Everyday life with gestational diabetes - Diabetes UK
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Everyday life with gestational diabetes
Contents
Everyday life with
Introduction
gestational diabetes
Introduction 2 Hypos & hypers 33
What is gestational diabetes? 4 Hypos 34
Hypers 36
Testing 7
Testing your blood sugar 8 Your care 39
My blood sugar targets 10 What care to expect 40
Your checklist 43 We know there’s a lot to think about when We also hear from people like you on how they’ve
Treatment & management 13 you’re having a baby. And, now that you’ve managed with gestational diabetes. We give
Healthy eating 14 Glossary 44 been diagnosed with gestational diabetes, you lots of tips to make your life easier – and there’s
Recipes 20 you’re probably feeling worried and have a handy glossary and index at the back to help
Who we are 45
Understanding food labels 24 a lot of questions. you get the most out of this guide.
Physical activity 26 Index 46
But the good news is that, by managing gestational If you find it all a bit overwhelming, there’s a lot
Medication 28
diabetes properly, there’s no reason why you won’t go of support available to you, so don’t be afraid
Using insulin 30
on to have a healthy pregnancy and birth. You’ll have to ask for help from your healthcare team. And,
a diabetes healthcare team to help – and we’ll help you can always send us an email or pick up the
you on your way, too. phone if you want to talk (see the back cover
for ways to get in touch).
In this guide, we give you the facts about gestational
diabetes and how you can treat it. We tell you what Armed with all the facts, and understanding what
you need to do to look after yourself to stay healthy, you and your healthcare team need to do, means
and list the care you should get from your diabetes you can go on to enjoy a healthy pregnancy.
healthcare team.
Our diabetes information is available in print
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donations of people like you to help us Everyday life with
gestational diabetes
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Published October 2017 – product code 9984EINT.
With thanks to all the contributors, advisors and volunteers
who helped with the production of this guide.
2 www.diabetes.org.uk Everyday life with gestational diabetes 3
What is gestational diabetes? where a dietitian explained that it was possible to
Introduction
control the GDM through diet. I’d already realised
that my cake-eating days were over, but she said
I’d need to limit certain carbohydrates, too. Bread,
pasta, potatoes – even porridge – could now push
Gestational diabetes develops when your Causes my blood sugars up if I ate bigger portions. Luckily,
insulin-producing cells can’t produce enough I’m not a very ‘carby’ person, and a diet geared
insulin. Or, when the insulin you do produce A lot of change happens to your body during more towards protein and vegetables wasn’t a
doesn’t work properly (called insulin resistance). pregnancy. Along with the physical signs, the great hardship, although it meant no more ‘treats’.
This leads to high blood sugar levels (also called hormones you produce can make it hard for your If I couldn’t control my blood sugars through diet I’d
blood glucose levels). If it’s left untreated, high body to use insulin properly. This puts you at an be put on medication – metformin, or insulin, which
blood sugar levels can cause serious health increased risk of insulin resistance, and some would mean daily injections. I was determined
complications to you and your baby. women can’t produce enough insulin to overcome to make the diet work.
it. This makes it difficult to use glucose (sugar)
properly for energy, so it stays in your blood and the Meet Vicky Testing
Main types of diabetes levels rise. This then leads to gestational diabetes. The diabetes nurse gave me a blood glucose testing
Vicky, a journalist from London, describes
The most common types of diabetes are Type 1 kit, to test my sugars four times a day – before
how she managed her gestational diabetes
breakfast, then an hour after each meal. For a week
and Type 2. In Type 1 diabetes, the pancreas stops Who’s at risk and offers her tips that may help you
I pricked my finger diligently and wrote down the
making a hormone called insulin, which controls the
glucose (sugar) levels in the blood. In Type 2 diabetes, You’re more likely to get gestational diabetes if you: “It was Christmas Eve when the midwife phoned. levels, trying to keep under the maximum levels I’d
the pancreas can’t make enough insulin, or the “Your 28-week blood test showed high sugar levels. been given. At first it was trial and error. A bowl of
• are overweight or obese
insulin it makes doesn’t work properly. This is known I’ve booked you in for an oral glucose tolerance test spinach soup and slice of bread was too much, as
• have had it before (OGTT), but try to stick to brown bread and rice I’d forgotten I’d made the soup with potato, but I
as insulin resistance. If diabetes isn’t treated (with
medications, including insulin, and/or changes to • have had a very large baby in another pregnancy in the meantime.” That made for a fun Christmas! became more used to it. There was always a pause
diet and lifestyle), blood sugar levels tend to stay (that’s classed as 4.5kg/10lb or more) But I never seriously thought I could have gestational before each reading, then a beep, and I’d feel elated
high. This can cause serious health problems. diabetes (GDM) – I wasn’t overweight, had always or guilty, depending on the result. ‘Not bad,’ was the
• have a family history of diabetes (parent or sibling) eaten healthily, and was known to be a bit verdict, and I was given another week’s reprieve
• have a South Asian, Black or African Caribbean, of a gym bunny. from medication, and then another.
Gestational diabetes or Middle Eastern background.
At 38, I was an older mum, but I hadn’t had GDM Moral support
The type of diabetes that affects pregnant women is
Women can reduce their risk by managing weight, in my first pregnancy, with my son Jack, 3, and just I limped through the last 10 weeks of pregnancy; a
gestational diabetes. At least five in every 100 women
eating healthily and keeping active before pregnancy. put the result down to the piece of cake I’d eaten renegade sandwich one week, too many potatoes
will develop it. It’s usually diagnosed from a blood test
the day of my blood test. The day after my OGTT, another, but on the whole with my sugars well under
24–28 weeks into pregnancy. Having gestational diabetes can increase your risk
the midwife phoned again. “I’m afraid it is control. Exercise helped greatly. I’d walk half an hour
of developing it in other pregnancies. You’re also at a
Women with gestational diabetes don’t have diabetes gestational diabetes,” she said. I burst into tears. to work after breakfast, thereby ‘earning’ an extra
greater risk of developing Type 2 diabetes later in life.
before their pregnancy – and it usually goes away It felt so unfair – and so overwhelming. I had spoonful of porridge. It was stressful, but I was
after giving birth. But, in some women, diabetes may very little idea what diabetes was, only that my closely monitored.
be diagnosed in the first trimester. If this is the case, Symptoms pregnancy was now classed as higher risk.
