Managing Gestational Diabetes Blood sugar, weight gain, diet exercise

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Three-quarters of women
with gestational diabetes
can manage it through diet
alone.Toxemia or preeclampsia is the medical term for high blood pressure that is caused by pregnancy. Symptoms of this type of high blood pressure include swelling of the feet and lower legs. High blood pressure is not good for you or for your baby. It can be life threatening. If you develop toxemia, your activity may need to be limited, you may be hospitalized, or have a cesarean birth. Like gestational diabetes, the high blood pressure usually goes away once the baby is born.

Urinary tract infections are more common for women with gestational diabetes. Besides the discomfort of burning with urination and frequent urination, urinary tract infections may lead to premature birth.

A program of meal planning, exercise, and possibly insulin therapy will help you keep your blood-sugar level within the normal range and your body healthy.

Earlier in this book, we told you that gestational diabetes is like Type 2 diabetes, except that it’s temporary and that it’s activated by your pregnancy. Certain hormones from your placenta block the insulin made by your pancreas from doing its job, which is to help your cells absorb the sugar in your blood. The result is not enough sugar in your cells to give you strength and energy and too much in your blood, which can be dangerous and even fatal if not treated. To correct this situation, you have to reduce the amount of sugar/glucose coming into your body (but not too much!) by changing your diet. About three-quarters of the women who get gestational diabetes are able to control their blood sugar levels through changes in their diets. You can also reduce the amount of sugar/glucose in your bloodstream by exercising. If both of these solutions/techniques are not enough, you may need to take insulin (by shots) to lower your blood sugar levels. The key is to keep just the right level of sugar in your blood – too much or too little blood sugar can cause problems for you and your baby.

You may have been shocked to find out that you have gestational diabetes. You may be wondering what you did to get it –– did I eat too much candy? –– or what you could have done to stop it. You didn’t do anything to get it and you couldn’t have stopped it. But with your efforts and with help from your doctor and the other diabetes specialists, you can learn to manage your diabetes and give you and your baby the best chance for a healthy pregnancy and birth.

Below are the tried and true ways to treat gestational diabetes:
• Eating the right foods
• Exercise
• Taking insulin
• Monitoring your efforts

One key to managing diabetes well is to develop routines. Get into a routine for eating, exercising, taking insulin if you need it, and testing for the results. Another important key is to learn all you can about gestational diabetes, what it does to your body, and how it can be controlled.

Eating The Right Foods

Eating the right foods is very important for pregnant mothers. First, the foods you eat must keep your body and your baby’s body healthy and provide the fuel for your baby’s rapid growth, and second, your body changes the way it uses certain nutrients. Nutrients include carbohydrates, proteins, fats, iron, calcium, vitamins, and minerals.

Because your body uses the nutrients first before your growing baby gets “fed,” if you don’t eat enough foods with the right balance of nutrients, your health will suffer and your baby will not grow and develop as he should. Also, your placenta, which takes glucose, amino acids, and hormones from your body and passes them on to your baby, will not work as well as it should.

Eating foods with the right balance of nutrients is even more important if you have gestational diabetes. The food you eat raises your blood-glucose level. Eating too much or not enough can be dangerous to you and your baby. Because of this, your doctor will very likely send you to a registered dietitian, who can tell you about the right kinds and amounts of foods to eat and when to eat them.

Remember, about 75% of women with gestational diabetes are able to keep their blood glucose levels within a normal range and provide the necessary nutrients for their baby just by sticking to a well-balanced diet.

You Need These Nutrients During Pregnancy

Carbohydrates –– provide the energy you and your baby need to keep your bodies working well.

About 40 to 50% of your daily calories should come from carbohydrates, including simple carbohydrates (sugar) found in fruits
and complex carbohydrates (starches) found in starchy vegetables, beans, pasta, whole-grain flours, breads and cereals. Honey or
table sugar should be limited because they provide few nutrients and lots of calories.

Protein — helps increase your blood volume and growth of breast and uterine tissues and is very important for the growth and development of your baby.

About 10 to 20% of your daily calories should come from protein, including milk and other dairy products, meat, poultry, fish, dried
beans, and peas.

Fat — a certain level of fat is important for good nutrition.

