Dining Out With Gestational Diabetes – Gestational Diabetes

Gestational diabetes is diabetes that occurs for the first time when you become pregnant. As in other kinds of diabetes, gestational diabetes leads to too much sugar in your blood.. If you have gestational diabetes, you will need to control your blood sugar with exercise, a gestational diabetes diet, and sometimes with medication.

But just because you have gestational diabetes doesn’t mean you can’t go out to eat. You just need to follow the same rules as you would at home and make healthy choices. “We generally recommend a diet for a woman with gestational diabetes that gets about 50 percent of calories from carbohydrates,” says Kelly O’Connor, a registered dietitian and certified diabetes educator at Mercy Medical Center in Baltimore. “Good sources of carbohydrates are whole-grain breads and cereals, fresh fruits, low-fat dairy products, potatoes, whole-wheat pasta, and brown rice. We try to have the women consume as close to the same amount of carbohydrates each day as possible,” says O’Connor.

One thing to keep in mind if you do go out to eat is timing. “We recommend women with gestational diabetes eat every two to three hours, which translates into three meals a day and two to three snacks a day. Putting a moderate amount of carbohydrate into your body every few hours keeps blood sugar stable throughout the day,” advises O’Connor. You can avoid problems by making reservations that coincide with your regular meal times. Try to go to restaurants at less busy times so you don’t get stuck waiting too long for a table.

Some Tips for Dining Out With Gestational Diabetes

“In terms of eating out, your choices do not have to be very different from your choices at home. The best choices are a balance of lean protein, carbohydrate, and a small amount of fat,” says O’Connor. You need to count your calories when you go out the same as you would at home.

• Choose the right restaurant. Stick with restaurants that offer “heart-healthy” selections. Some restaurants offer calorie and fat information on the menu. Ask if the chef can prepare lower-fat meals for you with lean cuts of meat, or chicken without the skin. A restaurant with a larger menu may give you more choices.
• Be aware of the serving size. Many restaurant servings are much larger than what you would serve at home. Avoid jumbo, deluxe, and super-size meals.
• Watch out for dressings and gravy. Ask for your dressing, sauces, and gravy to be served on the side and then use them sparingly to avoid excess calories. Order low-fat salad dressing if it’s available.
• Plan your meal. “If you take a roll before the meal, that has to be figured into your total carbohydrates. If you plan to eat a dessert, you need to budget your carbohydrates to leave room at the end,” says O’Connor. Ask for substitutes: Get an order of vegetables or garden salad in place of a side of fries.
• Remember to count what you drink. “Many beverages can add a lot of carbohydrates. Regular soda, juices, fruit drinks, lemonade, sweetened tea, and coffee can all elevate your blood sugar quickly,” warns O’Connor. Also remember that alcohol contributes extra calories to your meal, often without any nutritional value.
• Watch out for fast foods. Although it is possible to get a healthy meal at a fast food restaurant, keep in mind that the average fast-food meal has 1,000 calories or more and can cause a sharp increase in your blood sugar. Fast food also tends to be higher in salt and fat, and even if you choose chicken or fish, they may be breaded or deep fried. Look for grilled or baked options instead.

Eating out is fun and much easier than cooking and cleaning up at home. If you have gestational diabetes you just need to plan ahead, pick the right restaurant, and make the right food choices once you get there. As long as you follow the basic rule of counting your calories, and eating a balanced meal of carbohydrates and lean proteins with limited fat, you can enjoy a night out and still keep your blood sugar under control.

True Life: I Have Gestational Diabetes

No one ever thinks they’re going to develop gestational diabetes, but sometimes it’s out of our control. Here’s how the past month has gone after being diagnosed with gestational diabetes + meal and snack ideas.

↑ What I’ve been eating a lot of over the past month. GREEN STUFF. 

Well, the post headline pretty much sums it up – I have gestational diabetes. Apparently the third pregnancy was not the charm for this ol’ gal!

Sooo, YEAH. I have several reasons for writing this post. One, it felt like I was hiding something by not telling you. Lying by omission is still lying in my book and, well, Mama don’t get down like that. Second, my post on Living with Celiac Disease has been one of my most popular posts here on IGE because it’s real and, most importantly, helped people, which I hope to accomplish with this post. Not only by sharing some of the meals and foods I’ve been eating over the past month, but simply to give anyone struggling with gestational diabetes a virtual pat on the shoulder and say you’re not alone. We’ll get through this! Third, the word “diabetes” is a loaded word and I hope to spread some knowledge about what gestational diabetes is and who can develop it.

What is Gestational Diabetes?

Gestational diabetes affects only pregnant women – 7-9% of woman are said to develop it during pregnancy – and it goes away after delivery of the baby. Hormones from the placenta interfere with the mother’s ability to use insulin, which your body needs to turn glucose (sugar) into energy. Glucose builds up causing high blood sugar, which can have negative effects on both mom and baby. Baby can be born overly large and with low blood sugar, have breathing problems, and face potential issues with obesity and Type 2 diabetes down the road. Mom can develop preeclampsia and has a strong risk of developing Type 2 diabetes in the future.

If you’ve ever been pregnant, you most likely dreaded the gestational diabetes screening test as much as I did. Generally occurring around the 24-26 week mark of pregnancy, in 5 minutes or less you must chug a drink that’s basically corn syrup, artificial flavor, and food dye (read: highly disgusting and extremely unpleasant) then your blood sugar is tested an hour later to see if your body is using the sugar properly. If it’s not then at a later date you drink an even more concentrated sugary beverage and your blood sugar is re-tested at the one, two, and three hour mark after drinking. If you fail any of those tests then you’ve earned yourself a pregnancy complication: gestational diabetes.

Risk factors for gestational diabetes include being older then 25, having a family or personal history of Type 2 or pre-diabetes, a BMI of 30 or higher, or if you are black, Hispanic, American Indian, or Asian (source). As I read in a book on the subject, unless you’re 25 or younger, white, and have no family or personal history of diabetes – there’s a chance you could develop gestational diabetes. I think there’s a stigma surrounding gestational diabetes and I’m here to tell you that it can happen to anyone. The dietitian I’ve met with through this process told me she’s seen marathoners in her office with gestational diabetes!

The risk factor I met was age. As I always tell the whipper snappers who will listen to this crotchety old bag – don’t grow up! Truthfully, the age thing was a tough pill to swallow and it hasn’t been as simple as telling myself, the only reason you got this is because you’re an old(er) mom.  

Various thoughts ran through my mind when I got the call – why did I drink so many Chick-fil-A lemonades (to be fair, I didn’t drink that many!)? Why haven’t I been more active? HOW COULD I LET THIS HAPPEN?!

If getting Celiac Disease has taught me anything though, it’s that [email protected]!& happens. Some things in life can’t be prevented, helped, or predicted. This didn’t happen because of the foods I was or wasn’t eating, hormones are to blame. Thankfully in many cases, and so far in my case, gestational diabetes can be managed through diet, which is something I have a ton of experience with.

The “prescription” for gestational diabetes is not only to focus on eating healthy fats, proteins, and vegetables (so many vegetables,) but more importantly watch your total carb intake and spread them out throughout the day. The way I made sense of this for myself is that I need a slow and steady burn of the right amount and type of carbohydrate all day long. I check my blood sugar 4 times a day (finger prick) and log everything I eat in a spreadsheet for my doctor to keep tabs on. Fun!

What’s been hard:

• Eating ZERO added/processed sugar and limited fruit and berries. I have a raging sweet tooth when I’m pregnant so going cold turkey has been slightly torturous. Fruit and berries are also my summertime jam and I’ve missed them a lot.
• No more pretzels, tortilla chips, crackers – aka empty carbs I used to eat when I needed a little something to crunch on during the day. Not so mad about this as I needed a reason to ditch the junk.
• Mega meal planning. Normally I plan 3-4 dinners a week. Now I need to plan a breakfast, lunch, dinner and 2 snacks every single day x 7 days a week. There is no winging it when you’re eating to manage gestational diabetes.
• Eating for fuel vs fun.
• Measuring and tracking everything I eat. It’s as annoying as time tracking at work.
• No food-related spontaneity. Celiac Disease pretty much killed this for me already (no “ooo there’s a new restaurant in town – we should go!“) but it’s even harder now that I have to make sure a restaurant has low-carb options in addition to gluten-free ones, and the timing has to be right for a meal or snack. Heck, I can’t even eat an apple past 6pm without it effecting the next day’s blood sugar.
• Getting bored of eating a lot of the same foods over and over each day.
• Knowing my chances of developing Type 2 diabetes down the road is high.
• Playing poor me. I know – it’s childish – but when all I want is to sit down and watch trashy television at night with a glass of wine, pizza and giant brownie (dreaming big here,) the fact that I have gestational diabetes and Celiac Disease can be a bummer.

What’s been good:

• Knowing that I’m doing all I can to make sure we have a healthy baby and pregnancy.
• I get to eat A LOT. 3 meals + 2 snacks a day. Not mad about that!
• Learning about portion control. Let’s just say the amount of sweet potato fries that equals one carb choice is much smaller then I thought.
• Slower weight gain. I’ve never been one to care much about weight gain during pregnancy as long as I was in the healthy range and baby was growing at a healthy rate, but this has been a welcomed side effect.
• I’ve learned how my body processes carbs – at least during this pregnancy. Through trial, error, and testing, I’ve found my blood sugar hates white sugar, fruit in the morning and at night, super starchy vegetables, and even too many whole grain carbs. Totally changed my outlook on the (fun) foods I’ll be fueling my body with post-baby.
• I’ve never eaten healthier. My meals and snacks are filled with tons of vegetables, lean protein, nuts, and dairy – which thankfully my body handles well.
• I feel great! I was shocked to find out I had gestational diabetes in the first place because I’d felt the best this pregnancy out of all three prior to being diagnosed. Since changing my diet though, I’ve had more energy and feel better overall.
• This is temporary. Gestational diabetes ends when the gestation period ends. Yes, Type 2 diabetes is a very real risk for the future, but gestational diabetes specifically will end in a few weeks.

What I’ve Been Eating

It was a bummer to find out I had to start logging all my meals and snacks to share with my doctors and dietitian at every appointment, but it’s worked out well because now I can share some ideas with you!

NOTE: I am NOT a doctor nor dietitian so please discuss your meal plan with your care team, as I have, to identify what will work for you and your gestational diabetes care plan! 

Breakfast:

• 1-2 slices peanut butter toast (I’ve been eating Canyon Bakehouse Gluten-Free 7-Grain Bread vs their Mountain White)
• 1 slice buttered toast + 2 scrambled eggs + 2 slices bacon (I like Applegate Naturals No Sugar Bacon)
• Grain-free granola + almond milk, 1 slice peanut butter toast
• Handful raw almonds or pecans, small square Maple Cinnamon Breakfast Bars
• Greek yogurt + sliced almonds or grain-free granola
• 2 scrambled eggs with shredded cheese, 1 slice toast
• 2 fried eggs, 2 slices bacon or sausage, big handful sauteed spinach
• 1 slice avocado toast + goat cheese, fried egg
• Small bowl oatmeal – 1/4 cup gluten-free oats cooked with 1/4 banana in 1/4 cup each almond milk and water. Add chia seeds, toasted unsweetened coconut chips, chopped nuts, tiiiiny drizzle maple syrup, cinnamon, and vanilla.

