Gestational Diabetes - Allina Health

Gestational DiabetesWhen You Have Diabetes During Your Pregnancy

PATIENT EDUCATION

My Acceptable Blood Glucose Ranges

Before breakfast

1 hour after the start of breakfast (meal one)

1 hour after the start of lunch (meal two)

1 hour after the start of dinner (meal three)

Resource Information

1. Doctor / clinic name: __________________________________________________ Phone: ___________________________ Fax: ___________________________

2. Doctor / clinic name: __________________________________________________ Phone: ___________________________ Fax: ___________________________

3. Diabetes nurse educator: _______________________________________________ Phone: ___________________________ Fax: ___________________________

4. Diabetes dietitian: _____________________________________________________ Phone: ___________________________ Fax: ___________________________

Ketone Testing

Test every morning until you have 7 days of negative or trace ketones. Then, decrease to every other morning. Call your health care provider if you have ketones often.

Gestational Diabetes When You Have Diabetes During Your Pregnancy

Fourth edition

Developed by Allina Health.

© 2014 Allina Health System

The publisher believes that information in this manual was accurate at the time the manual was published. However, because of the rapidly changing state of scientific and medical knowledge, some of the facts and recommendations in the manual may be out-of-date by

the time you read it. Your health care provider is the best source for current information and medical advice in your particular situation.

All rights reserved. No part of this book may be reproduced in any form or by any means, electronic or mechanical, including photocopying, without permission in writing from the publisher.

Disclaimer

This publication is for general information only and is not intended to provide specific advice or recommendations for any individual. The information it contains cannot be used to diagnose medical conditions or prescribe treatment. The information

provided is designed to support, not replace, the relationship that exists between a patient and his/her existing physician. For specific information about your health condition, please contact your health care provider.

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Table of ContentsChapter 1: Gestational Diabetes Overview . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7 Who Gets Gestational Diabetes? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8 How Can Gestational Diabetes Affect Your Baby? . . . . . . . . . . . . . . . . . . . . . . . . . 8 How Can Gestational Diabetes Affect You?. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9 How is Gestational Diabetes Diagnosed? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9 How is Gestational Diabetes Managed? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10

Chapter 2: Learning Healthful Eating, Physical Activity and Stress Management Skills . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15 Healthful Eating Habits . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15 Understanding Carbohydrates . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16 Basic Meal Planning . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17 Food Safety . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30 How To Read Food Labels . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 33 How Physical Activity Affects Blood Glucose Levels. . . . . . . . . . . . . . . . . . . . . . 34 How Stress Affects Blood Glucose Levels. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 35 Stress Worksheet . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 37

Chapter 3: Monitoring Blood Glucose Levels and Ketones . . . . . . . 41 Checking and Recording Blood Glucose Levels . . . . . . . . . . . . . . . . . . . . . . . . . . 41 Learning About Ketones . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 42

Chapter 4: Taking Insulin During Pregnancy . . . . . . . . . . . . . . . . . . . . . 47 Determining the Right Insulin and Dosage . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 47 Time-action of Different Insulins . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 48 How to Help Insulin Work Best . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 48 Pen Devices . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 48 Giving Yourself Insulin Injections . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 49 Measuring and Injecting a Single Type of Insulin . . . . . . . . . . . . . . . . . . . . . . . . . 49 How to Get Rid of Sharps (Needles and Lancets) Safely . . . . . . . . . . . . . . . . . . . 50 Storing Insulin. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 53 Hypoglycemia (Low Blood Glucose). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 53 Insulin and Physical Activity . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 55 Sick Day Tips. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 56

Chapter 5: Monitoring Your Baby’s Health . . . . . . . . . . . . . . . . . . . . . . . . 59 Fetal Movement Counts. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 59 Other Tests to Monitor Your Baby’s Well-being . . . . . . . . . . . . . . . . . . . . . . . . . . 60

Chapter 6: Labor, Birth and Recovery . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 65 Getting Ready for Labor and Birth . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 65 Your Baby’s Recovery . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 65 Your Recovery. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 66 Your Next Pregnancy and Gestational Diabetes . . . . . . . . . . . . . . . . . . . . . . . . . . 66 Your Risk of Getting Type 2 Diabetes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 67 Diagnosing Diabetes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 68 Risk of Your Baby Getting Diabetes. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 68

Glossary . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 71

Worksheets . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 75

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IntroductionYou have just been told that you have gestational diabetes. You may have some concerns and worries.

It’s natural to feel confused and challenged by this diagnosis, but many people are ready to help and support you. Have your health care provider or diabetes educator provide you with the names and phone numbers of people who can help. Write this information on the inside front cover of this book. Remember: many women have gone through this and given birth to healthy babies!

When untreated, gestational diabetes can be serious. When treated, complications can be managed and prevented.

For many women, gestational diabetes can be managed by following a meal plan, exercising as recommended, lowering stress, and monitoring blood glucose levels. Some women will also need to have insulin injections.

Naturally, this can all sound overwhelming at first. Careful and regular monitoring from your health care provider, education about gestational diabetes, and this book all will help you understand:

what’s happening to your body how gestational diabetes is affecting you and your baby how it can be controlled.

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Chapter 1: Gestational Diabetes Overview

You’ve probably heard of diabetes, and think of it as a lifelong disease. There are several types of diabetes, and most types do last a lifetime. However, gestational diabetes:

occurs only during pregnancy usually goes away after your baby is born often does not have symptoms that show.

Diabetes prevents your body from using food properly. During digestion, most foods are converted to a sugar called glucose. Glucose is your body’s main source of energy. Your body’s pancreas produces a hormone called insulin to convert the glucose to energy. When you have diabetes, your body has trouble producing enough insulin or using insulin, or both.

There are three main types of diabetes:

Type 1 diabetes: The pancreas makes no insulin, and daily injections of insulin are needed to process glucose.

Type 2 diabetes: The pancreas may not make enough insulin or the body may not use it properly (called insulin resistance).

Gestational diabetes: During pregnancy, important hormones that are needed for the baby’s growth interfere with insulin. This happens to all women during pregnancy, but most women can make enough extra insulin to keep their blood glucose levels under control. With gestational diabetes:

— Your body has trouble producing the extra insulin needed.

— Your blood glucose levels become higher than normal.

— The extra glucose is passed on to your baby.

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Who Gets Gestational Diabetes?

About 3 to 8 percent of pregnant women in America develop gestational diabetes. The risk is higher than average if you:

had it during previous pregnancies have given birth to a baby who weighed more than 9 pounds

had abnormal blood glucose levels in the past are obese have a family history of diabetes are older than age 25 have had a stillbirth or more than one miscarriage are carrying twins or triplets are a member of certain ethnic groups.

However, women sometimes develop gestational diabetes without being in any one of the risk groups. You did not cause this to happen to you and your baby — gestational diabetes often happens for reasons that can’t be explained.

How Can Gestational Diabetes Affect Your Baby?

Untreated gestational diabetes can:

cause your baby to store extra glucose as extra fat and have a higher than average birth weight. This can result in delivery problems for both you and the baby.

cause your baby to be born with low blood glucose (called hypoglycemia)

— During pregnancy, the baby’s body makes more insulin to balance the extra blood glucose passed from you.

— After birth, the baby may continue to produce too much insulin.

— When undetected, the glucose-insulin imbalance can lead to seizures and even coma.

cause breathing problems, jaundice or premature delivery

cause stillbirth in rare cases put your baby at a higher risk of developing obesity and type 2 diabetes later in life.

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How Can Gestational Diabetes Affect You?

