On this page:
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.
This booklet gives you general guidelines for how to stay healthy with
gestational diabetes. Your health care provider can build a treatment program
to meet your specific needs. Remember that the most important person in the
treatment plan is you. You are the one who will be doing the work to keep
yourself healthy. Make sure you feel comfortable asking questions and talking
to your health care provider about any worries that you have.
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.
In this way, your health care provider can catch any problems before they
become major health issues.
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 diet, as outlined by your health care provider
- Getting regular, moderate physical activity
- Maintaining a healthy weight gain
- Keeping daily records of your diet, physical activity, and glucose levels
- Taking insulin and/or other medications as prescribed
Your health care provider should also tell you to:
- Test your urine for ketones, if needed.
- Have your blood pressure checked as indicated.
What are these things? Why are they important? How do you do them?
When do you do them? How do you know if you're doing them right? To
answer these questions, let's look at each one more closely.
Know your blood sugar level and keep it under control
What is it?
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 insulin, if needed.
Why do I have to do it?
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. Knowing if your glucose level is in the healthy range also tells you
whether or not it is safe for you to do physical activity.
As you get closer to your due date, your insulin resistance could increase.
If that happens, you might need to take insulin shots 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 amount of insulin for you.
|
Measuring your blood
sugar will give you
information about...
|
For example...
|
|
The amount of food
you can eat
|
Can you have that extra 1/2 bagel at breakfast?
|
|
Times when your glucose
level is high or low
|
You might have high blood sugar in the morning after
breakfast. Other women's levels are highest after dinner
|
|
Times that physical
activity is more likely to
keep your glucose level
in the target range
|
Does walking for 20 minutes after breakfast or dinner
help to keep your glucose level within the healthy range?
|
How do I do it?
Your health care provider will show you how to test your glucose level and will
give you detailed information about glucose testing. The steps below are only
meant to give you a basic idea of what is involved in testing:
- Wash your hands with warm water and soap.
- Prick your finger with a small needle called a lancet
(pronounced LAN-sett). Squeeze out a drop of blood.
(Note: You can prick any finger
to get a drop of blood. Some newer meters can use blood obtained from other places, like the forearm.)
- Place the drop of blood on the target spot of a special
testing device called a glucose meter, or onto the
paper strip that fits into the meter. Because each glucose
meter is different, your health care provider will show you
how to use your specific meter and will explain how the
meter works.
- Wait a while (Note: How long you have to wait
depends on the type of meter you have). The meter will
give you a number for your blood sugar level, like 128.
Use each lancet only once and be careful when you throw
away used lancets. Ask your health care provider how to
safely throw away testing supplies, like lancets.
Your health care provider will watch you do the test before you do it
by yourself or try it at home. Take your glucose testing items with you
when you go for health care appointments.
You can get supplies for testing your glucose level, like lancets and glucose
meters, in most drug stores, pharmacies, and medical supply stores. Your
health insurance plan might cover the cost of these supplies. You might
also be able to rent a glucose meter from a medical supply store. Renting
might be a better option for you, since you will probably need the device
only while you're pregnant. Ask your pharmacist for more information.
When do I do it?
Follow your health care provider's advice about when to test your glucose
level. You might have to test four times a day:
- Fasting glucose level-first thing in the morning, before you eat
- 1 or 2 hours after breakfast
- 1 or 2 hours after lunch
- 1 or 2 hours after dinner
You might also need to test your glucose level before you go to bed at night.
This test is called your nighttime or nocturnal (the word nocturnal means
nighttime) glucose level.
How do I know that I'm doing it right?
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 |
|
Time of Blood Sugar Test/b>
|
Healthy Target Levels (in mg/dl)
|
|
Fasting glucose level
|
No higher than 95
|
|
One hour after eating
|
No higher than 140 |
|
Two hours after eating
|
No higher than 120 |
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 back in range.
Eat a healthy diet,as outlined by your health care provider
What is it?
A healthy diet is one that includes a balance of foods from all the food
groups, giving you the nutrients, vitamins, and minerals needed for a healthy
pregnancy. For women with gestational diabetes, such a diet also helps to
keep blood sugar levels in the healthy target range.
Women with gestational diabe tes have special dietary needs.
Because eating a healthy diet is such an important part of a treatment plan
for gestational diabetes,women should n o t try to create their own diets.