A friend also put me in touch with another mum
they probably had diabetes before they got pregnant You may have been shocked to find out you have Blood sugars who’d had GDM and hearing how her baby was
– and it won’t go away after giving birth. gestational diabetes. Many women don’t have A few days later, I went to the diabetes clinic, where healthy and thriving was a huge relief. After learning
any noticeable symptoms. Some of the symptoms a nurse explained the importance of keeping my she’d been on insulin, I realised that I didn’t have
of diabetes are similar to the ones experienced in blood sugar levels stable. If they were consistently it so bad after all. I’d really recommend newly
pregnancy, but these are rare in gestational diabetes. too high, there was a risk that my baby would grow diagnosed mums speak to other mums with,
Symptoms may include: too big – and there was also an increased risk of or who’ve had, gestational diabetes, if they
stillbirth. Pregnancy was already such a huge can. The moral support really helps.”
• going to the toilet more often responsibility. Now I had this hanging over me. The
• Read more of Vicky’s story on page 42.
• feeling really tired day after diagnosis I had a series of appointments,
• feeling really thirsty.
4 www.diabetes.org.uk Everyday life with gestational diabetes 5
Treatment Some questions
Testing
Day to day, it’s about keeping your blood sugar levels
Will I get Type 2 diabetes?
under control. Your healthcare team – that’s your
midwife, doctors, nurses and a dietitian – will work Having gestational diabetes increases your
with you on targets for your blood sugar levels. If you risk of developing the condition again in other
meet your targets, you’re more likely to have a healthy pregnancies. It also increases your risk of developing
pregnancy and reduce the risk of complications. Type 2 diabetes in the future. It’s important to eat
healthily and take regular physical activity during
For some women, making changes to diet and
pregnancy, and to keep it up afterwards. This will
physical activity can help them to reach their targets.
reduce your risk of developing gestational diabetes
But, in most cases, medications – including
again, as well as your future risk of developing
injecting insulin – may be needed.
Type 2 diabetes.
You and your baby will be looked after more
closely during pregnancy and labour (see page 41). Will my baby have diabetes?
You should expect to have more:
Your baby has no more risk of developing diabetes in
• appointments with your midwife and childhood than any other baby. But, having gestational
healthcare team diabetes means your baby may have a higher risk of
being overweight or obese and/or developing Type 2
• blood and urine tests
diabetes later in life.
• ultrasound scans.
Possible complications
Need to know
If your gestational diabetes isn’t looked after properly, Need to know
it can increase your risk of complications. Having The good news is that you can make a difference
high blood sugar levels during pregnancy can lead to: to how you’re affected by gestational diabetes.
• Induced labour. The main ways you can do this are by:
• C-section. • eating a healthy, balanced diet
• Having a larger than normal baby, which could • being as active as you can
make for a more painful birth and possible stress • setting yourself goals to improve your health
for the baby.
• taking your medication as prescribed
• Your newborn having low blood sugar levels.
• getting support to look after yourself
• Your baby having a higher risk of being overweight
*Calls may be recorded for training and quality purposes.
or obese and/or developing Type 2 diabetes in later • going to your healthcare appointments.
life. As your child grows, managing their weight, We talk more about all of these things here in
eating healthily and being physically active will this guide. You can also call us on our Helpline
reduce this risk. on 0345 123 2399* for information, advice
There is also a risk of your baby dying at around the and support. If you’re in Scotland, call
time of the birth. But, remember, you can reduce all 0141 212 8710 or email helpline.scotland@
diabetes.org.uk In this chapter
of these risks by managing your blood sugar levels
with prescribed medications, and/or healthy eating
(page 14) and regular physical activity (page 26). Testing your blood sugar 8
My blood sugar targets 10
6 www.diabetes.org.uk
Testing your blood sugar Need to know Need to know
• Ask what your target is. It’s important to know
Some questions
My doctor won’t prescribe any more test strips
for me. What can I do?
your target blood sugar level. This lets you and
Everyone with gestational diabetes should be given
your healthcare team know how you’re doing
When you have gestational diabetes, it’s What to aim for a blood glucose meter, so they can test their blood
and if things can be improved.
really important to regularly test your blood sugar levels at home. Testing is an important part of
It’s best to check your blood sugar levels before • Medication, food and activity levels affect properly looking after your condition, so you shouldn’t
sugar levels at home. It also helps you and
breakfast (fasting) and one or two hours after your blood sugar levels every day. If you have test strips restricted. Speak to your diabetes and
your healthcare team work out the best way
every meal. understand how they affect your own levels, antenatal team. They should be able to help you get
of managing your condition. You should be
given a blood glucose meter to do it. But, if These are the targets women with gestational you can change what you eat, what you’re a prescription for the amount of test strips you need.
you haven’t, ask your healthcare team for one. diabetes are advised to aim for: doing and get advice on your medication.
If you’re still having problems, call our Helpline on
Testing
• fasting: below 5.3mmol/l, and either • It’s all about knowing your gestational diabetes 0345 123 2399*, Monday to Friday, 9am–6pm,
What it involves so that you can plan your life around it (and or email helpline@diabetes.org.uk
• one hour after meals: below 7.8mmol/l, or not the other way around).
Blood sugar testing tells you what the level of sugar If you’re in Scotland, call 0141 212 8710 or email
in your blood is at that time. It involves pricking the • two hours after meals: below 6.4mmol/l. helpline.scotland@diabetes.org.uk
side of your finger with a special device called a Your healthcare team will talk to you about how
lancet, and putting a drop of blood onto a test strip. often to test, how to do it properly and how
This is then read by a blood glucose meter. Everyone to safely meet your targets.
has glucose (sugar) in their blood, but if the figure is
too high or too low you can do something about it
(see page 34). If you don’t, it can cause problems.