Even when gestational diabetes is treated, you are at an increased risk of developing high blood pressure and urinary tract infections during pregnancy as well as type 2 diabetes later in life. However, following all the management guidelines for gestational diabetes — meal planning, exercising as recommended, managing stress and monitoring blood glucose — will help you lower these risks.

How is Gestational Diabetes Diagnosed?

All pregnant women, whether they are in a high risk group or not, are typically screened for gestational diabetes. This usually occurs between 26 and 28 weeks of pregnancy, when the hormones that cause gestational diabetes are at high levels. You do not need to do anything for this screening test.

Screening for gestational diabetes

The typical steps for the screening test at your health care provider’s office are:

You drink a 50-gram glucose beverage. You sit quietly for 1 hour. Your blood glucose level is measured. A result of 139 is considered a positive glucose screen.

If you have a positive result, you may be given a 3-hour glucose tolerance test on another day to confirm if you have diabetes.

Diagnosing gestational diabetes

The typical steps to confirm gestational diabetes using the glucose tolerance test are:

You fast the night before the test. On the days before the test, you should eat normally.

Your fasting blood glucose is measured before the test begins.

You drink a 100-gram glucose beverage at your health care provider’s office or lab.

You sit quietly for 3 hours.

Your blood glucose is measured at fasting, then at 1-, 2-, and 3-hour time spans during the 3-hour period.

Did You Know?

Any woman might develop gestational diabetes during pregnancy.

Tip

Two or more elevated test results means you have gestational diabetes.

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Your health care provider will review your test results and tell you what happens next. Information covered may include:

a special meal plan blood glucose monitoring urine testing for ketones physical activity guidelines medicine therapy.

Your health care provider’s clinic may have a diabetes dietitian or educator help you, or you may be referred to a diabetes center at your hospital.

How is Gestational Diabetes Managed?

The goal of managing gestational diabetes is to keep your blood glucose levels within a “normal” range for pregnancy. Your health care provider or diabetes educator will tell you what this range is.

Certain things directly affect your blood glucose level, including:

what you eat how much you eat how often you eat how physically active you are how much stress you feel.

You can control all of these things with help from your health care provider and diabetes educator.

Until your baby is born, you will have to think carefully every day about your food choices, the timing of your meals, and your physical activity level and routine. You will have to plan your day’s schedule to make room for eating, exercising and checking your blood glucose regularly.

General guidelines will help you choose foods and a routine. However, you may need to tailor your diet and physical activity plan from time to time to achieve the results you want.

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Sometimes, even when all guidelines are carefully followed, blood glucose doesn’t stay at an acceptable level. In these cases, it’s necessary to add medicines to your management plan.

This is a major change in your life. Expect it to take concentration and effort at first. Try not to get impatient with yourself. Remember that many resources are available to you. Your health care provider, the diabetes educators at your clinic or at your hospital’s diabetes center, and this book are all here to help you.

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Chapter 2: Learning Healthful Eating, Physical Activity and Stress Management Skills

The goal of managing gestational diabetes is to keep your blood glucose levels within a normal range for pregnancy. Food, physical activity and stress all affect your blood glucose level and the health of you and your baby.

Your body converts much of the food you eat into glucose. Insulin moves glucose from your bloodstream into your cells, where it is used for energy. Remember: with gestational diabetes, your body has trouble using insulin properly.

Eating habits and food choices affect blood glucose levels. Not eating at regular times and not eating often enough can cause dips and peaks in your blood glucose. Eating too much food at once can cause blood glucose to go too high.

Eating regularly and following the tips in this chapter will help you control your blood glucose and help you and your baby stay healthy.

Healthful Eating Habits

Choose a variety of healthful foods. Eat three meals and three snacks during the day. Eat something every 2 to 3 hours. Do not skip meals or snacks. Eat a small breakfast. Do not eat too much or too little. Your baby has constant nutritional needs and counts on you to eat the right amount of healthful foods.

Tip

Fill out "My Meal Plan" on page 75.

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Understanding Carbohydrates

All foods can affect blood glucose levels, but carbohydrates affect blood glucose the most. Carbohydrate foods give you and your baby energy.

Carbohydrate foods should make up 40 to 45 percent of the total calories you eat each day.

Carbohydrate foods are:

beans and lentils breads cereals fruits grains milk and yogurt starchy vegetables sweets fruit and vegetable juices.

Carbohydrate counting

Learning to count carbohydrates is a way to help you manage the amount of carbohydrate you eat each day at your meals and snacks.

A carbohydrate choice is a serving of food that contains about 15 grams of carbohydrate. Pregnant women need between 12 to 16 carbohydrate choices every day.

Remember: it is not healthy to leave out carbohydrate foods to control your blood glucose. On the next few pages are examples of carbohydrate choices. Try to choose a healthful variety of carbohydrate choices each day.

TipTo help control your blood glucose, avoid carbohydrates that often cause blood glucose to go up too high, such as soda, fruit juices or drinks, lemonade or Kool-Aid®, chocolate milk, or sugar-sweetened coffee, tea or other beverages.

Did You Know?Sweets may make your blood glucose go too high. Save eating something sweet for a very special occasion or a rare treat.

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Basic Meal Planning

Meal plan

You need to eat and drink at least 12 carbohydrate choices each day. Most women need 14 carbohydrate choices each day to maintain the desired weight gain of 1/2 pound each week. If you follow a vegetarian diet, you need 15 to 16 carbohydrate choices each day to get enough nutrients.

At breakfast, include:

2 to 3 carbohydrate choices (30 to 45 grams) protein (meat, poultry, fish, eggs, cheese, peanut butter) vegetable or fat, freely.

For a morning snack, include:


At lunch, include:


For an afternoon snack, include:


At dinner, include:


For an evening snack, include:


Did You Know?Blood glucose is hard to control in the morning when the hormones that boost your blood glucose level are released.

To help, follow these breakfast tips:

Eat a small breakfast. Eat whole-grain bread products.

Eat a food that has protein. Do not eat cereal or fruit. Do not drink fruit juice at breakfast or any other time of the day. Fruit juice raises your blood glucose very quickly.

Tip

Protein can help control blood glucose. Try to eat protein with each of your meals and snacks.

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Food Serving Size Carbohydrate Grams

