Everyday life with gestational diabetes - Diabetes UK

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Everyday life with gestational diabetes - Diabetes UK
Everyday life with
gestational diabetes
Everyday life with gestational diabetes - Diabetes UK
Contents
                                                                                                                                                     Everyday life with

                                                                                                                                                                                                                                                                                      Introduction
                                                                                                                                                     gestational diabetes
    Introduction                                                   2   Hypos & hypers                                                           33
    What is gestational diabetes?                                  4   Hypos                                                                    34
                                                                       Hypers                                                                   36
    Testing                                                     7
    Testing your blood sugar                                    8      Your care                                                                39
    My blood sugar targets                                     10      What care to expect                                                      40
                                                                       Your checklist                                                           43   We know there’s a lot to think about when                We also hear from people like you on how they’ve
    Treatment & management                                     13                                                                                    you’re having a baby. And, now that you’ve               managed with gestational diabetes. We give
    Healthy eating                                             14      Glossary                                                                 44   been diagnosed with gestational diabetes,                you lots of tips to make your life easier – and there’s
    Recipes                                                    20                                                                                    you’re probably feeling worried and have                 a handy glossary and index at the back to help
                                                                       Who we are                                                               45
    Understanding food labels                                  24                                                                                    a lot of questions.                                      you get the most out of this guide.
    Physical activity                                          26      Index                                                                    46
                                                                                                                                                     But the good news is that, by managing gestational       If you find it all a bit overwhelming, there’s a lot
    Medication                                                 28
                                                                                                                                                     diabetes properly, there’s no reason why you won’t go    of support available to you, so don’t be afraid
    Using insulin                                              30
                                                                                                                                                     on to have a healthy pregnancy and birth. You’ll have    to ask for help from your healthcare team. And,
                                                                                                                                                     a diabetes healthcare team to help – and we’ll help      you can always send us an email or pick up the
                                                                                                                                                     you on your way, too.                                    phone if you want to talk (see the back cover
                                                                                                                                                                                                              for ways to get in touch).
                                                                                                                                                     In this guide, we give you the facts about gestational
                                                                                                                                                     diabetes and how you can treat it. We tell you what      Armed with all the facts, and understanding what
                                                                                                                                                     you need to do to look after yourself to stay healthy,   you and your healthcare team need to do, means
                                                                                                                                                     and list the care you should get from your diabetes      you can go on to enjoy a healthy pregnancy.
                                                                                                                                                     healthcare team.
                                                                                                   Our diabetes information is available in print
    This guide is FREE                                                                             or you can download it as a PDF. Go to
                                                                                                   shop.diabetes.org.uk for more details.

    As a charity, we rely on the generous                                                          You can also view our diabetes guides on your
                                                                                                   smartphone or tablet – simply download the
    donations of people like you to help us                                 Everyday life with
                                                                            gestational diabetes
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    produce this vital information on living                                                       App store or Google Play.
    with diabetes.                                                     Advertisements
    To find out more about how you can help us, go to                  Products and services advertised in this guide aren’t necessarily
    www.diabetes.org.uk/gestational-get-involved                       recommended by Diabetes UK. Although the utmost care is taken
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    Or, to make a donation to support our work, go to
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    www.diabetes.org.uk/gestational-donate or send                     equipment. Please use your own discretion about whether or not an
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                                                                       take professional advice from your medical advisor. Please note also
    Please text DUK to 70123 to donate £5 to Diabetes UK
                                                                       that prices are applicable only to British buyers and may vary for
    and help us do even more for people with diabetes.                 overseas purchases. Paid adverts don’t necessarily represent the
    Diabetes UK will receive a minimum of £4.96. To give               views of Diabetes UK. Complaints regarding advertised services
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    This is a charity donation service. Texts cost £5+
                                                                       Our information is correct at the time of publication. It’s not a
    1 standard rate msg. By texting DUK to 70123 you are
                                                                       substitute for seeing a healthcare professional, and isn’t intended
    agreeing to us contacting you by phone and SMS to tell
                                                                       to replace the advice given by your diabetes healthcare team.
    you more about our work and how you can support it.
                                                                       Published October 2017 – product code 9984EINT.
    With thanks to all the contributors, advisors and volunteers
    who helped with the production of this guide.

2     www.diabetes.org.uk                                                                                                                                                                                                               Everyday life with gestational diabetes   3
Everyday life with gestational diabetes - Diabetes UK
What is gestational diabetes?                                                                                                                                                    where a dietitian explained that it was possible to