Tips for testing
1 Wash your hands with soap and water – don’t
use wet wipes as the glycerine can affect the
test result.
2 Make sure your hands are warm – it’s easier
to get blood and it doesn’t hurt as much.
3 Prick the side of the top part of your finger
– not the index finger or thumb. Don’t prick
the middle, or too close to a nail.
4 Use a different finger each time and
*Calls may be recorded for training and quality purposes.
a different part.
5 Keep a diary of your results – you’ll be able
to spot trends and help your healthcare
team decide whether your treatment
needs to change.
8 www.diabetes.org.uk Everyday life with gestational diabetes 9
My blood sugar targets
Fasting: One hour after meals: Two hours after meals:
Date Medication or insulin Before meals (fasting) One hour after meals Two hours after meals Comments
and dose
Testing
10 www.diabetes.org.uk Everyday life with gestational diabetes 11
Notes
Treatment &
management
In this chapter
Healthy eating 14
Recipes 20
Understanding food labels 24
Physical activity 26
Medication 28
Using insulin 30
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14 www.diabetes.org.uk
A charity registered in England and Wales (215199) and in
Scotland (SC039136). © Diabetes UK 2017. 0653B
Get your five a day. There are lots of easy brine, sandwiches and crisps. So, it’s best to poor snacks and drinks, like sweets, cakes, large amount in a short time. If you’re trying
ways you can have more fruit and veg. Try limit processed foods as much as possible, crisps, fizzy drinks, energy drinks, etc. to manage your weight, keep a check
using plenty of veg to bulk up your meals, and to go for lower or reduced-salt whenever on the calories in what you drink.
Eat less saturated fat. Fats don’t directly
and snack on fruit or vegetable sticks instead you can. Try:
affect your blood sugar levels, but choosing Here are some easy ways to have healthier drinks:
of sweets, crisps and biscuits. But, don’t go
• Cooking with less salt. Experiment with the right type of fat can benefit your heart
overboard with fruit juices and smoothies • Water is the best all-round drink. If you prefer
pepper, herbs and spices to give food health. Butter, cheese, ghee, lard and palm
– choose whole fruit or veg as much as flavoured water, always read the label to check the
more flavour. oil are all high in saturated fat. Swap these for
possible and limit fruit juice or smoothies to free (added) sugar content – there could be 5–7
small amounts of olive, rapeseed or sunflower
150ml a day. And, eat fruit throughout the day, • Reading food labels (see page 24). tsp sugar in a bottle. Make your own flavoured
oils and spreads. Here are some easy ways
rather than having lots in one go. A portion is: And, watch out for cooking sauces and waters by adding a squeeze of lemon or lime,
to have less saturated fat:
seasonings like soy sauce or jerk seasoning or strawberries.
• 1 piece of fruit, like a banana or an apple
– some of these are very high in salt. • reduce the amount of spread you put
• Tea, coffee and hot chocolate – cut back
• a handful of grapes on bread – spread thinly
• Asking for less or no salt in your food when on sugar, use artificial sweeteners, and try
• 1 tablespoon of dried fruit. you’re eating out or having a takeaway. • use less fat in cooking – try grilling, boiling, semi-skimmed or skimmed milk.
baking, steaming or poaching instead
Snack attack. You can still enjoy a snack, • Herbal teas can make a refreshing change
More ways to eat healthily but try to go for healthier ones. Fruit and
of cooking with added fat, like frying
and most are caffeine-free.
Watch the salt. Too much salt can raise vegetables, vegetable sticks with low fat • use spray oil or measure the amount of
• No added sugar squash and cordials are a
your blood pressure. All adults are advised hummus, natural or Greek yogurt, plain oil you use in cooking with a teaspoon
good option as you tend to use little and add
to have less than 6g (that’s about 1 tsp) a popcorn, unsalted nuts and seeds, (instead of pouring it straight from the bottle)
more water. They don’t affect your blood sugar
day. About three-quarters of the salt we eat sugar- free jelly and avocado are good
• choose lean cuts of meat, trimming the in the way that fruit juices and sugary drinks do.
choices – but keep an eye on your portions.
Treatment & management
comes from processed foods, like bacon, visible fat, and removing the skin from
sausages, cheese, sauces, tinned foods in Limit your intake of calorie-rich but nutritionally • Fruit juices (100 per cent juice) contain vitamins
chicken and turkey
and minerals, and 150ml provides one portion of
• try low-fat options – buy semi-skimmed your five a day – but, remember, fruit juices only
or skimmed milk and reduced-fat cheese count as one portion, however much you drink.
instead of full-fat ones. They are best avoided because they’re a source
Healthy swaps of free sugars, which we all need to cut down on.
• check food labels (see page 24).
Sweet Savoury Drinks But, if you do have them, don’t have more than
Stay hydrated. Water forms a substantial one small glass a day.
part of our body, so it makes sense to drink
Instead of Instead of Instead of • Fizzy sugary drinks provide little else apart
enough fluid every day to stay hydrated and
milk chocolate crisps fizzy sugary drinks from a lot of sugar, so try to go for sugar-free
healthy. Water, tea, coffee and milk all count.
alternatives, unless you’re using this to treat
We also get fluid from food, especially fruit
try low blood sugar (a hypo, see page 34).
try try and vegetables.
plain popcorn water flavoured • Malted drinks and energy drinks can be high
dark chocolate Fluid is important, and It’s best to drink 8–10
with added spices with mint or in sugar and calories. You don’t need any special
rice cakes cups or glasses of fluid a day. Tap water
or cinnamon fresh fruit drinks to stay healthy.
counts just as much as bottled water – so
does lower-fat milk and sugar-free drinks,
Instead of Instead of For more healthy swaps, including tea and coffee. But, if you drink a
ice cream bread and dips tasty recipes and loads lot of tea and coffee, you need to be aware
of food tips, go to of the amount of caffeine you’re having.
try try www.diabetes.org.uk/
gestational-food You do need to think about what you drink,
frozen banana carrots and celery
particularly when it comes to fruit juices,
or frozen low- with salsa or low-
smoothies and sugary or alcoholic drinks.
fat yogurt fat hummus
You can have more calories and sugar than
you mean to because it’s easy to drink a
16 www.diabetes.org.uk Everyday life with gestational diabetes 17
Managing your weight
Pregnancy isn’t the time to be on a really strict diet.