To promote health throughout your pregnancy, it is essential that you work
with your health care provider to create a plan for your healthy diet. It is also
important that you follow the plan as outlined by your health care provider.
The information in this booklet is specific to women who have been
diagnosed with gestational diabetes. These guidelines are not appropriate for
all pregnant women.
Carbohydrates are often at the center of a healthy diet for a woman with
gestational diabetes.
-
Carbohydrates are nutrients that come from certain foods, like grain
products, fruits, and vegetables. During digestion, your body breaks down
most carbohydrates into simple sugars, like glucose, which is your body's
main source of energy.
-
Eating carbohydrates affects your blood sugar level. For instance, 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 and your health care provider will 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.
There are a few things you should know about carbohydrates and your
healthy diet:
- Your health ca re provider will come up with a healthy diet for you that includes
the proper amount of carbohyd rates to maintain a healthy pre g n a n cy.
- Some women who have gestational diabetes may need to eat fewer
carbohydrates than they did before they were pregnant, to lower their total
amount of carbohydrates.
- Some women with gestational diabetes may need to avoid high-sugar foods,
like sweets and desserts, to keep their carbohydrate levels in line. But, even
though these foods have more carbohydrates and sugars in each serving
than other foods do, they can still be worked into a plan for healthy eating
in most cases.
- Not getting enough carbohydrates can also cause problems. So, you should only
limit your carbohydrate int a ke if advised to do so by your health care provider.
Most women with gestational diabetes follow a meal plan to make sure they
are getting the nutrients they need. Types of meal plans may include:
- Carbohydrate counting-For this meal plan, you count the number of
grams of carbohydrates that you eat at each meal and snack to make sure
you are within a certain range, as determined by your health care provider.
Your meal plan may be specific, giving you definite amounts for each meal
or snack, or it may be more general, with a daily carbohydrate total. A
slightly different version of this meal plan changes the grams of
carbohydrates into "points." Then you have to make sure you stay within a
certain range of carbohydrate points for each meal or each day.
- The exchange system-The exchange system has food groups that are
slightly different than the food groups in the U.S.Department of Agriculture
Food Guide Pyramid: breads/starches, fruits, vegetables, proteins, milk, and
fats. Each food within an exchange group has about the same amount of
carbohydrate, fat, protein, and calories, but the amounts of vitamins and
minerals may vary among foods within each group. To follow the plan, you
count the number of items from a food group that you eat at each meal.
You can "exchange" one food item in a group with another item in a group
without changing your plan. For instance, you can choose one (1) meat
exchange (a protein) or one (1) tofu exchange (also a protein) without
changing the amount of carbohydrate or calories in your meal.
Your health care provider may also tell you to get more fiber in your diet. Fiber
is the part of plant foods that your body can't digest, like skins, seeds, and bran.
Because fiber slows down digestion and absorption of nutrients, it can also
help to control your blood sugar level. Foods that are part of a healthy diet,
like fruits, vegetables, and legumes (beans and peas), are also good sources of
dietary fiber. Some foods that are high in fiber, like whole grain products, such
as cereals and some breads, also help prevent constipation. (See Appendix A:
High-Fiber Foods for a list of foods that contain high fiber.)
Why do I have to do it?
All pregnant women need to eat healthy diets, as laid out by their health care
providers, to help them get the right nutrients, in the right amounts. When you
have gestational diabetes, a healthy diet also helps to keep blood sugar in the
healthy range. Following a healthy diet is one of the best ways to promote a
healthy pregnancy.
How do I do it?
Women who have gestational diabetes should not try to create a healthy diet
on their own. They should work closely with their health care provider to make
sure they are getting proper nutrition and .
The table on the next page describes the Food Groups that your health care
provider will use to build your diet. He or she will tell you how many servings
of each group you should have in a day.
If one of the foods that you normally eat does not appear on this table, ask
your health care provider what group that food belongs to. You should also
ask about the serving size, so that you know how much of that food you can
eat. Every question you have is important, so don't be afraid to ask.
Food Groups
Please note that this booklet presents only general guidelines for a healthy
diet for women with gestational diabetes. Use the chart below to talk to your
health care provider about eating. This chart is not meant to take the place of
your health care provider's recommendations.
|
Food Group
|
Description and Tips
|
What are some foods in this group?
|
How much is one serving?
|
|
Fats and Oils
|
These foods give you essential
fatty acids and vitamins.
