Dietary advice for gestational diabetes. Information for patients Diabetes Service

Transcription

1 Dietary advice for gestational diabetes Information for patients Diabetes Service

2 page 2 of 12

3 Introduction Gestational diabetes is a type of diabetes that may occur when you are pregnant. During pregnancy your hormones can affect the insulin your body produces and cause it not to work as well as usual. We call this insulin resistance. Insulin is needed to keep your blood glucose levels well balanced. It does this by moving glucose out of your bloodstream into the cells where it is used for energy. In gestational diabetes the insulin resistance causes your blood glucose levels to rise to higher levels than normal. Your blood glucose levels are affected by many things. However one of the main contributors is the carbohydrate foods that you eat. This booklet provides information to help you with your diet during your pregnancy. By following the advice we provide, it should help you keep your blood glucose levels at a normal level. Keeping good control of your blood glucose levels during pregnancy should cause fewer complications for you and your baby. Monitoring blood glucose levels At the diabetes workshop you will be shown how to monitor your blood glucose levels. Your targets for blood glucose levels during your pregnancy are: Before meals: between 4 to 6 mmol/l After meals (1 hour after finishing a meal): less than 8 mmol/l page 3 of 12

4 Your diet during pregnancy Whenever you have food or drinks that contain carbohydrate, these foods are turned into glucose for energy. It is therefore important to learn more about carbohydrate foods as they are one of the main factors that cause your blood glucose levels to rise. There are different types of carbohydrate foods: starchy, sugary and naturally sweet and all types will affect your blood glucose levels. During your pregnancy you may need to eat less carbohydrate than usual and spread it out more evenly over the day. The type of carbohydrate you eat may also have an effect on your blood glucose levels. Low glycaemic index types are the best option (we provide more information on this later in this booklet). As well as thinking about carbohydrate foods, one of the best ways of managing your gestational diabetes is to have a healthy and balanced diet. The following tips should help you. Include a starchy carbohydrate food at each meal. A good place to start would be to keep the amount of carbohydrate at your main meal to around a third of your plate. Eat regular meals. Avoid long gaps of over 6 hours between meals. Aim for three meals a day and only have a snack in between if you feel hungry. Include some fruit and vegetables each day. Reduce the amount of sugary foods and sweet drinks you have. This will help control your blood glucose levels, sweet sugary drinks will cause your blood glucose level to rise quickly and provide little nutrition for you and your baby. There is no need to buy any diabetic foods as they may still raise your blood glucose level and can have a laxative effect. Keep fried and fatty foods to a minimum. This will help you to avoid gaining too much weight during your pregnancy which will help your blood glucose levels. Active dieting however is not page 4 of 12

5 recommended. Some women find that if they make a lot of changes to their diet and eat more healthily, the amount of weight gained in pregnancy is reduced. If your baby is growing well this should not be a problem. Be as active as you can unless you have been advised by your doctor not to. Including some activity each day, for example a 30 minute walk, is generally fine for most women. This will help you control your blood glucose levels and help prevent too much weight gain. Reducing sugar in your diet Avoid these high sugar foods Sugar added to foods and drink Sugary drinks for example full sugar fizzy drinks, lucozade, full sugar squash, fruit juices, smoothies. Sweets, chocolates, sweet puddings, cakes, sweet biscuits, jelly (unless this is a sugar free variety). Use these lower sugar or sugar free alternatives Sweeteners for example Hermasetas, Canderel and Sweetex. Diet fizzy drinks, no added sugar squash, water (including flavoured water if no added sugar). Plain biscuits such as ginger biscuits, sugar free jelly / no added sugar jelly and desserts, tinned fruit in fruit juice, diet yogurts. page 5 of 12

6 Which are the best foods to choose? Carbohydrate foods, especially low fat carbohydrates, are an important part of a healthy diet as they provide us with energy, some vitamins, minerals and iron. As mentioned before, all carbohydrate foods (sugary, starchy and naturally sweet), will affect your blood glucose levels. The best type of carbohydrates to include are those that are digested and absorbed slowly (low glycaemic index or low GI carbohydrates). These foods may help to reduce the peak in your blood glucose level after you have eaten. Examples of low GI carbohydrates Try to include one of these at each meal Granary or mixed seeded breads, rye breads instead of white bread Pitta bread wholemeal or white Pasta Basmati rice Oat based breakfast cereals for example porridge or oat flakes. Also low sugar muesli, bran flakes, Shreddies and Special K instead of sugar coated cereals such as Frosties, Coco Pops, and Rice Krispies Oat based biscuits and crackers such as oatcakes and crispbread Potatoes such as new boiled potatoes in skins and sweet potatoes instead of mashed potato Pulses such as lentils (dahl), red kidney beans, chickpeas and butter beans added to soups, curries and casseroles Other low GI starchy foods including pearl barley, yams, green banana, plantains, bulgar wheat, cous cous and quinoa page 6 of 12

