Today, we will learn what is gestational diabetes? What are the causes and symptoms? How we can treat gestational diabetes? And the gestational diabetes diet plan.
“Gestational diabetes is high blood sugar that develops during pregnancy and usually disappears after giving birth. It can occur at any stage of pregnancy, but is more common in the second half.”
(National Health Service UK, 5th August 2016)
According to the National Institute of Child Health and Human Development, gestational diabetes affects 5 percent of all pregnancies, which means that there are about 200,000 cases of gestational diabetes in the US each year.
CAUSE OF GESTATIONAL DIABETES
During the time of pregnancy, how the body reacts and utilizes insulin changes. Naturally, our body starts to withstand the effect of insulin to provide the baby with more glucose. However, this process does fail in the case of some women. Sometimes, the body fails to respond to insulin or the other time, the body does not succeed in making the required amount of insulin for the body. Whichever the case, it results in excess of sugar level in the blood which becomes the cause of gestational diabetes.
SYMPTOMS OF GESTATIONAL DIABETES
Most of the women don’t have or experience any symptoms but some women might have unusual thirst, frequent urination in large amounts, fatigue, and sugar in the urine. Gestational diabetes can be diagnosed by urine tests in which the sugar in the urine is checked. Moreover, glucose screening test is also conducted by doctors around the twenty-eighth week of pregnancy where the patient drinks a sugary liquid and blood is drawn out an hour later. If there is an increase in sugar level, then glucose tolerant test will be conducted to diagnose gestational diabetes.
WHO IS AT THE RISK OF GESTATIONAL DIABETES?
Researchers have provided that a woman may be at higher risk if:-
1. She is overweight and has a BMI (Body Mass Index) of 30 or over 30 which affects the ability of insulin to keep sugar level balanced
2. She has a higher level of abdominal or tummy fat in the earlier stages of pregnancy
3. Doctors have noticed that women over 35 have greater risks of being diagnosed with gestational diabetes
4. She had Gestational Diabetes at the time of previous pregnancies; the patient is at higher risk that she may develop gestational diabetes again this time
5. She has a family history and diabetes run in the family. Moreover, statistics prove that African-American, Native American, Asian and Hispanic women are more likely to have gestational diabetes
6. She has a slightly elevated sugar level before pregnancy
7. Some researchers suggest if the woman is inactive or has been put on a bed rest, that very woman is at higher risk of gestational diabetes as they can gain additional weight during pregnancy due to lack of activeness and activity.
WHY IS GESTATIONAL DIABETES A PROBLEM?
Gestational Diabetes can have adverse effects on the baby as well as the mother. These conditions do not occur every single time but it may develop in case of gestational diabetes.
For the baby, it can result in high birth weight of the baby (which is known as Macrosomia) which can result in a more complicated and difficult delivery. Large bodied babies can be injured in case of natural delivery via vagina as their shoulders can be stuck resulting in shoulder dystocia. It may also cause early pregnancy or force the surgeon to opt for C-section at the time of delivery. Moreover, the baby may have unstable blood sugar (known as Hypoglycemia) and breastfeeding has to be started right away in order to provide the baby with glucose. If feeding is not possible, a thin plastic tube will be used to provide the baby will required glucose. Additionally, it may cause difficulty in Respiratory Distress Syndrome (RDS) in which the baby will have difficulty in breathing and will require oxygen right away. Jaundice can also be developed in the baby in which skin of his or her body will turn yellowish and white parts may change its color slightly. If jaundice is not cured, it can pose risk to the baby. Moreover, the magnesium and calcium level in the body of the baby can drop significantly upon delivery, resulting in a sudden involuntary muscular contraction (spasms) especially in hands and feet so the baby will require calcium and magnesium supplements.
Most of the times, diabetes does disappear after pregnancy, but the mother can still have it after delivery. Likewise, the chance of diabetes later in life, increases in case of mother as well as the baby.