Choose a diet that is low in
saturated fat, trans-fats, and
cholesterol and moderate in
total fat. Use vegetable oils
rather than solid fats (such as
those in meat or dairy foods
and shortening).
|
Salad dressing
Butter/ margarine
Mayonnaise
Vegetable oil,
canola oil, olive
oil, soybean oil,
sunflower oil
Spray vegetable oil
|
1 tsp butter, margarine, or oil
1 TBSP regular salad dressing or
mayonnaise
2 TBSP low-fat or light salad
dressing
|
|
Milk,Yogurt, and
Cheese
|
Milk and milk foods give you
carbohydrates, proteins, and
vitamins and minerals.
Choose milk, cheese, and
yogurt products that are
fat free or low fat (1%).
|
Milk, powdered
milk, condensed
milk, buttermilk
Lactose-free milk
Cheese
Plain yogurt
Frozen yogurt
|
1 cup fat-free or low-fat (1%) milk
2 ounces fat-free or low-fat cheese
1 cup lactose-free milk
1 cup fat-free plain yogurt
1/3 cup powdered, non-fat milk
|
|
Meat, Poultry,
Fish, Dry Beans,
and Nuts
|
These foods provide protein,
vitamins, and minerals.
Trim extra fat off meats,
including the skin. Use
broiling, grilling, and roasting
to cook meats without adding
fat or cholesterol.
|
Lean beef, poultry,
pork, seafood, lamb,
meat substitute
Eggs, egg
substitute
Tofu
Peanut butter and
peanuts
|
3 ounces cooked lean meat,
chicken, fish, or pork
1/2 cup tofu
1 egg
2 TBSP peanut butter
|
|
Vegetables
|
Vegetables, either raw or
cooked, give you
carbohydrates, vitamins,
minerals, and fiber. They are
usually very low in fat, unless
they are cooked with butter,
margarine, salad dressing,
cream sauce, or other high-fat
ingredient.
|
Carrots, ce l e ry,
o kra, Bru s s e l s
s p rou t s, a s p a ra gu s,
cau l i f l owe r,
b roc co l i,
mu s h roo m s,
pe p pe r s, s qu a s h e s,
to m atoe s, o n i o n s,
cu cu m bers
Leafy ve g e t a b l e s :
l e t tu ce, s p i n a c h,
ca b b a g e
|
1 cup raw vegetables
1/2 cup coo ked ve g e t a b l e s
1 cup leafy, raw ve g e t a b l e s
1/2 cup to m ato or vegetable juice
|
|
Fruits
|
Fruits give your body
carbohydrates, vitamins,
minerals, and fiber.
Choose fresh fruits, fruits
canned in their own juices or
in water, or frozen fruits.
|
Bananas, apples,
berries,mango, plums,
peaches, figs, pears,
grapes, prunes
Citrus fruits: oranges,
tangerines, grapefruit,
kiwi, pineapple
Melons: watermelon,
cantaloupe, honeydew
|
1 piece small-to-medium whole
fruit (about 1/2 cup of cut
pieces)
1 slice of melon
1/2 cup canned or
fresh fruit pieces
1/2 cup or 4 fl.oz
fruit juice
br>1/2 banana
|
|
Bread, Cereal,
Rice, and Pasta
|
This group gives your body
carbohydrates, vitamins,
minerals, and fiber. Whole
grain products are high in
these nutrients.
Avoid high-fat or fried starchy
vegetables and grain products.
Use seasonings and fat-free or
low-fat toppings and sauces to
add flavor.
|
Bread: sandwich and
dinner breads, bagels,
flour tortillas, pita,
rolls, pizza crust,
cornbread, taco shells
Starchy vegetables:
white or sweet
potatoes
Legumes (peas, corn,
beans)
Rice, noodles, pasta
(spaghetti/macaroni),
dry or cooked cereal,
oatmeal
Crackers, pretzels,
unbuttered popcorn,
breadsticks
|
1 slice whole grain bread
1/2 bagel, English muffin, or
six-inch flour tortilla
1 small muffin or
waffle
2 pancakes
5 crackers
1/3 cup cooked rice
1 small baked
potato (plain)
1/2 cup cooked cereal,
pasta, mashed potatoes
1/2 cup coo ked beans or lentils
1/2 cup sweet potatoes, ya s,
peas, or corn
3/4 cup dry, u n s we e tened ce re a l
|
|
"Free"Foods
|
"Free" foods are those that
have less than 20 calories.