7 Other foods Fruit and vegetables Aim to include some fruit and vegetables each day as these are an important source of vitamins and fibre. Fruit is a naturally sweet carbohydrate so it is best not to eat large portions at a time, have at a meal or as a snack in between. Try to include 5 portions of fruit and vegetables a day. An example of a portion is: An apple, orange, pear, small banana, nectarine or peach A handful of grapes or berries 2 satsumas or plums A slice of melon, pineapple or mango 2 tablespoons of vegetables or a small bowl of salad Fruit juice can cause a quick rise in your blood glucose level so limit your intake to one small glass a day Meat, fish, eggs and alternatives (have at 2 or 3 meals) These foods contain protein so may be eaten according to your appetite, they generally do not raise your blood glucose level. Choose lean meat or chicken without skin or fat, make sure that these are cooked well. Avoid liver and liver based products such as liver sausage or paté as these are high in Vitamin A and harmful to your baby. Include more fish in your diet; both white and oily fish. It is safe to eat oily fish (salmon, sardines, trout, fresh tuna, mackerel and pilchards), though limit this to no more than 2 portions a week. You may have up to 4 cans of tinned tuna a week but if you have this amount do not choose fresh tuna as your oily fish. page 7 of 12

8 Eggs are a good source of protein. Make sure that eggs are cooked thoroughly and check that any products containing egg have been pasteurised. It is safe to eat peanuts as long as you are not allergic to them. The advice regarding peanuts has changed recently as the latest research has shown that there is no clear evidence that eating them during pregnancy affects the chances of your baby developing a peanut allergy. They are a good source of protein, fibre and healthy fats, however they are also high in calories so limit them if you are watching your weight. Include more beans and pulses in your diet. Add them to casseroles, soups and salads; they are a healthy alternative to meat, chicken and fish. Milk and dairy foods Aim to have 3 servings a day. A serving is: One third of a pint of milk A small pot of yogurt 40g of hard cheese (about the size of a matchbox) Choose lower fat milks such as skimmed or semi-skimmed. Try to limit the amount of high fat cheese to no more than 110 grams a week. Choose low fat cheeses such as cottage cheese and low fat cheese spreads (check that they are pasteurised) Choose diet/low fat fruit or natural low fat yogurts. Fats and oils These will not directly affect your blood glucose but choosing the right type of fat is beneficial to your health. It is important to remember that any type of fat is high in calories so cutting down can help you avoid gaining weight. Cut down on butter and margarine by putting less on your bread. Monounsaturated oils, for example olive and rapeseed (vegetable) oil, are healthier for your heart. Avoid using too much by page 8 of 12

9 measuring the oil used in cooking with a teaspoon or dessert spoon rather than pouring straight from the bottle. Cook food without added fat. Grill, roast, steam or poach rather than frying. Trim the fat from meat and remove the skin from chicken before cooking. Try to avoid high fat processed foods for example pies, pastries, chips, crisps, biscuits and cakes. Eat fewer take away meals. Alcohol Alcohol, if drunk during your pregnancy, will pass through the placenta to your baby. Your baby cannot process alcohol as well as you, so too much exposure to alcohol can seriously affect your baby s development. The Department of Health (DH) advises women to avoid alcohol during pregnancy. If you choose to drink, the DH advises limiting alcohol to no more than one or two units once or twice a week. page 9 of 12

10 Sample Menu Plan Breakfast Choose from one of the following: Breakfast cereal or porridge with low fat milk A couple of slices of toast with egg 1 slice of toast with baked beans 1 piece of fruit and a low fat yogurt Lunch and evening meal Ensure your meal includes items from each food group below: Meat, fish, eggs, cheese or dahl Potatoes, bread, rice, pasta or chapatti (around a third of a plate) Vegetables or salads (up to half a plate) Dessert Choose from one of the following: Tinned fruit in juice Fresh fruit Small serving of ice cream Yogurt page 10 of 12

11 What snacks are suitable to have between meals? Carbohydrate snacks Small fruit - apple, plum, kiwi, etc Small banana (fun size) Diet yogurt and other sugar free desserts Small glass of milk Thin small slice of bread with topping such as ham, chicken, salad, etc 2 wholegrain crackers, crispbreads 2 rice cakes 2 small plain biscuits Small bag of plain popcorn (15g) Non carbohydrate snacks Ham Chicken Hard boiled egg Tinned fish Hummus Vegetable sticks Sugar free jelly page 11 of 12

12 What happens after my baby is born Around six weeks after your baby is born, you may be asked to have another glucose tolerance test (GTT) to check that your blood glucose levels have returned to normal following your pregnancy. If so, you will be contacted should the test result be abnormal, and given advice about what to do next. Produced with support from Sheffield Hospitals Charity Working hard to fund improvements that make life better for patients and their families Please donate to help us do more Registered Charity No organdonation.nhs.uk Alternative formats may be available on request. Please Sheffield Teaching Hospitals NHS Foundation Trust 2015 Re-use of all or any part of this document is governed by copyright and the Re-use of Public Sector Information Regulations 2005 SI 2005 No Information on re-use can be obtained from the Information Governance Department, Sheffield Teaching Hospitals. PD8397-PIL1800 v2 Issue Date: November Review Date: November 2017