Lunch:

• Big salads with a mix of protein (turkey, chicken, nuts, seeds, cheese, hard-boiled egg, smoked salmon,) vegetables, and carbs like blueberries, diced apples, or dried cranberries + dressing
• Peanut butter sandwich, cheese stick, baby carrots
• Cheese quesadilla (2 small corn tortillas) with guacamole + salsa, 1/2 cup fruit
• Cheese stick, a few whole grain crackers, baby carrots, 1/2 an apple
• Burger (no bun) + pickles and ketchup. Salad with lots of vegetables + sliced almonds
• Meatballs + few Tablespoons marinara sauce + shredded cheese, baby carrots, 1/2 cup fruit
• Tuna salad + a few whole grain crackers and vegetable dippers, 1/2 cup berries
• 2 hard boiled eggs, salami, cheese, a few whole grain crackers, 1/2 cup fruit
• 2 hot dogs (local brand) sliced down the center and stuffed with cheddar cheese + ketchup, baby carrots
• Chicken salad + vegetable dippers and/or a few whole grain crackers
• Egg Salad Jars

Dinner:

• Zucchini Noodle Caprese Lasagna
• Crunchy Pesto Potato Chip Salmon
• Burgers (no bun), large vegetable-based salad, 1/2 cup berries
• Vegetable Stir Fry: 1/4 cup uncooked brown rice (max) cooked then stir fried with an egg + any/all vegetables and drizzled with gluten-free Tamari
• Crock Pot White Chicken Chili + shredded cheese
• 1/2 baked spaghetti squash + 3/4 cup marinara/meat sauce + parmesan or mozzarella cheese
• Skinny Shrimp (or Scallop) Piccata with Zoodles
• Crustless quiche, 1 cup fruit
• Buffalo Chicken Salad, 1/2 cup sweet potato fries
• Pan-Roasted Chicken Thighs, cauliflower rice, 1/2 cup sweet potato fries
• Cauliflower Fried Rice
• BBQ, Bacon, Avocado and Cheddar Chicken, roasted vegetables
• Grilled Pork Tenderloin, grilled vegetables
• Roasted Pork Tenderloin, roasted vegetables
• Perfect Roast Chicken, roasted vegetables or side salad
• Homemade Egg Drop Soup
• Grilled or seared steak, roasted or sauteed green beans, sauteed garlic butter mushrooms

Snacks:

• Beef jerky (Nick Sticks or Duke’s – buy at Costco)
• Enjoy Life Chewy Bars (in a pinch)
• Plantain chips (OBSESSED with these BBQ ones)
• Cottage cheese + 1/2 cup fruit
• Olives + cheese cubes + a pickle
• Raw nuts + 2 Tablespoons dried fruit
• Greek yogurt + grain-free granola or nuts
• Popcorn + raw nuts or seeds
• Salami + cheese stick + plantain chips
• Raw vegetables + guacamole
• 1/2 apple + cheese cubes + prosciutto
• 1/2 apple + 2 Tablespoons peanut butter
• Homemade Egg Drop Soup
• Raw vegetables
• Raw vegetables
• Raw vegetables

#notatypo. 😉 Click here for all my low-carb recipes >

Moving forward

“You have gestational diabetes” are four words that no mother on earth wants to hear, and this has made a time when I already feel out of control of my body (ie pregnancy) much more difficult. To be crystal clear, I cannot wait for this to go away. That said, I am grateful for this experience. As of 2017, it is said that 29 million Americans have Type 2 diabetes and 8 million of them are undiagnosed. I can say with 100% certainty that had I not been diagnosed with gestational diabetes, the thought of getting Type 2 diabetes would have never crossed my mind. I eat a balanced diet – no fast food and limited junk food – exercise moderately, and have no family history of diabetes, so it’s never been on my radar until now.

This experience has been a HUGE eye opener in terms of how I can make small, healthy improvements to my lifestyle moving forward though. Instead of white bread, I’ll choose whole grain. Instead of white rice, I’ll choose brown. Instead of brownies I’ll make a smoothie (ok maybe not every time!) Sit less. Move more.

I can’t pretend I don’t know I’m now at risk for developing Type 2 diabetes down the road but I’m super grateful to know how I can reduce my risk. Also grateful that I have just 5 more weeks of this “diet” left before meeting the sweet little lady who is worth every bite of carrot over cake!

Have you ever been diagnosed with gestational diabetes? What was your experience like? 

Takeaways • Gestational Diabetes UK

Many ladies still enjoy having takeaways with gestational diabetes and why not? As long as it’s not everyday then it’s one treat that you can adapt and still enjoy without causing high blood glucose levels.

Making the right choices with the type of takeaway you choose and sticking my 8 golden rules will help you make better choices when it comes to having a night off cooking and getting a treat but it’s all about being careful with your choices.

Many Indian or Chinese dishes contain added sugar. There’s the obvious ones to avoid such as sweet & sour, plum, hoisin, sweet chilli & BBQ sauce etc. But also be wary of dishes you perhaps didn’t expect having added sugar, like korma and butter chicken, crispy seaweed.

If in doubt then ask, many restaurants & takeaways will happily make the dishes without the added sugar in them for you, but if you don’t ask you don’t get!

Depending on what your diabetes team advises, you may try some takeaways and be led to believe that they give you even better results than your healthy GD food cooked from scratch⁉️
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But actually, it all comes down to WHEN you are advised to test your blood glucose levels & the TARGETS used.
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For many meals, a one hour post meal test will give a good indication as to whether you are tolerating a dish or not, however there’s a big exception to this and that’s food exactly like this! ????????? ??? ????????? ??? ??????? ?????? ????? and so that lovely low reading you got at one hour may be BEFORE your levels spike!
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This is due to the high fat content of these types of meals. With this in mind it is worth testing your blood sugars at 1hr AND 2hrs post meal.

8 golden rules to eating

The best approach to food we have found is to stick to these 8 golden rules:

1. Eat little & often, ideally 3 meals and 3 snacks a day
2. ‘Pair’ foods so that they will be tolerated better, “food pairing” is a term that we use in relation to the GD diet
3. Eat high protein
4. Eat good, natural fats
5. Eat low amounts of unrefined complex starchy carbohydrates at every meal
6. Bulk up meals with lots of vegetables & salad
7. Drink plenty of water
8. Go for a stroll  

Eating little and often, the key to stabilising blood sugar levels

Ideally we want blood sugar levels which look (if we were to draw a picture) like rolling hills, rather than huge spikes and crashes.  The best way to achieve good control over levels is to choose sensible foods and to eat little amounts often. We advise aiming for 3 meals and 3 snacks a day.

Avoiding to eat is something that many mothers do when they are first diagnosed with gestational diabetes and are unsure or too scared over what to eat.  This can actually have a detrimental effect on blood sugar levels.  If a meal or snack is missed then blood sugar levels can drop low and when this happens the liver dumps glucose into the bloodstream to give us energy and keep us going. The glucose can spike our levels high and then when eating our next meal, as levels are higher than they should be, they spike even higher.  Following a big spike, the body will signal the pancreas to produce insulin, but with gestational diabetes we may not be able to produce enough insulin or hormones block our body from using the insulin we have produced. Sometimes the body will overproduce insulin and cause a big crash in levels, which is the start of roller coaster blood sugar levels.

Use food pairing to make sensible choices when selecting a takeaway or eating out. If eating something that is higher in carbohydrates (starchy carbs, fruit) then add protein to make it more tolerable.

My biggest tip! Plan ahead

PLAN, PLAN, PLAN – if you plan your meals you won’t get caught out!  If you’re eating out, get the menu in advance so that you can plan what would be your best options.

No guarantees

Eating out and eating foods from takeaways is always tricky as ingredients and the way things are cooked will vary dramatically from one place to another.

You may be fine with a certain dish from your local takeaway but having the same dish from another takeaway causes your blood sugar levels to rise over your limit. Stick to the 8 golden rules when selecting what to eat.

Be wary of having a ‘little bit of everything’

Remember, avoid ‘double carbing’ i.e. avoid having chips and pitta, or a naan and rice in the same meal as this is one thing that catches a lot of ladies out with takeaways! It’s no different to any other meal other than you are not cooking it. Make sensible choices and enjoy your meal.

High fat and the late spike in levels

Whilst takeaways are nice as a treat every now again, they should not become a regular part of the gestational diabetes diet.

think about fat content

Many takeaway foods are high in saturated fats and transfats. This means that the absorption of glucose into the bloodstream will be slowed down and you will most probably see lower blood sugar levels, but that does not make them a better or a healthier choice.

TIP: Bearing in mind the time taken for fat to convert to glucose in the bloodstream you may wish to test your blood sugar levels at 2 hours post meal, as well as at 1 hour in case you see a rise in numbers later. If you do not have a 2 hour test target, you could use the A 2 hour test guideline recommended by NICE which is to be below 6.4mmol/L

Try to use protein first and fat secondary to pair foods, looking for good healthy fats before choosing a greasy kebab to eat every night just because it gives lower blood sugar levels.

MENU CHOICES FOR TAKEAWAYS

The following information has been compiled through data collected in my Facebook support group. The ideas can be repetitive, but it shows which meals people achieved good blood glucose levels with. It is important to bear in mind that test times and targets vary all over the country and individual tolerances also vary hugely. You know better than anyone which starchy carbs are tolerated better by you eg. if you tolerate rice better than breads, then choose a rice as your main starchy carb and avoid breads. Likewise if potato is you better tolerated carb, then opt for potato as your carb over other things which you know you struggle with

TAKEAWAYS

Indian

• Lamb dopiaza, basmati rice (only a few spoonfuls)
• Chicken korma with half a portion of rice, more if I had veg or mushroom rice
• Chicken tikka kebab with salad and sauce
• Lots of vegetarian side dishes, literally a teeny, little bit of everything
• Mixed tandoori grill, salad, spinach and cauliflower and half a naan
• Chicken Korma, mixed grill, half a portion of rice OR naan never both, veggie side dishes
• Chicken Tikka starter with salad then instead of ordering a large main I have chicken tikka chaat on purée which is normally a starter but is normally huge and left me extremely satisfied. Then I had a spinach side dish and nibbled at some poppadom too
• Tikka masala or butter masala. Only a small bit of rice. I normally have half a poppadom too
• Tandoori chicken or chicken tikka, pakoras
• Tandoori mixed grill, tarka dhal and a chapati
• Lamb tikka saag
• Chicken korma
• Korma with a mixed grill starter, a quarter of nann bread and loads of salad
• Lamb saag and tandoori is great! Lots of grilled meat, less sauce as you can’t predict the sugar in those sauces. Little of bit of rice and or little bit of naan
• Big portion of Chicken Korma, with an onion Bhaji, a vegetable samosa, and a big side salad
• Mixed meat starter, half an onion bhaji, share a sag, korma & bhuna curry and 3 veggie sides. I had around 5-6tbs of rice with it
• Chicken korma but just the chicken no extra sauce and did my own pack of tilda rice. Had the spinach from a saag aloo (hubby had the potato) and I had 1 onion bhaji
• Lamb tikka saag with no rice side of veg curry and a chapati
• Tandoori mixed grill, stuffed green pepper with curried lamb and a chapaati instead of a naan
• Chicken tikka starter with a couple of poppadoms
• Chicken shashlick with onion bhaji’s and saag aloo
• Tandoori mixed grill (meats) and creamy tikka masala, small bit of rice
• Chicken shashlik with loads of salad
• Lamb dupiaza, a couple of spoons of basmati rice
• Basmati rice and korma & saag paneer
• 2 tablespoons of rice, 1/2 poppadom, and a few spoons of saag baji, lamb korma and butter chicken
• mixed starter (chick tikka, lamb chop, samosa, sheesh kebab, lamb tikka) and a lamb korai with 1/2 a plain naan

Beware of added sugars in curries where you may not expect them to be eg. korma. It’s often best to call ahead to ask for no extra sugar to be added

Chinese & Thai

• Chicken & broccoli with mixed chow mein noodles & beansprouts. Only have about half the noodles but as much chicken and broccoli as I fancy
• Mixed meat chow mein from the Chinese
• Beef in black in sauce, chicken chow mien and special fried rice only small amount of each
• Chicken egg foo yung with a small amount of fried rice
• Chicken and mushroom with a small portion of fried rice
• Satay chicken
• Satay chicken & chow mein
• Satay chicken, noodles instead of rice
• Satay chicken, mixed meat and veg with noodles / rice but only have half the portion of the carb
• Chicken or beef with broccoli
• Chicken or beef with black bean sauce
• any tofu dishes
• Egg Fu Young
• Stir fry veg
• Beef & green peppers in black bean sauce
• Satay chicken for starter followed by 1/4 of crispy duck with pancakes, (no hoi sin sauce) extra veg
• Thai style fried rice
• Chow mein & vegetables
• Chicken with cashews, a satay chicken stick and a few spoons of boiled rice
• Thai red curry
• Chicken ginger and spring onions tiny bit of rice

WARNING! It is advisable to avoid any form of sweet and sour, Kung po, hoisin or plum sauce as its packed full of sugar

Kebab shops

• Chicken kebab, lots of salad, full fat mayo and either the pitta or some chips 
• Chicken shish kebab minus the pitta bread with loads of salad  
• Donner kebab with lots of salad 1 pitta and garlic sauce. No chips!
• Doner kebab chilli sauce garlic mayo salad chips OR the bread
• Chicken kebab, with salad & garlic sauce (no bread) but had a few chips
• Chicken or mixed kebab, loads of salad and garlic mayo. I only eat half the pitta
• Chicken kebab with salad and pitta, I don’t get any sauce and use my own full fat mayo
• Chicken salad wrap with a very small handful of chips (2 year old’s portion was bigger than mine)
• Chicken shish kebab with salad garlic sauce in a wrap
• Chicken & donner meat kebab and salad
• Chicken shish and donner wrap, salad garlic sauce
• Kebab meat chips and garlic mayo

