Download Having a baby? - International Diabetes Federation

HAVING A BABY?
Now is the time to
learn about
gestational diabetes
WINGS
WOMEN IN
INDIA with GDM
STRATEGY
Having a baby? Now is the time to learn about gestational diabetes
An International
Diabetes Federation Programme
1
The WINGS programme has been developed through a partnership between the
International Diabetes Federation (IDF), the Madras Diabetes
Research Foundation [MDRF] in Chennai, India, and the Abbott Fund,
the philanthropic foundation of the global healthcare company Abbott.
The content in this brochure has been developed by IDF in collaboration with MDRF.
Advisory Board
Ms. Anne Belton, Chair
Dr. V. Mohan
Prof. Adel El-Sayad
Dr. Uma Ram
Dr. Usha Sririam
Dr. Ranjit Unnikrishnan
Dr. RM Anjana
Ms. Rutu Dave
Ms. S Mahalakshmi
IDF
Dr. Belma Malanda
Dr. A Kayal
2
Having a baby? Now is the time to learn about gestational diabetes
TABLE OF CONTENTS
Introduction
Eating patterns and food intake
Weight gain during pregnancy
Healthy eating
General guidelines
Your plate
How many calories can I have?
Sample meal plans
Vegetarian meal plan
Non-vegetarian meal plan
Physical activity
Keeping track of your activities
Monitoring your blood sugar
Insulin
If you need insulin
Preparing a single dose of insulin
Injecting insulin
Where to inject?
Two kinds of insulin in one syringe
Hypoglycemia
During pregnancy
After the baby is born
The future
Appointments
Notes
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4
5
6
8
9
10
11
12
14
16
18
20
22
24
25
26
27
28
29
31
32
34
35
36
38
3
Introduction
Many women develop diabetes when they are pregnant. For most women
diabetes would not show up until the second half of the pregnancy.
This is called gestational diabetes mellitus. Your doctor ordered a simple
blood test to see if you have gestational diabetes mellitus (GDM).
How does the doctor know you have diabetes?
The bloodtest you had is higher than it should be.
Your test was
It should have been lower than 140 mg/dl
Why do you need to know if you have diabetes?
• Diabetes is too much sugar in your blood. This can harm you and
your baby.
• Too much sugar in your blood may cause you baby to be too big.
• There are things you can do to reduce the sugar in your blood.
What can you do to keep your sugar level safe?
There are several things you can do;
• Eat a healthy diet.
• Be physically active.
• Keep your appointments with your doctor and health team.
In the next pages we will find out more about you and what you can do
to have a healthy baby.
4
Having a baby? Now is the time to learn about gestational diabetes
Eating patterns
and food intake
Let’s talk about your eating patterns first. You can find out more about
what you should eat and how much you should gain on pages 6 and 12-17.
TYPE OF FOOD
AMOUNT
For breakfast at:
I eat:
Mid morning at:
I eat:
At lunch at:
I eat:
Mid afternoon at:
I eat:
For dinner at:
I eat:
Before going to bed at:
I eat:
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5
Weight gain
during pregnancy
Almost all women should gain some weight during pregnancy but it is
important not to gain too much weight.
Step A:
The amount of weight you should gain is calculated from your weight
before you got pregnant and is expressed as your BMI.
Write your weight in kilogram here
Write your height in meter here
(Divide height in cms by 100)
To calculate your BMI:
Weight (kg)
= BMI
Height in meters2
=
= BMI
x
6
Having a baby? Now is the time to learn about gestational diabetes
Circle the category you are in.
18.0
22.9 23.0
normal weight
24.9 25.0
overweight
and more
obese
Step B:
In the table below circle the amount of weight you should gain in your
pregnancy.
If your BMI is
Your recommended weight gain is
Less than 18.5
12.5 – 18 kg
18.5 - 24.9
11.5 - 16kg
25 - 29.8
7 - 11.5 kg
Over 30
5 - 9 kg
Having a baby? Now is the time to learn about gestational diabetes
7
Healthy Eating
What kinds of food should you
eat to keep you and your baby
healthy?