You can often eat free foods
without having to account
for them in your meal plan.
Water is considered a "free"
food; you can drink as much
water as you want. In fact,
most health care providers
recommend that you drink
a lot of water when you are
pregnant.
|
Raw vegetables:
cabbage (all varieties),
ce l e ry, cucumber, endive,
lettuces (all varieties),
mushrooms,peppe r s,
radishes, spinach
Drinks: sugar-free/
unsweetened and low-
salt versions of broth,
bouillon, consommes,
m i n e ral water, club sod a .
Condiments-Group 1:
ketchup, fat-free cream
cheese, horseradish,
fat-free mayonnaise,
fat-free margarine,
reduced-fat margarine,
mustard, fat-free or
reduced-fat sour cream,
taco sauce; Group 2:
salsa; Group 3: soy
sauce, non-stick
cooking spray
Seasonings-garlic,
herbs, flavoring agents,
pimento, spices (Note:
"salt" seasonings are
high in sodium and
should be used only in
small amounts.)
|
Up to 2 cups raw ve g e t a b l e s
Dri n k s : 8 fluid ounce s
1 TBSP Group 1 co n d i m e nt s
1/4 cup Group 2 condiment s
Group 3 condiments-no limit
2 to 3 dashes of seasonings
Water
|
* tsp. = teaspoon; TBSP = tablespoon
You might also have to include these changes in your eating habits to help
keep your blood sugar level under control:
- Eat meals and snacks (as allowed on your meal plan) on a regular
schedule throughout the day. Researchers recommend that women
with gestational diabetes eat at least three small-to-medium sized meals and
two-to-four snacks every day.
- Eat smaller amounts of carbohydrates at each meal. Rather than
eating a large amount of carbohydrate at a single meal, your health care
provider may suggest that you spread out your carbohydrates throughout
the day. Because eating carbohydrates directly affects your blood sugar
level, eating a small amount of carbohydrate all through the day will help
keep your blood sugar from rising too high after a meal.
- Add a nighttime snack to your meal plan. You may need to add a
snack of one-to-two servings of carbohydrate before you go to sleep to keep
your blood sugar at a healthy level overnight. Some examples of healthy
snacks include: a piece of fruit, a handful of pretzels, or crackers.
To give you an idea of what a meal plan for one day might look like, there is a
menu sample at the back of this booklet. This sample menu is not meant to
replace your health care provider's recommendations. (See Appendix C:
Sample Menu for more information.)
|
Whole Milk, Fat-free Milk, 1% Milk, or 2% Milk-How do you decide?
Health care providers recommend that pregnant women increase the amount
of milk they drink to make sure they get enough calcium. Milk is one of the best
sources of calcium, and of other nutrients that help the body absorb calcium. In
most cases, fat-free or low-fat milk and milk products are the best calcium options
because they contain the calcium and other nutrients, without the added fat. Fatfree
or 1% milk are among the suggested options.
If you are lactose intolerant or you have trouble digesting milk products, many
lactose-free products provide calcium and other nutrients without the milk sugar.
|
Following a meal plan and eating a healthy diet may seem like a lot of work
at first. You might have to measure food before you eat it, or not eat certain
foods while you are pregnant; you might have to count carbohyd ates, servings,
or exchanges. Don't give up! Sticking to your meal plan is one of the most
effective ways to control gestational diabetes.
When do I do it?
Eat a healthy diet or follow a meal plan for your entire pregnancy to improve
your health and to help ensure a healthy pregnancy. If you need to make
changes to your diet or meal plan to keep your glucose level in the healthy
range, your health care provider will help.
How do I know that I'm doing it right?
One sign that your diet or meal plan is successful is that your glucose level will
usually stay within the healthy range (see the Healthy Target Range for Blood
Sugar table). Talk to your health care provider about what to do if
you have abnormal blood sugar numbers.
