Download Gestational Diabetes: Basic Facts (MC 1656)

Gestational Diabetes
Gestational Diabetes – Basic Facts
Gestational Diabetes Mellitus (GDM) is a type of diabetes that only occurs during pregnancy. It
is a condition whereby the amount of glucose (sugar) in the blood rises above normal. This
usually occurs between the 24th and 28th week of pregnancy, when the placenta begins to
produce large quantities of hormones that cause your body’s insulin to be less effective.
The Good News
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GDM can be controlled.
You can have a healthy baby.
After GDM, your blood sugar usually goes back to normal levels.
Who is at risk? Women who:
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Have had GDM during a previous
pregnancy.
Have had previous babies weighing
more than 9 pounds.
Weigh more than 20% their ideal body
weight.
Are 25 years of age or older.
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Have a strong family history of diabetes
(1st degree relative).
Belong to a high-risk ethnic group, such
as African American, Hispanic,
American Indian, Alaskan Native,
Asian, Pacific Islander, or Indigenous
Australian.
Potential Concerns for the Baby
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High birth weight.
Low blood sugar after delivery.
Potential Concerns for the Mother
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Difficult delivery.
Increased risk of developing type 2 diabetes later in life.
How Can I Control my Gestational Diabetes?
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Follow a personalized meal plan developed by your Registered Dietitian.
Check your blood glucose and urine ketones at home – a Nurse Educator will teach you how.
Exercise regularly according to your doctor’s recommendations, to help control blood
glucose.
Work with your Diabetes team (Endocrinologist, Obstetrician, Nurse Practitioner, Nurse
Educator, and Registered Dietitian).
Copyright © 2007 by Joslin Diabetes Center (www.joslin.org). All rights reserved.
This document may be used for personal, noncommercial use only.
For permission for other use call (617-226-5815).
JDC # 0115-1007-001-0000
Understanding Blood Glucose
You should check blood glucose on a regular schedule. We recommend checking when you
wake up in the morning (fasting), and one hour after each meal. Keep records of your results in
your logbook or on the blood glucose record sheet and bring them to all your appointments.
Your blood glucose levels should be:
Before Breakfast
One Hour after Meals
less than 100 mg/dl
less than 130 mg/dl
90
Ketones
When fats are broken down for energy, by-products called ketones appear in the urine. In
pregnancy, this tells us that mom is not eating enough carbohydrate foods for her and for the
baby. Your Nurse Educator will teach you how to check for ketones.
You may use any brand of urine ketone strips. It is important to wait the correct amount of time
between placing the strip in the urine and reading the results (matching the colors). The goal for
this test is “negative”. In addition to checking blood glucose, you should check for ketones
everyday and write the results on your log sheet. Ketones should be checked each morning
before breakfast (the first urine of the day).
Schedule
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Before Breakfast (upon waking)
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One hour after breakfast
One hour after lunch
One hour after dinner/supper
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Urine ketone check
Blood glucose check
Blood glucose check
Blood glucose check
Blood glucose check
Staying Active
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Find something you like to do, such as walking, swimming, dancing,
or cycling.
Put activity into your schedule every day.
Even 20 minutes of walking after a meal can help to bring down blood
glucose numbers.
Include warm up and cool down.
Check with your health care provider about any possible activity
restrictions.
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Menu Planning Tips
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Eat at least 3 meals and 2-4 snacks each day. Choose a variety of foods.
Space your meals and snacks throughout the day to help you control your blood sugar.
Read food labels carefully and check serving sizes! You may think you are only eating
“1/2 cup,” but when you measure the food, it may be different.
Be sure to eat at least 2 servings of fruit and try to have 3-4 servings of dairy each day.
Keep your Carbohydrate Consistent from Meal to Meal
For blood sugar control, the most important part of your meal plan is to keep the amount of
carbohydrate that you eat about the same at each breakfast, each lunch, each supper and each
snack. Once you have found the right amount of carbohydrate to meet your blood sugar goals
(and also meet your weight goals during pregnancy) – you should stick with it! It does NOT
mean you have to eat the same foods.
Eat More Vegetables and High Fiber Foods
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Vegetables such as green beans, broccoli, cabbage, tomatoes and carrots are low in
carbohydrate; they are usually not “counted” unless you eat 3 or more servings at a meal.
Remember, some vegetables such as corn and peas are higher in carbohydrate and are
found in the starch food list.
Add beans like kidney beans or chickpeas to salads and soups; they have about 8 grams
fiber per half cup.
Look for “whole grain” foods when choosing breads, pastas, cereals, and crackers.