In order to get all the nutrition, vitamins and minerals you and your
baby need, you should try to eat food from different sources every day.
That means you should eat:
• Grains and starches, such as wheat, rice, ragi
• Vegetables and fruits, such as vegetables and fruits excluding
banana, mango, custard apple, jackfruit, chickp and grapes
• Vegetable protein such as lentils, pulses, tofu and nuts
• Animal proteins such as egg white, chicken and fish
• Milk and milk sources such as yogurt, paneer
Try to eat 3 meals and 3 snacks a day. By spreading the food out over
the day you will be better able to keep your blood sugar in the target
range and you will not be hungry.
8
Having a baby? Now is the time to learn about gestational diabetes
General
guidelines
• Include 4-5 servings of greens, yellow and green vegetables in the
•
•
•
•
•
•
•
•
•
daily diet
Include iron rich foods like ragi, red rice flakes, brown rice, wheat
germ, agathi, drumstick leaves, sundakai
Include fresh wholesome foods – whole fruits instead of fruit
juices, whole grains/ multigrain flours instead of refined flours
Include adequate intake of fluids—2 litres/day unless your health
team has advised lower quantities
Include minimum of 650ml of milk allowances to meet the calcium
needs
Include lean meats instead of red meats
Eat less junk food, bakery products, fried foods, salted foods
Eat less oil intake, fried snacks
Avoid direct sugars, avoid artificial sweeteners
Avoid alcohol and tobacco in all forms
Do you need extra vitamins?
Most women will take folic acid 0.4—1.0 mg, prior to and during
pregnancy. You may also be asked to take iron and calcium
supplements.
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9
your plate
One way to decide how much to eat is to divide your plate like the one
below. Half the plate should contain vegetables, one quarter of the plate
should be starch or grains and one quarter should be protein.
Milk and fruit should be added to every meal.
Fruit
Protein
Milk /
Yoghurt
Vegetable
Vegetable
Fruit
Milk /
Yoghurt
Starch /
Cereal
Protein
Vegetable
Vegetable
Starch /
Cereal
10
Having a baby? Now is the time to learn about gestational diabetes
How much
should i eat?
If you are able to see a dietitian she will give you an exact calorie level
to follow.
If you do not have access to a dietitian we have provided 2 sample
meal plans.
At about the 4th month of the pregnancy you could add about 350 calories
a day to the meal plans. This would mean you are eating about 19002000 calories a day.
If you were overweight (BMI 23 and over) before you became pregnant
you should not increase as much.
If you were underweight (BMI less than 18) before you got pregnant you
could eat even more.
Be sure to weigh yourself during the pregnancy to see if you are gaining
as on page 7.
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11
Sample Meal
plans
On the following pages are 2 sample meal plans. The first on pages
14 and 15 is a vegetarian meal plan. The one on pages 16 and 17 is a
non-vegetarian meal plan.
Both meal plans provide 1600 calories/day. If you need more calories
you need to add more food.
See the list below for calorie amounts of commonly eaten foods.