Maintaining a healthy weight gain and not having ketones in your urine are other
signs that your diet or meal plan is working. For more information about healthy
weight gain, see the Maintain a Healthy Weight Gain section of this booklet. For
information about ketones,go to the section titled Your health care provider might
also tell you to: Test your urine for ketones, if needed found later in this booklet.
Get regular,moderate physical activity
What is it?
Moderate physical activity is not the same as daily, routine activities, such as
shopping, doing household chores, or washing dishes. Women with gestational
diabetes often need regular, moderate physical activity, such as walking,
prenatal aerobics class, or swimming, to help control blood sugar levels.
Your health care provider may tell you not to do any moderate physical
activity because of other health conditions you have or because of
complications with your pregnancy. Do not begin any physical activity
without talking to your health care provider first.
Why do I have to do it?
Moderate physical activity is an important part of any healthy pregnancy.
For women with gestational diabetes, it also helps their bodies' insulin
work better, which is an effective way to help control blood sugar levels.
How do I do it?
Researchers are uncertain about the amount of physical activity that best
helps a woman with gestational diabetes to control her blood sugar. The
specific amount of physical activity that you need depends on how active you
were before you were pregnant, and whether or not you have any other health
concerns. For some women with gestational diabetes, regular, moderate
physical activity includes walking, swimming, or light running. For other
women, only slow walking is recommended. Talk to your health
care provider about what activities you should do, how
often, and for how long.
One thing you need to watch is your level of
effort, called your exertion (pronounced
ecks-ER-shun) level. If you can talk
easily while doing an activity, instead
of gasping for air, your level of
exertion is good. If you cannot talk
easily, or find yourself coughing or
gasping for air, you need to lower
your level of exertion by slowing
down or stopping for a while. Your
health care provider can advise you
on the best level of exertion for you.
When do I do it?
Most women can stay active throughout their pregnancies. However, your
health care provider may recommend that you become less active as you get
closer to your due date. Keep in mind that it may take two-to-four weeks for
your physical activity to have an effect on your blood sugar levels.
How do I know that I'm doing it right?
Listen to your body-Your body will tell you how much activity is enough. It
will also let you know when you are doing too much. Quit when you feel tired.
If you feel faint, dizzy, or extremely hot, you should stop the activity
immediately.
If you are taking insulin, see the Take medications and/or insulin as prescribed
section of this booklet for tips about physical activity and insulin.
The general guidelines listed below will help to ensure safety while doing physical activity.
| General Guidelines for Physical Activity |
|
Do
|
Don't
|
|
Moderate and regular physical activity
unless your health care provider tells
you not to.
|
Get too tired while working out or
doing physical activity.
|
|
Choose activities like swimming, that
don't require a lot of standing or balance.
|
Do any activity while lying on your back
when you are in your 2nd or 3rd
trimester of pregnancy.
|
|
Wear loose, light clothing that won't make
you sweat too much or get too hot.
|
Perform activities in very hot weather.
|
|
Drink a lot of water before, during, and
after your activity.
|
Perform activities that may bump or
hurt your belly, or that may cause you
to lose your balance.
|
|
Eat a healthy diet and gain the right
amount of weight.
|
Fast (skip meals) or do physical activity
when you are hungry.
|
|
Watch your level of exertion (Can you
talk easily?).
|
Over-exert yourself.
|
Maintain a healthy weight gain
What is it?
Healthy weight gain can mean either your overall weight gain, or your
weekly rate of weight gain. Some health care providers focus only on
overall gain or only on weekly gain, but some keep track of both types of
weight gain. First, let's look at overall weight gain.
The amount of weight gain that is healthy for you depends on how much
you weighed before you were pregnant. Find your pre-pregnancy weight
and height in the table on page 23 [Not reproduced in this file -- the editors]. Then look at the bottom row of the table
to find your overall healthy weight gain goal.
If you are expecting twins, an overall weight gain of 35 to 45 pounds is
considered healthy.
Remember that these goals are only a general range for overall weight gain.
Your health care provider will let you know if you're gaining too much or too
little weight for a healthy pregnancy. Weight loss can be dangerous
during any part of your pregnancy. Report any weight loss to your
health care provider right away.
[Table entitled "OVERALL WEIGHT GAIN GOALS" is not reproduced here. See page 23 of the original, at
http://www.nichd.nih.gov/publications/pubs/gdm/GDM2004_section3.pdf (PDF file) [PDF help]
-- the editors]
Why do I have to do it?
