What are the recommendations for gestational diabetes?

Many women with gestational diabetes have healthy pregnancies and healthy babies because they follow the treatment plan that their health care providers set up for them.

One of the most important things you can do to help ensure a healthy pregnancy is to make regular health care appointments and keep them.                

A general treatment plan to control gestational diabetes may include these items:

• Knowing your blood sugar (also called glucose) level and keeping it under control  
• Eating a healthy, balanced diet
• Getting regular, moderate physical activity
• Maintaining a healthy weight gain
• Keeping daily records of your diet, physical activity, and glucose levels
• Taking medications as prescribed, you may need a medication if:
  • Your blood sugar level is too high.
  • Your blood sugar level is high too many times.
  • Your blood sugar level remains high, but you are not gaining much weight or are not eating poorly.
  • You cannot safely add physical activity to your treatment plan.

Know Your Blood Sugar Level and Keep it Under Control

The first step in this general treatment plan has two parts:

1) Knowing your blood sugar level—means you test to see how much glucose is in your blood; and

2) Keeping your blood sugar level under control—means you keep the amount of glucose within a healthy range at all times, by eating a healthy diet as outlined by your health care provider, getting regular physical activity, and taking medication, if needed.

Your blood sugar level changes during the day based on what foods you eat, when you eat, and how much you eat. Your level of physical activity and when you do physical activities also affect your blood sugar levels.

By getting to know your body and how it uses glucose during the day, you can help your health care provider to adjust your treatment program. Measuring your glucose level every day, and often during the day helps pinpoint when you need to eat, how much you should eat, and what kinds of foods are best for you.

As you get closer to your due date, your insulin resistance could increase. If that happens, you might need to take medication to help keep your glucose level under control. Knowing your glucose levels at specific times of the day will allow your health care provider to figure out the right medicine for you.

Follow your health care provider’s advice about when to test your glucose level. You will have to test your blood sugars four times a day and keep track of the numbers in a log book.

Even though your glucose level changes during the day, there is a healthy range for these levels.  The goal is to keep your glucose level within this range.  The following chart shows the healthy “target” range for each time you test.

Healthy Target Range for Glucose Levels

Talk to your health care provider about what to do if your glucose level is outside the healthy target listed here. You may have to adjust your treatment plan to get your levels into a healthy range.

Eat a Healthy, Balanced Diet

Eating a healthy diet is an important part of a treatment plan for gestational diabetes. A healthy diet includes a balance of foods from all the food groups, giving you the nutrients, vitamins, and minerals you need for a healthy pregnancy. For women with gestational diabetes, eating a balanced diet also helps to keep blood sugar levels in the healthy target range. Following a meal plan and eating a healthy diet is a key part of managing gestational diabetes.  It is essential that you work with your health care provider to create a plan for your healthy diet. The information in this booklet is for women who have been diagnosed with gestational diabetes. These guidelines are not appropriate for all pregnant women.

Carbohydrates

• Carbohydrates are part of a healthy diet for a woman with gestational diabetes.
• Carbohydrates are nutrients that come from certain foods, like grains, milk and yogurt, fruits, and starchy vegetables.
• During digestion, your body breaks down most carbohydrates into simple sugars, which is your body’s main source of energy.
• Eating carbohydrates increases your blood sugar level. If you eat a small amount of carbohydrate at a meal, your blood sugar level goes up a small amount. If you eat a large amount of carbohydrate at a meal, your blood sugar level goes up a large amount.
• You need to find a balance between eating enough carbohydrates to get the energy and glucose you need, and limiting the carbohydrates you eat to control your blood sugar level.  The best way to do this is to spread them throughout the day.
• Your health care team will come up with a healthy diet for you that includes the right amount of carbohydrates to maintain a healthy pregnancy.
• Women with gestational diabetes usually need to avoid foods that are high in sugar, like sweets and desserts, in order to keep their blood sugar level in control.
• Not getting enough carbohydrates can also cause problems. You should follow the meal plan provided by your health care provider.