Tips for GI
Don’t try to lose weight while you’re pregnant – it You can get the most out of GI by switching to a
could be unsafe for you and your baby. But making lower GI food whenever you can. Here are some
small changes to your diet and physical activity levels ways you can do this:
can help you avoid gaining too much weight. It’ll also
• Add baked beans to your jacket potato and
help you manage your gestational diabetes better,
have it with a large green salad.
and help to reduce the risk of complications.
• Try wholegrain bread or wholegrain breakfast
It’s important to keep going with your healthier lifestyle cereal, like porridge.
after you’ve had your baby. It will reduce your risk of
developing gestational diabetes in future pregnancies. • Eat different types of breads, like grainy or
And, it will also help to reduce your risk of developing pumpernickel bread, instead of white or
Type 2 diabetes, too. wholemeal bread.
Remember to ask your healthcare team to refer you • Try a sweet potato or new potatoes with
to a dietitian if you haven’t already met with one. your meal, instead of a standard potato.
• Choose long, thin rice grains – basmati or
The glycaemic index wild rice – instead of shorter or sticky rice.
GI stands for glycaemic index. It’s a measure of how
Or, try quinoa, bulgur wheat or couscous Some questions
quickly foods containing carbohydrate affect your
for an even lower GI. Need to know Need to know
blood sugar levels after you eat them. Some foods • Get into the habit of eating fruit and vegetables, Is it OK to eat fish?
Treatment & management
affect sugars levels quickly and so have a high GI, and include plenty of veg with your meals. • Ask to see a dietitian, who’ll be able to help
Try to eat fish regularly, as it’s good for you and the
and others take longer to affect blood sugar levels and you plan a healthy diet to manage your
• Add beans and lentils to your meals – they’re development of your baby. The advice is to eat at
so have a low GI. Choosing low-GI carbohydrates gestational diabetes.
great in casseroles and curries. least two portions a week, including one or two
can help to even out blood sugars. portions of oily fish – like mackerel, sardines, salmon,
• Try low-fat yogurt – but check the label for
But focusing too much on the GI of foods without herrings, trout or pilchards. Oily fish is really good for
any added sugar.
looking at other aspects of your diet could lead to an heart health, but don’t have more than two portions
unbalanced way of eating. Also, not all low GI foods a week. A portion is about 140g.
are healthy choices as some are high in fat. It’s good Avoid fish which tend to have higher levels of mercury,
to think of the bigger picture and choose foods low like swordfish, shark and marlin. And, don’t have
in saturated fat, salt and sugar as part of a healthy, more than four medium-sized cans of tuna, or two
balanced diet. tuna steaks a week, as it can have relatively high
• You’ll still need to think about your portion sizes. amounts of mercury compared to other fish. To avoid
It’s the amount of carbohydrate in the meal that food poisoning during pregnancy, it’s best to avoid
will affect your blood sugar levels the most. And raw shellfish, and there are some types of fish like
not all low GI foods are healthy, so make sure wild salmon that will need to be frozen and safely
you look at the labels and make a healthy choice. defrosted before you eat them.
See page 24 for more on reading food labels.
For more on healthy eating, tips and loads
of tasty recipes, go to www.diabetes.org.uk/
gestational-food – and see our recipes for
breakfast, lunch and dinner over the page.
18 www.diabetes.org.uk Everyday life with gestational diabetes 19Recipes Lunch
Breakfast
Watermelon, butterbean and feta salad Kale and green lentil soup
A refreshing and colourful salad that’s quick A nutritious soup that’s quick to make
and easy to make. and super healthy.
Serves 4 Prep 10 minutes Serves 4 Prep 10 minutes Cook 30 minutes
Microwave mug: Apple and cinnamon Apricot porridge with toasted seeds Each 162g serving contains (excludes serving suggestion) Each 415g serving contains (excludes serving suggestion)
Treatment & management
fruity porridge
A winter warmer served with seeds and fruits. KCAL CARBS FIBRE PROTEIN FAT KCAL CARBS FIBRE PROTEIN FAT
122 12.8g 4.1g 6.4g 4.1g 154 18.9 8.2g 8.7g 3.1g
This fruity porridge is warming, filling and quick to
Serves 2 Prep 15 minutes Cook 10 minutes
make – ideal for a healthy start on a cold morning. SATURATES SUGARS SALT PORTION FRUIT SATURATES SUGARS SALT PORTION FRUIT
1.7g 5.9g 0.3g & VEG 1 0.4g 8g 0.9g & VEG 3
Serves 1 Prep 2 minutes Cook 2 minutes Each 389g serving contains (excludes serving suggestion)
KCAL CARBS FIBRE PROTEIN FAT
Each 244g serving contains (excludes serving suggestion) 219 34.6g 4.9g 5.8g 5.8g
Ingredients Method Ingredients Method
300g watermelon flesh 2 tsp sunflower oil
KCAL CARBS FIBRE PROTEIN FAT SATURATES SUGARS SALT PORTION FRUIT 1 Cut the watermelon into small 1 Put the oil in a pan over a
(with rind removed) 2 onions, finely
202 34g 5.3g 5.5g 3.7g 0.9g 17g 0g & VEG 0
100g rocket
slices and set aside. chopped
medium heat, add the onions
SATURATES SUGARS SALT PORTION FRUIT 5-6 sprigs mint
2 Scatter the rocket and mint 1 large carrot, diced
and stir for 7–10 minutes
0.8g 10.2g 0.01g & VEG 1 leaves, torn leaves over a serving platter until well browned.