HOW CAN GESTATIONAL DIABETES BE TREATED?
It is easy to treat gestational diabetes if it is found in earlier stage of pregnancy. Treatment for gestational diabetes includes
• Insulin injections
• Frequent monitoring of blood sugar
• Daily tests of blood glucose
• Physical activity/exercises
• A healthy diet and special meal plans
KNOWING & CONTROLLING SUGAR LEVEL
The patient must know and keep a check on two elements; She should know her sugar level( that is the to keep a frequent test on the level of glucose in the blood) and secondly how to keep the sugar level under control by eating a healthy diet, by the means of exercise or physical activity or through insulin, if required.
The sugar levels change every day and depend upon what kind of food you are consuming, in how much quantities and when are you eating the food. If you can keep a proper check on glucose levels and its changes during the day, it can help you and your nutritionist in devising and adjusting your diet plan and your overall treatment. Frequent checks during the day at will help choose what kind of meal is best for you, at which time of the day you need to eat and how much food is required by your body at a particular time. As the due date gets closer, the insulin resistance in the body increases gradually and then it may require your body to take insulin shots if glucose level is not under control.
Your health care provider can check the glucose level for you or even you can do it in a simple way at home. The glucose level can be checked in simple steps by squeezing out blood from any of your fingers using a small needle (called lancet) and then placing the blood on the specified place in the glucose meter. The meter will then provide your sugar level, in numbers, within a few minutes depending upon the type of meter. You need to test your sugar level four times a day or as prescribed by your health care provider. Four times might include early morning before you eat anything, 1 or 2 hours after breakfast, lunch, and dinner. You can also check the glucose level before going to bed at night which is called nocturnal glucose level.
Even though the glucose level fluctuates during the day, there is healthy range provided for each level and you should try to keep the glucose level within the range or otherwise you need to adjust your diet plan and overall treatment. For instance, in the early morning, fasting glucose level should ideally not be higher than 95 mg. Similarly, after an hour of eating, the sugar level should not rise above 120 mg.
GESTATIONAL DIABETES DIET PLAN
Eating well is beneficial and essential during pregnancy but the importance of opting for the right food and proper meal plan increases even more in the case of gestational diabetes. Sticking to a proper diet plan and regular exercise reduces the need for medication and also lessens the chance that you or your baby have complications during pregnancy, after delivery or in the future.
ROLE OF A PROPER DIET PLAN
Generally, a healthy and proper diet should include the perfect balance between all the food groups, thus it should be able to provide nutrients, minerals, and vitamins to the body during pregnancy. However, those women who have gestational diabetes tend to have special needs. The function of the ideal diet plan is to ensure two things that the blood sugar level stays in its level while the body gains weight accordingly as well. Therefore, it is important to consult a dietician, nutritionist or your health care provider for a proper diet plan.
BASICS OF A DIET PLAN
– According to the American Diabetes Association, women with gestational diabetes should have three meals (which are small to medium) and two to four snacks in the day. Small and frequent meals will ensure weight gain and control sugar levels
– Fiber and protein-rich food like salad, fruits and nuts should be preferred in your meal as mid-morning or mid-evening snacks
– Stick to exact same timings for the meal every day
– Do not tend to skip any meal or you will become more hungry for the next meal
– Limit or avoid processed food
– Avoid food that is high in sugar
– Vegetables and fruits should be included in every meal
– Proteins should be consumed with every meal
– Food portion should be controlled to avoid overeating
– Add nighttime snack like a piece of fruit or crackers in the plan
– We should keep in mind that every individual is different, so what works for an individual may not work for you. It is noticed that some meal which is recommended, might not work for you in keeping your glucose level in control so it is important to consult your nutritionist and sit together to devise a plan that works for you.
