Archives for March 2012

Gestational Diabetes Meal: Shape Up Your Plate

When you are planning out your gestational diabetes meal, creating a healthy yet well balanced meal is one of the most important parts of your process.

I am blogging about a gestational diabetes meal as part of National Nutrition Month, you can learn more at the Academy Of Nutrition and Dietetics website – http://www.eatright.org/nnm/ 

Gestational diabetes is a short term issue but can lead to long term problems because many women who have gestational diabetes will go on to develop type 2 diabetes.  Keeping your meals in check throughout your pregnancy will lower your stress as well as improve your long term health if you keep eating the healthy way you learn during pregnancy.

One of the priorities for you, your unborn child and your doctor is to manage your blood sugars through what you eat at a gestational diabetes meal, medication and exercise.  Many women find that part of that management means some foods are limited based on their bodies and hormones.  Every woman’s body is unique and may react differently to the same foods.  But the foods that we are talking about when it comes to controlling your blood sugars are mainly carbohydrates.

What are carbohydrates and how do they affect your gestational diabetes meal?

Carbohydrates are the component of food that breaks down into glucose in your digestive system (stomach) and is absorbed into your blood stream as glucose.  They are part of a lot of foods, and can be composed of simple to complex molecules.  It is not that you should avoid carbohydrate – you need some of it!  But certain types of carbohydrate are going to cause your blood sugar to increase quickly while some are absorbed more slowly and lead to a lower peak in your glucose level.

Take for example, simple sugar.  The white stuff.  Or honey, which is concentrated sugar.  This will be absorbed quickly by your body and cause a spike in your blood sugar.  Because your body, as a gestational diabetic, does not handle the increase as well as someone who does not have diabetes, you will find that your sugar may stay high.  I know that many women avoid sweeteners during pregnancy, and that is your choice.  But consider that you really should avoid simple sugar unless it is part of a combined gestational diabetes meal that has protein and fat.

Better carbohydrate choices are going to be multi-grain foods and items that have a lot of fiber and are less processed.  Fruits instead of fruit juice.  The fiber slows the absorption of the food and allows your body to respond a little slower, which is good.  Eating whole grain pasta or wild rice instead of plain white rice is a good choice.  Whole grain wheat breads (make sure it has 2-3 gm of fiber per slice) make a much better choice than a slice of white bread.  Your body can usually break down white bread almost as quickly as simple sugar, and should be exchanged for whole grains in a gestational diabetes meal.

Portion sizes of the carbohydrate foods are very important, and most of us can underestimate our portion sizes when creating a gestational diabetes meal plate.  I recommend that you use a scale and weigh your food until you have a better awareness of how much is supposed to be a portion.  Usually – it’s about 1/3 cup on rice, and that is cooked rice – but it’s not very much!  Weigh out your cereal – a whole grain or bran type cereal – and see how big the bowl looks compared to the serving!  Add milk to it and you are adding more carbohydrate so watch the portion on that as well.

Shaping Up Your Gestational Diabetes Meal As a Complete Plan

So, controlling the amount of carbohydrate is tantamount to good blood sugar control for all of the gestational diabetes meal plans that you use.  I want to state again that complete avoidance of carbohydrate is not the answer.  You can eat a low carbohydrate diet, and by that I mean even as low as 30 gm of carbohydrate at meals, but you still have to eat some.  You and your baby need it, and not eating it at a gestational diabetes meal would be detrimental.

But you can help your body to process that carbohydrate more slowly by eating combined meals.  A “shaped up plate” would be one that has protein and fat foods on it as well.  So, you may find that you can eat 1/2 a sandwich with a good helping of meat and some mayonnaise for lunch and your blood sugar is under 130 at your 1 hour check.  Add some vegetables to that meal, maybe raw vegetables with a light ranch dip, and you have a good meal to start with.  You would probably not want to add chips to the gestational diabetes meal, but you could add another ounce of meat to your sandwich or create a nice side salad and have a full meal.  Some women even find that they can tolerate peanut butter and crackers for their evening snack and have a good blood sugar in the morning.