Ingredients Method 1 stick celery, chopped
2 tsp olive oil and drizzle with the olive oil. 1-2 cloves garlic, 2 Add the carrot and celery and
50g ready-to-eat
1 Place the apricots in a small pan 400g tin butter Arrange the melon over the crushed cook for a further 2–3 minutes
Ingredients Method dried apricots
beans, drained
150ml orange or
and cover with the juice. Bring to leaves then scatter the butter 1 tsp ground cumin stirring regularly.
35g porridge oats 40g feta
1 Add the oats, sweetener, apple juice the boil and simmer for 5 minutes. beans and feta over the top. 1 tbsp tomato purée 3 Now add the garlic, cumin,
1 tsp artificial sweetener juice half lemon
cinnamon and apple to 50g porridge oats 2 Set aside for 10 minutes, then 3 Drizzle with lemon juice and 1 x 400g can green tomato purée, lentils and
1 tsp cinnamon, good grind black lentils in water (add
plus pinch to top
a mug and mix. 15g mixed seeds, place in a food processor or pepper black pepper to serve. the water, too) mix well.
2 Add 100ml water and cook toasted blender and blend to form
1 small apple, 200g Cavolo Nero 4 Add the stock, bring to the boil,
chopped small at full power (800W) for a purée. (black kale) or curly turn down the heat, cover and
kale, chopped (thick
25ml semi-skimmed two minutes. 3 Place the oats in a small pan, simmer gently for 12 minutes.
milk stalks removed)
3 Add the milk, mix and sprinkle cover with 600ml of water, then 500ml vegetable stock
5 Add the kale, replace the lid
over a little cinnamon. place over a low heat and cook black pepper, to taste and simmer a further 5 minutes,
for 3–4 minutes. season with pepper and serve.
4 Stir through half the apricot purée,
divide between 2 bowls, then top
with the toasted seeds and a swirl
of the remaining purée.
20 www.diabetes.org.uk Everyday life with gestational diabetes 21Dinner
had done something wrong, I wasn’t looking after
myself and things would have to change.
In hindsight (a wonderful thing), the changes really
weren’t that hard. Husband joined in and it sent
me on a slightly different course after our baby
was born and in preparation for baby number two.
I had lost weight too, so my BMI dropped before
I fell pregnant again.
Healthy eating
My gestational diabetes is probably linked to
my weight and eating habits like portion sizes
and sugar intake.
Spinach, corn and chickpea fritters Mixed bean chilli
I haven’t had sugar in my tea or coffee for almost
A perfect supper dish. Works well in pitta breads with A great vegetarian chilli which can work with whatever two years (and I won’t lie, I thoroughly miss it but
lots of salad. pulses you have in your store cupboard. I know I have to eat healthily). I wanted to avoid
Serves 4 Prep 15 minutes Cook 20 minutes Serves 4 Prep 15 minutes Cook 20 minutes indigestion at all costs through pregnancy, so portion
control has been key through both pregnancies.
Each 188g serving contains (excludes serving suggestion) Each 361g serving contains (excludes serving suggestion) That’s not to say I don’t treat myself. I love food,
Treatment & management
KCAL CARBS FIBRE PROTEIN FAT KCAL CARBS FIBRE PROTEIN FAT cooking, sharing, serving and eating, but all in
157 15.4g 7g 9.9g 4.5g 243 30.9g 13.4g 11.8g 4g moderation and using basic common sense.
SATURATES
0.7g
SUGARS
3.3g
SALT
0.10g
PORTION FRUIT
& VEG 2
SATURATES
0.5g
SUGARS
10.6g
SALT
0.1g
PORTION FRUIT
& VEG 4
I also hope this encourages my children to look
at how we eat, why we eat, why healthy food
is crucial, but also hold on to a love for food that
Ingredients Method Ingredients Method is very important at my kitchen table.
2 tsp rapeseed oil 1 tbsp oil
1 Add 1 tsp of oil to a saucepan, 1 Heat the oil in a medium pan, The blood sugar results in my first pregnancy were
1 small onion, grated 1 onion, finely chopped
then add the onion. Cook for add the onion, garlic, red and high and, as a result, I was on additional medication.
1 red pepper, finely 1 clove garlic, crushed
chopped
2-3 minutes. Add the red green peppers and chilli, fry I started testing my blood sugar levels at about 29
1 red pepper,
1 egg, beaten
pepper and fry for 4-5 minute. chopped small
for 3-4 minutes until beginning weeks, as it was delayed gestational diabetes.
150g frozen spinach, 2 Meanwhile, add the egg, 1 green pepper, to soften.
This pregnancy, I started testing automatically at
defrosted, water spinach, cumin, chilli and chopped small 2 Lightly crush half the pulses
squeezed out, 17 weeks, three to four times a day. I was perfectly
sweetcorn to a bowl and mix. 1 red chilli, deseeded using the back of a fork. Add
roughly chopped and finely chopped aware of my limitations, therefore portion control
Stir in the onion and red pepper, to the pan with the remaining
Meet Nicole and reducing sugar were the key factors for me
1 tsp cumin 2 x 400g tin mixed
then the chickpeas, gram pulses, chopped tomatoes,
1 red chilli, finely pulses, drained in making sure I didn’t have as high readings.
chopped flour and coriander. and rinsed tomato puree, sweetcorn,
Nicole has had gestational diabetes in
80g frozen corn, 3 Shape the mix into 8 patties. 400g tin chopped cumin, oregano, salt The testing becomes second nature and, because
defrosted tomatoes both of her pregnancies
4 Add the remaining oil to a large and pepper. you know it’s for the welfare of you and your baby
400g can chickpeas, 2 tbsp tomato puree
drained and mashed
non-stick frying pan over a 3 Bring to the boil, turn down “The first time I was diagnosed (toddler is just shy in the short and long term, you just get on and
50g frozen sweetcorn
thoroughly) medium heat. Place fritters in (defrosted)
the heat and simmer for of turning 2, it hit me like a freight train – the idea I do it. It is frustrating, but that’s all it is.”
