Healthy Eating with Gestational Diabetes

Healthy Eating with Gestational Diabetes

What is gestational diabetes? Gestational diabetes is the name given to diabetes that can occur during pregnancy (Gestation). Diabetes is an inability of the body to control the amount of sugar (glucose) in the blood. Why does this happen? Insulin is a hormone, which controls the glucose level in the blood. During pregnancy extra hormones and weight can increase the demand for insulin and in gestational diabetes your body cannot meet the extra demand or the quality of the insulin is inadequate (insulin resistance). How is it diagnosed? A glucose tolerance test is performed at booking if there are risk factors for gestational diabetes if this is negative the test is repeated at around 28 weeks gestation. A diagnosis of gestational diabetes is made when the blood glucose level is 7.8 mmol/l or above 2 hours after the test. If you have had gestational diabetes previously it is suggested that you start blood glucose monitoring early in your pregnancy. It is unlikely you will be asked to have a glucose tolerance test. 2

Risk factors for gestational diabetes A first degree relative with diabetes An unexplained stillbirth or neonatal death in a previous pregnancy A very large infant (greater than 4.5 kg) in a previous pregnancy Polycystic Ovary Syndrome (PCOS) Family origin with high prevalence of diabetes such as South Asian and Afro Caribbean Age over 35 years Gestational Diabetes in previous pregnancies BMI (body mass index) above 30kg/m 2 Blood Glucose Targets for Gestational Diabetes Pre Meal 3.5-5.3mmol/L 1 hour post meal 4-7.5mmol/L A balanced diet When you are pregnant it is important to follow a balanced diet to make sure that you and your baby get all of the nutrients that you need. This booklet provides some advice on a balanced diet for pregnancy while helping to control your diabetes and weight. If you have any questions about diet, pregnancy and diabetes please ask your midwife or dietitian. 3

Which foods cause my blood glucose levels to rise? There are 3 main nutrients that we eat: fat, protein and carbohydrates Carbohydrates are the foods that affect blood glucose levels. All carbohydrates are broken down into sugar (glucose). This glucose is absorbed into the blood stream and causes your blood glucose levels to rise. You need a regular supply of carbohydrate fuel over the day and the insulin you produce helps you to use this glucose for energy. The amount of glucose produced depends on the amount of carbohydrate eaten. Therefore it is important to spread carbohydrate foods evenly over the day and to avoid large portions. Blood glucose monitoring will help you to have an understanding of how different carbohydrate foods and portions affect your blood glucose levels. There are 4 main types of carbohydrate: Starch (e.g. potatoes or pasta) Sugar (glucose or sucrose) Fruit sugar (fructose) Milk sugar (Lactose) Fats and proteins have little, if any affect on your blood glucose levels. The amount of these eaten, especially fat, can affect your weight though. 4

Foods containing carbohydrates Sugar, e.g. glucose, fructose Breakfast cereals and cereal based products Fruit and fruit juices Pasta and grains, e.g. rice, couscous, bulgur wheat All types of bread and bread products Milk and milky products like yoghurt, ice cream Pulses, e.g. peas, beans and lentils Potatoes and yams Snacks like biscuits, cakes, crisps, cereal bars Confectionary sweets and chocolates Pies/pasties/pastry products Portion sizes for carbohydrates A portion of fruit or starchy carbohydrate should be no larger than the size of your fist: 5

Fortifying Food Healthy Portions Plate Choose low GI (slowly absorbed) starches whenever possible. Eat regular meals Sugary foods should be kept to a minimum. Replace larger portions of starchy foods with extra vegetables, low fat proteins e.g. chicken and fish or beans and pulses. 6

A word about breakfast time You have been asked to test your blood glucose levels before your meals and 1 hour afterwards. Breakfast is often the hardest meal to control the post-meal glucose level due to high levels of hormones your placenta produces at this time, especially in your 3rd trimester. You will likely need to eat less carbohydrates at this time of the day and may find including more protein based foods to help you feel fuller for longer. You could also try to split your breakfast i.e have half of your usual breakfast when you get up and then a mid morning snack with the other half. Some breakfast ideas: 1 slice of toast with mushrooms, tomatoes or eggs Plain or full fat Greek yoghurt with a handful of berries or tablespoon dried fruit Small bowl of plain porridge oats (some may not even manage this) Bacon and scrambled eggs For more ideas see the Enjoy Food section of the Diabetes UK website https://www.diabetes.org.uk/guide-to-diabetes/ Recipes/ 7

The Glycaemic Index High GI foods are broken down into sugars very quickly and so cause a rapid rise in blood glucose levels. Low GI foods are broken down into sugars much more gradually and so cause a more gradual rise and fall in blood glucose levels. They can also help you to feel fuller for longer and are a more slow release source of energy Try to choose low Glycaemic Index (GI) starchy foods. Low GI starchy foods release glucose very slowly into the blood, which is good for controlling your blood glucose level. Try to avoid large amounts of foods with a high glycaemic index. 8

Food Low <50 Medium 56-69 High >70 Breads Grains and Pasta Wholegrain or mixed grain breads, e.g. granary, rye bread, linseed bread Pasta (including gluten free), buckwheat, bulgur wheat, (cook al dente) Pitta breads, English muffins, crumpets, croissant Basmati rice, couscous, quinoa, brown rice Cereals Porridge Oats Shredded wheat, muesli Potatoes French fries, instant potato, roast potato, mashed potatoes Broad beans, parsnip Vegetables and pulses Sweet potato, yam Most vegetables All beans and pulses including peas New potatoes, boiled potatoes Beetroot White bread, Wholemeal bread, baguettes bagels white rice, rice cakes, cream crackers Sultana bran, rice krispies, cornflakes, sugary cereals weetabix 9