Carbohydrate Choice

Bagel (most bagel shops) 1 large 60 to 75 4 to 5

Bread: pumpernickel, rye, white, whole grain 1 slice 15 1

Breadstick (soft) 6- to 7-inch 30 2

Chapati or roti 6-inch 15 1

Cornbread 2-inch square 23 to 34 1 ½ to 2

Dinner roll 1 15 1

English muffin ½ 15 1

Enjera (bought from store) ½ large 45 3

Enjera (homemade) 1 small 15 1

Hoagie roll 1 75 5

Hot dog or hamburger bun ½ 15 1

Naan 4-inch 22 1 ½

Pancake 4-inch 15 1

Pita 6-inch 30 2

Stuffing 1 cup 22 1 ½


Carbohydrate Choice

Baked beans 1 cup 60 4

Lentils ½ cup 20 1

Other cooked beans: black, kidney, garbanzo, navy ½ cup 21 1 ½

Beans and Lentils

Breads

19


Carbohydrate Choice

Cooked and unsweetened ½ cup 15 1

Dry ½ to 1 1/3 cup 20 to 45 1 to 3


Carbohydrate Choice

Apple 1 large 30 2

Banana 1 large 30 2

Berries: blackberries, blueberries, raspberries, strawberries 1 cup, whole 15 1

Canned fruit (packed in juice) ½ cup 15 1

Cherries 15 15 1

Clementines 2 15 1

Grapefruit ½ medium 15 1

Grapes 15 15 1

Kiwi 1 large 15 1

Mango ½ cup 15 1

Melon 1/3 melon or 1 cup cubes 15 1

Nectarine 1 medium 15 1

Orange 1 medium 15 1

Peach 1 medium 15 1

Pear 1 large 30 2

Pineapple 1 cup 20 1

Plums 2 small 15 1

Raisins 2 tablespoons 15 1

Cereals

Fruits

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Carbohydrate Choice

Almond milk (unsweetened) 1 cup 0 0

Cheese (hard): cheddar, Swiss 1 ounce 0 0

Milk: buttermilk, skim, whole, 1 percent, 2 percent 1 cup 15 1

Milk: chocolate 1 cup 30 2

Milk: soy, plain or flavored ½ to 1 cup 15 1

Yogurt: plain or artificially sweetened ¾ cup 15 1

Yogurt: sweetened with fruit ¾ cup 30 2


Carbohydrate Choice

Couscous, cooked 1 cup 45 3

Pasta (cooked): macaroni, noodles, spaghetti 1 cup 45 3

Popcorn 6 cups 30 2

Rice (cooked): white or brown 1 cup 35 to 60 3 to 4

Rice (cooked): wild 1 cup 35 2

Grains

Milk and Other Foods with Calcium

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Carbohydrate Choice

Chips (regular): potato, tortilla 10 to 15 15 to 20 1

Graham crackers 3 squares 15 1

Granola bar 1 bar 30 2

Pretzels (mini twists) 20 25 1 ½

Ritz® crackers and saltine crackers 6 15 1

Triscuits® 6 15 1


Carbohydrate Choice

Corn ½ cup 15 1

Hash browns 1 cup 45 3

Peas ½ cup 15 1

Potatoes (baked) ¼ large (3 ounces) 15 1

Potatoes (frozen): french fries 20 30 2

Potatoes (mashed) ½ cup 15 1

Squash: acorn or butternut ½ cup 15 1

Yam ¼ large (3 ounces) 25 1 ½

Snack Foods

Starchy Vegetables

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Carbohydrate Choice

Asian

Chinese egg noodles 1 cup 45 3

Chow mein 1 cup 15 to 20 1

Chow mein noodles ½ cup 15 1

Egg roll 5-inch 23 1 ½

Fried rice 1 cup 45 3

Lo mein (meat, noodles, vegetables) 1 cup 30 to 50 2 to 3

Stir fry (meat, no rice) 1 cup 10 1

Sweet and sour chicken or pork (no noodles, no rice) 1 cup 45 3

Sweet and sour sauce 1 tablespoon 15 1

Combination Foods: Ethnic

Combination Foods


Carbohydrate Choice

Casserole (hot dish) 1 cup 30 2

Chili 1 cup 30 2

Coleslaw ½ cup 15 1

Pasta or potato salad ½ cup 15 to 25 1 to 1 ½

Soup: broth type 1 cup 15 1

Soup: cream type 1 cup 15 to 30 1 to 2

Sub sandwich 6-inch 45 3

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Carbohydrate Choice

Italian

Lasagna 4-inch square 45 to 60 3 to 4

Pizza: thick crust 1/8 large 30 to 45 2 to 3

Pizza: thin crust 1/8 large 25 to 35 1 ½ to 2

Ravioli (no sauce) 9 to 11 45 to 60 3 to 4

Tomato or pasta sauce ½ cup 8 to 15 ½ to 1

Mexican

Burrito 6- to 8-inch 45 to 60 3 to 4

Enchilada 8-inch 50 3

Fajita 6- to 8-inch 20 1

Tortilla (flour) 6-inch 15 1

Quesadilla 8- to 10-inch 30 to 40 2 to 3

Refried beans 1 cup 50 3

Taco (corn shell) 6-inch 15 1

Combination Foods: Ethnic

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Sweets

Sweets may make your blood glucose go too high. The information in the chart will help you know how to count these foods. In general, avoid sweets except for special occasions.


Carbohydrate Choice

Angel food cake: unfrosted 1-inch slice 15 1

Brownie: unfrosted 2-inch square 15 1

Cake: unfrosted 2-inch square 15 1

Chocolate 1 ounce 15 1

Cookie 3-inch 10 to 15 1

Doughnut: cake 1 25 1 ½

Flavored coffee: mocha latte 12 ounces 30 2

Frozen yogurt ½ cup 25 1 ½

Gelatin: regular ½ cup 15 1

Honey: regular 1 tablespoon 15 1

Ice cream cone: cake, sugar, wafer 1 3 to 9 0 to ½

Ice cream or frozen yogurt: light, low-fat, regular, sugar-free ½ cup 15 to 21 1 to 1 ½

Jam, jelly, honey: regular 1 tablespoon 15 1

Muffin: medium 1 24 1 ½

Pie: fruit 1/8 of 9-inch pie 45 to 60 3 to 4

Pudding: regular ½ cup 30 2

Pudding: sugar-free ½ cup 15 1

Sherbet, sorbet, gelato ½ cup 30 2

Sugar: brown packed or white 1 tablespoon 15 1

Syrup: light or sugar-free ¼ cup 15 to 25 1

Syrup: regular ¼ cup 52 to 60 3 ½ to 4

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Juice

Fruit juices often cause blood glucose to go too high. In general, avoid fruit juice. Drink fruit juice only if you are ill or when you need to treat low blood glucose if you take insulin.


Carbohydrate Choice

Apple, grapefruit, orange or pineapple ½ cup 15 1

Cranberry juice cocktail, grape, prune 1/3 cup 15 1

Fruit juice blends (100 percent juice) 1/3 cup 15 1

Fruit juice: reduced calorie 1 cup 10 to 15 1

Tomato juice 1 cup 10 1

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Free Foods

A free food is any food or drink that contains fewer than 20 calories or 5 grams of carbohydrate per serving. Foods with a serving size listed below should be limited to no more than three servings at one time.

Carbohydrate-free beverages such as club soda, Crystal Light®, calorie-free water, diet soft drinks, coffee, and hot or unsweetened teas will not affect blood glucose


Carbohydrate Choice

Artificial sweeteners 1 teaspoon 0 to 1 0

Barbeque sauce 2 teaspoons 4 0

Cocktail sauce 2 tablespoons 3 0

Dill pickles 4 slices 1 0

Gravy ¼ cup 3 0

Herbs and spices 1 teaspoon 1 0

Ketchup 1 tablespoon 4 0

Lemon and lime juice 1 tablespoon 2 0

Most vegetables ½ to 1 cup 5 0

Mustard 2 tablespoons 3 0

Olives 2 2 0

Salsa 2 tablespoons 4 0

Soy sauce 1 tablespoon 1 0

Steak sauce 1 tablespoon 3 to 5 0

Important

"Sugar-free" does not mean carb-free.

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Completing a meal plan

Vegetables

Most vegetables do not raise blood glucose. Vegetables supply many nutrients for both you and your baby. Try to eat at least four servings of vegetables each day.

Make sure you measure out your servings of vegetables that can raise your blood glucose. One-half cup of the following vegetables is equal to 15 grams of carbohydrate (one carbohydrate choice):

beans corn peas potatoes yams.

All other vegetables are “free” foods:

artichokes asparagus alfalfa sprouts bean sprouts beans (green, Italian, waxed)

beets broccoli Brussels sprouts cabbage carrots cauliflower celery collard greens cucumber edamame eggplant endive greens jicama kohlrabi leeks

lettuce mushrooms mustard greens okra onions parsnips pea pods peppers pumpkin radishes rhubarb rutabaga sauerkraut soybeans spinach squash: crookneck, crushaw, spaghetti, summer, zucchini

swiss chard tomatoes turnips zucchini.

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Protein

Protein is important for you and your baby. Protein helps build cells, helps with growth and healing, and helps hormones work. Most pregnant women need 6 to 8 ounces of protein each day.

