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1 www. Diabetes Care UHL Gestational Diabetes Dietary Advice A guide for patients and healthcare professionals

2 Gestational Diabetes-Dietary Advice Introduction Gestational diabetes occurs when your body has difficulty keeping your blood glucose levels within a particular range during pregnancy. Before you were pregnant a hormone called insulin will have kept your blood glucose levels well controlled. During gestational diabetes the insulin does not work as well as it should and levels of blood glucose rise. This type of diabetes usually goes away after the baby is born. The safe range for blood glucose levels is less than 5.5 mmol/l before meals and less than 7.0 mmol/l two hours after meals. Why is it important to keep blood glucose levels in target? Gestational diabetes is usually tested for between weeks of pregnancy. At this stage your baby s organs are well developed he or she will be doing most of their growing, until they are born. If your blood glucose levels are raised, any extra glucose will be passed onto your baby across the placenta. 2

3 3 Keeping your blood glucose levels controlled will help reduce risks to your baby This extra glucose in your blood can make your baby grow large around its stomach and shoulders, which can lead to difficulties during delivery. Having high glucose levels is also known to increase the risk of other complications. Keeping your blood glucose levels controlled is very important to help reduce the risks to your baby. Why have I got gestational diabetes? Gestational diabetes is more common is women with a history of diabetes in their family. It is also seen more often in women of South Asian origin and women that are overweight. Having gestational diabetes during pregnancy puts you at a higher risk of developing it again in future pregnancies. We also know women that have gestational diabetes are at a greater risk of developing Type 2 diabetes later in life.

4 Gestational Diabetes-Dietary Advice How is gestational diabetes diagnosed? Most people are diagnosed by having an Oral Glucose Tolerance Test (OGTT). This is when you have a fasting blood glucose test, followed by the taking of a sugary (glucose) drink and then a further blood glucose test after 2 hours. This will tell us how your body is managing the level of glucose in your blood, both before and after drinking glucose. In gestational diabetes, many women find that the second blood glucose test result is higher which means that your body had difficulty controlling your blood glucose levels after having a glucose drink. If you have found this, making some changes to your food choices and lifestyle can help to keep your blood glucose levels within the recommended target range of less than 7.0 mmol/l 4

5 5 Food choices with gestational diabetes If you have found out that you have gestational diabetes making small changes to your lifestyle can help you to keep your blood glucose levels well controlled. During pregnancy it is especially important to follow a healthy eating plan by having foods from a variety of food groups e.g. carbohydrates, fruit and vegetables, proteins and some fat. However there is only one group of foods that directly affects blood glucose levels.. these are carbohydrate containing food. There are two main forms of carbohydrate: Sugary Sugary Drinks Fruit Juice Sugar Sweets Chocolate Biscuits Fruit Milk Yoghurt Indian Sweets - Jellabi, Burfi Starchy Bread Rice Potatoes Chapattis Pasta Noodles Pastry Coated Food - Samosa Kitcheire Ganthia Chevda Bombay Mix Crisps

6 Gestational Diabetes-Dietary Advice 6 Advice on sugary foods with gestational diabetes Replace sugar in drinks such as tea and coffee with an artificial sweetener e.g. Splenda, Canderel, Sweetex. Avoid full sugar drinks. Try diet or no added sugar varieties e.g. Instead of ordinary cola, choose diet or sugar free Instead of full sugar cordial, choose no added sugar varieties Avoid large quantities of fruit juice. Try to limit yourself to one small glass (150ml) of unsweetened fruit juice per day with food Avoid large quantities of sweets, biscuits, cakes and chocolate. If you want some, have a small portion and monitor the effect it has on your glucose level. Fruit does contain natural sugar; however, it also has many other health benefits. It is advisable to have 2-3 portions of fruit per day (and 2-3 portions of vegetables to make up your 5 a day). Try to keep portion sizes to one handful and spread your fruit intake over the day. Yoghurts contain both added sugar and natural sugar. If you are trying to reduce the effect on your blood glucose levels then you could choose diet or light yoghurts. Milk contains some natural sugar so can have an effect on blood glucose levels. It is also a good source of protein and calcium, so it is important to include some of this in your diet. 6

7 7 Advice on starchy carbohydrates with gestational diabetes Starchy carbohydrates are broken down into glucose by the body; therefore they will affect your blood glucose level. Starchy carbohydrates are a good source of energy so it is important that you continue to have some of these in your diet. It is likely that you will be asked to continue with your normal portions of these foods initially. However, if you have glucose readings above target (more than 7.0 mmol/l two hours after eating your meal), and you have not had anything sugary it is important to think about the amount of starchy carbohydrate you had at your last meal. Did you have a bigger portion of carbohydrate than usual? Could you make a small reduction to the amount of carbohydrate the next time you have the same meal?