Food Low <50 Medium 56-69 High >70 Fruit Apples, pears, orange, kiwi, cherries, plums, grapes, strawberries, peach, mango dried pear, dried apricots, prunes, apricot, banana, fruit juice, smoothie sultanas, raisins, dried figs, pineapple Dried dates, melon Dairy Biscuits Low fat milk, diet yoghurt, soya milk, soya yoghurts, plain or greek yoghurt Oatmeal biscuits Rich tea, digestives, shortbread Rice milk vanilla wafer, custard creams, bourbon biscuits Other foods (limit portions of these) Dark chocolate, peanuts, cashew nuts, crisps Honey, reduced sugar jams Sugar, glucose tablets, soft drinks, sweets, jam and marmalade, popcorn 10

Small changes It may seem daunting if you need to cut back a lot from your usual eating pattern. Try these small changes Meal Current choice Try instead Breakfast White toast with jam Granary toast with reduced sugar jam OR porridge with milk Fruit juice A piece of fruit Snack Chocolate biscuit Plain biscuit or oat Lunch Brown bread ham sandwich, crisps and low fat yoghurt biscuit Ham and 2 high fibre crackers, small fruit portion, diet yoghurt Snack Crisps Fruit/veg sticks with hummus/mashed avocado or handful of popcorn/unsalted nuts/seeds Evening meal Cheese and pasta bake with garlic bread Small amount of pasta bake with added vegetables or side salad Fruit pie and custard Tinned fruit, juice removed, with natural yoghurt or small amount of custard made with sweetener Or sugar free jelly Evening snack Sugar coated cereal with milk High fibre cereal with milk or handful nuts Drinks With added sugar With sweetener or nothing added/water 11

Vegetables Fruit and vegetables are full of vitamins that are very good for you and your baby. Aim for at least 5 portions of fruit and vegetables a day. They also contain lots of fibre, which helps to fill you up and helps to prevent constipation which can sometimes be a problem in pregnancy. Filling up on vegetables at your main meal is really important to help to prevent too much weight gain. You should aim to have half the plate filled with vegetables, a quarter of the plate taken up with starchy food and the other quarter a portion of meat or fish. Ideas to include extra vegetables Salad with your meal Boiled vegetables on the side if you are having a ready meal Add extra vegetables into stews, curries, and pasta sauces Chop up vegetables like carrots and celery and have them as snacks Add beans and pulses to meals to help feel fuller. They are also low kcal and count as one of your 5 a day 1 portion vegetables = 80g 12

Can I eat fruit? Can I eat fruit? Fruit is an excellent, nutritious snack and is full of vitamins and fibre. Try to eat whole fruit rather than fruit juice. Fruit juice and smoothies have a large amount of fruit sugar. Try to have no more than 150ml per day but you may have to cut out these drinks out altogether if it causes your post blood glucose levels to rise too high. Having a piece of whole fruit would be preferable Try having fruit as a snack instead of crisps, biscuits or chocolate. You can have 3 to 4 portions of fruit each day (a portion of fresh fruit is about a handful one apple, one small banana, a handful of grapes, 2 satsumas etc a portion of dried fruit is around 1 tablespoon). Try to spread fruit out over the day and don t eat more than one portion at a time as they contain natural sugars (Fructose). This will help to control effects on blood glucose. 13

Eating for two? Should I gain or lose weight? Some people believe that because they are pregnant they should be eating lots more to feed the growing baby. Actually you don t need to eat much more than you would usually. It is more important that you eat the right balance of foods. Controlling your weight gain will help to control your diabetes and to help your baby s development. You should not aim to lose weight during pregnancy but if you were overweight before you became pregnant you should try to keep your weight stable and avoid gaining lots of weight. Your dietitian or midwife can discuss the right level of weight gain for you based on your weight before or at the beginning of pregnancy. 14

Top tips to prevent too much weight gain during pregnancy 1. Eat regular meals, 3 times a day. 2. Limit portion sizes and follow the handy portion guide on page 5. 3. Eat plenty of vegetables and salad. 4. Snack on a piece of fruit instead of crisps, biscuits, cakes. 5. Eat less fat. For example avoid pastry, fried foods, chocolate, biscuits, butter, cream. 6. Eat more fibre. Do this by including plenty of vegetables and fruit, and choosing wholegrain options. 7. Avoid sugary foods and drinks. 8. Drink plenty of water. 9. Be active, for example go for a 30 minute walk each day. Exercise Regular exercise can help improve blood glucose control Try including some moderate exercise such as a 30minute walk daily. 15

Leaflet produced by Western Sussex Hospitals Dietitians. For further information or to provide feedback please contact: St Richard s Hospital Tel: 01243 831498 Email: wshnt.chichesterdietitians@nhs.net Worthing & Southlands Hospital Tel: 01903 286779 Email: worthing.dietitians@wsht.nhs.uk We are committed to making our publications as accessible as possible. If you need this document in an alternative format, for example, large print, Braille or a language other than English, please contact the Communications Office by emailing Communications@wsht.nhs.uk www.westernsussexhospitals.nhs.uk Department: Diabetes Dietitians Issue date: August 2016 Review date: August 2018 Author: Chichester Diabetes Dietitians Version: 3 16