(1 Katori = 150 ml)
12
Food item
Amount
Calories
Idly/ brown rice
1
65
Dosa/brown rice dosa
1
110
Chapathi (25 gms flour)
1
65
Ragi dosa (25 gms flour)
1
110
Oats (30 gms)
1 Katori
110
Idiyappam
1
65
Pongal/ brown rice pongal
1 Katori
145
Wheat rava upma/brown rice kitchdi
1 Katori
145
Vegetable adai (30 gms dhal, 20 gms veg)
1
102
Having a baby? Now is the time to learn about gestational diabetes
Food item
Bajra roti (30 gms)
Amount
1
Calories
65
Wheat bread
1
65
Brown rice (cooked)
100 gms
110
Vegetable pulav
1 Katori
180
Fish curry
1 Katori
145
Chicken curry
1 Katori
145
Red rice flakes (cooked)
1 Katori
110
Channa/Rajma/cow pea/green gram (boiled)
1 Katori
120
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1600 Calorie
Vegetarian Meal
Plan- for GDM
(SOUTH INDIAN PATTERN)
Morning
6.00-7.00 am
Breakfast
8.00-9.00 am
10.00 – 10.30 am
Mid Morning
11.00 –11.30 am
Lunch
1.00-2.00 pm
Tea Time
3.00-4.00 am
14
Skimmed milk / Coffee / Tea - 1 cup
Iddlies- 3 / Chappathi - 3 / Dosai – 2 Chutney
(vegetable based), Sambar
Skimmed milk – 1 cup (without sugar)
Lime / tomato juice (without sugar)
(or)
Buttermilk / vegetable salad / vegetable soup
Rice - 1 Katori (preferably brown rice) (raw weight
50 gms, cooked weight - 150 gms)
Sambar - 1 cup, rasam - 1 cup vegetables (salad,
green leafy, other vegetables)
Skimmed curd - 11/2 cup
Buttermilk - 1 glass
Whole grams - 1 Katori / day (Bengal gram /
green gram, cow pea / rajmah)
whole wheat bread - 1 slice (with gram / dhal /
vegetable filling)
(or) Wheat rava kitchidi- ½ Katori
(or) Rice flakes uppuma – ½ Katori
(or) Any dhal / gram preparation – ½ Katori
Coffee / tea / skimmed milk - 1 cup (without
sugar)
Having a baby? Now is the time to learn about gestational diabetes
Mid Evening
5.00-6.00 pm
Dinner
8.00-9.00 pm
Bed time
Apple - 1 (small size) / orange - 1 (medium
size/150 g)
Watermelon 300 g / muskmelon - 1/2
(medium size) / Sweet lime - 1 (medium size
300 g)
same as lunch (or) chappathi - 3
Dhal, Vegetables (salad, green leafy, other
vegetable)
Skimmed curds - 11/2 cup / buttermilk
1 cup of skimmed milk (without sugar)
oil for cooking
Ground nut oil (or) gingelly oil (or) sunflower oil –10 gms / day
(i.e.2 tsp)
Skimmed milk allowance – 680 ml/ day
1 cup - 120 ml
1 Katori - 150 ml
Carbohydrate: 225gms, protein – 65gms, fat – 40gms.
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15
1600 Calorie nonVegetarian Meal
Plan- for GDM
(SOUTH INDIAN PATTERN)
Morning
6.00-7.00 am
Breakfast
8.00-9.00 am
10.00 – 10.30 am
Mid Morning
11.00 –11.30 am
Lunch
1.00-2.00 pm
16
Skimmed milk / Coffee / Tea - 1 cup without
sugar
Iddlies- 3 / Chappathi - 3 / Dosai – 2
Chutney (vegetable based), Sambar
Skimmed milk – 1 cup (without sugar)
Lime / tomato juice (without sugar)
(or)
Buttermilk / vegetable salad / vegetable soup
Rice - 11/2 Katori (preferably brown rice) (raw
weight 50 gms, cooked weight - 150 gms)
Sambar - 1 cup, rasam - 1 cup vegetables (salad,
green leafy, other vegetables)
Skimmed curd - 11/2 cup
Buttermilk -1 glass
Whole grams - 1 Katori / day (Bengal gram /
green gram, cow pea / rajmah)
OR Fish/chicken (without skin) - 100 gms twice
weekly)
OR Mutton - 100 gms once weekly
Whole egg 1 daily
Having a baby? Now is the time to learn about gestational diabetes
Tea Time
3.00-4.00 pm
Mid Evening
5.00-6.00 pm
Dinner
8.00-9.00 pm
Bed time
Whole wheat bread - 1 slice (with gram / dhal
/ vegetable filling)
(or) Wheat rava kitchidi- ½ Katori
(or) Rice flakes uppuma – ½ Katori
(or) Any dhal / gram preparation – ½ Katori
Coffee / tea / skimmed milk - 1 cup (without
sugar)
Apple- 1 (small size) / orange- 1 (medium
size/150 gms)
Watermelon 300 g / muskmelon -1/2 (medium
size)/ Sweet lime-1 (medium size 300 gms)
Same as lunch
(or) chappathi - 3
Dhal, Vegetables (salad, green leafy, other
vegetable)
Skimmed curds - 1 1/2 cup/buttermilk
1 cup of skimmed milk (without sugar)
oil for cooking
Ground nut oil (or) gingelly oil (or) sunflower oil –10 gms / day
(i.e.2 tsp)
Skimmed milk allowance – 620 ml/ day
1 cup - 120 ml
1 Katori - 150 ml
Carbohydrate: 220 gms, protein – 67gms, fat – 40 gms.