                                                                                                                                                                                                                                                        Introduction
                                                                                                                                                                                 control the GDM through diet. I’d already realised
                                                                                                                                                                                 that my cake-eating days were over, but she said
                                                                                                                                                                                 I’d need to limit certain carbohydrates, too. Bread,
                                                                                                                                                                                 pasta, potatoes – even porridge – could now push
Gestational diabetes develops when your                     Causes                                                                                                               my blood sugars up if I ate bigger portions. Luckily,
insulin-producing cells can’t produce enough                                                                                                                                     I’m not a very ‘carby’ person, and a diet geared
insulin. Or, when the insulin you do produce                A lot of change happens to your body during                                                                          more towards protein and vegetables wasn’t a
doesn’t work properly (called insulin resistance).          pregnancy. Along with the physical signs, the                                                                        great hardship, although it meant no more ‘treats’.
This leads to high blood sugar levels (also called          hormones you produce can make it hard for your                                                                       If I couldn’t control my blood sugars through diet I’d
blood glucose levels). If it’s left untreated, high         body to use insulin properly. This puts you at an                                                                    be put on medication – metformin, or insulin, which
blood sugar levels can cause serious health                 increased risk of insulin resistance, and some                                                                       would mean daily injections. I was determined
complications to you and your baby.                         women can’t produce enough insulin to overcome                                                                       to make the diet work.
                                                            it. This makes it difficult to use glucose (sugar)
                                                            properly for energy, so it stays in your blood and the      Meet Vicky                                               Testing
Main types of diabetes                                      levels rise. This then leads to gestational diabetes.                                                                The diabetes nurse gave me a blood glucose testing
                                                                                                                        Vicky, a journalist from London, describes
The most common types of diabetes are Type 1                                                                                                                                     kit, to test my sugars four times a day – before
                                                                                                                        how she managed her gestational diabetes
                                                                                                                                                                                 breakfast, then an hour after each meal. For a week
and Type 2. In Type 1 diabetes, the pancreas stops          Who’s at risk                                               and offers her tips that may help you
                                                                                                                                                                                 I pricked my finger diligently and wrote down the
making a hormone called insulin, which controls the
glucose (sugar) levels in the blood. In Type 2 diabetes,    You’re more likely to get gestational diabetes if you:      “It was Christmas Eve when the midwife phoned.           levels, trying to keep under the maximum levels I’d
the pancreas can’t make enough insulin, or the                                                                          “Your 28-week blood test showed high sugar levels.       been given. At first it was trial and error. A bowl of
                                                            • are overweight or obese
insulin it makes doesn’t work properly. This is known                                                                   I’ve booked you in for an oral glucose tolerance test    spinach soup and slice of bread was too much, as
                                                            • have had it before                                        (OGTT), but try to stick to brown bread and rice         I’d forgotten I’d made the soup with potato, but I
as insulin resistance. If diabetes isn’t treated (with
medications, including insulin, and/or changes to           • have had a very large baby in another pregnancy           in the meantime.” That made for a fun Christmas!         became more used to it. There was always a pause
diet and lifestyle), blood sugar levels tend to stay          (that’s classed as 4.5kg/10lb or more)                    But I never seriously thought I could have gestational   before each reading, then a beep, and I’d feel elated
high. This can cause serious health problems.                                                                           diabetes (GDM) – I wasn’t overweight, had always         or guilty, depending on the result. ‘Not bad,’ was the
                                                            • have a family history of diabetes (parent or sibling)     eaten healthily, and was known to be a bit               verdict, and I was given another week’s reprieve
                                                            • have a South Asian, Black or African Caribbean,           of a gym bunny.                                          from medication, and then another.
Gestational diabetes                                          or Middle Eastern background.
                                                                                                                        At 38, I was an older mum, but I hadn’t had GDM          Moral support
The type of diabetes that affects pregnant women is
                                                            Women can reduce their risk by managing weight,             in my first pregnancy, with my son Jack, 3, and just     I limped through the last 10 weeks of pregnancy; a
gestational diabetes. At least five in every 100 women
                                                            eating healthily and keeping active before pregnancy.       put the result down to the piece of cake I’d eaten       renegade sandwich one week, too many potatoes
will develop it. It’s usually diagnosed from a blood test
                                                                                                                        the day of my blood test. The day after my OGTT,         another, but on the whole with my sugars well under
24–28 weeks into pregnancy.                                 Having gestational diabetes can increase your risk
                                                                                                                        the midwife phoned again. “I’m afraid it is              control. Exercise helped greatly. I’d walk half an hour
                                                            of developing it in other pregnancies. You’re also at a
Women with gestational diabetes don’t have diabetes                                                                     gestational diabetes,” she said. I burst into tears.     to work after breakfast, thereby ‘earning’ an extra
                                                            greater risk of developing Type 2 diabetes later in life.
before their pregnancy – and it usually goes away                                                                       It felt so unfair – and so overwhelming. I had           spoonful of porridge. It was stressful, but I was
after giving birth. But, in some women, diabetes may                                                                    very little idea what diabetes was, only that my         closely monitored.
be diagnosed in the first trimester. If this is the case,   Symptoms                                                    pregnancy was now classed as higher risk.
                                                                                                                                                                                 A friend also put me in touch with another mum
they probably had diabetes before they got pregnant         You may have been shocked to find out you have              Blood sugars                                             who’d had GDM and hearing how her baby was
– and it won’t go away after giving birth.                  gestational diabetes. Many women don’t have                 A few days later, I went to the diabetes clinic, where   healthy and thriving was a huge relief. After learning
                                                            any noticeable symptoms. Some of the symptoms               a nurse explained the importance of keeping my           she’d been on insulin, I realised that I didn’t have
                                                            of diabetes are similar to the ones experienced in          blood sugar levels stable. If they were consistently     it so bad after all. I’d really recommend newly
                                                            pregnancy, but these are rare in gestational diabetes.      too high, there was a risk that my baby would grow       diagnosed mums speak to other mums with,
                                                            Symptoms may include:                                       too big – and there was also an increased risk of        or who’ve had, gestational diabetes, if they
                                                                                                                        stillbirth. Pregnancy was already such a huge            can. The moral support really helps.”
                                                            • going to the toilet more often                            responsibility. Now I had this hanging over me. The
                                                                                                                                                                                 • Read more of Vicky’s story on page 42.
                                                            • feeling really tired                                      day after diagnosis I had a series of appointments,
                                                            • feeling really thirsty.
4   www.diabetes.org.uk                                                                                                                                                                                   Everyday life with gestational diabetes   5
Everyday life with gestational diabetes - Diabetes UK
Treatment                                                   Some questions

                                                                                                                                                                                 Testing
                                                            Day to day, it’s about keeping your blood sugar levels
                                                                                                                        Will I get Type 2 diabetes?
                                                            under control. Your healthcare team – that’s your
                                                            midwife, doctors, nurses and a dietitian – will work        Having gestational diabetes increases your
                                                            with you on targets for your blood sugar levels. If you     risk of developing the condition again in other
                                                            meet your targets, you’re more likely to have a healthy     pregnancies. It also increases your risk of developing
                                                            pregnancy and reduce the risk of complications.             Type 2 diabetes in the future. It’s important to eat
                                                                                                                        healthily and take regular physical activity during
                                                            For some women, making changes to diet and
                                                                                                                        pregnancy, and to keep it up afterwards. This will
                                                            physical activity can help them to reach their targets.
                                                                                                                        reduce your risk of developing gestational diabetes
                                                            But, in most cases, medications – including
                                                                                                                        again, as well as your future risk of developing
                                                            injecting insulin – may be needed.
                                                                                                                        Type 2 diabetes.
                                                            You and your baby will be looked after more
                                                            closely during pregnancy and labour (see page 41).          Will my baby have diabetes?
                                                            You should expect to have more:
                                                                                                                        Your baby has no more risk of developing diabetes in
                                                            • appointments with your midwife and                        childhood than any other baby. But, having gestational
                                                              healthcare team                                           diabetes means your baby may have a higher risk of
                                                                                                                        being overweight or obese and/or developing Type 2
                                                            • blood and urine tests
                                                                                                                        diabetes later in life.
                                                            • ultrasound scans.

                                                            Possible complications
                                                                                                                          Need to know
                                                            If your gestational diabetes isn’t looked after properly,                             Need to know

                                                            it can increase your risk of complications. Having            The good news is that you can make a difference
                                                            high blood sugar levels during pregnancy can lead to:         to how you’re affected by gestational diabetes.
                                                            • Induced labour.                                             The main ways you can do this are by:

                                                            • C-section.                                                  • eating a healthy, balanced diet

                                                            • Having a larger than normal baby, which could               • being as active as you can
                                                              make for a more painful birth and possible stress           • setting yourself goals to improve your health
                                                              for the baby.
                                                                                                                          • taking your medication as prescribed
                                                            • Your newborn having low blood sugar levels.
                                                                                                                          • getting support to look after yourself
                                                            • Your baby having a higher risk of being overweight
*Calls may be recorded for training and quality purposes.