I think it’s important to realize that there are foods that will raise your blood sugars, and you need to eat some amounts of them at most of your gestational diabetes meal.  But combining them with protein and fat foods make them absorb slower and allow your body the chance to respond at it’s adjusted pace of insulin production.  For a gestational diabetic meal, you can have a healthy plate with a good portion of vegetables (green, orange or yellow) and some protein that will make a well rounded meal and keep you under control.

Other things affect your blood sugars, and you should be aware of them so you can note them in your blood sugar logs.  If you have a lot of stress, hormones that are released in your body can increase your blood sugar levels.  While you will never get your stress to zero, finding a way to reduce the amount of stress that you have is a priority.  The time of day can also play a big part in your blood sugars, as fasting blood sugars can be hard to control (but manageable with the adjustments of night time snacks) and hormones from your placenta may be released and cause an increase as well.  This is a big part of why every woman is going to be a little different when it comes to controlling your blood sugars.

Finally, exercise will help you keep your blood sugars down!  Something as simple as a walk right after you eat for 20 minutes will bring down your blood sugar levels because your body uses the sugar for energy.  It’s like a shot of insulin without the shot!

Consider your weight gain and the baby’s growth as two other important factors to determine if you are meeting your needs with what you eat at a gestational diabetes meal.  If you are in need of more information about how to follow a gestational diabetes diet meal plan, you can check out our meal plans – go there now.

Gestational Diabetes Treatment: What Are The Guidelines? Part 1

Now that you have been diagnosed with gestational diabetes based on the glucose tolerance test, what should you do?

Your gestational diabetes treatment is based on clinical guidelines that tell your obstetrician how to manage your blood sugars and keep you as healthy as possible!

The treatment uses 3 different types of controls to get your blood sugars where they need to be for your health and the safety of your baby.

When managing your treatment of gestational diabetes, some interventions are more complicated than others.  Most doctors typically start with trying to control your blood sugars using a diet and exercise plan that can keep your blood sugars under control most of the time.  Never forget, your pregnant body is full of hormones, and sometimes it does not react the way that would be expected.  During the management of gestational diabetes, what is of the utmost importance is the health of the baby and mom, not necessarily if you have to take medication or not.  It’s a short time that you will need to tightly manage your eating and blood sugars, so grin and bear it!

Most gestational diabetes treatment starts with dietary control.  It’s important that a mom be provided with some nutritional guidelines that are individualized based on what she needs.  If she is a vegetarian, the meal plan that is provided by the professional should reflect ways to get the needed protein, carbohydrate and fat without the animal proteins that mom has chosen to avoid.  Most moms see either a certified diabetes educator (nurse or dietitian) or a registered dietitian who can provide them with calorie levels and guidance about what foods to eat and how much.  Many women may find this to be enough information and be able to successfully navigate the foods that they need to eat and grow a healthy baby.  Sometimes, more information is needed, and some women may choose to purchase a gestational diabetes meal plan that can help them understand all of their options.  Either way, mom will start with eating the right amounts of carbohydrate at meals.

Often, pregnant women with diabetes find that their blood sugar is affected by foods in different ways.  Sometimes, a fruit can cause a spike in blood sugars, while other foods such as ice cream seem to allow for a smooth transition without a blood sugar spike.  It is important to track what you eat, how much and when as well as you check your blood sugars.  This will help you and your doctor understand what parts of the day and what foods are most affecting you.  It’s going to be different for every woman, as our bodies have different responses to hormones that are peaking during pregnancy.

How many calories should you eat for your gestational diabetes treatment plan?

For women who are not over weight before pregnancy, it is recommended to eat 30 calories/kg/day.  1 kilogram = 2.2 pounds, so divide your weight in pounds by 2.2, then take that number and multiply by 30.  For example, if you weighed 150 pounds that is 68.18 kilograms.  So you would estimate your calorie needs at about 2045 per day.  Women who are over weight should multiply by 25 calories/kg/day.  As long as your baby is growing and your blood sugars are under control, you should be okay with the amount of food you are eating during your gestational diabetes treatment.