Dried beans and lentils contain protein but they must be counted as carbohydrates. (See the list on page 18 for how much counts as one carbohydrate.) Examples of protein foods are:

beef or veal canned fish cheese chicken cottage cheese egg egg substitute fish and seafood game hot dogs lamb luncheon meat (choose lean cuts such as turkey breast, chicken breast or roast beef)

nuts peanut butter pork soy or veggie burgers tempeh tofu turkey.

TipEat foods that contain protein with each meal. This will help you to:

feel full get enough protein for you and your baby

control your blood sugar.

Important

Some types of fish and seafood can contain contaminants (mercury or PCBs) that can harm a developing baby. Turn to page 30 for more information about food safety.

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Fat

Fat contains calories to help supply energy to you and your baby. Fat helps your body absorb vitamins A, D, E and K. Fat also gives you essential fatty acids, which help your baby’s brain and nervous system develop.

It is important to focus on eating healthful fats. The following foods are good sources of healthful fats:

most nuts and seeds peanut butter (natural or trans fat-free) cooking oils (olive, canola, peanut or flaxseed) avocados fatty fish (salmon or trout).

Artificial sweeteners

Avoid saccharin (Sweet’N Low® or Sugar Twin®). It’s OK to eat two or three servings a day of foods that are sweetened with these artificial sweeteners:

— aspartame (NutraSweet® or Equal®) — sucralose (Splenda®) — acesulfame-K (Sweet One®, Sweet & Safe®, Sunette®).

Many artificially sweetened foods contain more than one of the above listed sweeteners. They are safe for pregnancy, but do not eat too much. Ask your health care provider how much you may eat if you are not sure.

Tips to remember

If you are hungry, add vegetables or a protein food to your carbohydrate snacks.

Focus on eating healthful fats. If your blood glucose is high when you wake up, have a bedtime snack that includes both protein and carbohydrates. This will help keep your blood glucose in check during the night.

Don’t drink alcohol. Follow your health care provider’s guidelines about caffeine.

TipOne serving equals 12 ounces of a beverage or one 6- to 8-ounce carton of yogurt that contains an artificial sweetener.

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Food Safety

The following tips will help keep your food safe from harmful bacteria.

Keep things clean

Wash your hands well before and after handling food. Always wash your hands after using the bathroom, changing diapers or handling pets.

Wash fruits and vegetables under running water before eating.

Wash utensils, dishes, cutting boards, counters and sinks with hot, soapy water after they come in contact with raw meat, poultry, seafood, eggs or unwashed fresh produce.

Clean up spills in your refrigerator right away. Look at expiration dates on containers. Once a week throw away food that should no longer be eaten.

Keep things separated

Keep raw meat, poultry and seafood separate from other items in your grocery cart and refrigerator.

Put uncooked meat, poultry and fish in sealed containers or plastic bags when storing them in the refrigerator.

Use one cutting board for raw meats and a different one for fruits and vegetables.

Place cooked meat, poultry and seafood on a clean plate. Do not reuse a plate that held the raw food.

Keep things chilled

Keep your refrigerator at 40 F or below and your freezer at zero F or below.

Refrigerate food quickly. Cold temperatures keep most harmful bacteria from multiplying.

Refrigerate perishable foods within 2 hours of purchase. (Refrigerate within 1 hour if the temperature is more than 90 F.)

Refrigerate or freeze prepared foods and leftovers within 2 hours (within 1 hour if the temperature is more than 90 F).

Use shallow containers for quicker cooling.

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Don’t overpack the refrigerator; leave room for the cold air to circulate.

Never thaw foods on the counter. Thaw foods in the refrigerator, in cold water or in a microwave.

Cook things well

Use a clean, quick-read food thermometer to determine the temperature of foods.

Cook foods until they have reached the proper temperature:

— roast beef and steaks to at least 145 F — ground beef to at least 160 F — pork chops and roasts to 160 F — chicken breasts to 170 F — whole poultry to 180 F — fish until it’s opaque and flakes easily with a fork — eggs until the yolks and whites are firm.

Reheat leftovers to 165 F.

Tips to prevent food-related illness

Listeria is a kind of bacteria that can contaminate foods and cause an infection called listeriosis. This is a serious illness that can cause premature labor or death to a developing or newborn baby. To reduce your risk of listeriosis:

Make sure all milk and milk products are pasteurized. Do not eat unpasteurized soft cheeses such as feta, Brie, Camembert, blue-veined cheeses and Mexican-style cheeses.

Reheat hot dogs, lunch meats and deli meats until they are steaming hot.

Do not eat refrigerated pâté or meat spreads. (Canned or shelf-stable spreads are fine.)

Only eat refrigerated smoked seafood as an ingredient in a cooked dish, such as a casserole.

Reheat precooked take-home meals to 165 F.

Toxoplasmosis is an infection caused by a parasite. This infection comes from cat feces and raw meat.

Tip

For more information visit foodsafety.gov.

Tip

Salmonella and E coli 0157 bacteria can contaminate foods and cause serious illness. Don’t eat raw sprouts while you are pregnant because they can be easily contaminated. In addition, follow the tips for safe food handling on the previous page and preparation listed at right.

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Choosing fish wisely

Fish is a good source of protein, contains fatty acids and is low in saturated fat. However, any fish (store-bought or fresh-caught) could contain contaminants such as mercury or PCBs that can harm a developing baby.

It’s best to vary the kind of fish you eat and limit the amount of fish you eat to one to two meals a week.

The amount of fish in a meal depends on your body weight. If you weigh 150 pounds, you could safely eat ½ pound (8 ounces) of fish (precooked weight).

To adjust the amount of fish, subtract or add 1 ounce of fish for every 20 pounds of body weight:

If you weigh 130 pounds, eat 7 ounces of fish. If you weigh 150 pounds, eat 8 ounces of fish. If you weigh 170 pounds, eat 9 ounces of fish.

Tips to help you choose fish

Avoid king mackerel, swordfish, tilefish and shark. These are large, salt-water fish most likely to have high levels of mercury.

Avoid eating these locally caught fish: walleye larger than 20 inches, northern pike larger than 30 inches and all muskellunge.

Limit canned tuna to 6 ounces a week. Light tuna is a smaller fish and less likely to have high levels of mercury. Limit eating canned albacore tuna to one 6-ounce meal a month.

Eat up to two meals a week of farm-raised or wild salmon from the Pacific or Atlantic Ocean, not from the Great Lakes.

Avoid raw fish, sushi and sashimi because it could contain harmful bacteria.

Tip

The Minnesota Department of Health has guidelines on eating specific kinds of fish. Visit health.state.mn.us/fish for more information.

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Use the nutrition label for a granola bar at left to understand the following.

Serving size: The serving size lists how many calories and nutrients are in one serving of the food. If you eat twice the serving size, you are getting twice the calories, fat, carbs, sodium, etc.

Calories and calories from fat: Calories are a measure of energy released by a food. Try to limit your food choices to those that have less than one-third calories from fat.

Total fat: Total fat includes all types of fat. Try to eat foods low in saturated and trans fats.

Saturated fat: Saturated fat raises LDL (the “bad”) cholesterol. Reduce saturated fats to help protect your heart.

Trans fat: Trans fats can raise LDL cholesterol, lower HDL cholesterol, and add to heart disease. Eat as little trans fats as possible. Avoid foods that contain “partially hydrogenated” and “hydrogenated” oils, including shortening.

Cholesterol: Foods from animals (meat, fish, eggs, cheese, butter) have cholesterol.

Sodium: Too much sodium (salt) can lead to high blood pressure. One teaspoon of salt has 2,400 milligrams of sodium. This is the upper limit most people need each day.