                                                              or obese and/or developing Type 2 diabetes in later         • going to your healthcare appointments.
                                                              life. As your child grows, managing their weight,           We talk more about all of these things here in
                                                              eating healthily and being physically active will           this guide. You can also call us on our Helpline
                                                              reduce this risk.                                           on 0345 123 2399* for information, advice
                                                            There is also a risk of your baby dying at around the         and support. If you’re in Scotland, call
                                                            time of the birth. But, remember, you can reduce all          0141 212 8710 or email helpline.scotland@
                                                                                                                          diabetes.org.uk                                        In this chapter
                                                            of these risks by managing your blood sugar levels
                                                            with prescribed medications, and/or healthy eating
                                                            (page 14) and regular physical activity (page 26).                                                                   Testing your blood sugar    8
                                                                                                                                                                                 My blood sugar targets     10

                                                            6   www.diabetes.org.uk
Everyday life with gestational diabetes - Diabetes UK
Testing your blood sugar                                                                                       Need to know           Need to know

                                                                                                               • Ask what your target is. It’s important to know
                                                                                                                                                                    Some questions
                                                                                                                                                                    My doctor won’t prescribe any more test strips
                                                                                                                                                                    for me. What can I do?
                                                                                                                 your target blood sugar level. This lets you and
                                                                                                                                                                    Everyone with gestational diabetes should be given
                                                                                                                 your healthcare team know how you’re doing
When you have gestational diabetes, it’s                   What to aim for                                                                                          a blood glucose meter, so they can test their blood
                                                                                                                 and if things can be improved.
really important to regularly test your blood                                                                                                                       sugar levels at home. Testing is an important part of
                                                           It’s best to check your blood sugar levels before   • Medication, food and activity levels affect        properly looking after your condition, so you shouldn’t
sugar levels at home. It also helps you and
                                                           breakfast (fasting) and one or two hours after        your blood sugar levels every day. If you          have test strips restricted. Speak to your diabetes and
your healthcare team work out the best way
                                                           every meal.                                           understand how they affect your own levels,        antenatal team. They should be able to help you get
of managing your condition. You should be
given a blood glucose meter to do it. But, if              These are the targets women with gestational          you can change what you eat, what you’re           a prescription for the amount of test strips you need.
you haven’t, ask your healthcare team for one.             diabetes are advised to aim for:                      doing and get advice on your medication.
                                                                                                                                                                    If you’re still having problems, call our Helpline on

                                                                                                                                                                                                                                                                                                        Testing
                                                           • fasting: below 5.3mmol/l, and either              • It’s all about knowing your gestational diabetes   0345 123 2399*, Monday to Friday, 9am–6pm,
What it involves                                                                                                 so that you can plan your life around it (and      or email helpline@diabetes.org.uk
                                                              • one hour after meals: below 7.8mmol/l, or        not the other way around).
Blood sugar testing tells you what the level of sugar                                                                                                               If you’re in Scotland, call 0141 212 8710 or email
in your blood is at that time. It involves pricking the       • two hours after meals: below 6.4mmol/l.                                                             helpline.scotland@diabetes.org.uk
side of your finger with a special device called a         Your healthcare team will talk to you about how
lancet, and putting a drop of blood onto a test strip.     often to test, how to do it properly and how
This is then read by a blood glucose meter. Everyone       to safely meet your targets.
has glucose (sugar) in their blood, but if the figure is
too high or too low you can do something about it
(see page 34). If you don’t, it can cause problems.
                                                             Tips for testing
                                                             1 Wash your hands with soap and water – don’t
                                                               use wet wipes as the glycerine can affect the
                                                               test result.
                                                             2 Make sure your hands are warm – it’s easier
                                                               to get blood and it doesn’t hurt as much.
                                                             3 Prick the side of the top part of your finger
                                                               – not the index finger or thumb. Don’t prick
                                                               the middle, or too close to a nail.
                                                             4 Use a different finger each time and

                                                                                                                                                                                                                                            *Calls may be recorded for training and quality purposes.
                                                               a different part.
                                                             5 Keep a diary of your results – you’ll be able
                                                               to spot trends and help your healthcare
                                                               team decide whether your treatment
                                                               needs to change.

8   www.diabetes.org.uk                                                                                                                                                                       Everyday life with gestational diabetes   9
Everyday life with gestational diabetes - Diabetes UK
My blood sugar targets
Fasting:                   One hour after meals:           Two hours after meals:

 Date                            Medication or insulin   Before meals (fasting)     One hour after meals   Two hours after meals   Comments
                                 and dose

                                                                                                                                                                                             Testing
10   www.diabetes.org.uk                                                                                                                      Everyday life with gestational diabetes   11
Everyday life with gestational diabetes - Diabetes UK
Notes

        Treatment &
        management

        In this chapter

        Healthy eating              14
        Recipes                     20
        Understanding food labels   24
        Physical activity           26
        Medication                  28
        Using insulin               30
Everyday life with gestational diabetes - Diabetes UK
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Healthy eating                                                                                                                                                                        Enjoy
Managing your gestational diabetes well is key
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and regular physical activity play an important
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most will also need medication, including insulin.         or reduced-sugar versions of food and
                                                           drink where you can.
Eating well is an important part of your treatment,
                                                         • Knowing other names for sugar on the
just like testing, being active and taking medication.
                                                           food label. These are sucrose, glucose,
                                                           dextrose, fructose, lactose, maltose,
Ways you can eat well                                      honey, invert sugar, syrup, corn
	Careful with carbs. All carbohydrates                    sweetener and molasses.
  (carbs) affect your blood sugar levels,                • Making your own treats and
  so be aware of how much you eat.                         experimenting with using less sugar.
	Your diabetes healthcare team will help you
  understand how carbs affect your blood
                                                         • Using artificial sweeteners. Some people
                                                           worry about the safety of sweeteners,
                                                                                                                   Enjoying what you eat is one of life’s pleasures
  sugar control. They may advise you to:                   but they can be one way to reduce sugar,
          • eat less carbohydrate                          carbohydrate and calories. They are safe in             But if you have gestational diabetes, it can be tricky at times.
                                                           pregnancy but, if you have any concerns,
          • choose better types of carbs                   talk through the different options with your
          • spread carbs over the day.                     healthcare team.
                                                          at regular meals. That usually means
                                                         E
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  carbohydrate foods, like white bread, refined          gaps in between. This will help you manage
  cereals, and ready meals that have added               your appetite and blood sugar levels.                              You’ll find mealtime inspiration and
  fat, salt and sugar.                                                                                                      handy tips to help you eat well, feel
                                                         Perfect your portion sizes. This will help
                                                         you manage your blood sugar levels and
                                                                                                                            good and enjoy food.
	Go low. Choosing low glycaemic index (GI)
  foods can help to manage your blood sugar              avoid too much weight gain during pregnancy.
  levels. Lower GI foods include muesli, oats,           Avoid ‘diabetic’ foods. The law has
  multigrain bread, granary/seeded bread,                changed and manufacturers are no longer                   Whether you’re newly diagnosed, looking
  wholewheat pasta, basmati rice, yams,                  allowed to label food as ‘diabetic’ or ‘suitable
  plantain, quinoa, beans, lentils, dhal, and            for diabetics’. They don’t have any special
                                                                                                                   for exciting new recipes or just in need of
  most fruits and vegetables. See page 18                health benefits, they’re expensive, could still           practical advice, Enjoy Food is here to help.
  for more on GI.                                        affect your blood sugar and may also have
                                                         a laxative effect.