Having a baby? Now is the time to learn about gestational diabetes
17
Physical Activity
How does exercise help your
blood sugar?
Exercise means being active. It helps to lower blood sugar. When you
have gestational diabetes being active every day can help lower your
blood sugar.
What is exercise?
Walking is good exercise.
What else might you do to stay active?
Before starting exercise discuss with your healthcare team.
Start with light to moderate exercise, i.e. 10 minute walk after meals,
upper body exercises while seated.
30 minutes a day is recommended.
Caution...
•
•
•
•
18
Do not do any exercises while lying flat on your back.
Stop exercising if you feel contractions.
Stop exercising if your heart rate goes over 140 beats per minute.
If you are taking insulin and feel you are having a low blood
glucose, stop exercising and treat it. See page 31
Having a baby? Now is the time to learn about gestational diabetes
What activity do you usually
do during the day?
Around the house
‰‰sweeping or cleaning inside
‰‰sweeping or cleaning outside
‰‰gardening
‰‰standing while washing or cooking
At work
‰‰walk to work? How far?
‰‰pedal bike to work
‰‰sitting all day
‰‰standing all day
‰‰walking around all day
‰‰lifting
Leisure activity
‰‰play with children
‰‰go for a walk, for how long?
‰‰other activity?
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19
Keeping track of
activity
One way to keep track of your activity is to wear a pedometer. This small device
is worn at your waist and counts every step you take all day long.
Record how many steps you are taking in the chart below. It is recommended that
people who are not pregnant take as many as 10,000 steps a day.
Write in the number of steps you take in a day and gradually increase your number.
Mon.
20
Tues.
Wed.
Thurs.
Fri.
Sat.
Sun.
Having a baby? Now is the time to learn about gestational diabetes
EXERCISES TO IMPROVE FLEXIBILITY
Do these exercises once a day. Try to do each one six times. Do them slowly and
stop if you experience pain or discomfort.
Cat
strech
Upper-back
strech
Heel cord and
hamstring strech
Pelvic tilt done standing
beginning with the 4th
month of pregnancy
Pelvic tilt done on
your back up to the 4th
month of pregnancy
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21
monitoring your
blood sugar
Your blood sugar will need to be checked several times during your
pregnancy.
You might do this at home if you have a blood glucose meter, or you
might need to go to the clinic to have the test done.
You should be tested at least 1 time a week until your numbers are ok,
then once a month until about 26 weeks and then once every 2 weeks.
Your numbers should be:
Before eating
1 hour after a meal
2 hours after a meal
less than 90 mg/dl.
less than 140 mg/dl.
less than 120 mg/dl.
Record your results
in the table on
the next page
22
Having a baby? Now is the time to learn about gestational diabetes
Record of blood sugar
results
Day
Before
breakfast
1 hour after a
meal
Having a baby? Now is the time to learn about gestational diabetes
2 hours after a
meal
23
insulin
Why do some women take
insulin?
Some women do not make enough of their own insulin as the baby grows.
Also their insulin may not work well.
Wise food choices + being active + a healthy body weight all help to
lower blood sugar. If this is not enough, taking insulin helps get your
blood sugar to a healthy level.
Is insulin recommended for you?
‰‰Yes No (If no, go to page 32)
How will you take insulin?
Insulin is injected using a syringe and a needle. Some people use an
insulin pen.
Be sure that your syringe matches the strength of the insulin you take.
Insulin strengths are U40 or U100.
What will I need to inject
insulin?