Total carbohydrate: Carbohydrates give your body energy. However, too many can raise your blood glucose.

Fiber: If the food has 5 grams or more of fiber, subtract half of the grams from the total carbohydrate. Try to get at least 25 to 35 grams of fiber each day.

Sugar: Sugar is included in the number of total carbohydrate.

Protein: Choose lean meats, poultry and fish.

How To Read Food Labels

Nutrition FactsServing Size 1 bar (40 g)

Amount Per Serving

Calories 170 Calories from Fat 60

% Daily Value*

Total Fat 7 g 11%

Saturated Fat 3 g 15% Trans Fat 0 g

Cholesterol 0 mg 0%

Sodium 160 mg 7%

Total Carbohydrate 24 g 8%

Dietary Fiber 3 g 12% Sugars 10 g

Protein 5 g

Vitamin A 2%

Vitamin C 2%

Calcium 20%

Iron 8% *Percent Daily Values are based on a 2,000 calorie diet. Your daily values may be higher or lower depending on your calorie needs:

Calories 2,000 2,500 Total fat Less than 65 g 80 g Sat fat Less than 20 g 25 g Cholesterol Less than 300 mg 300 mg Sodium Less than 2,400 mg 2,400 mg Total Carbohydrate 300 g 375 g Dietary Fiber 25 g 30 g

Food label for a granola bar

Source: U.S. Food and Drug Administration

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How Physical Activity Affects Blood Glucose Levels

Physical activity is good for most pregnant women. Being physically active helps insulin work better and can help control your blood glucose level. Check with your health care provider before starting any new physical activity or before adding to your routine.

Tip

Walking for 10 to 15 minutes after every meal may help control your blood glucose. If you are able to do this, count it as your physical activity, not as an addition to your daily physcial activity.

Grams of carbohydrate Number of carbohydrate choices

0 to 5 0

6 to 10 ½

11 to 20 1

21 to 25 1 ½

26 to 35 2

36 to 40 2 ½

41 to 50 3

51 to 55 3 ½

56 to 65 4

66 to 70 4 ½

71 to 80 5

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How Stress Affects Blood Glucose Levels

Stress can increase your blood glucose levels. Stress can also cause you to turn to unhealthful behaviors, such as overeating, eating unhealthful foods or smoking. Managing your stress and relaxing more will help you and your baby stay as healthy as possible.

Identify sources of stress

Being pregnant, preparing for a new baby and learning to manage gestational diabetes are stressful things on their own. But you also lead a life in the real world, with all its stresses and tensions.

Stress has many sources. Name some of your main sources of stress and see if you can identify an action to reduce or eliminate complications of gestational diabetes for you and your baby. You might find that simply learning as much as you can about gestational diabetes will relieve much of your worry.

How to reduce your stress level

Find opportunities to rest: sit, lie down, put your feet up. Talk to friends, family and your partner about your concerns and stresses.

Lower your expectations of yourself. The house can be messy, the laundry can fall behind and you can be less than perfect. You’re helping your baby grow and be healthy, and that’s your first priority.

Get enough sleep. Ask for help in getting tasks done. Ask a friend to drive, a sister to help set up the nursery, your partner to grocery shop. If possible, hire out tasks like yard work and house cleaning during your pregnancy.

Know and accept your limits. Let friends and family know that for now, you have to take special care of yourself and your baby. When you need rest, excuse yourself and go rest. When you feel overwhelmed, take on less.

Be physically active every day. It’s a great stress reliever. Add relaxation to each day. Listen to your favorite music at work. Take a bubble bath. Close your eyes and do nothing except breathe deeply.

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Schedule time for what you want to do. Book time on your own calendar for whatever gives you joy. Visit a museum. Do needlework. Talk long distance with a friend. Read a long novel. Sit in the garden.

Watch funny movies, read silly books, laugh with friends.

Cry if you want. It’s a great stress reliever. Remind yourself that gestational diabetes isn’t forever.

If you’re struggling with the emotions and stress caused by gestational diabetes and pregnancy, tell your health care provider and your diabetes educator. They can help you find ways to cope.

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My Sources of Stress Ways to Reduce or Eliminate Them

Example: Driving during rush hour. Shift work hours slightly to avoid rush hour or play relaxation tapes in the car.

Example: Keeping enough of the right foods in the house.

Make up daily menus for several days and then shop ahead of time.

Stress Worksheet

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Chapter 3: Monitoring Blood Glucose Levels and Ketones

Is your gestational diabetes management plan working? To measure your success at lowering your blood glucose level, you need to check your levels four or more times during the day with a small device called a blood glucose meter. There are several different types. Your health care provider or diabetes educator will help you select a meter and teach you how to use it.

Besides monitoring blood glucose levels, your health care provider will also ask you to check your urine for ketones.

Checking and Recording Blood Glucose Levels

It is important to check your blood glucose at consistent, regular times. Each day, check:

before breakfast 1 hour after the start of breakfast (meal one) 1 hour after the start of lunch (meal two) 1 hour after the start of dinner (meal three).

For results to be most accurate, meals should be eaten in 30 minutes or less. Keep a written record of your blood glucose levels. Share the results at each prenatal visit. Your health care provider may also ask that you call weekly to report your results. Be prepared to read your record over the phone. Also, be ready to discuss what you’ve eaten and when you’ve eaten.

Blood glucose rangesYour health care provider or diabetes educator will tell you what your acceptable blood glucose ranges are.

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Having an out-of-range reading

Ask your diabetes health care provider about when you should call the clinic with an out-of-range blood glucose reading. If you have an out-of-range reading, try to determine whether you’ve eaten at an unusual time or chosen foods outside of your meal plan.

Call your diabetes educator or dietitian with questions. You may only need to make some simple changes to your meal plan.

If you have some out-of-range readings within 1 week, your health care provider may review your diet and physical activity plan and may also investigate your need for medicine.

Learning About Ketones

Ketones are by-products of fat breakdown in your body. When found in your urine, they indicate that you’re not eating enough calories at regular intervals during the day or that your blood glucose is too high.

Small amounts of ketones in your morning urine can result from:

not eating enough the previous day missing your bedtime snack not eating all the carbohydrate choices in your meal plan more physical activity than usual on the previous day.

Acceptable Blood Glucose Ranges

Before breakfast

1 hour after the start of breakfast (meal one)

1 hour after the start of lunch (meal two)

1 hour after the start of dinner (meal three)

When To Call Your Health Care Provider

Call if you have some unexplained out-of-range blood glucose level results.

Tip

Add a protein to your snack at bedtime. A slice of turkey, a few cheese cubes, a scoop of cottage cheese or a glass of milk may help prevent ketones from forming overnight.

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Large amounts of ketones may be seen if you have:

extreme morning sickness vomiting and diarrhea so you can’t eat or drink illness or infection.

If you become sick, it’s even more important for you to regularly check your ketones.

Checking for ketones

You’ll check your urine for ketones each day and record the results. When you get up for the day, check your first morning urine. Ideally, ketone readings should be negative to a trace.

Avoiding ketones

Remember that ketones may be a signal that you need to eat more. The following will help to keep your ketones at a healthy level for you and your baby.

Don’t skip meals or snacks. Eat three meals and three snacks every day. Eat all of the carbohydrate choices in your meal plan. Include protein in each meal or snack.


Call if you are sick and:

your blood glucose levels are above your ideal level

your urine ketones are moderate to large

vomiting continues or diarrhea lasts longer than 4 hours

you have a fever of 101.5 F or higher.

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Chapter 4: Taking Insulin During Pregnancy

When your blood glucose levels stay raised despite meal planning and physical activity, insulin must be added to your management plan to keep you and your baby healthy. Pregnancy requires that your body produce extra amounts of insulin.