14   www.diabetes.org.uk
                                                                                                                   A charity registered in England and Wales (215199) and in
                                                                                                                   Scotland (SC039136). © Diabetes UK 2017. 0653B
Everyday life with gestational diabetes - Diabetes UK
Get your five a day. There are lots of easy                      brine, sandwiches and crisps. So, it’s best to          poor snacks and drinks, like sweets, cakes,                  large amount in a short time. If you’re trying
  ways you can have more fruit and veg. Try                        limit processed foods as much as possible,              crisps, fizzy drinks, energy drinks, etc.                    to manage your weight, keep a check
  using plenty of veg to bulk up your meals,                       and to go for lower or reduced-salt whenever                                                                         on the calories in what you drink.
                                                                                                                    	Eat less saturated fat. Fats don’t directly
  and snack on fruit or vegetable sticks instead                   you can. Try:
                                                                                                                      affect your blood sugar levels, but choosing              Here are some easy ways to have healthier drinks:
  of sweets, crisps and biscuits. But, don’t go
                                                                   • Cooking with less salt. Experiment with          the right type of fat can benefit your heart
  overboard with fruit juices and smoothies                                                                                                                                     • Water is the best all-round drink. If you prefer
                                                                     pepper, herbs and spices to give food            health. Butter, cheese, ghee, lard and palm
  – choose whole fruit or veg as much as                                                                                                                                          flavoured water, always read the label to check the
                                                                     more flavour.                                    oil are all high in saturated fat. Swap these for
  possible and limit fruit juice or smoothies to                                                                                                                                  free (added) sugar content – there could be 5–7
                                                                                                                      small amounts of olive, rapeseed or sunflower
  150ml a day. And, eat fruit throughout the day,                  • Reading food labels (see page 24).                                                                           tsp sugar in a bottle. Make your own flavoured
                                                                                                                      oils and spreads. Here are some easy ways
  rather than having lots in one go. A portion is:                   And, watch out for cooking sauces and                                                                        waters by adding a squeeze of lemon or lime,
                                                                                                                      to have less saturated fat:
                                                                     seasonings like soy sauce or jerk seasoning                                                                  or strawberries.
          • 1 piece of fruit, like a banana or an apple
                                                                     – some of these are very high in salt.                • reduce the amount of spread you put
                                                                                                                                                                                • Tea, coffee and hot chocolate – cut back
          • a handful of grapes                                                                                              on bread – spread thinly
                                                                   • Asking for less or no salt in your food when                                                                 on sugar, use artificial sweeteners, and try
          • 1 tablespoon of dried fruit.                             you’re eating out or having a takeaway.               • use less fat in cooking – try grilling, boiling,     semi-skimmed or skimmed milk.
                                                                                                                             baking, steaming or poaching instead
                                                            	Snack attack. You can still enjoy a snack,                                                                        • Herbal teas can make a refreshing change
More ways to eat healthily                                    but try to go for healthier ones. Fruit and
                                                                                                                             of cooking with added fat, like frying
                                                                                                                                                                                  and most are caffeine-free.
	Watch the salt. Too much salt can raise                     vegetables, vegetable sticks with low fat                    • use spray oil or measure the amount of
                                                                                                                                                                                • No added sugar squash and cordials are a
  your blood pressure. All adults are advised                 hummus, natural or Greek yogurt, plain                         oil you use in cooking with a teaspoon
                                                                                                                                                                                  good option as you tend to use little and add
  to have less than 6g (that’s about 1 tsp) a                 popcorn, unsalted nuts and seeds,                              (instead of pouring it straight from the bottle)
                                                                                                                                                                                  more water. They don’t affect your blood sugar
  day. About three-quarters of the salt we eat                sugar- free jelly and avocado are good
                                                                                                                           • choose lean cuts of meat, trimming the               in the way that fruit juices and sugary drinks do.
                                                              choices – but keep an eye on your portions.

                                                                                                                                                                                                                                                        Treatment & management
  comes from processed foods, like bacon,                                                                                    visible fat, and removing the skin from
  sausages, cheese, sauces, tinned foods in                   Limit your intake of calorie-rich but nutritionally                                                               • Fruit juices (100 per cent juice) contain vitamins
                                                                                                                             chicken and turkey
                                                                                                                                                                                  and minerals, and 150ml provides one portion of
                                                                                                                           • try low-fat options – buy semi-skimmed               your five a day – but, remember, fruit juices only
                                                                                                                             or skimmed milk and reduced-fat cheese               count as one portion, however much you drink.
                                                                                                                             instead of full-fat ones.                            They are best avoided because they’re a source
 Healthy swaps                                                                                                                                                                    of free sugars, which we all need to cut down on.
                                                                                                                           • check food labels (see page 24).
 Sweet                                     Savoury                              Drinks                                                                                            But, if you do have them, don’t have more than
                                                                                                                    	Stay hydrated. Water forms a substantial                    one small glass a day.
                                                                                                                      part of our body, so it makes sense to drink
 Instead of                                Instead of                           Instead of                                                                                      • Fizzy sugary drinks provide little else apart
                                                                                                                      enough fluid every day to stay hydrated and
 milk chocolate                            crisps                               fizzy sugary drinks                                                                               from a lot of sugar, so try to go for sugar-free
                                                                                                                      healthy. Water, tea, coffee and milk all count.
                                                                                                                                                                                  alternatives, unless you’re using this to treat
                                                                                                                      We also get fluid from food, especially fruit
                                                                                try                                                                                               low blood sugar (a hypo, see page 34).
 try                                       try                                                                        and vegetables.
                                           plain popcorn                        water flavoured                                                                                 • Malted drinks and energy drinks can be high
 dark chocolate                                                                                                     	Fluid is important, and It’s best to drink 8–10
                                           with added spices                    with mint or                                                                                      in sugar and calories. You don’t need any special
 rice cakes                                                                                                           cups or glasses of fluid a day. Tap water
                                           or cinnamon                          fresh fruit                                                                                       drinks to stay healthy.
                                                                                                                      counts just as much as bottled water – so
                                                                                                                      does lower-fat milk and sugar-free drinks,
 Instead of                                Instead of                           For more healthy swaps,               including tea and coffee. But, if you drink a
 ice cream                                 bread and dips                       tasty recipes and loads               lot of tea and coffee, you need to be aware
                                                                                of food tips, go to                   of the amount of caffeine you’re having.
 try                                       try                                  www.diabetes.org.uk/
                                                                                gestational-food                    	You do need to think about what you drink,
 frozen banana                             carrots and celery
                                                                                                                      particularly when it comes to fruit juices,
 or frozen low-                            with salsa or low-
                                                                                                                      smoothies and sugary or alcoholic drinks.
 fat yogurt                                fat hummus
                                                                                                                      You can have more calories and sugar than
                                                                                                                      you mean to because it’s easy to drink a

16   www.diabetes.org.uk                                                                                                                                                                                 Everyday life with gestational diabetes   17
Everyday life with gestational diabetes - Diabetes UK
Managing your weight
Pregnancy isn’t the time to be on a really strict diet.
                                                             Tips for GI
Don’t try to lose weight while you’re pregnant – it          You can get the most out of GI by switching to a
could be unsafe for you and your baby. But making            lower GI food whenever you can. Here are some
small changes to your diet and physical activity levels      ways you can do this:
can help you avoid gaining too much weight. It’ll also
                                                             • Add baked beans to your jacket potato and
help you manage your gestational diabetes better,
                                                               have it with a large green salad.
and help to reduce the risk of complications.
                                                             • Try wholegrain bread or wholegrain breakfast
It’s important to keep going with your healthier lifestyle     cereal, like porridge.
after you’ve had your baby. It will reduce your risk of
developing gestational diabetes in future pregnancies.       • Eat different types of breads, like grainy or
And, it will also help to reduce your risk of developing       pumpernickel bread, instead of white or
Type 2 diabetes, too.                                          wholemeal bread.

