﻿In this video we are going to look at how you can help to manage your
gestational diabetes through diet and lifestyle choices.
Gestational diabetes occurs when our blood glucose level goes too high during pregnancy.
Glucose is the sugar that is found in our blood. We get most of our glucose from a group of foods
called Carbohydrates. Our body normally keeps our blood glucose level nicely balanced using
a hormone called Insulin. During pregnancy, baby’s placenta produces other hormones that can make our
body become resistant to insulin. This sometimes leads to higher levels of glucose in the blood.
If blood glucose levels remain high this can increase the risk of a number of issues
during pregnancy and delivery of baby. However, by keeping your blood glucose level within a healthy
range, you can significantly reduce these risks. Most women with gestational diabetes go on to have
healthy babies and otherwise normal pregnancies. Gestational diabetes is managed by monitoring your
blood glucose, looking at the carbohydrates in your diet and regular physical activity.
First, let’s talk about diet. As I mentioned earlier, it is foods
that contain carbohydrate that are broken down into glucose, and increase our blood glucose
level. Carbohydrate foods are an important part of a healthy diet and should not be excluded from
our diet, even if you have Diabetes. Instead, it is important to look at the best types of carbs
to choose and what is considered a suitable portion size of these foods with diabetes.
So what are carbohydrates? These are foods and drinks
that are broken down by the body into glucose and used for energy.
They include starchy carbs and simple sugars. Starchy carbs include bread, rice, potato,
pasta, cereals, oats, and foods made from flour, such as pastry, chapattis and pizza.
Simple sugars include sweet treats, cakes, sugary drinks, jams, honey and syrups. Fruit
and some dairy foods such as milk and yoghurt also contain sugar, but they contain other
nutrients too that help to keep us healthy, and so are the better sugary options to go for.
Let’s look at the other food groups in our diet that don’t cause much of a rise in blood glucose.
There are protein foods, which include meat, fish, seafood and eggs. There are foods which are mostly
fat, such as butter, margarine, lard, ghee, oils and some dairy foods, like cheese and cream.
And there are vegetables. All of these foods take much longer for the body to digest, and as they
contain very little carbohydrate if any, they have very little effect on our blood glucose.
However, certain starchy vegetables can increase our blood glucose.
These include all kinds of potatoes, cassava and plantain.
Now let’s have a look at the different nutrients and their effect on blood glucose.
As you can see, carbohydrate is broken down into glucose and causes a rise in
blood sugar soon after it is eaten. Protein foods are not immediately
broken down into glucose and so have a minimal effect on blood sugars.
The same can be said for foods which are mostly fat.
Eating carbs, in combination with protein and fat foods,
can slow down the rise of glucose into your blood. This is called Food Pairing.
When we look at how quickly or slowly carbohydrate foods are absorbed into the blood, we are looking
at something called the Glycaemic Index, or GI. Pairing carbohydrate with proteins, fats and veg,
helps to lower the GI of the food. The lower the GI, the slower the rise.
Each person’s tolerance to carbs is a little different.
However, as a good starting point it would be useful to keep your carbohydrate portions
to around 1/3 of your plate, or the size of your clenched fist. Instead,
bulk up the rest of your plate with protein foods, vegetables and a little bit of healthy fat.
Carbohydrate foods which contain more fibre are better choices for managing gestational diabetes
as the fibre lowers the GI of the food and slows down the rise in blood glucose. Higher fibre carbs
include wholemeal, wholegrain or seeded versions, for example, seeded or granary bread, whole grain
or basmati rice, whole wheat pasta, noodles, oatcakes and wheat crackers. As for potatoes,
New or Sweet potatoes are the better options. Try to avoid white, refined carbs where possible
as these can have a high GI and will be absorbed quickly into the blood stream.
These include white bread, white rice and sugary cereals. It will be difficult for your body to
tolerate these at the moment. Mashed and baked potatoes may be ok in small amounts
but try to pair these foods with butter and cheese to reduce their effect on your ]
Now let’s have a look at some good choices for your meals and snacks.
