Introduction
Gestational Diabetes occurs because the body cannot produce enough insulin to meet the extra needs of pregnancy due to higher hormone levels and weight gain. This causes the glucose (sugar) in your blood to rise above normal levels.
Most pregnant women can produce extra insulin to cope with the increase in glucose, but for some women the body is unable to produce enough insulin to keep blood glucose at normal levels.
What foods affect my blood glucose levels?
All foods containing carbohydrates are digested and broken down into glucose (sugar), which is then absorbed into the bloodstream. Insulin is needed to transport the glucose to cells in your body where it will be used as energy.
If you are unable to use your insulin effectively, which happens during pregnancy, it will therefore be important to watch the type and amount of carbohydrates that you have in your diet, but it is still important to have carbohydrates in your diet.
What are carbohydrate-containing foods?
Carbohydrates are an important part of a healthy balanced diet, they provide us with energy and can also provide us with fibre, vitamins and minerals.
There are two main sources of carbohydrates, namely starch and sugar.
Starch
A starchy carbohydrate should be included in some form, at every meal. Starchy carbohydrates are generally low in fat and calories and many are also high in fibre. Choose high fibre varieties as they are absorbed more slowly.
Suitable choices include:
- Wholemeal, multigrain, granary bread, pitta bread or rye bread.
- Whole grain cereals e.g. All-Bran, Sultana Bran and Weetabix, Shreddies and Fruit and Fibre.
- Porridge oats, oat cereal, low sugar muesli.
- Jacket potatoes or new potatoes boiled in their skins.
- Basmati, brown or wild rice.
- Other grains e.g. couscous.
- Pulses – beans, lentils, peas, red kidney beans etc.
- All types of pasta, noodles.
Carbohydrates are also found in flour-based products, e.g. pastry, cakes and biscuits.
All of your meals should contain a small portion of starchy carbohydrate, aim for around a quarter of your plate to be covered by this kind of carbohydrate.
Sugars
There are two types of sugars: Natural and Added sugars
Natural sugars:
- Fruit sugar (fructose) – found in all types of fruit, fruit juice and fruit smoothies.
- Milk sugar (lactose) – found in milk and yogurts.
However, fruit and milk are a good source of vitamins and/or fibre so we do not want you to exclude them from your diet, but too much fruit or milk can affect your blood glucose levels.
Limit your fruit to 2 to 3 portions per day and spread throughout the day.
One portion of fruit is one small banana or apple, 2 small satsumas, a handful of grapes or 1 tablespoon of dried fruit for example.
Fruit juices are best avoided (even if unsweetened) as they contain free sugars. If you decide to have them then limit to one portion per day (one small glass – 150mls) and drink with a meal. If you regularly eat and enjoy whole fruit it is best to avoid fruit juice.
Be wary of milky drinks like lattes, cappuccinos and milkshakes as these can add a large intake of milk sugar to your diet. Try to choose yoghurts with the least added sugar also by checking the food labels.
Added sugar:
- Sugars (table sugar, brown sugar etc), honeys and syrups are often added to foods and drinks to sweeten them. This includes confectionary, cakes, sweet biscuits, desserts, ice cream, soft drinks.
It is best to try to reduce the amount of added sugar in your diet to help manage your gestational diabetes.
How can I reduce sugary foods in my diet?
Foods high in sugar may be absorbed very quickly and make your blood glucose levels rise suddenly.
- Stop adding white/brown sugar in coffee and tea or use artificial sweeteners.
- The use of honey, syrup, jams/lemon curd should be reduced as far as possible.
- Use low-sugar or diet fizzy drinks and low-sugar or no added sugar squashes, flavoured water and slimline mixers. Avoid high energy sugary drinks.
- Have healthy snacks instead of biscuits, cakes, sweets etc, for example a portion of fruit, diet yoghurt, rice cake or vegetable sticks and hummus, unsalted nuts and seeds.
- Have tinned fruit in natural juice instead of syrup or stewed fruit without sugar.
- Choose sugar free jellies, low sugar instant whip, low fat fruit yoghurts or fromage frais, low sugar milk puddings.
- If you want chocolate have a small amount of dark chocolate instead of milk chocolate.
- Use reduced sugar milky drinks e.g. Options, High Lights, Ovaltine Light or Horlicks Light instead of the originals.
- Avoid sugar/honey coated breakfast cereals. Rolled porridge oats with a portion of fruit and/or sweetener is a good substitute.
Balanced Meals
Remember it is really important to balance your meals and you may find that pairing your carbohydrate foods with protein and vegetables helps you to slow down its digestion and keep your blood sugars in target more often.
Snacking
If you find that altering your portion sizes makes you feel more hungry in between meals try to have lower carbohydrate snacks; we do not want you to be hungry all the time between meals.