Remember to ask your healthcare team to refer you            • Try a sweet potato or new potatoes with
to a dietitian if you haven’t already met with one.            your meal, instead of a standard potato.
                                                             • Choose long, thin rice grains – basmati or
The glycaemic index                                            wild rice – instead of shorter or sticky rice.
GI stands for glycaemic index. It’s a measure of how
                                                               Or, try quinoa, bulgur wheat or couscous                                                                Some questions
quickly foods containing carbohydrate affect your
                                                               for an even lower GI.                                Need to know            Need to know

blood sugar levels after you eat them. Some foods            • Get into the habit of eating fruit and vegetables,                                                      Is it OK to eat fish?

                                                                                                                                                                                                                                                Treatment & management
affect sugars levels quickly and so have a high GI,            and include plenty of veg with your meals.           • Ask to see a dietitian, who’ll be able to help
                                                                                                                                                                       Try to eat fish regularly, as it’s good for you and the
and others take longer to affect blood sugar levels and                                                               you plan a healthy diet to manage your
                                                             • Add beans and lentils to your meals – they’re                                                           development of your baby. The advice is to eat at
so have a low GI. Choosing low-GI carbohydrates                                                                       gestational diabetes.
                                                               great in casseroles and curries.                                                                        least two portions a week, including one or two
can help to even out blood sugars.                                                                                                                                     portions of oily fish – like mackerel, sardines, salmon,
                                                             • Try low-fat yogurt – but check the label for
But focusing too much on the GI of foods without                                                                                                                       herrings, trout or pilchards. Oily fish is really good for
                                                               any added sugar.
looking at other aspects of your diet could lead to an                                                                                                                 heart health, but don’t have more than two portions
unbalanced way of eating. Also, not all low GI foods                                                                                                                   a week. A portion is about 140g.
are healthy choices as some are high in fat. It’s good                                                                                                                 Avoid fish which tend to have higher levels of mercury,
to think of the bigger picture and choose foods low                                                                                                                    like swordfish, shark and marlin. And, don’t have
in saturated fat, salt and sugar as part of a healthy,                                                                                                                 more than four medium-sized cans of tuna, or two
balanced diet.                                                                                                                                                         tuna steaks a week, as it can have relatively high
• You’ll still need to think about your portion sizes.                                                                                                                 amounts of mercury compared to other fish. To avoid
  It’s the amount of carbohydrate in the meal that                                                                                                                     food poisoning during pregnancy, it’s best to avoid
  will affect your blood sugar levels the most. And                                                                                                                    raw shellfish, and there are some types of fish like
  not all low GI foods are healthy, so make sure                                                                                                                       wild salmon that will need to be frozen and safely
  you look at the labels and make a healthy choice.                                                                                                                    defrosted before you eat them.
  See page 24 for more on reading food labels.

                                                                                                                                                                       For more on healthy eating, tips and loads
                                                                                                                                                                       of tasty recipes, go to www.diabetes.org.uk/
                                                                                                                                                                       gestational-food – and see our recipes for
                                                                                                                                                                       breakfast, lunch and dinner over the page.

18   www.diabetes.org.uk                                                                                                                                                                         Everyday life with gestational diabetes   19
Recipes                                                                                                                                            Lunch

Breakfast

                                                                                                                                                   Watermelon, butterbean and feta salad                                  Kale and green lentil soup
                                                                                                                                                   A refreshing and colourful salad that’s quick                          A nutritious soup that’s quick to make
                                                                                                                                                   and easy to make.                                                      and super healthy.
                                                                                                                                                   Serves 4 Prep 10 minutes                                               Serves 4 Prep 10 minutes Cook 30 minutes

Microwave mug: Apple and cinnamon                                          Apricot porridge with toasted seeds                                       Each 162g serving contains (excludes serving suggestion)               Each 415g serving contains (excludes serving suggestion)

                                                                                                                                                                                                                                                                                                              Treatment & management
fruity porridge
                                                                           A winter warmer served with seeds and fruits.                                 KCAL         CARBS          FIBRE      PROTEIN         FAT             KCAL              CARBS         FIBRE         PROTEIN           FAT
                                                                                                                                                          122          12.8g          4.1g        6.4g          4.1g             154               18.9          8.2g           8.7g            3.1g
This fruity porridge is warming, filling and quick to
                                                                           Serves 2 Prep 15 minutes Cook 10 minutes
make – ideal for a healthy start on a cold morning.                                                                                                     SATURATES          SUGARS            SALT         PORTION FRUIT        SATURATES             SUGARS               SALT           PORTION FRUIT
                                                                                                                                                           1.7g              5.9g            0.3g            & VEG 1              0.4g                 8g                 0.9g              & VEG 3
Serves 1 Prep 2 minutes Cook 2 minutes                                       Each 389g serving contains (excludes serving suggestion)