Insulin is a hormone that is made by the pancreas. If your pancreas does not make enough insulin, injections can help you meet the need.

Your health care provider and diabetes educator will teach you how to inject insulin safely and comfortably.

Determining the Right Insulin and Dosage

Your health care provider will decide what kind of insulin is right for you, how much to use and when you should take it, based on:

your weight (which changes weekly) how far along your pregnancy is your meal plan your most recent blood glucose levels.

Sometimes, you may need more than one type of insulin. Different types of insulin work at different speeds, and your health care provider may combine insulins to achieve the best results for you.

Tip

Keep a record of the type and amount of insulin you take. It is important that you know and remember your insulin type every time you speak with a health care provider.

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Time-action of Different Insulins

How to Help Insulin Work Best

Take your insulin at the same times each day as directed. Talk with your health care provider if you feel sick. Follow any instructions your health care provider gives you.

Don’t change your meal plan, physical activity, prescribed medicines or insulin routines without talking to your health care provider.

Pen Devices

Most insulins are available in a pre-filled pen you throw away after use. See the product insert for specific use guidelines.

Insulins Starts Working Peaks Stops Working

Rapid Acting:Humalog® (lispro)NovoLog® (aspart)Apidra® (glulisine)

5 to 15 minutes 1 to 2 hours 2 to 4 hours

IntermediateActing:NPH (N)

2 to 4 hours 4 to 8 hours 10 to 16 hours

Basal*:Lantus® (glargine)Levemir® (detemir)

2 hours No peak 24 hours

*Lantus® and Levemir® cannot be mixed with any other insulin.

Tip

The insulin you inject only lowers your blood glucose. It does not cross the placenta to your baby.

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Giving Yourself Insulin Injections

The thought of injecting insulin may make you feel anxious. However, with good training from your diabetes educator, doing it can be surprisingly comfortable.

Your health care provider and diabetes educator will show you where insulin can be injected. The most common site for pregnant women is the abdomen. The needle poses no threat to your baby, which is well protected in your uterus far away from the needle.

Measuring and Injecting a Single Type of Insulin

1. Wash your hands.

2. Roll the bottle of cloudy insulin between your hands and turn it upside down to mix.

3. Remove the cover from the needle.

4. Draw air into the syringe equal to your prescribed dose of _________ units.

5. Put the needle into the top of the insulin bottle and shoot air in.

6. Turn the bottle and syringe upside down.

7. Pull down and push up on the plunger two or three times — slowly — to get rid of air bubbles. Look carefully to make sure that all bubbles are gone.

8. Draw out your prescribed amount of insulin:

_________ units ___________ type.

9. Pull the needle out of the bottle.

10. Clean the skin at the injection site, if needed.

11. Gently pinch skin and inject insulin. Your diabetes educator or doctor will advise you where to inject your insulin (usually the abdomen).

Important

Your health care provider or diabetes educator will show you how to inject insulin.

Tip

Do not use insulin that is lumpy, sticks to the bottle or looks discolored. Return it to your pharmacy for a new bottle.

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How to Get Rid of Sharps (Needles and Lancets) Safely

How to store your sharps at home

You will need to have a special container in which to store your used sharps at home. You can:

buy a sharps disposal container from your pharmacy make your own container from an empty laundry detergent bottle with a screw-on lid. To make your own sharps disposal container:

— use a pen or marker to write “Do not recycle: household sharps” on a piece of masking tape and stick it on the front of the container

— place your used sharps point-first into the container — screw the cap on tightly and do not take the cap off unless you are placing sharps into it

— return the sharps to your county drop-off site or send them to a mail-back program. (River Falls Area Hospital does accept sharps. Check with your hospital before dropping off your sharps.)

When storing sharps at home, it is important to remember the following.

Do not store sharps in glass bottles, aluminum cans or coffee cans.

Always keep your sharps storage container in a place where children and pets cannot reach it.

Follow any directions from your county drop-off site or mail-back programs. Some may require that you buy a special sharps disposal container.

Source: Minnesota Pollution Control Agency

You can buy a sharps disposal container from your pharmacy.

Source: Minnesota Pollution Control Agency

You can make your own sharps disposal container from an empty laundry detergent bottle.

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How to destroy your sharps

You need to prepare sharps properly before getting rid of them. You can buy a device that:

melts sharps. This device uses heat to melt the sharps into small BB-size balls. or

clips sharps. This device clips sharps and stores them.

How to get rid of your sharps

Never place sharps containers in the recycling or loose sharps in the trash. Choose one of the following options to get rid of your sharps.

Throw melted sharps in the trash (not the recycling). Return clipped and stored sharps to:

— your county drop-off site — a mail-back program. You will have to pay for this.

Allina Health hospitals and clinics in Minnesota do not accept sharps. Please do not bring them to your hospital or clinic.

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Whom to call with questions

Please call your city or county government’s household trash and recycling service with questions. You can find the phone number by visiting:

Minnesota: pca.state.mn.us

— Type “household hazardous waste” in the search box. — Click on Find your household hazardous waste collection site - Minnesota Pollution Control Agency in the search results.

— Select your county from the drop down menu and click Go!

Wisconsin: dnr.wi.gov

— Type “health care waste” in the search box. — Scroll down and click on DNR contacts under Additional resources.

— Find the phone number listed for your region.

If your county is not listed, you can get information about your city or county government’s household trash and recycling service by calling them at the number listed on their website or in your local phone book.

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Storing Insulin

You can keep bottles of insulin at room temperature if you use them up in 30 days. Keep extra insulin in the refrigerator. Remember to let refrigerated insulin warm up for about 15 minutes before using it. Throw away all open bottles of insulin after 30 days.

If you use insulin pens, be aware that room temperature storage guidelines can vary from 10 to 42 days, depending on the insulin type. Check with your diabetes educator or pharmacist.

Look at the expiration date on each insulin bottle/pen before you use it. Throw out insulin if the expiration date has passed.

Avoid exposing insulin to direct sunlight or freezing temperatures.

Do not use insulin that is lumpy, sticks to the edges of the bottle/pen or looks discolored.

When you travel, keep your insulin with you. Do not leave it in a car or other vehicle. It is a good idea to travel with extra supplies (insulin, syringes and test strips).

Regulations for airline travel may apply. Check with the airline before you fly.

— Keep all medicines in their original containers with the pharmacy labels on.

— Talk with your diabetes educator for more travel suggestions.

Hypoglycemia (Low Blood Glucose)

Hypoglycemia means that your blood glucose is low — generally below 60 to 80 mg/dL. Symptoms occur quickly and need to be treated as soon as possible.

Causes Prevention

Not enough food. Eat all your meals and snacks on time.

More physical activity than usual.

Eat extra food to match your increased activity.

Too much diabetes medicine. Take only the dose that has been prescribed.

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Symptoms

You may have one or more of the following symptoms:

sweating shaking feeling weak or tired feeling anxious or nervous feeling racing heart feeling hungry having a mild headache tingling sensation around lips and tongue.

Treating hypoglycemia

Test your blood glucose as soon as you feel symptoms. If your level is low, treat with 15 grams of carbohydrate. Examples include:

— ½ cup of fruit juice (you don’t need to add sugar) — ½ cup of regular pop — 1 tablespoon of honey or sugar — 2 tablespoons of raisins — 3 large marshmallows — 1 cup of skim milk — 3 to 4 glucose tablets — 15 grams of glucose gel.

After treating with one of these foods, test your blood glucose every 10 to 15 minutes. If it is still low, treat with another 15 grams of carbohydrate until your symptoms are gone or your blood glucose level is above 80.