You should check with a dietitian about the amount of fat you should have in your diet. Fat is found in meats, dairy products, snack foods, butter, margarine, peanut butter, salad dressings, oils, and nuts.

Iron — critical to provide for your increase in blood production and to supply iron to your unborn baby, so he or she can produce blood.

Since most foods don’t contain the amount of iron you will need during pregnancy, you will probably be asked to take an iron supplement.

Calcium — is important for bone development and strength.

About 1200 mg is the amount of calcium you should have daily. Milk fortified with vitamin D and other milk products, such as yogurt, are good sources of calcium. Vitamin D helps promote calcium absorption. If you’re not able to drink that much milk, you may need to take a calcium supplement.

Vitamins — eating a well-balanced diet will usually provide the nutrition, including the vitamins and minerals, except folic acid, your body needs during pregnancy.

You will need almost twice the usual need of folic acid during pregnancy. Some good sources include dark green leafy vegetables, dried beans, liver, oranges, and whole-wheat products.

Foods To Limit or Cut Out If You Have Gestational Diabetes

Foods that have a lot of pure sugar can make your blood-sugar level rise very quickly. These include table sugar, honey, molasses, syrup, candy, jellies and jams, nondiet soft drinks, and other snack foods and desserts. For this reason, you may need to reduce the amount of these foods that you eat. The artificial sweetener saccharin can cross the placenta to the baby. Even though this may or may not be a problem, most doctors would advise you to avoid it while you’re pregnant. Aspartame (as in NutraSweet and Equal) does not cause any concern for pregnant women. Caffeine is a stimulant; it increases the activity to the heart and central nervous system. Most doctors would tell you not to have a lot of caffeine. No one knows if there is a safe level of alcohol during pregnancy, so the best advice is to avoid it altogether. Smoking can lead to your baby having a low birth weight. Since most of the side effects of smoking happen during the last three months of pregnancy, stopping smoking even late in pregnancy may reduce the bad effects. If you can’t quit, at least cut back on the number of cigarettes you smoke. Cocaine and other “recreational drugs” are harmful to you at any time. But when you are pregnant, these drugs can do a lot of harm to your baby, such as low birth weight, undersized, mental retardation, and abruption of the placenta, a condition that could be deadly for your baby. Avoid these drugs during pregnancy.

Weight Gain During Pregnancy

A weight gain of 25 to 32 pounds is about right for women who are normal weight when they become pregnant. Weight gain is usually small during the first trimester (3 months) of pregnancy, about 2 to 4 pounds. Once you pass the second trimester (after 6 months), you gain weight much faster –– about a pound a week on average. About 7 to 10 pounds of your weight gain comes from an increase in fat stores. This fat gives you and your baby the energy you will need during pregnancy and delivery and provides nutrition to your baby when you are breast-feeding. Learn about where the weight goes during pregnancy?

• Pattern of weight gain is important— How you gain weight is as important as the amount of weight you gain. For instance, if you gain a lot of weight suddenly, stop gaining weight, or start losing weight, call your doctor. The problem may be that your body is holding too much fluid or that you’re not eating right. Your doctor or your dietitian can help you figure out the weight problem and how to solve it.
• If you are overweight— If you weighed more than 20% over your ideal body weight when you became pregnant, your doctor will probably tell you to gain less weight than the 25-32 lb. average. The reason for this is to prevent hypertension (high blood pressure) or preeclampsia (high blood pressure and swelling caused from pregnancy). The amount of weight gain that your doctor recommends will depend on your body and your baby’s needs. This is not the time to lose weight. You must eat enough calories to provide the nutrients for you and your baby. And remember, if you don’t eat enough calories, your body may start to burn more stored fat than usual, which will result in too many ketones (acids) in your blood and urine. High levels of ketones can act like a poison and hurt your baby.
• If you are underweight— If you were underweight when you became pregnant or become underweight from not eating enough during pregnancy, you may increase your risks of having a low birth weight baby. Ask your doctor what the right amount of weight is for you to gain and get a dietitian to help with planning meals that are healthy and that have foods you like to eat.
• If you are a teenager— If you are a pregnant teenager, you may need to gain more weight than average. This is because, as well as having a growing baby inside you to feed, your body is still growing and needs more nutrients than a grown woman’s