Carbohydrate Snack Ideas
1 carb (15 grams)
Low fat milk, 1 cup
Low fat, “light” yogurt, 6
oz
Small fresh fruit, 1 piece
1 ¼ cups strawberries or ¾
cup blueberries
Low fat cottage cheese with
1 cup strawberries
Sugar-free hot chocolate
with ½ cup low fat milk
1 ½ carbs (20-25 grams)
2 graham cracker squares and
1 cup low fat milk
6 Melba rounds with 1–2 oz
cheese or 1 tablespoon peanut
butter
1 small whole wheat pita, ¼
cup hummus and raw
vegetables
15-20 baked tortilla chips with
½ cup salsa
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2 carbs (30 grams)
½ sandwich and 1 cup low fat
milk
Sandwich with lean meat
Cottage cheese with 10 small
whole wheat crackers or 1½ cups
blueberries
Whole grain cereal, ½-¾ cup,
with 1 cup low fat milk
Smoothie: ¾ cup plain yogurt
blended with 1 cup frozen
raspberries
Choose Fish Carefully
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Fish, especially oily fish such as salmon, is an excellent source of protein, vitamin D and
omega-3 fats. However, some fish are high in mercury. Be sure to avoid the following
fish while you are pregnant: shark, swordfish, king mackerel and tilefish (golden or white
snapper). Limit albacore (white) tuna to 6 ounces per week. Use the website
“www.gotmercury.org” to check out mercury content of your favorite fish.
Fish that’s okay to eat include salmon, pollock, sardines, haddock, and canned light tuna.
Also, shellfish such as shrimp, lobster, and clams are safe to eat.
Avoid eating raw fish, such as sushi.
Sweeteners
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Foods and drinks that are sweetened with aspartame (Equal), acesulfame-K (Sweet One)
or sucralose (Splenda) are okay to use in moderation. Saccharin (Sweet ‘N Low) is not
recommended during pregnancy.
Sugar alcohols (sorbitol, mannitol, xylitol) are safe for use in pregnancy, but may have a
laxative effect. Remember that foods containing these sweeteners still contain
carbohydrate and must be “counted” in your meal plan.
Caffeine
Limit your caffeine intake to no more than 200 mg per day. Caffeine is found in regular
coffee and tea, as well as in many soft drinks. An 8-oz cup of regular coffee contains about
135 mg of caffeine; an 8-oz cup of black tea contains about 50 mg; and a 12-oz can of diet
cola contains about 35 mg of caffeine.
Calcium
Aim to consume at least 1,000 mg of calcium each day. Good sources of calcium include
milk, yogurt, cheese, and tofu with added calcium. One cup of milk and yogurt contains
about 300 mg of calcium; 1 oz hard cheese contains about 200 mg of calcium, and ½ cup
tofu contains 260 mg of calcium. If you would prefer to take your calcium by
supplementation, try the following;
 Calcium carbonate is generally the most economical calcium supplement.
 Take calcium supplements with meals, although calcium citrate or malate can be taken at
anytime.
 Take supplements containing up to 500 mg of calcium; we do not absorb more than that
amount at one time.
 Avoid supplements that contain bone meal or dolomite and look for supplements that are
labeled “lead-free”.
 Calcium supplements should be labeled with the amount of actual calcium or “elemental
calcium”. For example, the Supplement Facts panel for calcium carbonate might read
“Calcium (as calcium carbonate) 500 mg”.
 Calcium can decrease iron absorption from your iron supplement so take iron
supplements two hours apart from calcium supplements or calcium-rich foods.
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Folic Acid
Folic acid is needed to help make and maintain new cells and to help prevent anemia. The goal
for folic acid in pregnancy is 600 mcg per day. Prenatal vitamins include folic acid. Food
sources include breakfast cereals, enriched grain products, beans, dark leafy vegetables, and
fruits.
Iron
Iron helps to carry oxygen throughout the body and to regulate cell growth. The goal for iron
intake in pregnancy is 27 mg per day. Iron is available in prenatal vitamins and food sources.
Include iron in the diet by eating fortified cereals, lean meats, beans, and green vegetables.
Having vitamin C-rich food such as citrus fruits may help the body to absorb more iron from
vegetable sources. In GDM, it may be better to have fresh fruit instead of juice for added
vitamin C when taking iron supplements, because of the impact on blood glucose.
Listeria
Pregnant women are at high risk for illness from Listeria, which is a bacteria found in many
foods. To keep safe, follow these tips;
 Make sure that hot dogs and deli meats are reheated until steaming hot; do not eat cold.
 Do not eat refrigerated pate spreads or smoked seafood; canned fish are okay to eat.
 Do not drink unpasteurized milk or eat products that contain unpasteurized milk.