Syringes, needles - Insulin may come in a bottle (vial) or in a cartridge
that fits in the pen.
24
Having a baby? Now is the time to learn about gestational diabetes
If you need
insulin
What kind of insulin will I
take?
Date
Name of insulin
Amount
(dose)
Time
Action
What should my insulin look like?
NPH insulin or premix 70/30 insulin is cloudy.
Detemir and regular or rapid acting insulin is clear.
Name of insulin
What it looks like?
Where can I keep my insulin?
• Keep it in the fridge but not in an area where it might freeze.
• Mark the date you start using the insulin on the vial. After one
month start a new vial.
• Keep insulin out of sunlight.
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25
Preparing a
single type of
insulin injection
How to prepare insulin using
a syringe?
First you need to get the insulin into the syringe. Here is how you do it:
1. Wash your hands.
2. Get a syringe with a needle and your insulin.
3. Make sure you have the right insulin. Check the name on the
4.
5.
6.
7.
8.
9.
10.
11.
12.
13.
14.
26
bottle. Circle the strength U40 or U100.
If the insulin is cloudy roll the bottle upside down between your
hands to mix. Do not shake it.
Take the cap off the needle.
Pull the plunger back to draw in air equal to the amount of insulin
you take.
Put the needle through the rubber top.
Inject the air into the bottle and leave the needle in the bottle.
Turn the bottle upside down.
Keep the tip of the needle in the insulin.
Pull back on the plunger until you have the right amount of insulin
in the syringe.
If there are bubbles, tap the syringe with your finger. The bubbles
should go the top. Push them back into the bottle.
Recheck that you have the right dose of insulin.
Pull the needle out of the bottle and lay the syringe carefully on a
table. Do not let the needle touch anything.
Having a baby? Now is the time to learn about gestational diabetes
Injecting insulin
How to inject insulin
1.
2.
3.
4.
5.
6.
7.
8.
Wash you hands.
Prepare the syringe.
Choose the spot where you will give yourself insulin.
Push the needle through the skin quickly.
You can inject straight in or at a 45° angle.
Push the plunger all the way down.
Count to 5 to make sure all the insulin has gone in.
Pull the needle out and a little pressure on the spot.
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27
Where to inject?
Change spots where you inject. You might inject into your upper arms in
the day and into your upper leg in the evening. Move 2 inches from the
spot you injected into the last time.
The small squares in the diagram below show the spots where you
can inject your insulin. You may not want to use your abdomen during
pregnancy, arms and legs are preferred.
Common insulin injection
sites
28
Having a baby? Now is the time to learn about gestational diabetes
Two kinds of
insulin in one
syringe
Do you need to mix NPH and
regular insulin in one syringe?
‰‰Yes No (If no, go to page 32)
If you mix NPH and regular
insulin in one syringe, here is
what to do:
1. Wash your hands.
2. Get the syringe with a needle and both bottles of insulin.
3. Be sure you have the right kinds of insulin. Check the names on the
bottles.
4. Roll the cloudy insulin bottle upside down between your hands to
5.
6.
7.
8.
9.
10.
mix. Do not shake it.
Write down the name of the insulin you take and the strength:
 U40 or  U100
Clear insulin: Name ______________ Dose __________
Cloudy insulin: Name ______________ Dose __________
Total insulin: _________________________________
Take the cap off the needle.
Turn the bottle of clear insulin upside down.
Pull the plunger back to draw in air equal to the amount of clear
insulin you take.
Put the needle through the rubber top.
Inject the air into the clear insulin bottle and pull out the needle.
Having a baby? Now is the time to learn about gestational diabetes

29
11. Pull the plunger back to draw in air equal to the amount of cloudy
insulin you take.
12. Put the needle through the rubber top.
13. Inject the air into the cloudy insulin bottle and leave the needle in
the bottle.
14. Turn the bottle upside down.
15. Keep the tip of the needle in the insulin.
16. Pull back on the plunger until you have the right amount of cloudy
insulin in the syringe.
17. If there are bubbles, tap the syringe with your finger. The bubbles
should go the top. Push them back into the bottle.