Below are some suitable ideas:
- Vegetable sticks and hummus or reduced fat cheese dip or nut butter
- Sugar free jelly
- 1 small fruit (max 3 per day)
- Sliced cooked meat
- 1 to 2 wholegrain crispbreads with cottage cheese
- Hard boiled eggs
- Nuts and seeds
- 1 to 2 oatcakes with cottage cheese or spread
- Sliced mozzarella and tomatoes
- Guacamole with vegetable sticks
- Small amount of Greek or plain yoghurt with nuts
- Small amount of cheese
- Roasted chickpeas
- Avocado or olives
- Small slice malt loaf
- Feta or meat salad
- 1 crisp bread with melted grated cheese, spring onion and tomato
Other healthy eating tips
- Eat regular meals, i.e. breakfast, lunch and evening meal and include 1 to 2 healthy snacks in between meals if you are hungry.
- Try to have some protein at least at 2 of your meals e.g. meat/chicken/eggs/non-meat protein sources/tofu/lentils.
- Eat plenty of vegetables – these can be fresh, frozen or tinned. Vegetables/salad can be used to bulk out meals to reduce overall starchy carbohydrate intake.
- Limit caffeine intake – try decaffeinated options.
Diabetic products
You do not need to buy special diabetic products as they have no added health benefits. They are often expensive, high in fat and might cause stomach upsets with diarrhoea.
Artificial sweeteners
All artificial sweeteners used in food and drink in the UK are suitable for pregnant women. Use these in tea/coffee and on foods in place of sugar.
Weight gain and pregnancy
Your calorie requirements do not increase during the first 6 months of pregnancy and only increase by 200 calories per day for the last 3 months. This is usually met by a natural increase in appetite.
The average weight gain in pregnancy is 12kg (just under 2 stone); 2 to 3kg (5lb) in the first 20 weeks and 9 to 10kg (20lbs) in the last 20 weeks.
Avoid gaining excessive weight if you were overweight on becoming pregnant but remember it is not advisable to try to lose weight while you are pregnant.
Breakfast ideas
Some ladies find breakfast is a struggle to keep their blood sugars in target. You can try splitting your carbohydrate portions at breakfast or feel free to try some of these lower carbohydrate, higher protein breakfast ideas you might like to try:
- Avocado and eggs
- Omelettes with mushrooms, peppers, onion, ham, cheese etc
- Scrambled eggs or tofu with smoked salmon and/or asparagus, peppers, onions etc
- Rye bread and nut butter
- Baked mushroom with cheese
- Natural yoghurt with berries, seeds and nuts
- Smoked salmon and low fat cream cheese on a small seeded slice of bread
- Grilled bacon, reduced fat sausages with mushrooms and tomatoes
- Baked eggs (made with crème fraiche)
What about physical activity?
Exercise is important as it will help keep your blood glucose levels in target, make you feel better and prevent excessive weight gain.
Walking and swimming are the easiest exercises to do when you are pregnant, however, other exercises can also be beneficial but note the following:
- If you are new to exercise, start with 5 to 10 minutes a day and work up to 30 minutes a day.
- If you are normally very physically active you can continue doing so as long as it is safe. Check with your doctor or midwife first.
- Be aware of the increased risk of hypoglycaemia while exercising if you are on insulin. Ask for further information from the Diabetes Team.
Diabetes Discovery Sheet
Inside this diet sheet there is a diabetes discovery sheet. This allows you to record your meals and snacks and record your blood sugar levels to help you to identify which foods cause your blood sugars to go high, or where you need to review the portion of carbohydrate you have had with that meal.
You do not have to use this sheet, but for the first week or so you may find it very helpful.
Summary
- Ensure you have regular meals which contain a moderate portion of starchy carbohydrate.
- Balance all meals with vegetables/salad and protein.
- Snack if you are hungry on lower carbohydrate or carbohydrate free snacks.
- Keep all drinks sugar free.
- Reduce the amount of added sugar you have in your diet.
- Keep moving.
References
Sources of information used in the preparation of this leaflet:
- Diabetes UK (www.diabetes.org.uk)
- Manual of Dietetic Practice fifth edition. Edited by Joan Gandy in conjunction with the British dietetic Association(2014).
Nutrition and Dietetic Department
Lincoln County Hospital
Greetwell Road
LINCOLN
LN2 5QY
Telephone: – (01522) 573418
Nutrition and Dietetic Department
Pilgrim Hospital
Sibsey Road
BOSTON
PE21 9QS
Telephone: – (01205) 446450
Nutrition and Dietetic Department
Grantham and District Hospital
101 Manthorpe Road
GRANTHAM
NG31 8DG
Telephone: – (01476) 464339