 Avoid store-bought protein salads like ham, chicken, egg, tuna, and seafood. If making
them at home, make sure to cook protein thoroughly and refrigerate leftovers in airtight
containers.
 Soft cheeses like feta, Brie, Camembert and Mexican varieties like queso blanco and
queso fresco, can be eaten if they are labeled as made with pasteurized milk.
Alcohol
Alcohol has been linked to Fetal Alcohol Syndrome and should be avoided throughout
pregnancy.
Herbal Supplements
Herbal supplements are not regulated by the federal government and may contain ingredients
that are not listed on the packaging. Some supplements have been associated with negative
side effects during pregnancy. Always discuss the use of supplements and over the counter
medications with your doctor.
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Sample Menus
Breakfast 2 carb choices or 30 grams carb
Rye toast, 1 slice
Low fat cheese, 2 oz
Low fat milk, 1 cup
Oatmeal, ½ cup
Low fat milk, 1 cup
1 whole wheat English ”Light” yogurt, 6 oz
muffin,
Mini-shredded wheat
Low fat cheese, cottage biscuits, ½ cup
cheese or peanut butter
Lunch 3 carb choices or 45 grams carb
Sandwich:
Whole grain bread, 2
slices
Lean meat, 3-4oz
Lettuce and tomato
Low fat mayo, 2 tsp
Low fat milk, 1 cup
Seltzer with
lemon/lime
1 medium whole wheat
pita
Sliced turkey, 3-4 oz
Low fat mayo or
mustard
Cut up raw veggies
1 small piece fresh fruit
Sugar-free drink or
seltzer with lemon/lime
Chili, 1 cup
on a small
baked
potato
Side salad
with Italian
dressing
Seltzer with
lemon/lime
or
herbal tea
Noodle soup, 1 cup
Wheat crackers, 6 small
Low fat cheese, 2 oz
Sugar-free drink or
seltzer with lemon/lime
or
herbal tea
Dinner 3 carb choices or 45 grams carb
Baked fish 4 oz
Potato, 1 medium
Corn, ½ cup
Green beans
Margarine, 1 T
Sugar-free beverage
Rice, 2/3 cup
Red beans, ½ cup
Chicken, 4 oz.
Large green salad with
tomatoes and cucumbers
Oil and vinegar dressing
Sugar-free beverage or
seltzer with lemon/lime
Salad, raw vegetables
Oil and vinegar
dressing
Steamed vegetables
and 1 cup winter
squash with lean beef
strips, 4 oz
1 small whole wheat
pita or dinner roll
Melon, 1 cup
Sugar-free beverage
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Thin spaghetti, 1 cup
Tomato sauce, ½ c.
Meatballs using ground
turkey, 4 oz
Steamed green
vegetables
Garden salad
Oil and vinegar dressing
Flavored seltzer water
MY MEAL PLAN
Meal
Sample #1
Breakfast
Time: _____
_____Carb choices or
Carb grams _____
____Starch
____Fruit
____Milk
_____ Meat / Protein choices
_____ Fat choices
Snack
Time:_____
Lunch
Time:_____
_____Carb choices or
Carb grams _____
____Starch
____Fruit
____Milk
____Vegetables
_____ Meat / Protein choices
_____ Fat choices
Snack
Time:_____
Supper
Time: _____
_____Carb choices or
Carb grams _____
____Starch
____Fruit
____Milk
____Vegetables
_____ Meat / Protein choices
_____ Fat choices
Snack
Time:_____
Notes:
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Sample #2
Staying in Touch with your Health Care Team
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You are the most important member of your team.
Keep all your appointments for doctors and educators.
Call if you have questions.
Call if blood glucose is not in target.
Call if you don’t feel well.
The team is here to help you have a healthy baby.
Your Action Plan
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Check blood glucose 4 times a day and record results in your logbook/log sheets.
o Fasting (before breakfast) – within the first half hour of waking.
o One hour after each meal – one hour from the start of eating.
Follow a healthy meal plan; control carbohydrates, especially at breakfast!
o Have balanced meals with lean protein, heart healthy fat, and moderate
carbohydrate.
o Make an appointment to see a licensed Registered Dietitian.
Be physically active at least 20-30 minutes each day.
Check urine for ketones each morning.
If blood glucose continues to run high, you may need insulin; it is safe and effective.
Keep all appointments with your healthcare team.
Call your healthcare team if blood glucose levels are not in target range.
Follow up appointments:
_____________________________________
Fax food and blood glucose records on: _____________________________________
Your Joslin Healthcare Team and Diabetes Educators
Joslin MD:
__________________________________
Diabetes Educators:
__________________________________
Pregnancy Program Coordinator: __________________________________
Telephone number:
__________________________________
Fax number:
__________________________________
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