If you tend to have a cereal-type breakfast, you could pick a wholegrain, low sugar option
with high fibre, such as shredded wheat or porridge, and have it with nuts and seeds.
Higher protein breakfast options such as a cooked breakfast, or cheese, eggs, fish or
peanut butter on granary toast, tend to work well with you blood sugar level at this time of day.
Rye or high protein bread is also a good option. As for yoghurts, plain natural yoghurt, Greek or
high protein Icelandic yoghurt are good options, especially if paired with nuts or seeds.
Low-fat yoghurts are often higher in sugar so best to avoid these where possible.
At Lunch time meal ideas could include Half a baked potato with tuna
mayonnaise or cheese. Greek salad with plenty of olives and feta cheese,
or Tuna salad with plenty of tuna and egg. You might also have a slice of seeded bread
or 2 wholegrain crackers or oatcakes with this. An open sandwich, soups, stews and casseroles.
Just be mindful of your carb portion size with these foods.
For your evening meal good options include Stews or casseroles with a small portion of rice.
Chicken or steak with salad and a handful of sweet potato fries.
Meat or vegetable curry with one chapatti or a cupful of cooked rice
Grilled fish fillets with new potatoes and salad Or Fajitas made with any meat, Quorn or tofu,
with vegetables and sour cream. As you can see, the majority of meals
can be adjusted to support your blood glucose level, simply by keeping your carbohydrate food
portion to 1/3rd of the plate and bulking up the rest of your meal with protein and veg.
As for snacks suitable options include sugar-free popcorn, Houmous or peanut
butter with carrot sticks or celery and Full fat Greek, or soya yoghurt with a little fruit.
Other options include oatcakes with cheese, Olives, Nuts and seeds, and cooked meats.
Drinks such as lattes, full sugar pop and fruit juice contain sugar
and will cause a rise in your blood glucose soon after drinking them.
This effect was demonstrated during your glucose tolerance test.
Drinks that contain very little or no sugar include water, no added sugar squash, diet soda,
and tea or coffee made without sugar and little milk. It is recommended that you drink 8-10
containers of sugar-free fluids every day, to help you to stay hydrated during your pregnancy.
So, we’ve talked about how you can manage your diabetes with your diet.
Now let’s look at how else you can support your diabetes.
It is really important to regularly monitor your blood glucose level with gestational diabetes.
Your diabetes team will ask you to test your blood glucose at least 4 times a day. This includes as
soon as you wake up in the morning – which we refer to as your fasting blood glucose - and
1 hour after your meals. In some instances you may also be asked to test before your meals too.
For blood glucose level targets, please refer to those advised by your diabetes team.
By testing your blood glucose level as advised, you will better understand what works for you
and can check that your gestational diabetes is being well controlled.
This information will also help your diabetes team to offer informed and timely advice,
to support you with keeping your blood glucose levels where they need to be.
We all know that being physically active is part of a healthy lifestyle,
and it is especially useful in supporting your blood glucose levels during pregnancy. This is
because during movement, your major muscles use some of the glucose in your blood for energy.
This can make your cells more sensitive to insulin. Even standing up for 20mins after a
meal rather than sitting straight down can help to reduce blood glucose levels by up to 25%.
However, moving around while pregnant can be difficult,
so try and find something that suits you. Any extra movement you can do will be worthwhile.
It is really important to remember that gestational diabetes affects
everyone differently. For some, diet and lifestyle are enough to control your blood glucose levels.
For others, sometimes medication may be needed to give you a helping hand. This may be in the
form of a tablet called metformin or as insulin, given by an injection, or a combination of both.
Please do not feel guilty if medication is needed to support you and your diabetes.
Sometimes, even with dietary and lifestyle change, your body’s insulin and blood sugars need more
support. This is not a reflection of your efforts, just the nature of gestational diabetes itself.
Remember, your diabetes team understands how difficult managing gestational diabetes can be,
and will always be there to offer their support.