WARNING! Beware of chilli sauce, ketchup & BBQ sauce etc as they can contain a lot of sugar

Fish & chip shops

• Large fish and small chips
• Fish and chips with salad. 2 small to medium pieces of cod. A handful of skinny chips and a large side portion of salad containing lettuce, cucumber, tomato and coleslaw. I didn’t eat all of the batter on the fish. Avoided the big lumps of it at the ends.
• Chippy fish and mushy peas with a couple of chips
• Large fish and battered sausage instead of chips
• Large fish and 1/2 portion of chips
• Fish and (a handful of) chips 
• Mini fish and chips
• Large fish (batter removed) and mushy peas
• 2 Battered sausages & small chips
• Battered fish, peas and gravy but any amount of chips takes me over my target
• Fish with a few chips, and a dollop of mayo
• Large battered cod and mushy peas
• Chicken, small handful of chips, salad and mayo
• Cheesy chips with lots of mayo and salad
• Scampi with a large salad and mayonnaise

Pizza

• Dominos pizza on Italian/ thin crust with chicken, ham, peppers and red onion and a side order of chicken wings
• HALF a medium dominoes pizza. I had a thin ‘new yorker’ (ham, bacon, pepperoni and mushrooms), extra cheese
• Chicken wings, 2 slices of large thin crust and salad
• Dominos thin crust pizza 2 large slices, garden salad, olives, Parmesan, olive oil, coke zero
• A couple of slices of cheesy meat one on thin base with about 4 chicken strips
• 3 or 4 slices of Domino’s thin crust pizza with as much meat as possible and extra cheese
• 3-4 slices of Dominos thin and crispy ham, cheese and pineapple
• Thin crust with ham and mushroom and extra cheese
• Vegetarian calzone with diet coke
• Thin crust pizza with extra cheese and extra meats, full fat coleslaw & salad on the side

KFC

• Zinger tower meal
• KFC 2 piece meal with few chips
• 3 pieces of chicken & some chips
• 3 KFC chicken pieces
• KFC Zinger tower meal
• Chicken from KFC with a couple of chips
• The boneless banquet, but not all the chips and I had 7up free and then water after
• Fully loaded zinger meal with chips and diet coke
• Chicken Caesar salad with 7up zero
• Fully loaded meal and 7up zero
• Boneless banquet, chips, diet coke and coleslaw
• Fillet burger, 2 pieces of original chicken – no fries, with 7up zero
• KFC, zinger tower burger with chips and popcorn chicken
• Chicken chicken n more chicken and I ate about 7 fries
• Boneless banquet for one
• 2 piece meal and only eat half chips
• Loads of chicken and corn on the cob
• KFC Boneless banquet for one
• rice box from KFC, with extra fillet, extra cheese, no BBQ sauce and extra mayo
• Loaded up with chicken and a corn on the cob
• KFC boneless banquet with corn and hot wings but didn’t eat the chips
• Original recipe chicken (quite a few pieces) and a portion of fries

WARNING! Beware of chilli sauce, ketchup & BBQ sauce etc as they can contain a lot of sugar

McDonalds

• McDonald’s salad with non breaded chicken 
• Medium cheese burger meal washed down with loads of water
• Chicken selects on their own I then add cheese and salad when I get home
• Chicken selects, side salad & diet coke
• The chicken and bacon salad with a few fries
• Chicken wrap and fries
• MacDonalds chicken selects, fries and diet coke
• A big tasty burger with mozzarella bites on the side with a large diet coke
• Big Mac, bun removed, a few fries and Sprite zero
• Triple cheeseburger bun removed and fries
• Cheese quarter pounder, minus the bun & a side salad
• Mozzarella dippers and salad
• Chicken nuggets and side salad with lots of mayo
• 5 piece chicken selects with sour cream dip

WARNING! Beware of chilli sauce, curry sauce, sweet and sour sauce, ketchup & BBQ sauce etc as they can contain a lot of sugar

Subway

• Salad bowls (double your meat/fish/cheese, add guacamole, olives and seeds for extra pairing. Opt for mayonnaise, creamy caesar sauce, Chipotle Southwest sauce, garlic aioli sauce)
• 6″ wheat sub with high protein fillings, cheese and salad*

*Only try subs if your tolerance to bread is better than other carbohydrates and overload with protein and salad

Nandos

• Nando’s 1/4 chicken with medium sauce. Corn on cob and filo coleslaw
• Nandos half a chicken chips and corn on the cob and peri Mayo
• Grilled chicken thighs with medium sauce, macho peas & coleslaw plus a few diet cokes
• Avocado and green bean salad, chicken and garlic bread
• Whole chicken with sides. Salad a few chips, houmous (shared between us)
• Chicken chips rice and coleslaw, olives and halloumi
• 1/4 chicken, peas and side salad
• Prego Steak roll – minus the roll, with a toasted pitta instead, a side of salad and coleslaw, grilled halloumi and a sparkling water
• Olives for starters, chicken wrap with haloumi and ratatouille and coleslaw
• Chicken in pitta with rice and corn on cob
• Half a nandos chicken, creamy mash, coleslaw, 5 pieces of halloumi cheese
• Nando’s chicken thigh burger, no bun, cheese and coleslaw and half the chips

TAKEAWAY DRINKS

A common problem when ordering takeaway dispenser drinks and coffees etc. is that full sugar versions can accidentally be given. Always double check you have been given the correct drink, or if you want to play completely safe, opt for sealed drinks instead.

Ice cream milkshakes

All I can say is walk the other way!

Ice cream milkshakes should come with a huge sugar warning sign on them!

These thick, creamy milkshakes can contain anything from 66g – 90g of total carbs for a medium or large serving!

There is a HUGE 90g of carbs in a large banana flavoured McDonald’s milkshake is the equivalent of 22 ½ tsp of sugar!!

Iced fruit smoothies, iced coffees & coolers

Unfortunately these icy, refreshing and fruity drinks can also be packed with sugar. Not such a big surprise when we know that fruit itself and even more so, fruit juice and sweet syrups can spike levels very high, very quickly.

• Costa Massimo Caramel Latte Cooler, 61g total carbs!
• Starbucks Tall (small) Iced Chai Tea Latte, skimmed milk, 33g total carbs
• Costa Primo (small) Watermelon & Strawberry Cooler, 36g total carbs
• McDonald’s (medium) Strawberry & Banana Iced Fruit Smoothie, 40g total carbs
• McDonald’s (regular) Caramel Iced Frappé, 46g total carbs
• Costa Medio (medium) Mango & Passionfruit Cooler, 57g total carbs
• Costa Massimo (large) full fat Caramel Latte Cooler, 61g total carbs

Costa Caramel Latte Cooler, 61g total carbs, equivalent to 15. 25 tsp of sugar!

Lower carb iced/cold drinks to take out, but many still contain high carbs so beware…

• Starbucks Cool Lime Refresha, 13g carbs, or just over 3 tsp of sugar! You could just have iced water with a slice of lime instead? You decide!
• WATER! This is our top recommendation!! 0g carbs and no added artificial sweeteners! The best way to flush blood sugar levels through the body and handy for tipping onto a tissue when testing blood sugar levels…win, win!
• McDonald’s Sprite Zero, 0g carbs
• McDonald’s Diet Coke, 0g carbs
• Starbucks Venti Iced Americano, 4g total carbs
• Starbucks Tall Iced Cappuccino, coconut milk, 7g total carbs
• Starbucks Tall Iced Cafe Latte, skimmed milk, 9g total carbs
• Starbucks Grande Iced Cafe Latte, soya milk, 9g total carbs
• Starbucks Tall Cool Lime Refresha, 13g total carbs
• Costa Primo Soya Coffee Cooler, 16g total carbs
• Starbucks Tall skimmed milk frappuccino, no whip, 18g total carbs
• Costa Primo Full Fat Coffee Cooler, 18g total carbs
• Starbucks Tall skimmed milk mocha frappuccino, no whip, 21g total carbs
• Starbucks Tall skimmed milk caramel frappuccino, no whip, 21g total carbs
• Costa Primo Peach Iced Lemonade, 22g total carbs
• Costa Primo Summer Fruit Punch, 23g total carbs

GD safe Fakeaways

For some, the worry over not knowing is in takeaway foods can put them off having a treat. If you feel like this but would like to make your own fakeaway version of your favourite takeaway foods, then take a look through some of my recipes.

These recipes are based on the 8 Golden Rules and have been developed to achieve optimal blood glucose levels.

Eating Out | CDC

Three in five Americans say they eat dinner out at least once a week.

Three in five Americans say they eat dinner out at least once a week, and as you’ve probably noticed, restaurant portions have gotten a lot bigger. Unless you have a plan in place, that can be a recipe for regular overeating.

While you can’t directly control the way the food is prepared or the calories in each dish, you can plan ahead, ask questions, and order food that both tastes good and is good for you. With practice, it’ll get easier to separate the healthier choices from the not so healthy and to keep portions under control. Some tips:

Plan Ahead

• Decide what you’re going to order before you go so you don’t feel rushed or tempted by less healthy choices.
• If your meal will be later than normal, have a snack that contains fiber and protein—a small handful of nuts is a great choice—before you go out to avoid getting too hungry. Then cut back by that amount when you eat your meal.

Start Smart

• Drink a big glass of water as soon as you sit down. It’s been shown to help you eat less.
• Skip the chips and salsa or bread that comes to your table before you order. Better yet, ask your server to remove them.

Order Wisely

• Choose baked, steamed, grilled, or broiled instead of fried, breaded, crispy, or creamy to reduce fat and calories.
• Ask for veggies instead of fries or other high-calorie side dishes.
• Avoid items that seem healthy but aren’t, such as salads loaded with dressing, cheese, croutons, and bacon.
• Avoid added sugar—don’t order dishes that have BBQ, glazed, sticky, honey, or teriyaki in their name.
• Order sauces, salad dressing, and spreads on the side and use sparingly. Try dipping your fork in the dressing before taking each bite to enjoy the flavor for fewer calories.

Share and Savor

• Share your main dish or eat half and wrap up the rest for later.
• Enjoy the occasional sweet treat (minus the guilt) by cutting back on carbs during your meal, and get a dessert to share with the table. You won’t miss out—the first few bites are usually the tastiest.

Eating Fast Food With Diabetes – Making Smart Choices

What you eat is one of the most important factors in controlling diabetes, so avoiding fast food may be a priority. Still, fast food is almost sure to be an occasional or regular part of life since it is so convenient and great-tasting. The Center for Disease Control (CDC) reports that on a given day, nearly 37% of Americans consumed fast food.

The good news is that eating fast food with diabetes can be healthy if you make better choices.

With some planning, you can choose meals that are:

• Low or moderate in carbohydrates and calories.
• High in protein.
• Low in unhealthy fats.
• Sources of fiber, essential vitamins and minerals.

These are some fast food choices that can fit into your diabetes diet. Just because you have diabetes doesn’t mean you can’t eat fast food if you make smart choices!

Burger and Chicken Joints

Small burgers and grilled chicken can keep you on track, while double or triple cheeseburgers and fried chicken sandwiches and nuggets can set you back. Look for small or kid-sized burgers and hold the mayo and fatty dipping sauces. When you can, order extra lettuce and tomatoes.

Follow your instincts when it comes to sides and desserts. French fries, onion rings, and mashed potatoes and gravy are as bad as you may think, while carrot sticks and side salads with dressing on the side can be the answer. Similar, choose fresh fruit or yogurt instead of cookies, apple pie, and ice cream.

Try:

• Small burger or cheeseburger – hold the bun if you are low-carbing it – with apple slices or baby carrots.
• Grilled chicken salad with vinaigrette or light dressing and without croutons or noodles.
• Grilled chicken with a fresh fruit cup.

Sandwich Shops and Cafes

You usually have quite the range of choices here, and can walk away with a diabetic disaster or a healthful meal. Sandwich shops and cafes often give you complete control over what goes into your meal, so take advantage.

You have the right to ask for your order to exclude certain ingredients, even if they are listed on the item’s description on the menu. But do be careful with the amount of carbs per serving if you are following a low-carb diet.

Go for a salad or eat only half the bread in your sandwich, try for mustard instead of mayo, and look for more healthful proteins such as chicken or cheese instead of processed meats or meatballs. Processed foods have been reported to be the source of 70% of an average American’s daily sodium intake according to The American Heart Association (AHA or heart. org).