25g gram flour the pan and flatten slightly with 1 tsp ground cumin 10 minutes. Stir through the
10g fresh coriander, a spatula to about ½-1cm thick. 1 tsp dried oregano coriander and serve with rice.
chopped salad,
5 Cook until lightly browned for Freshly ground
to serve
3-4 minutes, then flip and repeat. black pepper
2 tbsp fresh coriander,
chopped
22 www.diabetes.org.uk Everyday life with gestational diabetes 23Understanding food labels Reference Intakes
Reference Intakes, sometimes shortened to RI, can
also be found on the front or the back of the packaging.
Tips to be label savvy
• With colour coded labels, go for green as
much as possible, sometimes amber and
There are recommended amounts for how much red less often/only occasionally.
sugar, salt, fat and saturated fat everyone should eat
Figuring out food labels makes it easier to ll measures
A and drink each day. A Reference Intake label tells you • Reference Intake (RI). It’s a percentage figure
eat the right things in the right amounts. per 100g Low Medium High per portion. It indicates what percentage of an
the percentage that item of food will contribute to
Fat 3g or less More than 3g More than these daily targets. adult’s daily recommended amount of calories,
to 17.5g 17.5g
Traffic light labels Saturated fat 1.5g or less More than More than 5g In our example of a front of pack label (see page 24),
fat, sugar and salt is in one portion of that
product. You need to check how much of the
Food companies don’t have to put labels on the front 1.5g to 5g the salt content of that product is 42 per cent of your pack counts as a portion so that you don’t
of their packs. If they do, they use traffic light labels. Sugars 5g or less More than 5g More than Reference Intake, of how much salt you should eat more of these things than you need.
to 22.5g 22.5g
be having a day. That’s very high.
These tell you whether the product has low, medium Salt 0.3g or less More than More than • All carbohydrates raise blood sugar levels. The
or high amounts of fat, saturated fat, sugars and salt. 0.3g to 1.5g 1.5g Of course, everyone is different but you should aim labels on the front won’t tell you about carbs
They’re designed to let you know at a glance how not to eat or drink more than the Reference Intake so you need to check on the back for the ‘total
healthy or unhealthy something is and make it easy The numbers for sugars don’t tell you whether the for fat, saturates, sugar and salt each day. carbohydrates per 100g’. This includes carbs
to compare similar products. sugars are natural, like in fruit, or added by the food from starchy foods as well as sugars.
company when the product is being made, like
Example of a front of pack label sucrose, but checking the ingredients list can help. • On the front of labels, the colour coding tells
you about total sugars. They don’t tell you
Need to know how much of that sugar comes from natural
Portion size
Treatment & management
Need to know
sources (like fructose) and how much is
We all have a different idea of what makes up a Information on food packaging can be confusing added (like sucrose or glucose). Check the
portion of food. But, in general, the portion size on all the same. Here are things to know: ingredients. If syrup, cane sugar, molasses
packaging is based on what an adult over 18 should or anything ending ‘ose’ is in the first three
• Fat free: has to have no fat, but check
eat. Still, bear in mind that your idea of a portion may ingredients, then it’s probably high in sugar.
for added sugar which is often used to
be more than other people’s (or the manufacturer) so Choose something else if you can, or watch
replace the fat.
you may end up eating more calories, fat and sugar how much of it you eat.
Green means low and a healthier choice. These foods than you need. In the same way, don’t feel you have • Sugar free: check the ingredients for fats
are low in fat, saturated fat, sugars and salts. Usually, to eat a whole portion if it feels too big for you. which may replace the sugar. • Check the fibre content on the back of pack
the healthier the food, the more greens on the label. label. If you’re trying to decide between two
• Low fat: 3g or less of fat per 100g. products, it’s better to go for the one with
On the back
Amber means medium. It’s OK to have these foods • Low sugar: less than 5g of sugar per 100g. more fibre.
some of the time. Labels on the back of food list ingredients, nutrition,
known things that can cause allergies (allergens), • No added sugar: although no sugar is • Check the manufacturer’s definition of a
Red means high. Most people like food with lots best before/use by dates and the overall weight. added, there may be naturally occurring portion. It may be different from yours and
of red. But try to eat them only occasionally and sugar in the food. it might well be smaller.
in small quantities. Ingredients are listed in bulk order from high to low. At
the top is the ingredient there’s most of, at the bottom • Reduced fat or sugar: contains at least
Most foods will have a mix of traffic light colours. Pick the ingredient with the smallest amount. So, if sugar’s 30 per cent less fat or sugar than the standard
items with more greens and ambers, and fewer reds. at the top, then it’s high in sugar. version. And it doesn’t mean it’s healthy.
The ‘light’ version of, say, one brand of
Some questions
The next table (right) shows what value of fats, sugars
and salts are considered low, medium or high in a crisps, could have the same calories and
What if there isn’t any nutritional information?
food product. Lower values apply for drinks and larger fat as the standard version of another brand.
portion sizes of food. Not everything you buy will have nutritional information.
But there’ll still be clues. Remember that the ingredients
are listed from high to low, so if a fat or sugar is at the
top, it may be worth looking for an alternative.
24 www.diabetes.org.uk Everyday life with gestational diabetes 25Physical activity
Exercise is part and parcel of managing your Moderate intensity – breathing is increased,
diabetes. In just the same way that you need to but you can talk comfortably.
eat the right things, you can also help to manage
This could be walking quickly or a leisurely swim.
your gestational diabetes by being more active.