FOOD PORTION CONTROL
Even if healthy foods are consumed, eating too much can cause an increase in high glucose levels and cause a spike in blood sugar level, therefore it is necessary that a proper watch is kept on food portions consumed during the day. Using smaller plates can help in controlling food portion. Portion sizes have the biggest impact on glucose levels It is important that the same amount of carbohydrates are consumed in each meal. Food labels contain important information that can help you to manage the diet plan efficiently. You can also follow websites like My Plate Planner to create a healthy plan that keeps your glucose level in the range. My Plate “is the current nutrition guide published by the USDA Center for Nutrition Policy and Promotion, a food circle depicting a place setting with a plate and glass divided into five food groups.”
FOOD GROUPS – GESTATIONAL DIABETES DIET PLAN
Let’s take a look at the food groups and whether they should use or avoided and in how much quantities.
CARBOHYDRATES
Carbohydrates are the nutrients that are found in fruits, grain, milk products, and vegetables. Carbohydrates are important for the body during pregnancy and is the main source of energy for the body as the body uses carbohydrates to make sugars, like glucose. The consumption of carbohydrates works proportionately with the blood sugar level like a small intake of carbohydrate results in a small increase and likewise, a large intake of carbohydrates at a single meal can result in a large increase in the sugar level. Thus, it is important that the diet plan includes the intake of carbohydrates to such an extent that the requirement of glucose in the body is met and the sugar level is also kept in control.
The balance of carbohydrates will include that excess consumption at one meal should be avoided. Carbohydrates that are rich in fiber should be used and carbohydrates should be combined with protein or healthy fats in the meal. Moreover, the carbohydrate intake should be spread evenly over the day.
Example of healthy carbohydrates includes starches (whole grain bread, brown rice), beans, starchy vegetables, fruits, low-fat dairy products. Milk and yogurt provide carbohydrates plus also providing proteins and calcium alongside. Low-fat dairy can be used to manage the weight during pregnancy. Likewise, soy milk can be used by people who are either vegetarians or lactose intolerant. Similarly, almond milk or flax milk can control carbohydrate intake as they are not a source of carbohydrates but can be used as good alternatives.
Carbohydrate Counting
For the meal plan, it is important that the number of grams carbohydrate that is consumed in every meal and every snack is counted so that it does not go out of the range that is prescribed either by your health care provider or nutritionist You should have the count for each meal or snack as well as the total consumption during the day. A slight change in the meal plan can result in the count of grams of carbohydrates, therefore it is necessary to stay in the prescribed range
PROTEINS
Protein is an important part of a healthy diet. Most of the protein intake does not have carbohydrates and therefore they don’t result in an increase in the sugar levels but some vegetarian intakes of proteins like beans and legumes can contain carbohydrates. Two to three servings of protein are required by women with gestational diabetes.
FATS
These are responsible for providing fatty acids and vitamins. Fats are not responsible for raising blood sugar level because they don’t have carbohydrates, but they have a concentrated amount of calories. That is why fat intake should be limited to manage weight gain. It is necessary that such a diet is opted for which is low in saturated fat, trans-fat and cholesterol while is moderate in total fat. It is more appropriate to use vegetable oil than solid fat like the ones found in meat or daily products. Some foods in this group include butter, mayonnaise, and salad dressing.
FIBER
Fiber is that component of plant foods that cannot be digested by the body It includes skins, seeds and, bran. Fiber is important in controlling the glucose level as it slows down the digestion process and the absorption of nutrients. Foods like fruits, vegetables, beans and, peas are a good source of dietary fiber. Some sources of fiber like whole-grain products also help in preventing constipation.
VEGETABLES
Vegetables are a good source of carbohydrates, vitamins, fiber and, minerals. They have a small amount of fats unless they are cooked in high-fat ingredients like salad dressing, butter or cream, etc.
FRUITS
They are also providers of vitamins, fibers, minerals and, carbohydrates. Fresh fruits, fruits canned in their own juice or frozen fruits can all be consumed during gestational pregnancy.