You may also have the chance to load up on vegetables to help you create a filling, low-calorie meal, and you can finish with some sweet but guilt-free fresh fruit.

Consider:

• A sandwich with vegetables and cheese or grilled chicken on whole-grain bread.
• A large salad with grilled chicken and dressing on the side, and with limited add-ons such as croutons, chow mein noodles, dried fruit, and bacon bits.
• Lentil or bean soup or a broth-based soup with vegetables instead of broccoli cheese or another creamy or cheesy soup.

Pass up the syrupy coffee beverages and sweet tea, and opt instead for unsweetened tea.

Best Fast Food Choices for Diabetes at the Biggest Fast-Food Restaurants

1. McDonalds: Southwest Grilled Chicken Salad
2. Starbucks: Chicken, Quinoa, and Protein Bowl with Black Beans and Greens
3. Subway: Veggie Delite Salad with cheese, vegetables, guacamole, and Subway vinaigrette
4. Burger King: Veggie Burger
5. Taco Bell: Chicken Soft Taco with a side of Pintos n Cheese
6. Wendys: Large or Small Chili and a Garden Side Salad without croutons and with Light Ranch dressing
7. Dunkin Donuts: Egg and Cheese on half a Multigrain Bagel
8. Chick-fil-A: Grilled Nuggets with Zesty Buffalo Sauce plus a Small Superfood Salad
9. Panera Bread: Lentil Quinoa Broth Bowl with Egg
10. Pizza Hut: 2 slices of Large Thin N Crispy Veggie Lovers Pizza with Chicken

Pizza Parlors

There may be more good news about pizza than you knew. Although it can be over-the-top in calories, saturated fat, and carbs if you get thick or stuffed-crust pizza, it can be a low-glycemic manageable treat if you stick to 1 or 2 slices of thin-crust pizza.

As for toppings, keep the cheese light – it adds calories and fat, but lowers the glycemic index. Skip the processed fatty meats such as pepperoni and sausage, and instead look for vegetables.

You are also sure not to find a good dessert option for diabetes, since “dessert pizzas” and cinnamon sticks are a combo of refined starches and sugars plus excess fats.

Good fast food choices for diabetes when eating pizza may include:

• Thin crust.
• Extra sauce.
• Extra tomatoes, bell peppers, mushrooms, onions, and any other vegetable toppings.
• Anchovies or chicken instead of pepperoni or sausage.

Skip the breadsticks, pasta, and chicken wings as sides, and opt for green salad instead.

Tips for Eating Fast Food with Diabetes

• Check the nutrition information before you go or while you are there – most chains are great at making their info available, especially if you ask for it.
• Plan your order ahead of time when you can. Even if you cannot, look for a lean protein such as grilled chicken plus a vegetable such as a salad.
• Go easy on the bread or skip it entirely, and ask for whole-grain when you can.
• Check for green salads and steamed or raw vegetables for your side dishes.
• Limit fried or starchy sides such as French fries, mashed potatoes, noodles and pasta, onion rings, and rice.
• Get dressing and sauces on the side, and look for lower-calorie condiments such as mustard, hot sauce, and salsa.
• The “small” size can easily have less than one-third the calories as the “large” size.
• Get baked, roasted, or grilled, and not fried, battered, or breaded.
• Keep your eyes open for opportunities to add vegetables as sides, as toppings on burgers, tacos, sandwiches, and pizza, and in stir-fry and entree salads.

Mexican Food

Eating fast food with diabetes can be disastrous if you choose wrong at a Mexican restaurant, but it can also be nutritious if you are careful. Grilled chicken and lean steak are rich in protein and low in fat, pinto and black beans are high in fiber and protein, and avocados (think: guacamole!) are among the healthiest possible sources of fat in a study from the Mayo Clinic. Tacos can be good choices because they tend to be smaller than burritos and tostadas.

Just keep in mind that too much of anything can be bad for diabetes, blood sugar, and weight, and that Mexican fare tends to include plenty of problem ingredients, such as fried tortilla chips and tostada shells, oversized starchy tortillas, and overly generous amounts of unhealthy cooking fats.

Any of these options may help you come out ahead.

• “Naked” burrito or burrito bowl with grilled or salad vegetables, pinto beans, and chicken, and with no tortilla.
• Taco salad with lettuce, tomato, light cheese, pinto or black beans, avocado, and olives, with no sour cream or chips, and with salsa or pico de gallo instead of creamy dressing.
• Chicken or fish taco with lettuce, tomatoes, salsa, and avocado.
• Chicken shrimp, or steak fajitas without the tortillas.

Chinese and Other Asian Cuisines

Chinese and other Asian fast food choices for diabetes can be really good, or really bad. You are sure to spike your blood sugar and put a damper on weight loss if you have mounds of white rice, fried rice, or chow mein or pad thai noodles. The same is true if you get fried or breaded chicken, fish, or shrimp dishes.

On the other hand, you can almost always find dishes with plenty of vegetables and lean protein, such as skinless chicken, shrimp, tofu, or fish. Oyster sauce and wine sauce are lower in sugar than sweet and sour sauce. Teriyaki salmon and chicken are good options at Japanese restaurants. For dessert at a Chinese fast food joint, enjoy a fortune cookie for 30 worthwhile calories.

• Clear soup, such as hot and sour, egg drop, or tom yum, plus stir-fried vegetables and tofu or chicken.
• Stir-fry with chicken and vegetables, plus a fortune cookie.
• Fish in black bean sauce plus mixed vegetables.
• Teriyaki salmon, seaweed salad, and edamame.

When possible, ask for vegetables or brown rice instead of white or fried rice.

Beverages

Wherever you eat, your choice of beverage can make or break your meal. Water is always a great choice, since it is naturally calorie-free. Decaffeinated tea and coffee are also good options. While diet drinks are calorie-free, they can throw your body’s blood sugar regulation further out of whack.

Steer clear of sugary beverages, such as regular soft drinks or other sugary fountain drinks such as sports drinks or lemonade. A large soda can have 400 or more calories and 100 or more grams of sugar – more than the daily recommended limit for four days! Blended coffee beverages and sweet tea are just as bad.

Most fast food places these days do have healthy choices. You may just need to look for them or special-order the regular menu items to make them healthier. With diabetes, you can eat convenient and great-tasting fast food while managing blood sugar and weight.

Gestational diabetes diet: MedlinePlus Medical Encyclopedia

For a balanced diet, you need to eat a variety of healthy foods. Reading food labels can help you make healthy choices when you shop.

If you are a vegetarian or on a special diet, talk with your health care provider to make sure you’re getting a balanced diet.

In general, you should eat:

• Plenty of whole fruits and vegetables
• Moderate amounts of lean proteins and healthy fats
• Moderate amounts of whole grains, such as bread, cereal, pasta, and rice, plus starchy vegetables, such as corn and peas
• Fewer foods that have a lot of sugar, such as soft drinks, fruit juices, and pastries

You should eat three small- to moderate-sized meals and one or more snacks each day. Do not skip meals and snacks. Keep the amount and types of food (carbohydrates, fats, and proteins) about the same from day to day. This can help you keep your blood sugar stable.

CARBOHYDRATES

• Less than half the calories you eat should come from carbohydrates.
• Most carbohydrates are found in starchy or sugary foods. They include bread, rice, pasta, cereal, potatoes, peas, corn, fruit, fruit juice, milk, yogurt, cookies, candy, soda, and other sweets.
• High-fiber, whole-grain carbohydrates are healthy choices. These types of carbohydrates are called complex carbohydrates.
• Try to avoid eating simple carbohydrates, such as potatoes, french-fries, white rice, candy, soda, and other sweets. This is because they cause your blood sugar to rise quickly after you eat such foods.
• Vegetables are good for your health and your blood sugar. Enjoy lots of them.
• Carbohydrates in food are measured in grams. You can learn to count the amount of carbohydrates in the foods that you eat.

GRAINS, BEANS, AND STARCHY VEGETABLES

Eat 6 or more servings a day. One serving equals:

• 1 slice bread
• 1 ounce (28 grams) ready-to-eat cereal
• 1/2 cup (105 grams) cooked rice or pasta
• 1 English muffin

Choose foods loaded with vitamins, minerals, fiber, and healthy carbohydrates. They include:

• Whole-grain breads and crackers
• Whole grain cereals
• Whole grains, such as barley or oats
• Beans
• Brown or wild rice
• Whole-wheat pasta
• Starchy vegetables, such as corn and peas

Use whole-wheat or other whole-grain flours in cooking and baking. Eat more low-fat breads, such as tortillas, English muffins, and pita bread.

VEGETABLES

Eat 3 to 5 servings a day. One serving equals:

• 1 cup (340 grams) leafy, green vegetables
• 1 cup (340 grams) cooked or chopped raw leafy vegetables
• 3/4 cup (255 grams) vegetable juice
• 1/2 cup (170 grams) of chopped vegetables, cooked or raw

Healthy vegetable choices include:

• Fresh or frozen vegetables without added sauces, fats, or salt
• Dark green and deep yellow vegetables, such as spinach, broccoli, romaine lettuce, carrots, and peppers

FRUITS

Eat 2 to 4 servings a day. One serving equals:

• 1 medium whole fruit (such as a banana, apple, or orange)
• 1/2 cup (170 grams) chopped, frozen, cooked, or canned fruit
• 3/4 cup (180 milliliters) fruit juice

Healthy fruit choices include:

• Whole fruits rather than juices. They have more fiber.
• Citrus fruits, such as oranges, grapefruits, and tangerines.
• Fruit juices without added sugar.
• Fresh fruits and juices. They are more nutritious than frozen or canned varieties.

MILK AND DAIRY

Eat 4 servings of low-fat or nonfat dairy products a day. One serving equals:

• 1 cup (240 milliliters) milk or yogurt
• 1 1/2 oz (42 grams) natural cheese
• 2 oz (56 grams) processed cheese

Healthy dairy choices include:

• Low-fat or nonfat milk or yogurt. Avoid yogurt with added sugar or artificial sweeteners.
• Dairy products are a great source of protein, calcium, and phosphorus.

PROTEIN (MEAT, FISH, DRY BEANS, EGGS, AND NUTS)

Eat 2 to 3 servings a day. One serving equals:

• 2 to 3 oz (55 to 84 grams) cooked meat, poultry, or fish
• 1/2 cup (170 grams) cooked beans
• 1 egg
• 2 tablespoons (30 grams) peanut butter

Healthy protein choices include:

• Fish and poultry. Remove the skin from chicken and turkey.
• Lean cuts of beef, veal, pork or wild game.
• Trim all visible fat from meat. Bake, roast, broil, grill, or boil instead of frying. Foods from this group are excellent sources of B vitamins, protein, iron, and zinc.

SWEETS

• Sweets are high in fat and sugar, so limit how often you eat them. Keep portion sizes small.
• Even sugar-free sweets may not be the best choice. This is because they may not be free of carbohydrates or calories.
• Ask for extra spoons or forks and split your dessert with others.

FATS

In general, you should limit your intake of fatty foods.

• Go easy on butter, margarine, salad dressing, cooking oil, and desserts.
• Avoid fats high in saturated fat such as hamburger, cheese, bacon, and butter.
• Don’t cut fats and oils from your diet entirely. They provide energy for growth and are essential for baby’s brain development.
• Choose healthy oils, such as canola oil, olive oil, peanut oil, and safflower oil. Include nuts, avocados, and olives.

OTHER LIFESTYLE CHANGES

Your provider may also suggest a safe exercise plan. Walking is usually the easiest type of exercise, but swimming or other low-impact exercises can work just as well. Exercise can help you keep your blood sugar in control.

YOUR HEALTH CARE TEAM IS THERE TO HELP YOU

In the beginning, meal planning may be overwhelming. But it will get easier as you gain more knowledge about foods and their effects on your blood sugar. If you’re having problems with meal planning, talk with your health care team. They are there to help you.

Dietary Recommendations for Gestational Diabetes

Dietary Recommendations

It is important to be meet with a registered dietitian to have your diet assessed. The dietitian will calculate the amount of carbohydrates that you need at meals and snacks. You will also be taught how to count carbohydrates.

The following are dietary recommendations that will help you maintain safe blood sugar levels:

Distribute your foods between three meals and two or three snacks each day

Eating too much at one time can cause your blood sugar to rise too much. It is very important that you do not skip meals. During pregnancy, you have increased nutritional needs and your baby requires balanced nutrition.