The next step that many doctors also recommend in combination with diet control is exercise.  While you probably were exercising during your pregnancy, exercise in small bursts throughout the day can help a mom control her blood sugars well.  After every meal, it will be important to take a 15 minute walk at a quick pace to lower your blood sugar. Exercise causes your body to use the sugar in your blood more effectively, and you can decrease your spike by adding in a burst of exercise a few times a day.  This also gives you health benefits by controlling the weight gain and improving your aerobic capacity.  That will come in handy during labor.  Check with your doctor if you are concerned about exercise, but it’s one of the best ways to lower blood sugar without using insulin.

In our next post we will talk about the medications that are used to manage gestational diabetes treatment and how they work.

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Pregnancy Induced Diabetes: Your Questions Answered

We’ve gathered some of the most common questions asked about pregnancy induced diabetes, and brought them together to provide you with some answers.

Gestational diabetes is defined as diabetes that is diagnosed during pregnancy and was not present prior to pregnancy.  Sometimes people call it pregnancy induced diabetes.  Because you have the condition only while you’re pregnant.  And once you deliver the baby and the placenta, typically you can return to normal eating pattern.  Today I’m going to review some questions and provide answers for the most commonly asked items related to pregnancy induced diabetes.

How Common Is Pregnancy Induced Diabetes?

Nationally, between 1 to 2 women in 10, develop gestational diabetes during their pregnancy.  The guidelines are somewhat stricter for the development of the disease because of the fact that you’re pregnant and they want to take extra caution caring for your baby.  Even though it is fairly common, it’s not clear what women can do to prevent developing pregnancy induced diabetes.

What Are the Causes of Gestational Diabetes?

As you may be aware of, when you’re pregnant your hormones in your body do all kinds of things to your emotions, physical body amongst other things.  Hormones are the root cause of development of pregnancy induced diabetes as well.  As your pregnancy progresses, insulin sensitivity decreases.  Women who are overweight when they get pregnant may already have pre-diabetes and their body can’t manage the changes in insulin sensitivity.  Insulin resistance is also increased because of placental hormones.  Some of these hormones are cortisol, estrogen, and progesterone.  As the baby develops your placenta gets larger and also secretes more hormones.  This further causes insulin sensitivity to decrease.  So as your pregnancy progresses, if your body can’t make enough insulin to adjust to the amount that your body needs, you develop gestational diabetes.  This is also why they tend to test for gestational diabetes during the 24th through 28th week, because by that point it will have developed enough to show in a blood test.

How Does My Doctor Screen and Diagnose Pregnancy Induced Diabetes?

Your obstetrician initially determines your risk level for developing pregnancy induced diabetes and that helps them to determine when to test you.  If the determination is made to give you the initial test, for screening women are typically given 50 g of sugar.  This is called an oral glucose challenge because you drink a sugary sweet liquid.  Blood is drawn at 1 hour, and tested.  Typically, your physician will consider you for further testing if your 1 hour glucose challenge lab result is over 130 mg/dL.  If you fail the one hour glucose challenge test, your doctor will require you to do a 3 hour oral glucose tolerance test [OGTT].  In this testing, women are given 100 g of glucose and their blood is taken every hour for 3 hours.  Your doctor will determine the thresholds and how to diagnose.  Even if your blood sugar seems just a little bit elevated you should consider following a gestational diabetes diet plan to keep from having a larger baby or gaining too much weight.

Even if you have pregnancy induced diabetes, it’s important to realize that it’s easily managed using a meal pattern, exercise, and sometimes medication.  Most women view it as something that they have to tolerate for the duration of the pregnancy knowing that after the placenta is delivered, the condition typically goes away.  Click here now to learn more about our gestational diabetes meal plan and get an e-book that tells you even more about diabetes during pregnancy and how you can manage it.