Usually, people gain weight because the amount of fuel they take in, as food,
is higher than the amount they use up, as energy. When you have gestational
diabetes, if you gain too much weight, gain weight too quickly, or begin to
lose weight, your body may be telling you something is wrong. Because your
body's insulin isn't working well already, your condition can get out of control
quickly if you gain too much weight, or if you gain weight too quickly.
How do I do it?
You already learned two useful ways to maintain a healthy weight gain: eating
a healthy diet as outlined by your health care provider, and getting regular,
moderate physical activity.
If you think your weight gain is out-of-control, but you are following a
recommended diet and physical activity program, tell your health care
provider. He or she will adjust your treatment plan to get your weight gain
back into healthy range.
When do I do it?
It's a good idea to keep track of how much weight you gain from the time you
learn you are pregnant to the time you have the baby. Knowing your weight
status can help your health care provider detect possible problems before
they become dangerous.
It's also a good idea to weigh yourself on the same day of the week and at the
same time of day. Your health care provider can make a schedule for you so
you know how often to weigh yourself and at what time of day. You will also
be weighed at your prenatal appointments.
How do I know that I'm doing it right?
One way to determine if your overall weight gain is within the healthy range
is to follow your we e kly rate of we i g ht gain. The table below gives some
general guidelines for weekly rate of weight gain.
Some health ca re providers feel that your weekly rate of gain is just as impo rtant
as your overall weight gain be cause it shows how well your treat m e nt plan is
wo rking to cont rol your gestational diabe te s. If your we e kly rate of gain is low,
you might need to adjust your diet to get more calories. If your weekly rate
of gain is high, you may be developing a condition called preeclampsia, which
can be dangerous. (See the section titled Your health care provider might also
ask you to: Have your blood pressure checked as indicated for more information
about preeclampsia.)
WEEKLY RATE OF WEIGHT GAIN
Aim to keep your weekly rate of weight gain within these healthy ranges:
|
|
In the first trimester of
pregnancy: (the first 3 months)
|
Three-to-six pounds for the
entire three months.
|
|
During the second and third
trimesters: (the last 6 months)
|
Between 1/2 and one (1) pound each week.
|
|
If you gained too much weight
early in the pregnancy
|
Limit weight gain to 3/4 of a pound each week
(3 pounds each month) to help get your blood
sugar level under control.
|
A weight gain of two (2) pounds or more each week is considered high. |
Keep in mind that your weekly rate of weight gain may go up and down
throughout the course of your pregnancy. Some weeks you may gain weight,
other weeks you won't; as a result, your weekly rate of gain may not match
your overall weight gain goal exactly. Your health care provider will let you
know if you're gaining too much or too little weight for a healthy pregnancy.
Weight loss can be dangerous during any part of your pregnancy.
Report any weight loss to your health care provider right away.
You may also notice that your weight gain slows down or stops for a time.
It should start going up again after one-to-two weeks. If not, tell your health
care provider immediately. He or she may need to adjust your treatment plan.
Are there any other ways I can maintain a healthy weight gain?
Some general guidelines that might help you reach your target weekly rate
of gain include:
- Try to get more light or moderate physical activity, if your health care
provider says it's safe.
- Use the Nutrition Facts labels on food packages to make lower-calorie food
choices that fit into your meal plan.
- Eat fewer fried foods and "fast" foods.
- Eat healthy foods that fit into your meal plan, such as salads with low-fat
dressings and broiled or grilled chicken.
- Use less butter and margarine on food, or don't use them at all.
- Use spices and herbs (such as curry, garlic, and parsley) and low-fat or lowercalorie
sauces to flavor rice and pasta.
- Eat smaller meals and have low-calorie snacks more often, to ensure that
your body has a constant glucose supply, and to prevent yourself from
getting very hungry.
- Avoid skipping meals or cutting back too much on breakfast or lunch. Eating
less food or skipping meals could make you overly hungry at the next meal,
causing you to overeat.
Keep daily records of your diet, physical activity,
and glucose level
What is it?
Keeping records means writing down your blood sugar numbers, physical
activities, and everything you eat and drink in a d a i ly re co rd boo k. You
can use a small notebook or ask your health care provider for a testing record
book. There are also sample record book pages at the back of this booklet
(see Appendix C and Appendix D).