Eat reasonable portions of starch

Starchy foods eventually turn into glucose so it’s important not to be excessive. However, starch should be included in every meal. A reasonable portion is about one cup of total starch per meal, or two pieces of bread.

Drink one cup of milk at a time

Milk is a healthy food and an important source of calcium. However, milk is a liquid form of carbohydrate and drinking too much at one time can raise your blood sugar.

Limit fruit portions

Fruit is a healthy food, but it is high in natural sugars. You may eat one to three portions of fruit per day, but only eat one at a time. A portion of fruit is either one very small piece of fruit, half of a large piece of fruit, or about one-half cup of mixed fruit. Do not eat fruit that has been canned in syrup.

Breakfast matters

Blood sugar can be difficult to control in the morning because of normal fluctuations in hormone levels.

Refined cereals, fruits and even milk may not be well tolerated in your morning meal. If your post-breakfast blood sugar level increases too much after having these foods, then you should not eat them for your breakfast. A breakfast that consists of starch plus protein is usually tolerated the best.

Avoid fruit juice

It takes several fruits to make a glass of juice. Juice is a concentrated source of carbohydrate. Because it is liquid, juice can raise blood sugar quickly.

Strictly limit sweets and desserts

Cakes, cookies, candies and pastries tend to have excessive amounts of carbohydrate. These foods often contain large amounts of fat and offer very little in terms of nutrition. Additionally, avoid all regular sodas and sugar-sweetened beverages.

Stay away from added sugars

Don’t add sugar, honey or syrup to your foods.

Use artificial sweeteners instead of added sugars

The following sweeteners have been approved as safe to eat during pregnancy:

• Aspartame, which includes Equal, NutraSweet, Natra Taste
• Acesulfame K, which includes Sunett
• Sucralose, which includes Splenda

When a product says it’s “sugar-free,” take a closer look

Products containing sugar-alcohols are often labeled “sugar-free,” but they may still contain significant amounts of total carbohydrate. Look at the food label to see the grams of total carbohydrate contained.

Sugar alcohols may have a laxative effect or cause gas and bloating. The following are examples of sugar-alcohols:

• Mannitol
• Maltitol
• Sorbital
• Xylitol
• Isomalt
• Hydrogenated starch hydrolysate

Some products labeled “sugar-free” are indeed carbohydrate-free and will not affect your blood sugar, including diet sodas and sugar-free Jell-o.

Keep food records

Be sure to record all of the foods and the amount that you eat each day, which will help you monitor your carbohydrate intake. Also, use measuring cups for accuracy when possible.

90,000 Pregnancy Diabetes: What an expectant mother needs to know

The moment a woman finds out about her pregnancy, the world around her changes. Life takes on new meaning and takes on new colors, because pregnancy is real magic and the greatest wonder of the world. Within 9 months, a small creature develops inside a woman, which will soon become a new man. This is a wonderful and unique period of life, it is full of new sensations, emotions, worries and worries.And before the new man is born, a lot of important and interesting changes will take place in the woman’s body. But, unfortunately, not all metamorphoses at this time are positive. There are pathological conditions that develop exclusively against the background of pregnancy and can bring serious and sometimes irreparable harm to the health of the expectant mother and baby.

Today we will talk about gestational diabetes mellitus (GDM) – a fairly common endocrine pathology that manifests itself during the period of gestation.Anna Georgievna Akopova, an endocrinologist of the highest qualification category at the Smitra Clinic, will tell us about what GDM is, how it is dangerous for the health of mothers and babies, and how to prevent the development of severe complications.

What is gestational diabetes?

Gestational diabetes is an endocrine disorder characterized by high blood sugar levels that manifests itself during pregnancy. It is based on a violation of carbohydrate metabolism, a decrease in glucose tolerance in the body of a pregnant woman.

Why is gestational diabetes dangerous?

Due to the limited development time, the disease may not cause serious complications for a woman’s health and is most often asymptomatic. As a rule, the ailment is discovered by chance, during a routine examination of a pregnant woman.

But at the same time, gestational diabetes can cause serious complications of pregnancy, such as gestosis – late toxicosis, the birth of a child weighing more than 4000 g (this condition is called macrosomia), which, in turn, increases the likelihood of complications and injuries during natural childbirth and the need for a cesarean section.

But gestational diabetes is the most dangerous for a baby . The consequences of this disease on the developing fetus can be unpredictable. Sugar crosses the placenta and causes the baby’s pancreas to produce an increased amount of insulin, which leads to overgrowth and pathological weight gain with impaired formation and maturation of internal organs. An excess of insulin in the body of the fetus is the cause of the development of oxygen starvation (hypoxia), asphyxia and increased injuries during childbirth, as well as respiratory disorders.The most formidable complication of untreated GDM is fetal death. After childbirth, overproduction of insulin leads to a sharp drop in blood glucose levels in a newborn with a high risk of cerebral hemorrhage. In addition, often such an increased production of insulin persists in the child in the future, causing increased appetite and the formation of obesity with all its sad consequences.

Who gets gestational diabetes?

Most often, the occurrence of gestational diabetes is associated with the woman’s pre-pregnancy problems with excess weight and insulin metabolism. The main risk group for GDM is women of middle and older reproductive age who are overweight or obese. Before pregnancy, the body manages to keep insulin at the desired level and prevent an increase in blood sugar levels. But during the period of bearing a child, the effect of hormonal levels significantly increases the load on carbohydrate metabolism, and as a result, compensatory capabilities are exceeded with an increase in blood sugar levels.

GDM can also occur in young girls who are not overweight.The fact is that there are hereditary mild forms of diabetes mellitus associated with small deviations in the mechanism of insulin work. Before pregnancy, such forms of diabetes, as a rule, do not manifest themselves in any way, and are discovered for the first time only during pregnancy due to a changed hormonal background.

In addition, in rare cases, it is during pregnancy that a woman is diagnosed with type 1 insulin-dependent diabetes.

Diagnosis of gestational diabetes mellitus

Due to the fact that pregnancy diabetes can manifest itself in any woman, diagnosis of this pathology should be carried out for all pregnant women, regardless of age and weight.

For the first time, the measurement of blood sugar levels occurs when a woman first visits an obstetrician-gynecologist. It is important to note that normal blood sugar levels in women carrying a baby differ significantly from normal values ​​outside of pregnancy. This is far from always indicated on the form of the laboratory performing the analysis, which can lead to serious errors in the diagnosis.

Every expectant mother should remember: the detection of glucose in the venous plasma of more than 5.0 m / mol is the basis for the diagnosis of gestational diabetes.In this case, the so-called “presumption of guilt” operates: an increase in glucose is so potentially dangerous for the fetus that the diagnosis is made on the basis of a one-time increase in the result.

If, at short stages of pregnancy, the sugar level is within the normal range, at 24-28 weeks all women must undergo a test with a glucose load to exclude latent pregnancy diabetes. Such an analysis will help to identify a violation of carbohydrate metabolism at the earliest stage, not allowing it to harm the developing baby.

If diagnosed with gestational diabetes mellitus

The attending physician for such a pathology is endocrinologist . If an elevated blood sugar level is detected, the patient should be urgently referred to a doctor.

At the first visit, the doctor will talk about the main way to control diabetes in pregnant women – a new diet and physical activity. Your doctor will recommend a healthy, controlled carbohydrate diet and moderate exercise such as walking, light fitness, yoga.And no starvation! In the diet for pregnancy diabetes, the products necessary for the mother and baby are by no means limited, the nutrition will be correct, complete and, of course, tasty.

The next recommendation of the doctor will be the purchase of a special device – glucometer , which will allow the patient to independently control the blood sugar level. A few days in a new lifestyle, with proper nutrition and moderate exercise, will allow you to understand whether diet therapy is enough to maintain safe glucose levels.

If the blood sugar level continues to rise even if all the doctor’s recommendations are followed, the patient will be prescribed drug therapy. Do not be discouraged and intimidated if the diet has not helped to cope with gestational diabetes! This does not mean that you have not coped with the disease. In some cases, the body is simply not able to produce the amount of insulin needed by the mother and baby.

Due to the fact that all tablets that can be used today for the treatment of diabetes mellitus have not been shown to be safe for a growing fetus, insulin remains the only drug for the treatment of pregnancy diabetes.This is often very frightening for a woman. After all, there is a need for constant injections, there are doubts about the safety of such treatment for the baby, and about whether this therapy will lead to lifelong dependence on insulin.

In fact, all these fears are completely unfounded and based on misconceptions about insulin therapy.

Firstly, pregnancy-related diabetes is non-insulin-dependent diabetes , the mechanism of its development is fundamentally different, and insulin injections are not able to turn non-insulin-dependent diabetes into insulin-dependent diabetes. Insulin therapy is canceled on the day of delivery, and this is where the use of insulin ends. This treatment has no effect on the development of insulin-dependent diabetes (type 1 diabetes) after childbirth.

Secondly, insulin is absolutely safe for the developing fetus . That is why it is used to treat pregnancy diabetes.

At the stage of selection of therapy, the patient needs to visit the endocrinologist every 2-3 days. After the situation is stabilized, the frequency of appointments will be reduced to 1 visit per month.

What to do after childbirth?

In order to make sure that pregnancy diabetes is gone, a woman needs to take a glucose load test 1–3 months after giving birth. Such an analysis can reveal in a woman a state of pre-diabetes, a precursor of type 2 diabetes, which will require medical correction, or, as is most often the case, show good results, which indicate that the woman is healthy and the diabetes is gone completely.

But even when getting perfect test results, a woman should understand that the previous pregnancy diabetes indicates intense carbohydrate metabolism and a high risk of developing prediabetes and type 2 diabetes in the coming years. What does it mean? This means that it is necessary to reconsider your lifestyle, eating style and introduce regular physical activity into your life, no matter how busy the mother is with pleasant chores and caring for the baby.

It is also necessary to think about proper nutrition for the child in order to prevent the problems faced by his mother in the future.

Pregnancy is a job that requires mandatory preliminary preparation. Every woman needs to take care of her health and the health of her unborn baby even at the stage of pregnancy planning.A balanced diet, moderate physical activity, emotional ecology – such simple and well-known rules will help you live 9 wonderful months happily and without health problems.

But if the disease does come, highly qualified specialists of the Clinic “SMITRA” are always ready to help. Our endocrinologists will listen, examine, prescribe the correct treatment and will definitely help you and your baby to be healthy and happy.

Health to you and your loved ones! Take care of yourself and your little miracle!

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Diet for pregnancy diabetes

Diet for pregnancy diabetes. How to eat with gestational diabetes?

Daily calorie content

The daily caloric content depends on the woman’s weight. Whether there is overweight, whether it was at the time of pregnancy.Or maybe she was even underweight. Or she is of normal weight.

If you are overweight, then we try to limit the calorie intake, but the daily rate should be at least 1800 kcal . That’s quite a lot.

If the weight is normal , it can be 2200 – 2500 kcal and even more if the woman is underweight.

Proteins

Let’s start with proteins and fats. I have to say that in gestational diabetes, we should only count carbohydrates. With protein and fat, we have a more liberalized diet.

Proteins are the most valuable and most important element of nutrition. In no case should you cut it down somehow. Proteins are the structure, growth and development of the embryo (fetus), the formation of the placenta, amniotic fluid. Therefore, it is the most important plastic element, a building material that cannot be limited.

What do these numbers mean? They do not mean that, say, 100 g of cottage cheese or 100 g of meat. No.
● A 150 – 200 g portion of meat contains an average of 25 – 30 g of protein;
● 100 g of cottage cheese contains approximately 18 g of protein.
● Dairy products, eggs contain approximately 5 g of protein per 100 g of food.
● Proteins are also found in plant products, such as cereals, bread.But there are not many of them. For 200 g of product, about 3 g of protein. But, nevertheless, it is also protein.
● Soy proteins are more valuable in terms of amino acid composition of plant products. But soy is not the most popular product. It is by no means harmful, but not the most popular product for our taste habits. But, nevertheless, it is worth remembering that this is an almost complete protein in terms of amino acid composition.

What about the ratio of plant to animal proteins?

Animal protein should make up at least 50.0% of your diet.These are meat or fish, poultry, cottage cheese, cheese, eggs, dairy products. This should be mandatory, because these are sources of the so-called essential amino acids, which our body has not yet learned to synthesize. But they are extremely important for the formation and growth of the fetus.

Vegetable proteins you can supplement with some legumes, maybe more lentils, fresh green peas, to some extent cereals, bread from whole grain flour. These vegetable proteins will “run over” by themselves.Because other products are used too.