                                                                                KCAL           CARBS          FIBRE      PROTEIN         FAT
  Each 244g serving contains (excludes serving suggestion)                       219            34.6g          4.9g        5.8g          5.8g
                                                                                                                                                   Ingredients                 Method                                     Ingredients                     Method
                                                                                                                                                   300g watermelon flesh                                                  2 tsp sunflower oil
      KCAL           CARBS            FIBRE      PROTEIN         FAT           SATURATES           SUGARS             SALT         PORTION FRUIT                               1 Cut the watermelon into small                                            1 Put the oil in a pan over a
                                                                                                                                                   (with rind removed)                                                    2 onions, finely
       202            34g              5.3g        5.5g          3.7g             0.9g               17g               0g             & VEG 0
                                                                                                                                                   100g rocket
                                                                                                                                                                                 slices and set aside.                    chopped
                                                                                                                                                                                                                                                            medium heat, add the onions
     SATURATES               SUGARS           SALT         PORTION FRUIT                                                                           5-6 sprigs mint
                                                                                                                                                                               2 Scatter the rocket and mint              1 large carrot, diced
                                                                                                                                                                                                                                                            and stir for 7–10 minutes
        0.8g                  10.2g           0.01g           & VEG 1                                                                              leaves, torn                  leaves over a serving platter                                              until well browned.
                                                                           Ingredients                  Method                                                                                                            1 stick celery, chopped
                                                                                                                                                   2 tsp olive oil               and drizzle with the olive oil.          1-2 cloves garlic,              2 Add the carrot and celery and
                                                                           50g ready-to-eat
                                                                                                        1 Place the apricots in a small pan        400g tin butter               Arrange the melon over the               crushed                           cook for a further 2–3 minutes
Ingredients                   Method                                       dried apricots
                                                                                                                                                   beans, drained
                                                                           150ml orange or
                                                                                                          and cover with the juice. Bring to                                     leaves then scatter the butter           1 tsp ground cumin                stirring regularly.
35g porridge oats                                                                                                                                  40g feta
                              1 Add the oats, sweetener,                   apple juice                    the boil and simmer for 5 minutes.                                     beans and feta over the top.             1 tbsp tomato purée             3 Now add the garlic, cumin,
1 tsp artificial sweetener                                                                                                                         juice half lemon
                                cinnamon and apple to                      50g porridge oats            2 Set aside for 10 minutes, then                                       3 Drizzle with lemon juice and             1 x 400g can green                tomato purée, lentils and
1 tsp cinnamon,                                                                                                                                    good grind black                                                       lentils in water (add
plus pinch to top
                                a mug and mix.                             15g mixed seeds,               place in a food processor or             pepper                        black pepper to serve.                   the water, too)                   mix well.
                              2 Add 100ml water and cook                   toasted                        blender and blend to form
1 small apple,                                                                                                                                                                                                            200g Cavolo Nero                4 Add the stock, bring to the boil,
chopped small                   at full power (800W) for                                                  a purée.                                                                                                        (black kale) or curly             turn down the heat, cover and
                                                                                                                                                                                                                          kale, chopped (thick
25ml semi-skimmed               two minutes.                                                            3 Place the oats in a small pan,                                                                                                                    simmer gently for 12 minutes.
milk                                                                                                                                                                                                                      stalks removed)
                              3 Add the milk, mix and sprinkle                                            cover with 600ml of water, then                                                                                 500ml vegetable stock
                                                                                                                                                                                                                                                          5 Add the kale, replace the lid
                                over a little cinnamon.                                                   place over a low heat and cook                                                                                  black pepper, to taste            and simmer a further 5 minutes,
                                                                                                          for 3–4 minutes.                                                                                                                                  season with pepper and serve.
                                                                                                        4 Stir through half the apricot purée,
                                                                                                          divide between 2 bowls, then top
                                                                                                          with the toasted seeds and a swirl
                                                                                                          of the remaining purée.
20   www.diabetes.org.uk                                                                                                                                                                                                                                       Everyday life with gestational diabetes   21
Dinner
                                                                                                                                                                                                                had done something wrong, I wasn’t looking after
                                                                                                                                                                                                                myself and things would have to change.
                                                                                                                                                                                                                In hindsight (a wonderful thing), the changes really
                                                                                                                                                                                                                weren’t that hard. Husband joined in and it sent
                                                                                                                                                                                                                me on a slightly different course after our baby
                                                                                                                                                                                                                was born and in preparation for baby number two.
                                                                                                                                                                                                                I had lost weight too, so my BMI dropped before
                                                                                                                                                                                                                I fell pregnant again.

                                                                                                                                                                                                                Healthy eating
                                                                                                                                                                                                                My gestational diabetes is probably linked to
                                                                                                                                                                                                                my weight and eating habits like portion sizes
                                                                                                                                                                                                                and sugar intake.
Spinach, corn and chickpea fritters                                        Mixed bean chilli
                                                                                                                                                                                                                I haven’t had sugar in my tea or coffee for almost
A perfect supper dish. Works well in pitta breads with                     A great vegetarian chilli which can work with whatever                                                                               two years (and I won’t lie, I thoroughly miss it but
lots of salad.                                                             pulses you have in your store cupboard.                                                                                              I know I have to eat healthily). I wanted to avoid
Serves 4 Prep 15 minutes Cook 20 minutes                                   Serves 4 Prep 15 minutes Cook 20 minutes                                                                                             indigestion at all costs through pregnancy, so portion
                                                                                                                                                                                                                control has been key through both pregnancies.
  Each 188g serving contains (excludes serving suggestion)                   Each 361g serving contains (excludes serving suggestion)                                                                           That’s not to say I don’t treat myself. I love food,

                                                                                                                                                                                                                                                                                         Treatment & management
       KCAL            CARBS          FIBRE      PROTEIN         FAT             KCAL           CARBS          FIBRE      PROTEIN         FAT                                                                   cooking, sharing, serving and eating, but all in
        157             15.4g           7g         9.9g          4.5g             243            30.9g         13.4g       11.8g          4g                                                                    moderation and using basic common sense.
      SATURATES
         0.7g
                           SUGARS
                             3.3g
                                              SALT
                                              0.10g
                                                           PORTION FRUIT
                                                              & VEG 2
                                                                                SATURATES
                                                                                   0.5g
                                                                                                     SUGARS
                                                                                                      10.6g
                                                                                                                       SALT
                                                                                                                       0.1g
                                                                                                                                    PORTION FRUIT
                                                                                                                                       & VEG 4
                                                                                                                                                                                                                I also hope this encourages my children to look
                                                                                                                                                                                                                at how we eat, why we eat, why healthy food
                                                                                                                                                                                                                is crucial, but also hold on to a love for food that
Ingredients                     Method                                     Ingredients                   Method                                                                                                 is very important at my kitchen table.
2 tsp rapeseed oil                                                         1 tbsp oil
                                1 Add 1 tsp of oil to a saucepan,                                        1 Heat the oil in a medium pan,                                                                        The blood sugar results in my first pregnancy were
1 small onion, grated                                                      1 onion, finely chopped
                                  then add the onion. Cook for                                             add the onion, garlic, red and                                                                       high and, as a result, I was on additional medication.
1 red pepper, finely                                                       1 clove garlic, crushed
chopped
                                  2-3 minutes. Add the red                                                 green peppers and chilli, fry                                                                        I started testing my blood sugar levels at about 29
                                                                           1 red pepper,
1 egg, beaten
                                  pepper and fry for 4-5 minute.           chopped small
                                                                                                           for 3-4 minutes until beginning                                                                      weeks, as it was delayed gestational diabetes.
150g frozen spinach,            2 Meanwhile, add the egg,                  1 green pepper,                 to soften.
                                                                                                                                                                                                                This pregnancy, I started testing automatically at
defrosted, water                  spinach, cumin, chilli and               chopped small                 2 Lightly crush half the pulses
squeezed out,                                                                                                                                                                                                   17 weeks, three to four times a day. I was perfectly
                                  sweetcorn to a bowl and mix.             1 red chilli, deseeded          using the back of a fork. Add
roughly chopped                                                            and finely chopped                                                                                                                   aware of my limitations, therefore portion control
                                  Stir in the onion and red pepper,                                        to the pan with the remaining
                                                                                                                                                    Meet Nicole                                                 and reducing sugar were the key factors for me
1 tsp cumin                                                                2 x 400g tin mixed
                                  then the chickpeas, gram                                                 pulses, chopped tomatoes,
1 red chilli, finely                                                       pulses, drained                                                                                                                      in making sure I didn’t have as high readings.
chopped                           flour and coriander.                     and rinsed                      tomato puree, sweetcorn,
                                                                                                                                                    Nicole has had gestational diabetes in
80g frozen corn,                3 Shape the mix into 8 patties.            400g tin chopped                cumin, oregano, salt                                                                                 The testing becomes second nature and, because
defrosted                                                                  tomatoes                                                                 both of her pregnancies
                                4 Add the remaining oil to a large                                         and pepper.                                                                                          you know it’s for the welfare of you and your baby
400g can chickpeas,                                                        2 tbsp tomato puree
drained and mashed
                                  non-stick frying pan over a                                            3 Bring to the boil, turn down             “The first time I was diagnosed (toddler is just shy        in the short and long term, you just get on and
                                                                           50g frozen sweetcorn
thoroughly)                       medium heat. Place fritters in           (defrosted)
                                                                                                           the heat and simmer for                  of turning 2, it hit me like a freight train – the idea I   do it. It is frustrating, but that’s all it is.”
25g gram flour                    the pan and flatten slightly with        1 tsp ground cumin              10 minutes. Stir through the
10g fresh coriander,              a spatula to about ½-1cm thick.          1 tsp dried oregano             coriander and serve with rice.
chopped salad,
                                5 Cook until lightly browned for           Freshly ground
to serve
                                  3-4 minutes, then flip and repeat.       black pepper
                                                                           2 tbsp fresh coriander,
                                                                           chopped