Keep in mind that if you are supposed to keep track of everything you eat
and drink, that means everything. Bites, nibbles, snacks, second helpings, and
liquids can really add up and may upset your meal plan. It's also easy to forget
or underestimate how much snacking you really do.
Why do I have to do it?
Keeping daily records helps to track how well your treatment plan is working
and what, if anything, should be changed. The information also reveals
whether or not you need insulin, and if so, how much you need.
You might also find the information helpful when talking to your health care
provider about how you feel. Your record book is a good place to write down
questions or notes on how your body feels, so that you can remember them at
your next prenatal appointment.
How do I do it?
Your health care provider can give you more details about what to write in
your record book. He or she might ask you to keep track of these things:
- Blood sugar level-What is your level? Are you in the healthy range?
- Food-What did you eat and drink? Was the food on your meal plan?
Did you have any snacks? How large/small was your snack? Was it
more or less than usual?
- Physical wellness-How do you feel? Are you sick to your stomach? Do you
feel tired, or do you have lots of energy?
- Physical activity-What activity did you do? How long did you do it? Was it
within your physical activity program? How did you feel after the activity?
- Weight gain-Are you gaining a healthy amount of weight?
When do I do it?
It's a good idea to follow a schedule for writing in your record book, so that
you get used to doing it and don't forget to do it. It might seem like a lot of
work in the beginning, keeping track of so many things, but the more you do
it, the less work it will be.
How do I know that I'm doing it right?
The most important part of keeping daily records is that you do it. Make sure
that you are recording all the items identified by your health care provider.
Take insulin and/or other medications as prescribed
What is it?
Even if you do everything your health care provider tells you to manage your
gestational diabetes, you still might need to take insulin during your pregnancy
to keep it under control. You already know that insulin moves glucose out of
your bloodstream and into your cells to use as energy; you may need extra
insulin to lower your blood glucose level. The only way to get extra insulin
into your body is to inject it under your skin with a needle. Taking insulin is
the same as any other part of this treatment plan. It's just another way to help
you stay healthy.
Why do I have to do it?
You may have to include small amounts of insulin in your treatment plan 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.
In these cases, the best action for maintaining a healthy pregnancy is to add
insulin. Insulin does not hurt the fetus. The daily records that you keep help
your health care provider decide when and if it's time to begin insulin. That's
why it's important to keep good records.
Here are some other things you should know about insulin:
-
If you need to take insulin, it does not mean that you didn't try
h a rd enough or that you failed at taking ca re of yo u r s e l f. It just
means that your body has a high level of insulin resistance and needs some
help getting glucose level back into healthy range. (Refer to the Knowing
your blood sugar level and keeping it under control: How do I know I'm doing it
right? section of this booklet for more details on the healthy range for glucose.)
- Taking insulin does not mean you have type 1 diabetes. People
with type 1 diabetes have to take insulin shots every day of their lives because
their bodies don't make enough insulin. As a woman with gestational
diabetes, taking insulin does NOT mean that you now have type 1 diabetes.
It only means that your body needs some extra help to balance its insulin
and glucose levels. After your baby is born, your diabetes will likely go away,
and with it, your need to take insulin.
- An increase in the amount or dosage of insulin you need does
not mean that your pregnancy is in danger. The amount of insulin
you take will probably increase as your pregnancy goes on. Because your
insulin resistance increases as your pregnancy continues, your body needs
more insulin to overcome this resistance. The goal is to keep your blood
sugar under control, no matter how much insulin it takes. Most women
take two insulin shots each day, but you may get better glucose control
with three injections.
- You may need more insulin if you are under high amounts of
stress or if you are sick be cause your blood sugar level gets
higher on its own in these cases. Some medicines can also cause
blood sugars to rise above the healthy range.
How do I do it?
Your health care provider will teach you how to give yourself insulin shots, if
you need them. Use the space below to write down what your health care
provider tells you about your insulin treatment.
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Question
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Answer
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What kind of insulin
are you taking?
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When should you take
your insulin shot or shots?
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How long does it take for
the insulin start working?
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How long does the insulin
last in your body?
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How do you store insulin?
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How do you measure the
right amount of insulin?
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How do you give yourself
an insulin injection?
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Should you eat before or
after your insulin shot?