Exercise

Exercise is almost always good for your body. For women with gestational diabetes, exercise is good for lowering blood glucose levels. But too much or the wrong kind of exercise may result in
(1) lowering your blood sugar too much and
(2) your baby’s premature birth.
In general, walking, swimming, aerobic exercises done in a swimming pool, and stationary bicycling are good exercises for pregnant women. Here are some rules to follow while exercising:

• Ask your doctor when to test your blood sugar levels during exercise
• Drink lots of fluids before, during, and after you exercise
• Warm up before and cool down after you exercise
• Make the hard part of your exercise (when you sweat the most) no longer than 15 minutes
• Keep your heart rate under 140 beats per minute during exercise
• Keep your body temperature under 100 degrees F.
• Don’t do exercises that involve
—Lying on your back after your fourth month of pregnancy
—Straining or holding your breath
—Jerky movements or quick changes of direction
• Stop exercising if you feel faint, weak, or very out of breath
• Ask your obstetrician how to feel for contractions during exercise. Contractions can mean you’re overdoing it.

Because you are pregnant and have gestational diabetes, you should check with your doctor before beginning any exercise program.

Taking Insulin

If eating the right foods and exercising aren’t enough to keep your blood-glucose level within a normal range, you may need to take insulin. About 15% of the women who develop gestational diabetes need insulin.

There are two types of insulin prescribed for women with gestational diabetes:
• Short-acting insulin — reach the bloodstream quickly (often within 30 to 60 minutes), are the most effective, peak 2 to 3 hours after you get a shot, and stay in your bloodstream from 6 to 8 hours.
• Intermediate-acting insulin — reach the bloodstream from 2 to 3 hours after you get a shot, peak in 6 to 10 hours, and stay in the blood up to 24 hours.

Your doctor will tell you the type and amount of insulins that are right for you and may recommend a combination of the short-acting and intermediate-acting insulins. How many daily shots you need will depend on how well the insulins correct your high-sugar levels and on where you are in your pregnancy. Usually, the further along you get in your pregnancy, the more your body resists the effects of the insulin, so the more insulin you need. This doesn’t mean your diabetes is getting worse. It means you need more insulin to get the same effect.

Staying in Balance

Sometimes your blood sugar will get out of balance; it may be too high or too low. Here are some of the causes for high or low blood sugar and how to treat them:

Low Blood Sugar (Hypoglycemia)

Low blood sugar can happen if:
• You skip a regular meal or snack
• You eat a regular meal or snack at a later time than usual
• You don’t eat enough or eat less than usual
• You are exercising more than usual
• You are getting too much insulin

There are many signs when your blood sugar levels are too low. You may feel one or more of these symptoms: confused, can’t think, cold, dizzy, heart beating fast, hungry, shaky, sweaty, sleepy, tired, weak. If you think your blood sugar is low, test your blood glucose level (see under Monitoring Your Treatment) if you can. If it is low, eat or drink something with sugar (see the carbohydrate list), wait 10 to 15 minutes and test your blood again. If it is still low, eat or drink a little more food or liquid with sugar, but not too much. You don’t want to overdo it and get your blood sugar too high. Test again after another 10 to 15 minutes. If you can’t test your blood and you feel low, eat or drink something anyway, even if you aren’t sure. It is very important for you to keep some type of sugar or snack with you all the time.

To bring your sugar level up fast have one of these:
• 4 to 6 ounces of fruit juice or regular soda
• 2 or 3 glucose tablets
• 4 to 6 sugar cubes

Then have any one of these to keep your sugar level from falling:
• 4 crackers
• 2 peanut butter sandwich crackers
• 1 cup of cereal
• a sandwich
• your regular meal or snack

High Blood Sugar (Hyperglycemia)

Sometimes, your blood sugar can be high without a reason. High blood sugar can happen if you:
• Are sick
• Eat too much food
• Eat or drink foods that are high in sugar
• Are not as active as usual or skip regular exercise
• Don’t take enough insulin

If you have signs that your blood sugar may be high, such as urinating often, thirsty, blurry vision, or feel tired, your body may be making ketones. Test your blood sugar level and test your urine for ketones. If your blood sugar is a little high, and you don’t have ketones, a little exercise may help to bring down your blood sugar level. If you have ketones, don’t exercise –– your body can make more ketones, which can make you sick. Ask your doctor when you should exercise and what exercises are safe for you.