22    www.diabetes.org.uk                                                                                                                                                                                                                 Everyday life with gestational diabetes   23
Understanding food labels                                                                                                  Reference Intakes
                                                                                                                           Reference Intakes, sometimes shortened to RI, can
                                                                                                                           also be found on the front or the back of the packaging.
                                                                                                                                                                                        Tips to be label savvy
                                                                                                                                                                                        • With colour coded labels, go for green as
                                                                                                                                                                                          much as possible, sometimes amber and
                                                                                                                           There are recommended amounts for how much                     red less often/only occasionally.
                                                                                                                           sugar, salt, fat and saturated fat everyone should eat
Figuring out food labels makes it easier to                    ll measures
                                                              A                                                            and drink each day. A Reference Intake label tells you       • Reference Intake (RI). It’s a percentage figure
eat the right things in the right amounts.                    per 100g        Low            Medium High                                                                                  per portion. It indicates what percentage of an
                                                                                                                           the percentage that item of food will contribute to
                                                              Fat             3g or less     More than 3g More than        these daily targets.                                           adult’s daily recommended amount of calories,
                                                                                             to 17.5g     17.5g
Traffic light labels                                          Saturated fat   1.5g or less   More than      More than 5g   In our example of a front of pack label (see page 24),
                                                                                                                                                                                          fat, sugar and salt is in one portion of that
                                                                                                                                                                                          product. You need to check how much of the
Food companies don’t have to put labels on the front                                         1.5g to 5g                    the salt content of that product is 42 per cent of your        pack counts as a portion so that you don’t
of their packs. If they do, they use traffic light labels.    Sugars          5g or less     More than 5g More than        Reference Intake, of how much salt you should                  eat more of these things than you need.
                                                                                             to 22.5g     22.5g
                                                                                                                           be having a day. That’s very high.
These tell you whether the product has low, medium            Salt            0.3g or less   More than      More than                                                                   • All carbohydrates raise blood sugar levels. The
or high amounts of fat, saturated fat, sugars and salt.                                      0.3g to 1.5g   1.5g           Of course, everyone is different but you should aim            labels on the front won’t tell you about carbs
They’re designed to let you know at a glance how                                                                           not to eat or drink more than the Reference Intake             so you need to check on the back for the ‘total
healthy or unhealthy something is and make it easy           The numbers for sugars don’t tell you whether the             for fat, saturates, sugar and salt each day.                   carbohydrates per 100g’. This includes carbs
to compare similar products.                                 sugars are natural, like in fruit, or added by the food                                                                      from starchy foods as well as sugars.
                                                             company when the product is being made, like
Example of a front of pack label                             sucrose, but checking the ingredients list can help.                                                                       • On the front of labels, the colour coding tells
                                                                                                                                                                                          you about total sugars. They don’t tell you
                                                                                                                             Need to know                                                 how much of that sugar comes from natural
                                                             Portion size

                                                                                                                                                                                                                                                               Treatment & management
                                                                                                                                                     Need to know

                                                                                                                                                                                          sources (like fructose) and how much is
                                                             We all have a different idea of what makes up a                 Information on food packaging can be confusing               added (like sucrose or glucose). Check the
                                                             portion of food. But, in general, the portion size on           all the same. Here are things to know:                       ingredients. If syrup, cane sugar, molasses
                                                             packaging is based on what an adult over 18 should                                                                           or anything ending ‘ose’ is in the first three
                                                                                                                             • Fat free: has to have no fat, but check
                                                             eat. Still, bear in mind that your idea of a portion may                                                                     ingredients, then it’s probably high in sugar.
                                                                                                                               for added sugar which is often used to
                                                             be more than other people’s (or the manufacturer) so                                                                         Choose something else if you can, or watch
                                                                                                                               replace the fat.
                                                             you may end up eating more calories, fat and sugar                                                                           how much of it you eat.
Green means low and a healthier choice. These foods          than you need. In the same way, don’t feel you have             • Sugar free: check the ingredients for fats
are low in fat, saturated fat, sugars and salts. Usually,    to eat a whole portion if it feels too big for you.               which may replace the sugar.                             • Check the fibre content on the back of pack
the healthier the food, the more greens on the label.                                                                                                                                     label. If you’re trying to decide between two
                                                                                                                             • Low fat: 3g or less of fat per 100g.                       products, it’s better to go for the one with
                                                             On the back
Amber means medium. It’s OK to have these foods                                                                              • Low sugar: less than 5g of sugar per 100g.                 more fibre.
some of the time.                                            Labels on the back of food list ingredients, nutrition,
                                                             known things that can cause allergies (allergens),              • No added sugar: although no sugar is                     • Check the manufacturer’s definition of a
Red means high. Most people like food with lots              best before/use by dates and the overall weight.                  added, there may be naturally occurring                    portion. It may be different from yours and
of red. But try to eat them only occasionally and                                                                              sugar in the food.                                         it might well be smaller.
in small quantities.                                         Ingredients are listed in bulk order from high to low. At
                                                             the top is the ingredient there’s most of, at the bottom        • Reduced fat or sugar: contains at least
Most foods will have a mix of traffic light colours. Pick    the ingredient with the smallest amount. So, if sugar’s           30 per cent less fat or sugar than the standard
items with more greens and ambers, and fewer reds.           at the top, then it’s high in sugar.                              version. And it doesn’t mean it’s healthy.
                                                                                                                               The ‘light’ version of, say, one brand of
                                                                                                                                                                                      Some questions
The next table (right) shows what value of fats, sugars
and salts are considered low, medium or high in a                                                                              crisps, could have the same calories and
                                                                                                                                                                                      What if there isn’t any nutritional information?
food product. Lower values apply for drinks and larger                                                                         fat as the standard version of another brand.
portion sizes of food.                                                                                                                                                                Not everything you buy will have nutritional information.
                                                                                                                                                                                      But there’ll still be clues. Remember that the ingredients
                                                                                                                                                                                      are listed from high to low, so if a fat or sugar is at the
                                                                                                                                                                                      top, it may be worth looking for an alternative.