Don’t be put off by the word ‘exercise’. You don’t Vigorous intensity – you’re breathing fast Staying healthy
have to take out a gym membership, wear lycra or and it’s hard to talk.
take up sports if you don’t want to. But, making time Alcohol
This could be walking briskly, faster swimming,
to be active and making that a priority is important The safest option is not to drink any alcohol
or low-impact exercise for pregnancy.
now more than ever. Activity helps to manage your while you’re pregnant. Drinking during pregnancy
gestational diabetes because it increases the amount can lead to long-term harm to your baby. The
Exercises for muscle strength
of glucose (sugar) used by your muscles for energy, more you drink, the greater the risk.
so it usually lowers blood sugar levels. Also, being For example, carrying groceries or pregnancy
active helps the body use insulin more efficiently. yoga or pilates. Alcohol can also make low blood sugar
And, regular activity can help reduce the amount hypoglycaemia (hypos) more likely, if you treat your
gestational diabetes with insulin or glibenclamide.
of insulin you need. How you can move more
Treatment & management
Being active helps with your gestational diabetes by: Smoking
Walking is a great activity. Here are some ideas:
• Helping you keep to a healthy weight. If you smoke, being pregnant may be the incentive
• Helping to improve your blood sugar levels. to try quitting. Smoking can harm your unborn
baby and makes it harder for them to get their
• Improving circulation. essential oxygen supply.
• Strengthening your muscles and bones. Don’t forget, if your partner or anyone else who
• Reducing stress levels and symptoms of Need to know lives with you smokes, their smoke can also affect
you and your baby before and after birth. You may
Need to know
depression and anxiety.
Get off the bus Walk to the shops to • Find something you enjoy. You’re more likely want to talk about these risks with them.
• Improving your sleep. a stop earlier pick up a few items to stick to it.
For help to quit smoking, ask for support from
It also reduces your risk of heart disease, cancer, • Check with your healthcare team before your diabetes healthcare team.
joint and back pain, depression and dementia you start anything new.
• Extra help: NHS Pregnancy Smoking helpline:
How much to aim for • Start slowly and gradually increase the intensity call 0800 123 1044 or go to www.quitnow.
and time you spend on new activities. If you’re smokefree.nhs.uk
The general advice for adults is to aim for 30 minutes at risk of hypos (low blood sugar) because
of moderately intense activity – or 15 minutes of you take insulin or the tablet glibenclamide,
vigorous activity – at least five days a week. Women Have a walking meeting se a pedometer to
U test your blood sugar regularly and have
with gestational diabetes should aim to complete or catch up with friends keep track of your steps hypo treatments to hand.
30 minutes of activity after a meal – this could – aim for 10,000 a day
include walking. • Wear diabetes identification (like a bracelet
or necklace) or carry an ID card. This is very
Also, try to do activities that improve muscle important if you’re at risk of hypos
strength on two or more days a week. These
are the government guidelines: • Remember to keep hydrated (see page 17).
26 www.diabetes.org.uk Everyday life with gestational diabetes 27Medication Need to know Need to know
• Discuss all the treatments with your
Some questions
My medication says it’s not suitable during
pregnancy. So why has it been given to me?
healthcare team.
Even though the patient information leaflets (PIL) for
Depending on your blood sugar levels when • Report any side effects of your medications. metformin and glibenclamide say that they shouldn’t
you were diagnosed with gestational diabetes, Tips for remembering your meds • Don’t stop taking your medications without be used during pregnancy, both are safely used
your healthcare team may initially help you to talking to your healthcare team. in the UK to help manage diabetes in pregnancy
1 Make a schedule. If you take more than
understand how to manage it with changes and breastfeeding.
one medicine, make a schedule showing • Get your Maternity Exemption Certificate
to your diet and physical activity levels.
when to take them each day and in the or Card, which entitles you to free NHS There’s strong evidence for their effectiveness and
But, if these changes don’t help within one or two best order. Ask your pharmacist to help. prescriptions. Ask your GP or midwife safety. Your diabetes healthcare team will consider
weeks, you’ll be offered medication. In some cases, for a form. the benefits to your blood sugar against any
2 Use a pill box. Get one that has separate
your team may prescribe medications at the time of potential harm. Talk to your healthcare team
days of the week – you can get organised
diagnosis. Remember, even when medications are if you have any worries.
a week at a time.
needed, you’ll still need to make changes to your
diet and physical activity – this is essential to help 3 Keep your meds handy. Keep them
you manage your blood sugar levels. somewhere you will see them (but away
from children’s reach) – near your TV,
How do the medications work? computer or with your toothbrush.
Metformin: This tablet helps to reduce the amount 4 Use an alarm. Set reminders on your
Treatment & management
of glucose produced by the liver, and to make your phone or computer.
own natural insulin work properly. It’s taken with, or
5 Make a note to order repeat prescriptions.
after, a meal.
Glibenclamide: This tablet works by stimulating
your pancreas to make more insulin. It’s taken
with, or immediately after, food.
Insulin: Insulin is a hormone that allows glucose –
the body’s main fuel – to enter the cells to be used for
energy. It can’t be taken orally because your stomach
will digest it. It’s given as an injection using a small
needle just under the skin. If you need insulin, your
healthcare team will teach you how to inject safely.
See page 30 for more on insulin.
Side effects
All medications have side effects. You’re unlikely to
experience them all and may not even experience
any. The patient information leaflet – PIL – will tell you
about possible side effects. If you do have any of
them, speak to your healthcare team or pharmacist.
28 www.diabetes.org.uk Everyday life with gestational diabetes 29Using insulin Need to know Need to know
• Change the place you inject. Don’t go to the
Some questions
Can I inject into my abdomen?
You may be worried about injecting in this area while
same place – rotate where you inject. This
pregnant, but with a short (4–6mm) needle, you
stops the build-up of small lumps under the
Your healthcare team may talk to you about • Inject the insulin. Make sure the plunger (syringe) can inject insulin into the fatty layer safely. Avoid the
skin. These lumps don’t look or feel very nice,
using insulin to treat your diabetes. This doesn’t or thumb button (if using a pen) is fully pressed area too close to your belly button. Speak to your
and they make it difficult for your body to
mean that you’ve developed Type 1 diabetes. down and count to 10 before removing it. healthcare team if you have concerns.
absorb the insulin properly.