Fat

Fat is the most nutritious part of our diet. But, nevertheless, it is also important. And during pregnancy, we are not talking about some kind of strict restriction of cholesterol. Of course, we are talking about limiting the fat content of foods, fat percentage, but, nevertheless, we do not exclude it.

Fats should average 20% – 30% of the diet , as should proteins.

Fats

• Must be 20-30% of the diet (no more than 35%) • The ratio of vegetable and animal fats – 70/30 • Saturated – no more than 10% • ω-3 fatty acids – not less than 200 mg per day Sources of fats: • unrefined vegetable oils (olive, corn, sunflower, sesame, linseed) • Nuts, seeds • Butter • Omega-3 sources:, sardines, mackerel, saury, herring, salmon, trout, linseed oil, walnuts.

Regarding overweight. If you are overweight, then in terms of oil it is 40-50 g. What is 40-50 g of oil? For example, if you take vegetable oil, then a tablespoon contains 20 g of oil. This refers to what you personally can eat, not what you dress up in the salad that the whole family eats. No, this is your fat intake. That is, in your 200 g serving of salad, you can put 1-1.5 teaspoons of vegetable oil.In a specific meal, of which, of course, there are many.

In addition, your fats already come not only from vegetable oil, but also from animal products. These are saturated fats that are also needed. The only thing is that let it be milk fats, and not some visible fat, for example, from meat. And even more so, from some kind of sausages, smoked meats, semi-finished products. Of course, you do not need to consume such fats.

Fatty acids	Food sources
Monounsaturated	Oils – olive, sunflower, corn Avocado, sesame, peanut, walnut, walnut Brazil nuts, peanuts
Polyunsaturated	Oils: flaxseed, soybean, sesame, walnut Pumpkin and sunflower seeds Fish and seafood, fish oil
Saturated meat	Saturated meat	sour cream, cheese, milk, ice cream
Trans fats (should not be consumed in the diet!)	Margarine, margarine baked goods, spreads, chips, convenience foods, low fat cheese, fast food.

You can even afford to eat 5 g of butter a day by spreading it on bread. During pregnancy, cholesterol will go where it is needed – for the synthesis of nervous tissue, for the synthesis of hormones. We do not have any strict restrictions. The only thing, if you are overweight, try to limit the fat content of the cheeses you eat, if they are fatty yellow cheeses. Choose less fatty varieties. Take sour cream and cottage cheese not 18.0% or 30.0% fat, but within 5.0% or even 9.0%.If sour cream – 15.0% and even 20.0%. And already you choose leaner types of meat.

Carbohydrates

And we moved on to carbohydrates. It is carbohydrates in food that increase blood glucose levels in the first place. They break down and enter the bloodstream of the gastrointestinal tract and require the presence of insulin in order to be absorbed. Our goal is to reduce the intake of carbohydrates, but not to their elimination. It is harmful.

Now I will tell you how many carbohydrates you need to eat during pregnancy with gestational diabetes mellitus, and how to stretch them smoothly throughout the day so that it does not require a large amount of insulin from the pancreas at once. When the blood glucose level rose sharply, and which sharply beeps to her: “Give a lot of insulin quickly! Take it out and put it to me! ”

What are the harmful fast carbohydrates that you need to try to remove. They are also called easily digestible carbohydrates. You need to try to remove them. They should be limited at the end of pregnancy for all women, because it should be remembered that it is more and more difficult for the pancreas to expel insulin, even if there is no gestational diabetes mellitus.

What is Fast Carbohydrate? These are sugar and those products where it is added.This is the so-called added sugar. It’s one thing to take some kind of whole grain bread, another thing to make some kind of bun with sugar from the same whole grain bread. This will already be a different carbohydrate load, even if it is whole grain flour. Of course, the added sugar is preserves, jams, jams. Honey – somehow usually not perceived as sugar, as a fast carbohydrate. Of course, honey contains many biologically active and useful substances, but, nevertheless, it is practically pure glucose, and it must be excluded.

Excluded foods , fast carbohydrate sources

• Sugar and sugar-containing foods (jam, jam, confiture) • Fruit and carrot juices • Popsicles (fruit sorbet) • Pastila marshmallow, marmalade • Fruits and berries that quickly increase blood glucose – grapes, bananas, cherries, watermelons, melons, figs • Dried fruits: dates, dried apricots, prunes, dried figs • Cooked starch vegetables – potatoes, beets, carrots, pumpkin • Cereals: semolina, millet, white rice, sushi rice, couscous, all instant cereals and cereals, puffed rice • Non-durum wheat pasta • Canned vegetables: sweet corn, peas, beans. • Dairy: Low fat or low fat liquid dairy products with added sugar, glucose or starch. fruit puree.

Fruit juices. Fruit juices are also perceived as a kind of useful product. They are given to pregnant women in the dairy kitchen. Of course, this is not a good practice because it encourages women to drink fruit juices. Why are fruit juices so bad? It’s not even that they are packaged, canned. Let them even be without preservatives.Or you squeezed these fruit juices, canned it yourself. Or maybe you have a juicer and you squeezed it out of an orange, apple, carrot, any kind of fruit …
Why are they not good? They are not good in that we threw out all the fiber, healthy dietary fiber from this fruit. We drink a solution, albeit fruit, but sugars. If you eat an orange, then that fiber, films that are between the slices. They will slow down the absorption of those carbohydrates, those sugars that are there.If you squeezed it out, drank only the juice, even if with pulp, then all this very quickly – already in the oral cavity – begins to break down and is already very quickly absorbed in the stomach, and causes a rapid peak of glucose in the blood.

What else is fast carbs? These are some crushed cereals . For example, semolina. We were all fed semolina in childhood. This milled wheat is a fast carbohydrate. Everything that has been crushed and even boiled – these starch grains that are there – become available for digestive enzymes and quickly raise blood sugar.

This is semolina, this is buckwheat. These are some kind of instant cereals, for example, oatmeal, “Minutka” flakes, when you see “0 minutes” on the package. This is something that you don’t need to buy, and you don’t need to eat during pregnancy. And, frankly, outside of pregnancy too. Because the value of any grain is not only and not so much in its core as in its shell. Because there is dietary fiber, there are B vitamins. And in the core is starch. It is nutritional substance for the fetus, but it is empty calories.Therefore, instant porridge is “not good to eat.”

Low fat dairy products . In our situation, milk 0% -1.0% is what is not very good. Low-fat dairy products are also fast carbs.

Sweet corn, dried fruits are also fast carbohydrates. From fruits – grapes, bananas, watermelons, melons and cherries – these are the only food categories for fast carbohydrates.

As a matter of fact, we have finished with the products that need to be excluded.Agree that there are not so many of them.

Everything else: all fruits, some flour products, but I will emphasize – from whole grain flour or from flour of coarser grinding – you can eat.

Permitted sources of carbohydrates (Consume in moderation!)

• Bread made from whole wheat or wholemeal or with added bran. • Cereals: buckwheat, barley, red and brown, wild rice, bulgur, barley groats • Durum wheat pasta (cook until Al dente) • Raw starch vegetables (carrots, beets, corn, peas) • Stewed non-starchy vegetables (zucchini, eggplant, bell peppers, green beans, all types of cabbage) – limit to 200 grams per meal. • Legumes: beans, chickpeas, lentils • Fresh fruits and berries (except excluded) • Seeds and nuts: all + chia, flax • Liquid dairy products of normal fat content.

What is generally related to carbohydrates ? If we talked about dairy products, then it is liquid dairy products (milk, kefir, yogurt, fermented baked milk) that contain carbohydrates. Why do they contain carbohydrates? Because milk contains lactose . There is milk sugar. Therefore, a glass of milk is roughly equivalent to a slice of bread.On average, it contains 10 g of carbohydrates.

Flour products. Everything from flour contains carbohydrates. This is bread, this is some kind of baked goods (crackers, cookies, buns), rich or non-rich baked goods – they contain carbohydrates. These are all cereals. These are fruits. These are ripe legumes – peas, beans. Some carbohydrates are found in seeds and nuts. In smaller quantities, but they are there too. If you eat a handful of nuts weighing 50 g, you get some carbohydrates.

How many carbohydrates are there for gestational diabetes?

Carbohydrates should never be ruled out.They should make up almost half of your diet – 45% – 50.0%. Let me remind you that proteins and fats account for 20.0% -30.0%.

At least 175 g of carbohydrates should be in the diet.Otherwise, the body begins to use proteins and adipose tissue as a source of energy. Proteins for us are a very expensive building material, they must go to plastic processes, to synthesize proteins necessary for the body. The same hemoglobin for the construction of the child’s body. Fats, when used as an energy source, form so-called ketone bodies, the entry of which into the child’s bloodstream is undesirable, because it is believed that they are somewhat toxic to him. But, of course, for this, their concentration must be high.But nonetheless. Therefore, just because we have gestational diabetes does not mean we are cutting out carbohydrates. Carbohydrates should remain at least 170 g per day.

What does 170 mean? A piece of bread weighing 20-25 g, about 1 cm thick from a “sliced ​​loaf”, or about half a slice from a loaf of our “Darnitskiy” – they contain 10 g of carbohydrates.
A glass of milk equals 10 g of carbohydrates.
On average, a fruit contains 10 to 20 g of carbohydrates, if it is an apple, orange or pear.
So these carbohydrates are coming in. Two tablespoons of some kind of boiled crumbly porridge – buckwheat, pearl barley, rice – is 10 g of carbohydrates. Thus, carbohydrates will be recruited in your diet.

It is also important to say that not all, even slow carbohydrates, which we did not classify as fast carbohydrates, are equally good. Among the slowly digesting carbohydrates, there are those that are absorbed faster and some more slowly. We need to choose the slowest carbs.

If you take cereals, glucose is absorbed the slowest of all, that is, the starch is broken down more slowly and converted into glucose, for example, from buckwheat.But this does not mean that you can eat it in unlimited quantities. But, nevertheless, it is the slowest. This is oatmeal and this is barley. And it’s wild or brown rice. We are accustomed to using white polished rice in our diet more often. It raises blood sugar much faster. Millet is also faster. Let’s just say that these are already such cereals that are not very desirable.

Bread. Generally, ideally if you bake it in a bread maker when using good whole grain flour. Even if you mixed it with fine flour.But you know what you made it from. Nevertheless, even in stores now there is whole grain bread with the addition of some seeds, cereals, seeds, bran, and you can choose. Of course, our traditional “sliced” loaf, or if you take any loaf of any kind and see that it is fine or premium flour, this is not quite what you need. This is permissible, but it is better to choose whole grain or from a lower grade flour, for example, as they say: “first grade”. This is much better.

There are breads like Finn Crisp with the addition of bran.They can also be used as a cereal source instead of bread by placing a slice of cheese or fish on top of the sandwich.

Fruit. Optimally, fruit is eaten as a snack. Here you can vary the fruits and berries you like. Some larger fruits, if it is an apple, orange, pear, peach for one snack – 1 fruit. If these are some small fruits, for example, tangerines, plums, you can eat 2-3 pieces at a time. If it is a very large fruit, such as a grapefruit, then it is better to divide it in half. The time will come for cherries, watermelons – try to abstain if you have gestational diabetes mellitus. Cherries will go, cherries will not.

Ripe legumes are not often consumed by us. They can cause bloating. But if you tolerate them well, you can eat them too. But remember that these are carbohydrates.

It is important to say that some vegetables contain a fairly high amount of carbohydrates and starch. Of course, these are potatoes. These are root vegetables such as beets and carrots, but boiled. Fresh carrots can be eaten without thinking about anything.But, if you cooked it and cooked it, for example, a vinaigrette of beets, carrots and potatoes, you can assume that this is a completely carbohydrate dish. It is advisable to eat such salads in an amount of 100 – 150 grams, so as not to get a large portion of carbohydrates.

If you cook borscht, you stew carrots, stew beets, add potatoes. There, too, you get a fairly large portion of carbohydrates. Therefore, do not eat bread with borscht. You can add low-fat sour cream.

And the second. For the second in such a dinner, a side dish of pasta or rice is undesirable.As for the pasta. They are not prohibited. But it is still better to choose pasta from durum wheat. Pasta. Unfortunately, I will not show patriotism here now if I say that it is better to buy products from Italian manufacturers. Because, after all, we can only conventionally call our wheat varieties hard varieties. They are more boiled down. This can be seen even without any laboratory research. When you cook these spaghetti, pasta, pasta – you can name it by different names – do not overcook them. As the Italians write on the label, but they write very clearly: cook for 10 minutes, do not overcook.So that they are “by the teeth” (“al dente”). This reduces the rate of breakdown and absorption of starch already in the stomach.