A Good Way To Spread Calories Throughout Your Day

One way to keep blood glucose levels steady and low throughout the day is to follow the program below.
• 10 to 15% of calories at breakfast
• 5 to 10% of calories at mid-morning snack
• 20 to 30% of calories at lunch
• 5 to 10% of calories at mid-afternoon snack
• 30 to 40% of calories at dinner
• 5 to 10% of calories at bedtime snack

This plan keeps your carbohydrates (that make sugar) lower in the morning when your body has lower insulin levels. Your doctor or dietition will tell you if this plan makes sense for you.

Monitoring Your Treatment

Monitoring the results of your treatment –– your meal plans, exercise routine and insulin shots – is a must when you have diabetes to know if the treatment is working. This is especially true if you are taking insulin, which has to be carefully balanced with food and exercise. You can monitor your treatment (whether you take insulin) by tracking your blood-glucose levels. The blood-glucose tests can be done at your doctor’s office, at a hospital, or at a lab.

Most often, though, you will test yourself, using one of the following methods:
• Visual Glucose Test Strip — With this method, you prick your finger to get a drop of blood, put it on a test strip, wait for the test strip to change color and compare the strip to a color chart. Each color on the chart shows a range of glucose levels. Your colored strip will then show you which range of blood-glucose levels your blood matches. Keep the strips in a cool, dry place. Do not keep them in sunlight, in a hot car, or in a bathroom (they can be ruined by moisture).
• Glucose Meter — This method works almost the same as the test strip method, except that you put the test strip with your blood in a blood-glucose meter. Your blood-glucose level is shown on the meter’s screen.

Using either the Glucose Meter, you can test your blood-glucose levels at home, work, school, during exercise, play, travel, etc. Being able to test all during the day wherever you are is a great benefit. You get to have “right now” information on your blood glucose levels and on how your levels change throughout the day. Over several days and even weeks, you may see certain patterns of blood-glucose levels that can help you and your doctor make changes in your diet, exercise or insulin shots, to keep your blood-glucose levels in a good range for you.

Well-controlled glucose levels for women with gestational diabetes might be:
Before a meal – 60 to 105 mg./dl (milligrams per deciliter of blood)
After a meal – 100 to 120 mg./dl
Target average over the day –– 70 to 100 mg./dl

Your doctor will tell you what a normal blood-glucose range is for you so that you can compare your test results against that range. For women on insulin, it’s best to test your glucose levels after a meal rather than before eating. Both may be recommended, before the meal and 1 to 2 hours after the meal. Your doctor may also ask you to test your urine for ketone levels. Remember, ketones are acid substances that are made when your body starts using stored fats for energy. This can happen if
(1) you’re not eating enough calories,
(2) you’re not getting enough nutrients (especially carbohydrates) from your diet or
(3) you’re going too long between meals Large amounts of ketones in your blood can cross the placenta and enter your baby’s blood, which may be harmful to your baby.

If there are too many ketones in your blood, they will spill over from your blood into your urine. So if ketones are present in your urine, that means there is too much of it in your bloodstream. Testing your urine, which is very easy to do, is one way of tracking your ketone levels.

There are different kinds of urine tests. Generally, you get a sample of your urine. Usually the morning before breakfast is the best time to do this test. You place a test strip in the urine sample, wait the specified time on the bottle of strips (usually 60 seconds), then compare it to a color chart, which will give you a range of ketones in your urine. Your doctor will tell you if you need to test your urine, when to test it, and how often to test it. See the back cover of this book for a Sample Page for Blood Sugar Records.

Changing Your Treatment

Because your physical activities and work or home duties change from day to day and because your body is going through a major change due to your pregnancy, changes to your treatment should be expected. The purpose of your treatment is to keep a good balance between the nutrition your body is getting from your diet and the effects of exercise and insulin shots on your glucose levels. That’s why the results of your blood and urine tests are so important. They can help you and your doctor know if your treatment is working or if it needs some changes.

Managing Gestational Diabetes