WHOLE GRAIN PRODUCTS
Products like bread, rice, starchy vegetables cereal, pasta, crackers, and, pretzels are high in nutrients, vitamins, fibers, carbohydrates and minerals. High fat or fried starchy vegetables and grain products should not be consumed. Fat-free or low-fat sauces and toppings can be used occasionally.
DAIRY PRODUCTS
Products like milk, cheese, and yogurt should strictly be restricted and only fat-free or extremely low-fat ones (less than 1%) should be used.
MEAT, POULTRY, FISH, BEANS, AND NUTS
These food provide the body with minerals, vitamins and, protein. Extra fat and skin should be cut off from meat and meat should be cooked, grilled, broiled or roasted without any addition of fat or cholesterol.
FREE FOODS
Free foods are the ones that have an intake of less than 20 calories in them. They can be consumed without adjusting them into the diet plan. These include raw vegetables, condiments (like ketchup, fat-free cream, and salsa) and seasonings. Water is also considered as free food and it is advised you should drink a lot of water during pregnancy.
ALCOHOL
Alcohol is not a safe option to consume during pregnancy at all, so risk increases in cases of those women who have gestational diabetes as consumption of alcohol during the first three months of pregnancy can lead to miscarriage and other complications. Moreover, it can also result in hypoglycemia (drop in glucose level below 4 mmol/L) if gestational pregnancy is dealt with insulin
WATER
Water will not only help you keep hydrated but it will also help balance the blood sugar level by helping to flush sugar out of your body system. Therefore it is important to have a glass of water with each meal and another between each meal, therefore consuming three to four liters of water in the day while also exercising and participating in physical activity.
SAMPLE DIET PLAN
A sample diet plan, provided by Yale Health, is as follows
Breakfast (2 carbs=30g)
• 1 slice whole-wheat toast (1 carb)
• 1 egg
• 1 cup fat-free milk (1 carb)
Snack (1 carb=15g)
• 4-6 whole what crackers (1 carb)
• 1 ounce cheddar cheese
Lunch (3 carbs=45g)
• 2 slices whole wheat bread (2 carbs)
• 3 ounces turkey
• Lettuce and tomato
• 1 cup raw veggies
• 1 cup berries (1 carb)
• 1 cup fat-free milk (1 carb)
Snack (2 carbs=15-30g)
• 2 tablespoons peanut butter
• 1 small apple (1 carb)
• 3 cups popcorn (1 carb)
Dinner (3 carbs=45g)
• 4 ounces skinless chicken breast
• 1 medium baked potato (2 carbs)
• 2 tablespoons reduced-fat sour cream
• 1 cup broccoli salad
• 1-2 tablespoons salad dressing
• 1 cup fat-free milk (1 carb)
Snack _1-2 carbs-15-30g)
• 1/2 banana (1 carb)
• 2 tablespoons nuts
• 1/2 cup plain nonfat Greek yogurt (1/2 carb)
AFTER PREGNANCY
Research shows that those women who have gestational diabetes during pregnancy tend to have about 3 to 7 percent chance of developing type 2 Diabetes within 5 to 10 years. That is why it is important to remain healthy after pregnancy as well. Make sure to make a visit to your doctor after six weeks and then each year. Moreover, you should also contact your nutritionist to develop a diet plan that keeps your glucose level under control. You should also try to avoid sugars and refined carbohydrates that can spike your blood sugar level and increase risks of diabetes. You should continue your exercise and keep yourself fit. Moreover, try to breastfeed the baby for as long time as possible because breastfeeding women have a low level of glucose to circulate in their bodies.
Similarly, the baby should be tested for hypoglycemia, even when there are no symptoms of it. Make sure that the child consumes a nutritious diet, maybe the one that you were consuming during your pregnancy days. Make sure he keeps his body weight under control and his BMI is checked regularly. Moreover, the child gets exercise as much as possible and participates in physical exercises and sports