What can you eat without restrictions? You can eat vegetables without restriction: cucumbers, tomatoes, all types of cabbage, lettuce, greens, zucchini, eggplants. It may not be very affordable now. But vegetables of our strip are coming soon, take advantage of this. You can eat sweet peppers practically without restrictions. There is a certain amount of carbohydrates, but you are unlikely to eat it in 2-3 pieces.What you put in a salad can be neglected.

Oils

A little more about oils. I urge you to use a variety of unrefined oils for salad dressing because unrefined oils contain important phospholipids that are used to build your baby’s cells and support your plastic processes.

In addition, each oil, even unrefined sunflower oil, olive, sesame, corn, grape seed, camelina, flaxseed oil, has its own unique composition of fatty acids, many of which are irreplaceable and not synthesized in our body.

Which oil is especially important? This is linseed oil . It contains alpha-linolenic acid, a class of omega-3 fatty acids that cannot be synthesized in our body. Therefore, buy flaxseed oil, but only in dark glass. It is very unstable in the light and will taste very bitter. If you buy it in clear glass, it will be unusable.

In camelina oil in a lesser amount, but also contains omega-3 fatty acids. But the greater emphasis here is on flaxseed oil.

Eat fatty fish . These are also omega-3 fatty acids. It doesn’t have to be expensive. Mackerel, herring. Just try not to make it salty. Mackerel is frozen, herring to a lesser extent.

Far Eastern salmon, wild – is a source of omega-3 fatty acids, which are important for the protection of the embryonic brain and have an anti-inflammatory effect. They are deficient and not synthesized in our body . This is when it comes to fats.

Distribution of meals throughout the day

What about the distribution of carbohydrates throughout the day? In the morning , when the counterinsular hormones act more, insulin antagonists – cortisol, growth hormone, it is better to eat less. That is, you can eat cottage cheese, scrambled eggs, casseroles or cheesecakes. And literally one piece of bread. A sandwich or 1-2 tablespoons of some kind of porridge. And until 12 o’clock.

For lunch carbohydrates are also better a little. This will be approximately 5% – 10% from carbohydrates.

Approximately 30% – 35% – for lunch .
For an afternoon snack, another 10% – 15%.
And somewhere around 20% – dinner .

I might be short on it right now, but a carbohydrate dinner can be plentiful. If you are hungry in the evening, there may be some more kefir, some kind of light snack, a second dinner.

Try to keep the break between the last meal of the current day and breakfast the next day no more than 10 hours. Why? Because if you fast longer, fatty tissue begins to actively break down.And again these notorious ketone bodies come in. Ketone bodies are one of the indicators that it is also desirable to control. There are strips on ketone bodies in the urine. They are quite inexpensive, so if you manage to buy them, order them somewhere on the Internet or in a pharmacy, it is better to control ketone bodies in the morning, at least a couple of times a week or a little more often. This will be the criterion that you are loosely restricting carbohydrates. There are 2 options: either you went hungry for a long time between dinner and breakfast, or you drastically limited carbohydrates, and you urgently need to expand.

What else about nutrition. If you are not overweight, if you can eat more, let’s say sugar does not rise with more carbohydrates, you can eat them. The only thing I’m convincingly asking of you is not to eat fast carbohydrates. After an hour, you may not see an increase in blood sugar, but they increase blood glucose levels literally in 15 minutes and immediately go to the child.And already the child has to “deal” with this glucose himself, at the cost of his pancreas, at the cost of his insulin. Because maternal insulin is broken down in the placenta. It doesn’t go away. It is inhibited at the placenta stage. Therefore, exclude fast carbohydrates for the sake of the child. It is very important.

Desserts

And what else did I not say about gestational diabetes. If you want something sweet, what can you do? You can dark chocolate with a high content of cocoa butter. There will be more chocolate, more fat, but less carbs.This will be healthy, “good” fat. Try to choose good manufacturers (let’s not go over to brands). 75% cocoa and more. If 50%, then there is already more sugar. You can eat about 30 grams per day. As an exception, you can afford creamy ice cream. But quite a bit, about 50 grams. This is when you really want something sweet. Caramel, candy, marmalade, of course, jam, honey, added sugar – this is what will dramatically increase your blood sugar.
So-called diabetic products.If it’s waffles or biscuits, don’t forget that there is flour in there that won’t go anywhere. Fructose is not very well absorbed. Her metabolism is not going very well, in conditions of insulin deficiency. So not very good. But, if the product is prepared on the basis of stevia sweetener (there is such a herb – stevia), then you can use it. Can be purchased as a sweetener. Perhaps this is the only sugar substitute that can be used during pregnancy. Cyclamate, saccharin, aspartame are not allowed.

What else is monitored? Monitor another a blood pressure , because the likelihood of an increase is slightly higher if a woman has gestational diabetes mellitus.

Proper nutrition for pregnant women without GDM

Now, as I promised, we will talk about women’s nutrition.

Even if you don’t have gestational diabetes, some of the things I mentioned (about oils, for example) apply to all women. You alternate between different types of oils.

As for the nutrition of healthy pregnant women, here the calorie content may depend, firstly, initially on the weight.

It can reach 2200 – 2500 kcal, if there is no excess weight.
If there is a deficiency in weight, then up to 2700 kcal. This is much more than we can afford before pregnancy.

With regard to quantitative nutrition.
Proteins
First half of pregnancy: this is approximately 60 – 90 g of protein. The second half of pregnancy is already 80-100 g and even 110 g of proteins.

Fats
If there is no excess body weight, this is from 50 to 70 g of fat. That is, you can distribute them in different ways – into vegetable fats, into saturated animals. The only thing that animals are saturated – what you get from dairy products, from cheese, from meat products – should not exceed 30%. There are 50-70 g of fat in total.

Carbohydrates
Quite a lot of carbohydrates are allowed – from 325 to 450 g. If translated into some practical equivalent, if we assume that this is only bread (I hope that this is not only bread), then this is about day 18 pieces of bread.This will be 325 grams of carbohydrates. But, of course, this also includes fruits (these 325 – 450 g of carbohydrates), cereals, and potatoes.

Remark about cereals, whole grain bread is a valuable source of B vitamins, which is responsible for the adequate functioning of the nervous system of both the child and the mother.
And, of course, there must be fiber. These are vegetables.

If at all to count on some such equivalent, if there is no self-isolation regime and nutrition, then a woman can eat every day:
● 120 – 150 g, and even 200 g of meat or fish.Please don’t forget about fish either.
● Somewhere up to 150 g of cottage cheese, up to 2 glasses (about 400-500 ml) of liquid dairy products: fermented milk, fresh milk, if you tolerate it.
● We do not exclude eggs, although they still talk about the dangers of eggs – of course, this is a valuable protein, this is a valuable lecithin, which is contained in the yolk.
● Bread up to 200 g, this is in the region of 7 – 8 pieces.
● Cereals: 50 – 60 g. In dry terms, this is quite a lot.
● Vegetables. This refers to leafy vegetables, those that can be eaten without restriction, up to 500 g.
● Fruits and berries too 200 – 500 g.

Please don’t forget about vegetables, about fiber. This will provide you with good digestion and good stool. And, of course, it will prevent a sharp rise in both blood glucose, and if you are a little too high in fats, in cholesterol.

What if the self-isolation mode? Of course, still try to get a little fresh air. The only thing that I do not urge you to go to the shops. Because these are places where people gather. Try to expand your activity at home.Perhaps some kind of exercise, exercise complexes. This will be helpful too. Ventilate the room often.

How can we limit our diet?
We never touch proteins! We leave the proteins. We cut back on the diet due to the excess amount of carbohydrates. If you do not have gestational diabetes, and you allow yourself to drink tea with jam, sugar, or something sweet, take it away. And, of course, excess fat. We don’t forget, first of all, saturated fat.If you like fatty meat, fried meat, pork with visible fat, lamb or beef with visible fat – this, of course, must be removed. No semi-finished products, sausages, sausages, because there is a lot of hidden fat. And just remember that GOSTs of the 30s and modern GOSTs are different recipes for cooking.

And don’t forget the vegetables. What you can eat is unlimited.

In our center for immunology and reproduction, we handle both physiological pregnancies and high-risk pregnancies .

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Gestational diabetes mellitus: diagnosis and treatment

Ushakova O.V.

Gestational diabetes mellitus: diagnosis, treatment.

Department of General Medical Practice and Preventive Medicine of the State Educational Institution of Additional Professional Education “Institute for Advanced Training of Healthcare Professionals” of the Ministry of Health of the Khabarovsk Territory.Abstract The HAPO study (Hyperglycemia and Adverse Pregnancy Outcomes), conducted in 2000-2006, showed that the diagnostic criteria used require revision, since among the observed women, adverse pregnancy outcomes increased in direct proportion, starting from a significantly lower level of glycemia than accepted until now as a criterion for gestational diabetes mellitus. In 2008, in Pasadena (USA), the International Association of Diabetes and Pregnancy Study Groups proposed new diagnostic criteria for discussion based on the results of NARO, which includes more than 23 thousand pregnant women.On October 26, 2009, at the 20th World Diabetes Congress, The International Diabetes Federation (IDF) announced new guidelines for the diagnosis and management of diabetes in pregnancy. Experts of the Russian Association of Endocrinologists and experts of the Russian Association of Obstetricians-Gynecols, as a result of repeated discussions of this issue, came to the conclusion that it is necessary to adopt new criteria for the diagnosis of gestational diabetes mellitus and other disorders of carbohydrate metabolism during pregnancy.Key words: gestational diabetes mellitus, diagnostic criteria for gestational diabetes mellitus. Ushakova O.V. Gestational diabetes: diagnosis and treatment. Department of General practice and preventive medicine at the state educational institution of additional professional education “Institute of qualification improvement of specialists of the health Ministry of health of the Khabarovsk Kray. Summary Study NARO (Hyperglycemia and Adverse Pregnancy Outcomes-Hyperglycemia and Adverse Pregnancy Outcomes) conducted in 2000-2006, showed that the criteria used for diagnostics, require revision because, among women observed adverse outcomes of pregnancy is directly proportional to grow up, starting with a significantly lower level of glycemia, than exists up to the present time as a criterion of gestational diabetes.In 2008, Pasadena (USA) International Association of groups for the study of diabetes and pregnancy were proposed for the discussion of new criteria diagnosis based on the results of NARO, which includes more than 23 thousand pregnant women. on 26 October 2009 at the twentieth world Congress on diabetes, the international diabetes Federation (The International Diabetes Federation (IDF) today announced the adoption of new recommendations on diagnosis and treatment of diabetes in pregnant women. Experts of the Russian Association of endocrinologists and experts of the Russian Association of obstetricians-gynecols through multiple discussions of this matter came to the conclusion about the necessity of the adoption of new criteria for the diagnosis of gestational diabetes and other disorders of carbohydrate metabolism during pregnancy.Keywords: gestational diabetes, diagnostic criteria for gestational diabetes. The main hormonal and metabolic changes in women during pregnancy are associated with the formation of the placenta, which secretes chorionic gonadotropin, placental lactogenic hormone, progesterone and estrogens into the mother’s bloodstream. These hormones cause insulin resistance or decreased sensitivity of cells to insulin, contributing to the development of gestational diabetes mellitus [1]. The prevalence of gestational diabetes is growing steadily.Its frequency in the general population in different countries varies from 1% to 14%. These variations are due to differences in the methods of its diagnosis and are directly related to the prevalence of type 2 diabetes mellitus in certain ethnic groups [1]. In most clinical situations, gestational diabetes develops between 16 and 32 weeks of gestation. The disease is often asymptomatic and is detected only during laboratory research. An increase in glucose levels in the first trimester of pregnancy most often indicates the manifestation of true diabetes mellitus, which began before pregnancy.An increase in blood glucose levels during pregnancy is a great risk for both mother and baby. For a woman with gestational diabetes, the development of premature birth, and gestosis, and hydramnios, and genital tract infections, and the development of ketoacidosis are possible. The peculiarities of carbohydrate metabolism between mother and child are such that the fetus receives glucose from the mother, as a result of which the fetus develops hyperinsulinemia. Hyperinsulinemia threatens the development of asphyxia and injuries during childbirth, respiratory disorders (respiratory distress syndrome) and hypoglycemic conditions in newborns.It is possible to prevent the listed risks for mother and child with timely diagnosis of gestational diabetes. In accordance with the WHO classification of diabetes mellitus (1999 with amendments), gestational diabetes mellitus is defined as any disorder of carbohydrate metabolism that occurs during pregnancy. Diagnostic criteria for gestational diabetes mellitus are defined (WHO 1999-2002): fasting glycemic level in capillary whole blood ≥ 6.1 mmol / l, in venous plasma – ≥ 7.1 mmol / l; or 2 hours after a glucose tolerance test with 75 g glucose in capillary whole blood and venous plasma ≥ 7.8 mmol / L or random determination of glucose in capillary whole blood or venous plasma ≥ 11.1.The HAPO study (Hyperglycemia and Adverse Pregnancy Outcomes), conducted in 2000-2006, showed that the diagnostic criteria used require revision, since among the observed women, adverse pregnancy outcomes in direct proportion increased, starting with a significant a lower level of glycemia than accepted until now as a criterion for gestational diabetes mellitus. In 2008, in Pasadena (USA), the International Association of Diabetes and Pregnancy Study Groups proposed new diagnostic criteria for discussion based on the results of NARO, which includes more than 23 thousand pregnant women.On October 26, 2009, at the twentieth world congress on diabetes mellitus, the International Diabetes Federation (IDF) announced the adoption of new recommendations for the diagnosis and treatment of diabetes in pregnant women: – fasting fingerstick blood glucose greater than 5.1 mmol / l or – glucose of blood taken from a vein on an empty stomach (plasma) is more than 6.1 mmol / l; or – glucose of blood taken from a finger or from a vein 2 hours after loading 75 g of glucose is more than 7.8 mmol / l. During pregnancy 24-28 weeks, the threshold level of fasting plasma glucose for the diagnosis of gestational diabetes mellitus is 4.8 mmol / L.During 2010-2011. a number of developed countries (USA, Japan, Germany, Israel, etc.) independently adopted these new criteria. Experts of the Russian Association of Endocrinologists and experts of the Russian Association of Obstetricians-Gynecols, as a result of repeated discussions of this issue, came to the conclusion that it is necessary to adopt new criteria for the diagnosis of gestational diabetes mellitus and other disorders of carbohydrate metabolism during pregnancy. Based on the agreed opinion, a draft Russian Consensus on the Diagnosis and Treatment of Gestational Diabetes Mellitus was created and submitted for discussion.During 2012, repeated meetings of working groups of obstetricians and endocrinologists were held, at which diagnostic criteria for gestational diabetes mellitus, the procedure for conducting a glucose tolerance test were discussed. The result of this work was the regulatory document “Russian national consensus” Gestational diabetes mellitus: diagnosis, treatment, postpartum follow-up “. According to this document, gestational diabetes mellitus is a disease characterized by hyperglycemia, first detected during pregnancy, but not meeting the criteria for “overt” diabetes mellitus.Thus, another key phrase “not meeting the criteria of“ overt ”diabetes mellitus” appeared in the definition, and it became necessary to distinguish between diagnostic criteria for gestational diabetes mellitus and “overt” diabetes mellitus during pregnancy (Table 1.2) [