8 Pre-Pregnancy Gestational Diabetes-Dietary Planning Advice Example of changing carbohydrate portions at a meal You had a full plate of chapattis, rice and curry for your evening meal and your blood glucose levels were above 7.0 mmol/l two hours later. To prevent this from happening again you could try having less rice, or fewer chapattis the next time you have the same meal. This would reduce the total amount of starchy carbohydrate at the meal and will help to lower your blood glucose level following the meal. You could swap this meal......for this When reducing the amount of starchy carbohydrate, this can sometimes make you feel hungry later on. Try to fill up on extra vegetables or salad with your meal if this is the case. Or you may wish to have a small carbohydrate based snack later in the day so the distribution of carbohydrate is more evenly spread. It is important that you are not too strict with your diet. If you have made some changes and you are feeling hungry or losing weight then you should speak to your diabetes or pregnancy team. 8

9 9 Glycaemic Index There is evidence to say that the type of carbohydrate you choose will have an influence on your blood glucose levels. Some carbohydrate foods are broken down into glucose more quickly than others; this is known as Glycaemic Index (GI). Choosing slow release forms of carbohydrate may help to slow down a rise in your blood glucose levels after meals. Slow release foods are known as low GI foods. Have a look at the list below for more information. Low GI foods include: mixed grain/ granary bread porridge pasta basmati rice chapattis branflakes milk diet/ light yoghurt sweet potato new potatoes beans pulses fruit For more information on GI foods ask your Diabetes Specialist Dietitian

10 Gestational Diabetes-Dietary Advice 10 Physical Activity Another option to manage blood glucose and stay healthy would be to try some gentle physical activity after your meal. For example, going for a walk after your evening meal would help you to use up some of the extra glucose in your blood. If you have made some small changes to your diet and lifestyle and your blood glucose levels are still over 7.0 mmol/l two hours after your meal, it is important to speak to a member of the diabetes specialist team, as treatment may be required. Diabetic Products You do not need to have special diabetic foods e.g. jams, biscuits, cakes, sweets, chocolates, ice cream, toffee. Many of these products are not very tasty and they can be expensive. Often they contain sweeteners which can have a laxative effect if eaten in large quantities. 10

11 Pre-Pregnancy Planning 11 Fruit and Vegetables Fruit and vegetables can help to increase the natural fibre in your diet and provide you with the vitamins and minerals your body needs. It does not matter whether the fruit is fresh, frozen or tinned. Some people are concerned that fruit contains natural sugar. This is true, however the fibre in the fruit will slow down the release of the glucose into the blood. Try to spread your fruit portions evenly across the day. A portion is: 1 apple, orange, nectarine or banana 2 small fruits e.g. plums, kiwis and Clementine 7 strawberries ½ grapefruit 5cm slice of melon 30g dried fruit 3 heaped tablespoon of vegetables 1 small bowl of salad 7 cherry tomatoes If you are unsure,remember a portion will fit into the palm of your hand. Remember We should all aim to have 5 portions per day.

12 Gestational Diabetes-Dietary Advice 12 Meat, poultry, fish and alternatives Try to include some food from this group into your diet twice per day. A portion is 75g meat (around the size of a deck of cards). 100g cooked fish 125g of beans, lentils 100g soya, Quorn or tofu Try to remove visible fats from meat and use low fat cooking methods to prepare them e.g. grilling, baking (with no added oil), steaming, boiling. Weight Management Body mass index is a measurement of your weight in relation to your height. The healthy range prior to pregnancy is 20-25kg/m 2. If your BMI is above 25kg/m 2 prior to pregnancy then it is advisable to aim for weight loss before you become pregnant. Cutting down on fatty and sugary foods could help you lose weight. 12

13 13 During Pregnancy Having a BMI over 30kg/m 2 during pregnancy can make it harder to control blood glucose levels and can cause your baby to grow more than it should. You do not need to aim for weight loss during pregnancy, but small healthy changes to your diet and a gentle increase in activity can help to prevent excessive weight gain. It is important to continue with the healthy changes after pregnancy, as this can help to lower your risk of gestational diabetes in future pregnancies and reduce or delay the risk of Type 2 diabetes later in life. Some healthy choices you could make include: Instead of Frying foods Butter, ghee, margarine Ordinary cheese Full fat milk Crisps, nuts, chevda Cakes, biscuits, sweets Large portions of food Try Grilling, baking, boiling and using less oil (measure using a spoon) Using less (ie a thumb nail size) or try low fat spread Using less or try a low fat, edam or cottage cheese Use less or try semi-skimmed or skimmed Fruit, rice cakes, low fat crisps Fruit, diet/ light yoghurts, low calorie drinks Smaller portions, using a smaller plate

14 Gestational Diabetes-Dietary Advice After your baby is born During your pregnancy making sensible food choices and adopting a healthier lifestyle will help you to manage your blood glucose levels in Gestational Diabetes. (See Gestational Diabetes Antenatal Care booklet also) Having gestational diabetes can put you at a higher risk of developing it again in future pregnancies and of developing Type 2 diabetes later in life. In order to delay or prevent these risks, aim to be a healthy weight by eating a balanced diet and having some regular activity in your daily routine. If you would like more information or support with this, speak to your GP at your post natal check up. 14

15 15 Your Notes

16 Gestational Diabetes-Dietary Advice Contact us The Diabetes Specialist Dietitians Diabetes Care Unit General Hospital Gwendolen Road Leicester LE5 4PW T: (0116) The Diabetes Specialist Nurses (DSN s) Department of Diabetes and Endocrinology Victoria Building Level 2 Leicester Royal Infirmary Leicester LE1 5WW T: (0116) Department of Diabetes and Endocrinology Victoria Building Level 2 Leicester Royal Infirmary Leicester LE1 5WW T: (0116) Diabetes Care Unit Leicester General Hospital Gwendolen Road Leicester LE5 4PW T: (0116) Diabetes Specialist Midwives T: (LRI) or (0116) (LGH) Diabetes UK website Leicestershire Diabetes website 16 Designed by Shehnaz Jamal 2010

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