You still have gestational diabetes, which is
• Let go of the skin fold (if you’re doing this) and • Always dispose of needles in a special sharps Will injecting into my abdomen hurt my baby?
treated with insulin. Changing your treatment
dispose of the needle safely. disposal bin, not a rubbish bin. It’s also where
doesn’t change your diagnosis. Your baby is growing in the uterus, which is several
• Always use a new needle. Reusing a needle you need to put used lancets (the device used
layers below the skin. Insulin needles are very short
How it’s taken makes it blunt and painful to inject with. for a blood sugar test).
and can’t touch your baby. Speak to your healthcare
You’ll need to inject insulin with a syringe or a • Sharps disposal bins and needle clippers are team about shorter needles if you’re worried.
special pen. Your healthcare team will show you free on prescription. Talk to your clinic about
how. The places to inject are usually the thighs, how to dispose of the boxes when they’re full.
buttocks and abdomen. You may be able to inject into
Tips for injecting
your upper arms, but check with your diabetes team If you’re finding it difficult or painful to inject, then
first as this isn’t always suitable. speak to your nurse who’ll be able to help. It
shouldn’t hurt much and, as you get better at
These are the steps you’ll be shown:
it (and less worried), it will hurt even less. With
• Decide where you’re going to inject. confidence, it’ll become second nature.
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• Make sure your hands and the place that you’re
injecting are clean.
• If you’re using a pen, squirt out two units of insulin
into the air. This makes sure the top of the needle
is filled with insulin. Ready, steady, shop
• If the nurse has told you to do this, lift a fold
of skin (but not so tightly that it causes skin
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30 www.diabetes.org.uk Everyday life with gestational diabetes 31
Diabetes UK is a charity registered in England and Wales (no. 215199) and in Scotland (no. SC039136). © Diabetes UK 2017Notes
Hypos &
hypers
In this chapter
Hypos and hypers 34Hypos and hypers
To find out how much you need to take, check the
food label to see how much carbohydrate it contains. Need to know
It’s important to check as products and ingredients,
Need to know
like the sugar and carbohydrate content, can change. • Keep hypo treatments with you all the time.
If you’re not sure how much to take, speak to your
healthcare team. • Check the carbohydrate content of your hypo
An important part of managing your gestational Hypo signs treatment regularly, as products can change.
You should test your blood sugar level again 15–20
diabetes is understanding how your blood sugar • If you have a hypo, don’t go for foods that are
They can come on quickly. Everyone has different minutes after treating the hypo and treat again if your
levels are affected by the food you eat, the high in fat like chocolate or biscuits. The fat
symptoms, but the most common ones are: level is still less than 4mmol/l.
exercise you do and any medication you take. slows down how quickly the sugar is absorbed
Then, finding the best way to keep them within • trembling and • palpitations and After a hypo, you may need to then eat or drink a and they don’t work quickly enough.
the healthy range. This is a bit of a balancing act. shakiness a fast pulse bit more: 15–20g of a slower-acting carbohydrate to
There’ll be times when your blood sugar levels stop your sugar levels going down again. It could be • Talk to your healthcare team if you have a
• sweating • lips feeling tingly severe hypo or keep having hypos. They can
are higher or lower than your targets. a sandwich, a piece of fruit, cereal or milk. O,r it could
• becoming anxious • blurred vision be your next meal if that’s due. look at your treatment and medication and
suggest changes.
Hypos or irritable
• feeling hungry
If you become unconscious • Carry some diabetes ID with you, in case
The proper name for a hypo is hypoglycaemia, • becoming pale
It’s pretty rare for gestational diabetes, but severe you ever become unwell.
and it’s when your blood sugar level is too low.
That’s usually below 4mmol/l. Why they happen hypos do happen and could mean you fall
unconscious. Then someone else needs to act
Not all women with gestational diabetes will have You can’t always know why you’ve had a hypo,
quickly. These are the things they’ll need to do:
hypos, but you’re more likely to have a hypo but these things make them more likely:
• Put you into the recovery position (on your side Some questions
if you take insulin, or the tablet glibenclamide. • you’ve taken too much diabetes medicine for
If you take any of these, it’s extra important with head tilted back and knees bent).
the amount of carbohydrate you’ve eaten How will a hypo affect my blood sugar levels?
to know the symptoms of a hypo. • Call an ambulance, and tell the operator you’re
• missing a meal After you’ve treated one hypo, you’re more likely
pregnant and have diabetes.
• exercising more than normal (or you didn’t to have another one. That’s why it’s really important
• Make sure your family and friends know to continue regularly testing your blood sugar
plan to exercise)
that they mustn’t try to give you any food levels after a hypo.
• drinking alcohol on an empty stomach. or drink (or put anything in your mouth)
if you’re unconscious or unable to swallow.
Treating a hypo
Always tell your healthcare team if you’ve had
You need to act quickly as soon as you notice a severe hypo.
symptoms, or if a blood sugar test has shown
Hypos & hypers
your levels are too low.
If you don’t, it could get worse and you might become
confused, drowsy, or even fall unconscious or have a fit. Tips for preventing a hypo
If you can, treat the hypo immediately by eating or drinking 1 Don’t miss a meal.
15–20g of fast-acting carbohydrate. This could be: 2 Eat enough carbohydrate.
• a sugary (non-diet) • glucose gel. 3 Eat more carbohydrate if you’re more active
drink than normal.
• if you find it easier,
• glucose tablets you can have a small 4 Take your medication correctly.
carton of pure fruit
• sweets, like jelly babies 5 Test your blood sugar levels regularly
juice.
34 www.diabetes.org.uk Everyday life with gestational diabetes 35You can also read
