommendations often feel like a crash diet dressed up in a lab coat. “Don’t eat carbs by themselves.” “Eat a snack before bed.” “Be sure to walk after every meal.” “Track every bite.” “Don’t spike your blood sugar.” It starts to feel eerily familiar—like every client I’ve ever sat across from, trying to unlearn the rigid food rules they were handed.

Now I’m the one wrestling with the guilt of going “off plan,” wondering if the slice of birthday cake at a friend’s party was “too much,” and hearing the tiny ED voice whispering, See? You’re better when you’re in control.

Spoiler alert: I'm not better when I’m obsessing about food. I’m anxious. I’m distracted. I’m frustrated. And while I want to care for this baby and my body, I also want to keep my sanity and maintain the peace I’ve worked hard to build with my body and food.

And let’s be honest—sometimes I worry about whether my provider would side-eye me if I didn’t follow the meal plan to the letter.

Spoiler alert #2: I’m not. I am making it work for me. Which, yes, involves stabilizing my blood sugar and, yes, still includes joy and carbs. I am choosing to approach GD with the same principles I use in my practice: curiosity, flexibility, self-compassion, and honoring the unique needs of my (temporarily glucose-sensitive) body. But it ain’t easy, and it definitely isn’t perfect.

Body Image and the Pregnant Therapist

Pregnancy is already a wild ride when it comes to body image. Your body is growing, stretching, and expanding in ways that don’t follow Instagram or Tik Tok aesthetics. You are constantly being measured, weighed, and poked—sometimes all before 10 a.m. And despite being the one growing a whole human, you’re often not treated like the expert of your own body. As someone who supports people in making peace with their bodies, I feel like I should be more okay with it. Some days I am. Some days I marvel at my belly and say sweet things to the baby. And some days I look in the mirror and think, “Whose swollen feet are these?”

Now, layer on GD. Suddenly, your body is “high risk,” your placenta is “misbehaving,” and the implication is that you must’ve done something to deserve this—too many Dairy Queen blizzards, perhaps? Suddenly, every part of your body feels like it’s up for debate—your weight, your blood sugar numbers, even how much fluid you're retaining. I’ve found myself needing the same compassion, tools, and grounding practices I offer my clients. Deep breaths, gentle movement, stretchy pants, and a whole lot of self-talk that sounds like, “my body is not broken—it’s just doing its best under complex hormonal circumstances. And so am I.”

Oh, and Fertility Stuff? That’s for a (potential) future blog…

Did I mention that getting pregnant wasn’t exactly a breeze either? That’s a whole other blog post I might write when I’m not growing a tiny human and Googling "gestational diabetes-friendly bedtime snacks that don’t taste like cardboard." But if you’re navigating fertility challenges, know that I see you too. It's not easy, and there's a lot to hold.

What I Wish Others Knew

If you’ve been diagnosed with gestational diabetes, please hear this: You didn’t cause this. You are not a failure. Your cravings aren’t wrong. Your body isn’t bad. The system is just . . . a lot.

You’re allowed to grieve the experience you thought you’d have. You’re allowed to be annoyed when the nurse tells you to “cut back a little bit more on the carbs” while holding a glucose testing kit in one hand and your dignity in the other.

You can manage GD without sliding into disordered eating. You can question bad advice. You can build a team around you that helps you care for yourself in a way that feels nourishing, not punishing.

And, if you’re a provider like me, navigating this from the other side of the therapy chair—know that your knowledge, your compassion, your humor are tools that you get to use for you, too.

So here’s to pregnant therapists with gestational diabetes. To blood sugar logs scribbled next to client notes. To managing insulin and imposter syndrome at the same time. To loving your changing body while also occasionally hating how your pants fit.

And to remembering that you can do hard things—including this—without losing your intuitive voice along the way.

Warmly (and with a snack nearby),

A very pregnant, very glucose-aware therapist