Balancing your diet

• All foods contain some combination of carbohydrate, fat, and protein. Fat and protein affect your blood glucose over many hours, but carbohydrate affects it much faster. For this reason, you will need to regulate your intake of foods that are rich in carbohydrate (“carbs”). Your healthcare provider will show you how and your meal plan will help you stay on track.
• It is important to make healthy food choices. Nutritious foods support your baby’s growth and development, help control your gestational diabetes, and keep you feeling well.
• Controlling your gestational diabetes requires controlling the pattern of your eating. Your meal plan gives you targets for when to eat and how much to eat.

Steps to get started

1. Begin Counting Carbohydrates.  To manage your blood sugar you will learn a technique called “carbohydrate (“carb”) counting”.  This system helps you balance your meals and snacks throughout the day.  Begin by reading the Nutrition Facts labels for “Total Carbohydrates”.  Your target for will likely be 30-45 grams for meals and 15-30 grams for snacks. Details about Carbohydrate Counting.
2. Eat smaller amounts of carbohydrates at each meal. Rather than eating a large amount of carbohydrate at a single meal, spread out your carbohydrates throughout the day. Eating carbohydrates directly affects your blood sugar level, so eating a smaller amount of carbohydrate at regular intervals through the day will help keep your blood sugar from rising too high after a meal
3. Eat small, frequent meals and snacks. Eat about every 2 to 3 hours. Because you are eating fewer carbohydrates at your meals, you will needs to eat more frequently in order to meet your daily nutritional needs.  Plan at least 3 meals and 3 snacks a day.
4. Include protein at meals and snacks. You protein needs increase during your last trimester.  Protein may help even out your blood glucose. It may also help you feel more satisfied throughout the day.
5. Eat a very small breakfast, with a similar mid-morning snack about 2 hours later. Blood glucose levels tends to be higher in the morning. To offset this, your meal plan will probably include fewer carbs at breakfast than at lunch or dinner. 
6. Have a nighttime snack. It is good to eat a snack before you go to sleep to keep your blood sugar at a healthy level overnight. Some examples of healthy snacks include: a Greek yogurt, an apple with peanut butter or whole grain crackers with cheese.Choose high-fiber foods. Good sources include whole-grain breads and cereals, fresh and frozen vegetables, and beans. Fruits can also a good source of fiber — most plans include fruit in afternoon or evening meals and snacks.
7. Watch out for sugar and concentrated sweets.
   • Do not drink fruit juice.  Plan to get your fruit servings later in the day (not at breakfast). Although fruits are a healthy source of carbohydrate, their carbs are easily absorbed and tend to raise blood glucose levels quickly.
   • Avoid regular soft drinks, fruit juice and fruit drinks. High-carbohydrate drinks like these raise your blood glucose quickly.
   • Limit desserts such as ice cream, pies, cakes, and cookies. These foods often have large amounts of added sugar, honey, or other sweeteners.
   • Read labels carefully and check them for total carbohydrates per serving.
8. Be careful about fat
   • Consume lean protein foods, such as poultry and fish. Avoid high fat meats, lunch meat, bacon, sausage, and hot dogs.
   • Remove all visible fat by removing the skin of poultry and trimming fat from meat.
   • Bake, broil, steam, boil, or grill foods.
   • Avoid frying. If you do fry foods, use nonstick pans, vegetable oil spray, or small amounts (1 to 2 teaspoons) of oil.
   • Use skim or low-fat (1%) milk and dairy products.
   • Limit or avoid adding extra fat, such as butter, margarine, sour cream, mayonnaise, avocados, cream, cream cheese, salad dressing, or nuts.
   • Limit convenience foods. These are often higher in carbohydrate, fat, and sodium.
   • Avoid instant noodles, canned soup, instant potatoes, frozen meals, and packaged foods.

What are the recommendations for gestational diabetes screening?

What dietary recommendations would you give a pregnant woman with gestational diabetes?

What is the management of gestational diabetes?

What should I avoid with gestational diabetes?