Threshold values ​​of venous plasma glucose for the diagnosis of gestational diabetes mellitus (at the first visit to a healthcare facility) Table 1

Gestational diabetes mellitus, oral glucose tolerance test with 75 g glucose

For the diagnosis of gestational diabetes mellitus, one anamolic value of measuring the level of venous plasma glucose is sufficient.According to the results of the glucose tolerance test with 75 g of glucose, at least one value of the venous plasma glucose level out of three is sufficient, which would be equal to or higher than the threshold value. If abnormal values ​​are obtained when contacting a healthcare facility, a test with a load of 75 g glucose is not performed. Interpretation of analyzes should be able to be carried out not only by endocrinologists, but also by doctors of any specialization, including obstetricians and gynecologists.

Threshold values ​​of venous plasma glucose for the diagnosis of overt (newly diagnosed) diabetes mellitus during pregnancy (table 2)

In case of detection of overt diabetes mellitus, he must be qualified in any diagnostic category according to the current classification of diabetes mellitus: type 1 diabetes mellitus or type 2 diabetes mellitus [2].Determination of the level of glycated hemoglobin should be used in accordance with the National Glicohemoglobin Standartization Programm. Diagnosis of carbohydrate metabolism disorders is carried out in 2 stages [3]. The first stage is determined when a pregnant woman first visits a doctor of any specialty for up to 24 weeks. It is imperative to conduct the following studies: determination of glucose in venous plasma on an empty stomach (against the background of preliminary fasting for at least 8 hours and no more than 14 hours.), glycated hemoglobin HbA1c, determination of glucose in venous plasma at any time of the day, regardless of food intake. If the test result corresponds to the category of overt diabetes mellitus, its type is established: type 1 diabetes mellitus or type 2 diabetes mellitus. If the level of glycated hemoglobin HbA1c is <6.5% or an occasional certain level of venous plasma glycemia is <11.1 mmol / L, then the level of glycemia in venous plasma is determined on an empty stomach. If the level of fasting venous plasma glycemia is ≥5.1 mmol / L, but <7.0 mmol / L, then gestational diabetes mellitus is established.The second stage is carried out for a period of 24-28 weeks for all women who did not have a violation of carbohydrate metabolism at the first stage. It is optimal to conduct a glucose tolerance test with 75 grams of dry glucose for a period of 24-26 weeks. The following rules for the glucose tolerance test have been established [2]: 1. 3 days before the examination, a woman is on her usual diet (at least 150 grams of carbohydrates per day) and adheres to her usual physical activity. 2. The test must be carried out in the morning on an empty stomach (after an overnight fast for at least 8 and no more than 14 hours).Medicines (multivitamins, iron supplements and others prescribed during pregnancy are taken after the test). The test is not carried out with toxicosis, against the background of an acute inflammatory or infectious disease. No portable blood glucose meters are used for the test. After fasting venous blood is drawn, an immediate glucose measurement is taken. If an increase in the level of fasting glycemia is detected, then the test is not performed further. If the level of fasting glycemia is within normal values, then a pregnant woman within 5 minutes should drink a solution consisting of 75 grams of glucose and 250-300 ml of water, the temperature of which is 37 C? ...A repeat blood sugar sample is taken 1 and 2 hours after glucose loading. Rice. Algorithm for diagnosing carbohydrate metabolism disorders during pregnancy. Treatment of gestational diabetes mellitus includes several components: balanced nutrition, exercise, self-control, insulin therapy. With gestational diabetes, at the first stage, a diet, moderate exercise is prescribed. It is also mandatory to monitor blood glucose levels, the target values ​​of which are presented in Table 3.Rational nutrition: the basics of diet therapy for pregnant women with gestational diabetes are: calorie content of 25-30 kcal per 1 kg of ideal body weight; carbohydrates make up 45-50%, proteins - 20-25%. The diet consists of 3 main meals and 3 snacks. It should not be forgotten that a sharp decrease in caloric intake (more than 50%) can lead to ketonemia in women with gestational diabetes. Physical activity: women with gestational diabetes need dosed physical activity - 8-10 thousand.steps a day. In addition, the program includes physical exercises for pregnant women for 20 minutes daily. If this regimen is ineffective, insulin therapy is prescribed. Self-control is a routine procedure for pregnant women with impaired carbohydrate metabolism and includes determining: - glycemia using portable glucometers on an empty stomach, before and 1 hour after the main meals; - ketonuria using special test strips; - blood pressure; - fetal movement; - body weight.Self-monitoring includes keeping a diary of self-monitoring of blood glucose and food intake.

Table 3 Self-control targets

Indications for the appointment of insulin therapy are: – inability to achieve target glycemic levels within 1-2 weeks of self-control; – the presence of signs of diabetic fetopathy according to ultrasound, which is indirect evidence of chronic hyperglycemia; – overt diabetes mellitus.Depending on the severity of carbohydrate metabolism disorders in the treatment of gestational diabetes mellitus, manifest diabetes mellitus, genetically engineered insulins or insulin analogues of a short (before meals) are used in case of an increase in the level of glycemia after a meal; insulins of medium duration of action or insulin analogs of prolonged action (administered 1 or 2 times a day) with an increase in the level of fasting glycemia and before meals; if necessary, intensive insulin therapy is prescribed with short-acting + long-acting insulin preparations or a combination of insulin or insulin analogs of short and medium duration of action [4].Of the insulin analogues for use in pregnant women, the following are allowed: Aspart (Novorapid), Lizpro (Humalog), Detemir (Levemir), Aspart-30 (Novomix – 30). It is forbidden to use oral hypoglycemic drugs and biosimilar insulins during pregnancy and breastfeeding. Gestational diabetes mellitus, overt diabetes mellitus, by themselves, is not an indication for early delivery or elective caesarean section. It must be remembered that if a woman has had gestational diabetes, the risk of developing true diabetes mellitus increases 3-6 times.Therefore, it is important to follow the woman after giving birth. 6 weeks after childbirth, it is imperative to conduct a study of the state of carbohydrate metabolism of a woman. If no changes are found, control is assigned once every 2-3 years, and in case of violation of glucose tolerance, recommendations for nutrition and observation are given once a year. In this case, all subsequent pregnancies should be strictly planned.

Literature: 1. Arzhanova, ON. features of the course of pregnancy and childbirth in diabetes mellitus in modern conditions / Arzhanova O.N., Kosheleva N.G. Journal of Obstetrics and Women’s Diseases – 2006 – T.LV№1 – P. 12-16. 2. Dedov, II. Algorithms of specialized medical care for patients with diabetes mellitus / Dedov I.I., Shestakova M.V. – M. 2013. 3. Dedov I.I. Russian national consensus “Gestational diabetes mellitus: diagnosis, treatment, postpartum follow-up” / Dedov II, Krasnopolsky VI, Sukhikh GT. on behalf of the working group Journal of Diabetes Mellitus – 2012 – 4– P. 4-10. 4. Klimont, A.L. Insulin analogs. Klimont A.L., Best F., Lauritzen T. Recommendations for the treatment of diabetes mellitus in adults – M. 200

Diagnosis of gestational diabetes – Articles – Maternity hospital Vidnoe

During pregnancy, a woman’s glucose level is normally lower than outside of pregnancy, an average of 3.8-4.2 mmol, which is due to the consumption of glucose by the fetus and an increase in the production of insulin by her own pancreas.

Since gestational diabetes mellitus is a disease that can negatively affect the health of both the mother and the child, active screening for gestational diabetes should be performed in all pregnant women.

Screening of gestational diabetes is carried out for all pregnant women in two phases according to the international criteria for diagnosing carbohydrate metabolism disorders during pregnancy, approved in the USA, Germany, Israel and other countries in 2010-2011, in our country in 2012 These criteria are based on the international study HAPO which included more than 25,000 pregnant women.

In the 1st phase, it is carried out at the first visit to a doctor of any specialty for a period of up to 24 weeks; it is examined in the laboratory, glucose of venous plasma on an empty stomach:

– less than 5.1mmol is the norm;

– equally and more than 5.1 mmol, but less than 7.0 mmol – gestational diabetes mellitus;

– equal to or more than 7.0 mmol – type 1 or type 2 diabetes mellitus.

Diabetes mellitus type 2 or 1 are chronic diseases that do not go away after childbirth, gestational diabetes mellitus occurs only during pregnancy.

If no carbohydrate metabolism disorders were detected at the 1st stage, then at the period of 28-28 weeks of pregnancy all women undergo the 2nd stage of screening – oral glucose tolerance test.

The indication for the test is pregnancy.

Contraindications to the test: individual glucose intolerance, manifest diabetes mellitus, diseases of the gastrointestinal tract, accompanied by impaired glucose absorption. The test should be postponed for a while in case of toxicosis of pregnant women (vomiting, nausea), acute inflammatory or infectious disease, the need to comply with strict bed rest (until the expansion of motor loads)

Correct conduct and preparation for the test is very important.The test is performed on the background of a normal diet (at least 150 g of carbohydrates per day), at least 3 days before the study. The last meal should contain 30-50g of carbohydrates. A woman comes to the test on an empty stomach, it is 8-14 hours of night hunger, you can drink water. Her blood is drawn from a vein, then she drinks 200-300 ml of non-mineral, non-carbonated water with glucose dissolved in it (75 g), 1 and 2 hours after her blood is taken from the vein again. Smoking, eating, and physical activity are prohibited during the test.Blood tests are carried out only in the laboratory, the use of glucometers is prohibited.

Norms: on an empty stomach up to 5.1 mmol, after 1 hour up to 10.