Food and diabetes diabetes in pregnancy

Transcription

1 Food and diabetes diabetes in pregnancy This leaflet provides dietary advice to pregnant women who have diabetes. If you have any further questions, please speak to your diabetes dietitian. The results of your glucose tolerance test have shown that your blood sugar level after eating is going above the level that is considered safe in pregnancy. This means that you have developed what is called gestational diabetes. It may be possible to achieve and maintain normal blood sugar levels by making simple changes in the diet. Some women may also need daily insulin injections as the pregnancy progresses. You will be instructed to test your blood regularly and to aim for blood sugar levels of 4-7 mmol/l. For a healthy pregnancy and a healthy baby it is essential that all suggested changes are started immediately. What changes do I need to make? Reducing the quantities of sugar that the body has to cope with is often enough to ensure that the blood sugar stays normal. Therefore, the first change is to limit all sugar, sugary foods and sweet drinks, such as cola, Ribena and Lucozade. Sweets, chocolate, cakes, biscuits, sweet desserts, such as ordinary jelly, mousse, custard and trifle, should also be avoided. Please see table on page 2. Fruit You may eat three or four fruits throughout the day (but not all at once). Fruit juices labelled pure/unsweetened have a high natural sugar content and should be restricted to one small glass a day as they can cause a high blood sugar. Dried fruit needs to be limited as it is a more concentrated source of sugar. However, small quantities in high-fibre breakfast cereals, for example, are acceptable. 1 of 5

2 The table below lists high-sugar foods and their alternatives High-sugar foods Instead you can use Sugar, dextrose, glucose, sucrose, invert sugar (sucrose that has been broken into glucose and fructose) Jam, honey, marmalade Sweetened squashes and cordials Sweetened fizzy drinks and glucose drinks, such as Lucozade, sweetened flavoured waters Sweet puddings and desserts, tinned fruit in syrup Fruit yoghurt, low-fat flavoured yogurts and flavoured fromage frais Sweet biscuits Drinking chocolate, Horlicks and Ovaltine Condensed milk Sweets, chocolates, mints Artificial sweetener, such as Canderel, Hermesetas, Sweetex, Nutrena, Sweet N Low and supermarkets own brands Reduced-sugar jam and marmalade, or pure fruit spread No added sugar or low-calorie drinks Diet drinks, mineral water, Pepsi Max, lowcalorie flavoured waters Sugar-free jelly, fresh fruit, tinned fruit in natural juice, homemade low-sugar puddings Natural yogurt, fromage frais, diet and very lowcalorie yogurts Plain biscuits, crackers, crispbreads (limit if you are overweight) Low-calorie chocolate drinks, such as Options, Highlights and supermarket own brands Milk, preferably skimmed or semi-skimmed Sugar-free mints or chewing gum Timing Having three to four small meals spaced throughout the whole day is easier for the body to cope with than one or two bigger meals. Meal size Each meal should contain some starchy carbohydrate food. Choose any of the following: bread, crispbreads, flour or flour-based products (such as chapattis), potato, rice, pasta, noodles, breakfast cereals, cereals, oats, yam, plantain, green banana, gari or kenkee. All these foods are digested and turned into sugar, therefore the quantities at any one time should be moderate. It is best to choose high-fibre starchy foods, such as high-fibre breakfast cereals (Shredded Wheat or Weetabix ) oats, or whole wheat or granary bread. 2 of 5

3 Balance of good health The plate model illustrated below shows the type of foods that you might include in your diet. Tips to help slow down weight gain Sometimes slowing the rate of weight gain can also help the body keep the levels of blood sugar down. So you may also need to reduce the amount of fat, oil and fatty foods that you are having. You will be advised about this if it is or becomes necessary. If you do need to cut down, bear in mind the following: All fats and oils are high in calories so use very little. Spread any butter or margarine very thinly, they all have the same calorie content. If you find it hard to cut down, it may be worth trying reduced fat spread usually labelled as Lite or reduced fat spread. Try to grill, bake, stew, boil, dry roast, steam or microwave. If you need to use oil in cooking, measure only a small amount of olive oil, rapeseed, corn or sunflower oil. Trim the fat off meat and remove the skin from poultry (chicken or turkey) before cooking. Use semi-skimmed or skimmed milk. Pregnant women are advised to take up to one pint (500ml) of milk per day or the equivalent as yogurt and cheese. This is to cover the increased need for calcium. All pies and pastry-based dishes should be limited as much as possible because of their very high fat and calorie content. Limit high-fat snacks, such as crisps and nuts. 3 of 5