Tip

You are never harming yourself if you take glucose tablets or eat a simple sugar food because you think you have low blood glucose. If you are injecting insulin, always carry a simple sugar food with you. These include raisins, marshmallows, glucose tablets or a juice box.

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Follow-up treatment after hypoglycemia

After you’ve experienced hypoglycemia, you may need more food.

If your next meal or snack is less than 1 hour away, eat at your normal time.

If your next meal or snack is 1 to 2 hours away, eat an extra snack that contains 15 grams of carbohydrate.

If your next meal or snack is more than 2 hours away, eat a snack that contains 30 grams of carbohydrate.

Do not subtract what you eat to treat hypoglycemia from your next snack or meal. This food is needed to keep your blood glucose in a better range.

Insulin and Physical Activity

If you take insulin, it’s possible for you to become hypoglycemic (blood glucose level drops below 60) during physical activity. Symptoms occur quickly and need to be treated right away. Some women with gestational diabetes find that exercising consistently and for the same amount of time will help avoid physical activity-related hypoglycemia.

Avoid physical activity when you haven’t had any food for 3 to 4 hours.


Call your health care provider or diabetes educator if you have unexplained hypoglycemia two times in 1 day or 2 days in a week.

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Sick Day Tips

If you become ill or get an infection, your blood glucose levels will often rise.

If you are taking insulin, continue your insulin as prescribed.

Check your blood glucose levels as directed by your educator or health care provider.

If a blood glucose level is higher than recommended for two readings in a row, check your urine ketones.

If your ketone reading is moderate or large, call your health care provider and provide your blood glucose and ketone readings.

If you can’t eat your regular foods, try these foods in place of carbohydrate foods (starches, fruits and milk). Replace one carbohydrate food (15 grams) with one of the following:

— 4 ounces fruit juice

— 4 ounces regular pop

— 6 saltine crackers

— ½ twin Popsicle®

— ½ cup regular gelatin (Jell-O®)

— 8 ounces soup

— ½ cup unsweetened applesauce

— 1 slice bread. If you can’t tolerate the replacement foods, try to eat one serving of a carbohydrate-containing food every 1 to 2 hours to prevent low blood glucose and dehydration.

Drink a total of six to eight 8-ounce glasses of fluids during the day to avoid dehydration. Take small sips.

After 3 to 4 hours without vomiting, gradually return to your normal meal plan.

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Chapter 5: Monitoring Your Baby’s Health

“Is my baby healthy?” It’s the question on the mind of every pregnant woman. Your gestational diabetes may add concern about your baby’s health.

Fetal Movement Counts

There is a simple way to check your baby’s health at home or anywhere, called a fetal movement count. Every baby has normal sleep and awake times, so your baby will have periods of both quiet and active time. A movement may be a kick, stretch, turn or flip.

By keeping track of your baby’s movements for each day during the third trimester, you will get to know your baby’s activity pattern. This can help alert you if your baby is not feeling well.

A total of 10 or more distinct movements in 2 hours suggests your baby is doing well. If your baby is moving less than usual, this may be a sign that he or she is under some stress or that a problem may be developing. If you are worried and do not have at least five movements in 1 hour, call your health care provider.

When to count

Once a day, during the third trimester of your pregnancy, record your baby’s activity. Choose the time of day your baby is the most active, and begin timing fetal movements at about the same time every day.

If you smoke and have not been able to quit during your pregnancy, try not to smoke for at least 1 hour before you start counting. (Your baby gets less oxygen and food because nicotine from cigarettes tightens up your blood vessels.)

Tip

Your baby might be quite active while you are at work, but that may not be a very relaxing, easy place for you to count movements. Try resting in bed at home and counting kicks and movements there.

Your baby won’t slow down and become less active before birth. The movements may change — as your baby grows, there is less room to maneuver — but the frequency of movement should not decrease.

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How to count

Choose a quiet place where you can focus on your baby’s movements without being distracted.

Lie down on your side or sit in a comfortable chair. When you count the 10th movement, write down the time and stop counting. Figure out how long it took to record the 10 movements. (Often, the 10 movements occur in fewer than 30 minutes.)

When to call your health care provider

Call your health care provider if:

you notice a significant change in your baby’s activity (such as fewer than half the number of movements you normally feel)

your baby has not moved 10 times in 2 hours you have questions or concerns.

Other Tests To Monitor Your Baby’s Well-being

Your health care provider may also do the following tests to check your baby’s progress and growth.

Nonstress test

You lie down for about 30 minutes. Two small, round parts of a fetal monitor are placed on your abdomen.

— One records your baby’s heart rate. — The other detects any uterine activity, such as preterm contractions.

If your test results are “reactive,” that’s good news — your baby is responding in a healthy way.

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Biophysical profile

Uses both ultrasound and a fetal monitor to evaluate five areas: your baby’s breathing motions, body movements, muscle tone, amniotic fluid amount and heart rate activity. The fetal monitor evaluates the heart rate activity.

Two points are given for each measurement (a score of eight to 10 is reassuring). Lower scores may mean that your health care provider will want to further evaluate your baby’s health.

Because you have gestational diabetes, you may need this test done regularly until your baby’s birth.

Ultrasound

Ultrasound uses sound waves to “see” your baby and placenta. This test works a bit like underwater radar.

Gel is applied to your abdomen as you rest. A technician moves a transducer (microphone) over your abdomen.

A picture of your baby and placenta appears on a nearby monitor. Sometimes the ultrasound equipment can take a photo for you to take home.

Ultrasound can:

determine the age of your baby tell if you are carrying twins help determine your due date measure your baby’s growth and development sometimes tell your baby’s gender.

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Chapter 6: Labor, Birth and Recovery

Although you’ve been dealing with gestational diabetes during pregnancy, chances are that your labor and the birth of your baby won’t differ much from any other mother’s.

Getting Ready for Labor and Birth

Attend childbirth classes and read prenatal education materials.

Learn about contractions, relaxation and breathing techniques. Practice these techniques with your partner or labor companion.

Talk with your health care provider and your diabetes educator about what to expect during labor. Most women with gestational diabetes go through labor and birth without complications.

If you’ve been taking insulin, discuss with your health care provider how insulin needs will be managed during labor.

During labor

Your blood glucose levels will be monitored. Sometime during labor, or perhaps shortly after your baby’s birth, your level will probably return to normal.

You and your health care provider may decide that a Cesarean birth is safest for you and your baby. Talk this possibility over in advance with your health care provider and with your partner. Include any preferences in your birth plan.

Your Baby’s Recovery

During the first few hours after birth, your baby’s blood glucose level will be monitored carefully. If your blood glucose level was high before the birth, your baby’s blood glucose level may be low after birth. If needed, extra glucose may be given to your baby.

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Your Recovery

After your baby’s birth, your blood glucose levels should return to normal (less than 100 fasting and less than 140 2 hours after eating). Your health care provider may have your levels tested while you’re still in the hospital. At your first postpartum visit, your blood glucose level will be tested.

Your Next Pregnancy and Gestational Diabetes

Two out of three women who have had gestational diabetes during a pregnancy will have it again during a future pregnancy. (Gestational diabetes goes away as soon as your baby is born.)

Preparing for a healthy pregnancy for you and your baby starts before you get pregnant. Make sure you do the following as you plan for your next pregnancy.

It is important to get your blood glucose checked before you get pregnant. Make an appointment at your clinic to have your blood glucose checked before you stop taking birth control.

When you’re pregnant again, tell your health care provider of your gestational diabetes history at your first prenatal visit.

— Expect to have a glucose screening at this visit.

— If the test is negative, screenings will be repeated at 24 to 28 weeks and again at 32 weeks.

— If the test is positive, monitoring and meal plan strategies will begin.