18. Recheck that you have the right dose of insulin.
19. Pull the syringe out of the bottle and put the needle into the bottle
with the clear insulin.
20. Turn the bottle upside down.
21. Keep the tip of the needle in the insulin.
22. Pull back on the plunger until you have the total amount of insulin
needed.
23. If you mix some of the cloudy insulin in with the clear insulin
throw out the bottle of clear insulin . Use a new bottle for the next
injection.
30
Having a baby? Now is the time to learn about gestational diabetes
Hypoglycemia
When you take insulin it is possible that your blood glucose might drop
too low.
If this happens you might feel:
• Shaky
• Sweating
• Heart pounding
• Hungry
• Dizzy
If you feel any of these you need to eat something sweet right away,
such as:
• 3 teaspoons of sugar
• 1/2 glass of juice
• 1/2 can of regular soft drink
• 4-6 hard candies, chewed
• 1 cup milk with 2 tsp sugar
If you have a low before a meal, treat the low then eat the meal. If your
next meal is more than 1 hour away, have a snack.
You can prevent your blood sugar from dropping too low by eating your
meals on time and eating a little extra if you are going to be very active.
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31
During Pregnancy
Your doctor will measure the size of your baby at every visit. By keeping
your blood sugar at normal levels your baby will stay a normal size.
If you blood sugars are too high during the pregnancy,
• The baby may get bigger than normal
• The baby may have trouble breathing after birth
• The baby may have a low blood sugar immediately after birth
AC in mm
450
405
360
315
270
225
180
135
90
45
0
32
12
15
18
21
24
27
30
33
36
39 42
GA in weeks
Having a baby? Now is the time to learn about gestational diabetes
WEIGHT BPD AC in gms*10
450
405
360
315
270
225
180
135
90
45
0
12
15
18
21
24
27
30
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33
36
39 42
GA in weeks
33
After the baby is
born
Your blood sugars will likely return to normal and you may not need insulin.
You may have another blood test done a day after delivery just to make
sure your level has returned to normal.
Your baby will not have diabetes.
Your baby may have slightly lower blood sugar levels than he should
in the first hours after birth. This may require the baby be given some
sugar water.
You should breast feed your baby. Breastfeeding is healthy for the baby
and for you.
You should get back to a healthy weight by eating a healthy meals and
getting some regular physical activity.
Birth control:
Your next pregnancy should be planned. Breast feeding offers some
protection against getting pregnant but is not a guaranteed birth control
method. Speak to your doctor about birth control until you are ready to
get pregnant again.
Very important:
Between 6 – 12 weeks after your baby is born you need to return to the
clinic for a blood test. Your blood will be tested before you eat and then
again 1 and 2 hours after you have had a 75 gm glucose drink.
This test will determine if you have developed pre-diabetes or diabetes.
34
Having a baby? Now is the time to learn about gestational diabetes
The future
Another pregnancy?
Yes you can have another baby. Be sure to get your blood sugar checked before
you get pregnant. Once you are pregnant go to see your doctor early in the
pregnancy and be sure to tell the doctor you had gestational diabetes mellitus.
Birth Control
Any birth control is acceptable for women who have had gestational
diabetes mellitus.
Risk of type 2 diabetes
Women who have had gestational diabetes mellitus are at high risk of
developing type 2 diabetes. You should have a blood test done every year
to see if you have developed it.
Having a baby? Now is the time to learn about gestational diabetes
35
My appointments
Date
36
Time
Where
Having a baby? Now is the time to learn about gestational diabetes
Date
Time
Having a baby? Now is the time to learn about gestational diabetes
Where
37
notes
38
Having a baby? Now is the time to learn about gestational diabetes
MY BABY
Name of baby
Date of birth
Weight at birth
Length of baby
Amount of hair
Colour of eyes
HAVING
A BABY?
Now is the time
to learn about
gestational
diabetes
Paste a picture of your baby here:
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39
HAVING
A BABY?
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to learn about
gestational
diabetes
40
Having a baby? Now is the time to learn about gestational diabetes