4 Keep the amount of cheese quite small. Fish dishes including tinned fish are very nourishing for you and the baby but pour off any oil or choose the ones tinned in brine or tomato sauce. Keep the portions of meat, chicken and fish quite small. Try to include more beans, peas or lentils, as these are useful in improving your blood sugar levels. Other food-related guidance in pregnancy While you are pregnant, it is important to make sure that you and your baby stay healthy. You can take simple precautions, listed below, to avoid infection from foods and animals. 1. Avoid ripened/unpasteurised cheese, such as camembert, brie and similar blue veined cheeses. Reason: risk of listeria, a bacterial infection that may harm your unborn child. Instead, choose Edam, reduced fat cheddar, pasteurised low-fat soft cheese and cottage cheese. 2. Avoid raw egg products and ensure that all eggs are well cooked. Reason: risk of salmonella, a common cause of food poisoning leading to sickness and diarrhoea. Eat only hard-boiled eggs and thoroughly cooked egg dishes. 3. Avoid liver and liver products, such as paté or sausage. Reason: risk of very high level of Vitamin A, which could be harmful to your unborn child. 4. Don t eat food which has passed the manufacturers use by date indicated on the label. Reason: risk of food poisoning. 5. Reheat ready-cooked meals until piping hot. Reason: risk of listeria. Listeria has been found in cooked chilled meals. 6. Always wash all fruits, vegetables and salads to remove any soil and dirt which can carry bacteria and other organisms. Ensure any soil is also washed from hands and surface. 7. Avoid uncooked poultry (chicken or turkey), meat and unpasteurised goat s, sheep s, and cows milk. Reason: risk of toxoplasmosis, an infection caused by a parasite, which in rare cases can affect the unborn child. This organism is destroyed by thorough cooking. Please note that it is also found in cat faeces. 8. Follow good food hygiene wash hands before and after handling foods, and clean chopping boards and work surfaces. 9. Avoid eating raw shellfish, such as oysters and other shelled seafood, for example prawns, mussels and crab, unless they are part of a hot meal and have been cooked thoroughly. Reason: when raw, these foods may be contaminated with harmful bacteria and viruses leading to food poisoning. Further information and guidance on food hygiene and safety can be found on the Food Standards Agency website: 4 of 5

5 After your baby is born Once your baby is born, it is likely that your sugar levels will return to normal. However, you do have an increased risk of developing diabetes in any future pregnancies and later life. For this reason, we recommend that you continue with the healthier way of eating that is described in this booklet. It is not necessary to avoid sugar completely, simply reduce the amount and frequency. Eating less sugar, more fibre and not too much fat is a healthy way of eating that all the family should aim for. Lastly, there is a lot of evidence that regular exercise helps the body use insulin much more efficiently so try to find time for this too. Consult your doctor or midwife for some suggestions of suitable exercise. Useful sources of information Diabetes UK Provide information, help and peer support for people with diabetes so that they can manage their condition effectively. t: w: Contact us If you have any questions or concerns, please contact the diabetes dietitians on or (Monday to Friday, 9am to 5pm). For more information leaflets on conditions, procedures, treatments and services offered at our hospitals, please visit Pharmacy Medicines Helpline If you have any questions or concerns about your medicines, please speak to the staff caring for you or call our helpline. t: am to 5pm, Monday to Friday Patient Advice and Liaison Service (PALS) To make comments or raise concerns about the Trust s services, please contact PALS. Ask a member of staff to direct you to the PALS office or: t: at St Thomas t: at Guy s e: pals@gstt.nhs.uk Language Support Services If you need an interpreter or information about your care in a different language or format, please get in touch using the following contact details. t: fax: NHS 111 Offers medical help and advice from fully trained advisers supported by experienced nurses and paramedics. Available over the phone 24 hours a day. t: of 5 Leaflet number: 3919/VER1 Date published: June 2014 Review date: June Guy s and St Thomas NHS Foundation Trust