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How will the insulin make
you feel?
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How can you safely throw
away used supplies?
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When do I do it?
How often you need insulin shots will depend on your body. Your health care
provider will tell you how often to take the shots and at what times of day.
Make sure you follow his or her advice about taking insulin to help ensure
the safety of your pregnancy.
Special instructions for women taking insulin
Follow a regular eating schedule. Your health care provider can tell
you when to take the insulin and when to eat your meals so that the timing
of both is correct. Do not skip or delay meals and snacks when taking insulin
because this can affect your glucose-insulin balance.
Know the symptoms of low blood sugar. If your blood sugar level
drops below 60 at any time, you have hypoglycemia (hypo means low, and
glycemia means sugar). Low blood sugar can be dangerous. Hypoglycemia is
not common in women with gestational diabetes, but you are at greater risk
for it if you take insulin. The table shown here describes some reasons that
low blood sugar might occur and some of its symptoms.
| Know the symptoms of low blood sugar |
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Why does low blood sugar occur?
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How might I feel if I have low
blood sugar?
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- Too much exercise
- Skipping meals or snacks
- Delaying meals or snacks
- Not eating often enough
- Too much insulin
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- Very hungry
- Very tired
- Shaky or trembling
- Sweating or clamminess
- Nervous
- Confused
- Like you're going to pass out or faint
- Blurred vision
- Or...You might feel fine.
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Know when your insulin is working its hardest. Low blood sugar
is more common at these times, depending on how your body uses insulin
and glucose.
- Be careful about doing physical activity, but remain active.
Because both insulin and physical activity lower your blood sugar level,
when combined they can cause your blood sugar level to drop very quickly.
- Test your blood sugar before you do any physical activity. If your level is low,
eat something and test again to make sure your level is higher before you
start an activity. Be smart about how much physical activity you do, how
much you eat, and how much insulin you take.
- Be prepare d. Take your insulin supplies with you when you go out,
especially if you are going to be gone a long time. You should also take
some form of sugar with you, in your purse, in your car's glove compartment,
or in your pocket, in case your blood sugar drops too low. The best form of
sugar for an emergency is glucose paste or glucose tablets. You can buy
these at the drug store or pharmacy. Ask your health care provider for more
information.
- Test your blood sugar if you start to feel dizzy, faint, or tired.
- Report any abnormal blood sugar level to your health care
provider right away, in case a change in your treatment
plan is needed.
Your health care provider might also tell you to:
Test your urine for ketones if needed
Your body makes ketones (pronounced KEE-tones) when it uses or breaks
down its own fat. Your body uses fat for fuel when it can't get glucose.
Ketones might appear in your urine if your meal plan is not providing enough
carbohydrates or calories, if you skip meals or snacks, or if you go for more
than five hours without eating. Your health care provider might test your urine
for ketones at your prenatal appointments to see if you are getting enough
glucose. Or, you may have to do the test at home, every day.
Your health care provider will give you more specific information about testing
your urine for ketones, including how to do the test, where to get testing
supplies, how often you should test your urine, and what to do if your urine
has ketones in it. Ketone test supplies are available at your local drug store,
pharmacy, or medical supply store.
Your health care provider might also tell you to:
Have your blood pressure checked as indicated
Increased blood pressure may bring about a condition called preeclampsia.
Preeclampsia11 is a sudden increase in blood pressure after the 20th week of
pregnancy that is associated with swelling in your face and hands. If left
untreated, this condition can be fatal and can lead to long-term health
problems. Daily or weekly blood pressure checks may be needed to detect
any changes that might indicate preeclampsia.
If your blood pressure is high, your health care provider might also test your
urine to see if it contains protein. Protein in the urine can also be a sign of
preeclampsia. You may have to perform the test yourself, as directed, if your
blood pressure is elevated. Your health care provider can give you specific
information about testing your urine for protein, including how to do it, when
to do it, and what to do if your urine has protein in it.
From
the National Institute of Child Health and Human Development
July 2004
http://www.nichd.nih.gov/publications/pubs/gdm/GDM2004_section3.pdf (PDF file) [PDF help]
Also see
table of contents: managing gestational diabetes: a patient's guide to a healthy pregnancy
managing gestational diabetes
will gestational diabetes hurt my baby?
what should I do after my baby is born?
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