If you find out you are pregnant but did not plan the pregnancy, get your blood glucose checked right away. You will be able to start treatment early if your blood glucose is high.

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Your Risk of Getting Type 2 Diabetes

Because you’ve had gestational diabetes, you have an increased risk (40 to 60 percent) of developing type 2 diabetes during your lifetime. You can reduce this risk by eating well-balanced meals, maintaining a healthy body weight and exercising regularly.

Stay alert to the signs and symptoms of developing diabetes, including:

increased thirst frequent urination sores that do not heal frequent yeast infections less energy blurred vision.

If you have any of these symptoms, it doesn’t necessarily mean you have type 2 diabetes, but it’s important that you call your health care provider. In some cases, there are no symptoms at all.

To test for diabetes, your health care provider may do the following tests:

hemoglobin A1c (A1c) test: This test measures the amount of glucose that attaches to protein in the red blood cell. Because red blood cells live for about 3 months, A1c tests show your average blood glucose during that time.

fasting plasma glucose: This test measures the amount of glucose in your blood after at least 8 hours of no eating or drinking calories.

oral glucose tolerance test: This test measures the amount of glucose in your blood when you are fasting and 2 hours after drinking a sweet glucose beverage.

Tip

It is recommended that you have your fasting blood glucose tested each year.

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Diagnosing Diabetes

Your health care provider will use the following chart to determine whether you have developed prediabetes or diabetes after having gestational diabetes.

Risk of Your Baby Getting Diabetes

Your baby isn’t at risk for developing diabetes simply because of your gestational diabetes. If you follow the guidelines for managing your gestational diabetes and maintain a normal blood glucose level during pregnancy, your baby is less likely to be predisposed to obesity and type 2 diabetes later in life.

Diagnosis Tests

Fasting Casual

A1c

Diabetes126 mg/dL or higher on two occasions

200 mg/dL or higher (with symptoms)

6.5 percent or higher

Prediabetes

100 to 125 mg/dL (IFG*: when your blood glucose is too high in the morning)

140 to 199 mg/dL (IGT**: when your blood glucose is too high during the day)

5.7 to 6.4 percent

Normal less than 100 mg/dL less than 140 mg/dL 4 to 5.6 percent

*IFG stands for impaired fasting glucose. **IGT stands for impaired glucose tolerance.

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GlossaryBiophysical profile: a monitoring test that checks five areas of your baby’s development: breathing motions, body movement, muscle tone, amniotic fluid amount and heart rate activity

Blood glucose meter: a device used to accurately measure your blood glucose levels

Fetal movement count: measuring the number of kicks and movements your baby makes during the most active hour of each day

Fetal monitor: an electronic device used during pregnancy to assess your baby’s health and, during labor, to measure your baby’s response to contractions

Gestational diabetes: occurs only during pregnancy and results from not having enough insulin to process blood glucose

Glucose: the sugar, converted from food, that your body uses as its main source of energy

Glucose screen: a 1-hour screening test that measures your current risk for developing gestational diabetes

Glucose tolerance test: a 3-hour diagnostic test that measures whether or not you have gestational diabetes

Hypoglycemia: a low blood glucose level

Insulin: a hormone produced in the pancreas of the body; it helps your body move glucose out of blood vessels into body cells

Insulin resistance: when your body doesn’t use, or can’t use, insulin properly

Ketones: by-products of fat breakdown in the body that are found in the blood and urine; ketones can cross the placenta and enter your baby’s blood, which may be harmful in high amounts

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Nonstress test: a monitoring test that records your baby’s heart rate and detects any uterine activity, such as preterm contractions

Pancreas: the organ in your body that produces insulin

Placenta: the organ in a woman’s body that joins the baby to the mother and nourishes the baby

Sharps: Syringes and needles that need special disposal so that trash handlers and others won’t be injured

Type 1 diabetes: the pancreas makes no insulin, and daily injections of insulin are needed to process food

Type 2 diabetes: the pancreas makes insulin, but not enough, or the body doesn’t use insulin properly

Ultrasound: a monitoring test that creates a picture of your baby and placenta and helps measure the baby’s growth and development

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First meal:

_____________________ carbohydrate choices or ______________________ grams of carbohydrate

carbohydrate(s): ____________________________________________________________________________

vegetable(s): ________________________________________________________________________________

protein (meat, poultry, fish, eggs, cheese or peanut butter): _______________________________________

fat(s): ______________________________________________________________________________________

Snack:


Second meal:


carbohydrate(s): ____________________________________________________________________________

vegetable(s): ________________________________________________________________________________


fat(s): ______________________________________________________________________________________

Snack:


Third meal:


carbohydrate(s): ____________________________________________________________________________

vegetable(s): ________________________________________________________________________________


fat(s): ______________________________________________________________________________________

Snack:


My Meal Plan

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Notes

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Notes

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ALLINA HEALTH

Your account is a free service of Allina Health

Sign up for your account at allinahealth.org*Availability varies by location. Ask your clinic or hospital if this service is available.S410726A 162301 1016 ©2016 ALLINA HEALTH SYSTEM. TM – A TRADEMARK OF ALLINA HEALTH SYSTEM.

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School

form

schedule appointments*

receive lab results

sooner

email your care team*

do an online visit for common

conditions

write a health care directiveview

immunizations and medications

view and pay bills

manage a child’s or another adult’s care

read visit notes and follow-up instructions

set and track health goals

refill a prescription

Get better communication and faster answers online with your Allina Health account.Health is a journey that happens beyond the walls of your clinic or hospital and we will be there to help you – whether it’s a question that pops into your head at midnight or recalling the date of your last tetanus shot. When you sign up for an Allina Health account online, you get better communication with your clinic, hospital and provider; faster answers and your (and your loved one’s) health information organized and at your fingertips anytime.

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Nondiscrimination in Health Programs and Activities

Affordable Care Act – Section 1557

Allina Health complies with applicable federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, gender identity or sex. Allina Health does not exclude people or treat them differently because of race, color, national origin, age, disability, gender identity or sex.

Allina Health:• provides free aids and services to people with disabilities to communicate effectively with us, such as:

◊ qualified sign language interpreters, and◊ written information in other formats (large print, audio, accessible electronic formats, other formats)

• provides free language services to people whose primary language is not English, such as:◊ qualified interpreters, and ◊ information written in other languages.

If you need these services, ask a member of your care team.

If you believe that Allina Health has failed to provide these services or discriminated in another way on the basis of race, color, national origin, age, disability, gender identity or sex, you can file a grievance with:

Allina Health Grievance CoordinatorP.O. Box 43Minneapolis, MN 55440-0043Phone: 612-262-0900Fax: [email protected]

You can file a grievance in person or by mail, fax or email. If you need help filing a grievance, the Allina Health Grievance Coordinator can help you.

You can also file a civil rights complaint with the U.S. Department of Health and Human Services, Office for Civil Rights, electronically through the Office for Civil Rights Complaint Portal, available at https://ocrportal.hhs.gov/ocr/portal/lobby.jsf, or by mail or phone at:

U.S. Department of Health and Human Services200 Independence Avenue, SW Room 509F, HHH Building Washington, D.C. 20201 1-800-368-1019, 800-537-7697 (TDD)

Complaint forms are available at http://www.hhs.gov/ocr/office/file/index.html.

S415075A 248931 1116 ©2016 ALLINA HEALTH SYSTEM. TM – A TRADEMARK OF ALLINA HEALTH SYSTEM.

© 2014 ALLINA HEALTH SYSTEMALLINA® AND THE ALLINA LOGO ARE REGISTERED TRADEMARKS OF ALLINA HEALTH SYSTEM

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Gestational Diabetes - Allina Health

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