24   www.diabetes.org.uk                                                                                                                                                                                        Everyday life with gestational diabetes   25
Physical activity
Exercise is part and parcel of managing your             Moderate intensity – breathing is increased,
diabetes. In just the same way that you need to          but you can talk comfortably.
eat the right things, you can also help to manage
                                                         This could be walking quickly or a leisurely swim.
your gestational diabetes by being more active.
Don’t be put off by the word ‘exercise’. You don’t       Vigorous intensity – you’re breathing fast                                                                    Staying healthy
have to take out a gym membership, wear lycra or         and it’s hard to talk.
take up sports if you don’t want to. But, making time                                                                                                                  Alcohol
                                                         This could be walking briskly, faster swimming,
to be active and making that a priority is important                                                                                                                   The safest option is not to drink any alcohol
                                                         or low-impact exercise for pregnancy.
now more than ever. Activity helps to manage your                                                                                                                      while you’re pregnant. Drinking during pregnancy
gestational diabetes because it increases the amount                                                                                                                   can lead to long-term harm to your baby. The
                                                         Exercises for muscle strength
of glucose (sugar) used by your muscles for energy,                                                                                                                    more you drink, the greater the risk.
so it usually lowers blood sugar levels. Also, being     For example, carrying groceries or pregnancy
active helps the body use insulin more efficiently.      yoga or pilates.                                                                                              Alcohol can also make low blood sugar
And, regular activity can help reduce the amount                                                                                                                       hypoglycaemia (hypos) more likely, if you treat your
                                                                                                                                                                       gestational diabetes with insulin or glibenclamide.
of insulin you need.                                     How you can move more

                                                                                                                                                                                                                                             Treatment & management
Being active helps with your gestational diabetes by:                                                                                                                  Smoking
                                                         Walking is a great activity. Here are some ideas:
• Helping you keep to a healthy weight.                                                                                                                                If you smoke, being pregnant may be the incentive
• Helping to improve your blood sugar levels.                                                                                                                          to try quitting. Smoking can harm your unborn
                                                                                                                                                                       baby and makes it harder for them to get their
• Improving circulation.                                                                                                                                               essential oxygen supply.
• Strengthening your muscles and bones.                                                                                                                                Don’t forget, if your partner or anyone else who
• Reducing stress levels and symptoms of                                                                         Need to know                                          lives with you smokes, their smoke can also affect
                                                                                                                                                                       you and your baby before and after birth. You may
                                                                                                                                        Need to know

  depression and anxiety.
                                                         Get off the bus              Walk to the shops to       • Find something you enjoy. You’re more likely        want to talk about these risks with them.
• Improving your sleep.                                  a stop earlier               pick up a few items          to stick to it.
                                                                                                                                                                       For help to quit smoking, ask for support from
It also reduces your risk of heart disease, cancer,                                                              • Check with your healthcare team before              your diabetes healthcare team.
joint and back pain, depression and dementia                                                                       you start anything new.
                                                                                                                                                                       • Extra help: NHS Pregnancy Smoking helpline:
How much to aim for                                                                                              • Start slowly and gradually increase the intensity     call 0800 123 1044 or go to www.quitnow.
                                                                                                                   and time you spend on new activities. If you’re       smokefree.nhs.uk
The general advice for adults is to aim for 30 minutes                                                             at risk of hypos (low blood sugar) because
of moderately intense activity – or 15 minutes of                                                                  you take insulin or the tablet glibenclamide,
vigorous activity – at least five days a week. Women     Have a walking meeting        se a pedometer to
                                                                                      U                            test your blood sugar regularly and have
with gestational diabetes should aim to complete         or catch up with friends     keep track of your steps     hypo treatments to hand.
30 minutes of activity after a meal – this could                                      – aim for 10,000 a day
include walking.                                                                                                 • Wear diabetes identification (like a bracelet
                                                                                                                   or necklace) or carry an ID card. This is very
Also, try to do activities that improve muscle                                                                     important if you’re at risk of hypos
strength on two or more days a week. These
are the government guidelines:                                                                                   • Remember to keep hydrated (see page 17).

26   www.diabetes.org.uk                                                                                                                                                                      Everyday life with gestational diabetes   27
Medication                                                                                                  Need to know          Need to know

                                                                                                            • Discuss all the treatments with your
                                                                                                                                                             Some questions
                                                                                                                                                             My medication says it’s not suitable during
                                                                                                                                                             pregnancy. So why has it been given to me?
                                                                                                              healthcare team.
                                                                                                                                                             Even though the patient information leaflets (PIL) for
Depending on your blood sugar levels when                                                                   • Report any side effects of your medications.   metformin and glibenclamide say that they shouldn’t
you were diagnosed with gestational diabetes,                Tips for remembering your meds                 • Don’t stop taking your medications without     be used during pregnancy, both are safely used
your healthcare team may initially help you to                                                                talking to your healthcare team.               in the UK to help manage diabetes in pregnancy
                                                             1 Make a schedule. If you take more than
understand how to manage it with changes                                                                                                                     and breastfeeding.
                                                               one medicine, make a schedule showing        • Get your Maternity Exemption Certificate
to your diet and physical activity levels.
                                                               when to take them each day and in the          or Card, which entitles you to free NHS        There’s strong evidence for their effectiveness and
But, if these changes don’t help within one or two             best order. Ask your pharmacist to help.       prescriptions. Ask your GP or midwife          safety. Your diabetes healthcare team will consider
weeks, you’ll be offered medication. In some cases,                                                           for a form.                                    the benefits to your blood sugar against any
                                                             2 Use a pill box. Get one that has separate
your team may prescribe medications at the time of                                                                                                           potential harm. Talk to your healthcare team
                                                               days of the week – you can get organised
diagnosis. Remember, even when medications are                                                                                                               if you have any worries.
                                                               a week at a time.
needed, you’ll still need to make changes to your
diet and physical activity – this is essential to help       3 Keep your meds handy. Keep them
you manage your blood sugar levels.                            somewhere you will see them (but away
                                                               from children’s reach) – near your TV,
How do the medications work?                                   computer or with your toothbrush.
Metformin: This tablet helps to reduce the amount            4 Use an alarm. Set reminders on your

                                                                                                                                                                                                                                     Treatment & management
of glucose produced by the liver, and to make your             phone or computer.
own natural insulin work properly. It’s taken with, or
                                                             5 Make a note to order repeat prescriptions.
after, a meal.
Glibenclamide: This tablet works by stimulating
your pancreas to make more insulin. It’s taken
with, or immediately after, food.
Insulin: Insulin is a hormone that allows glucose –
the body’s main fuel – to enter the cells to be used for
energy. It can’t be taken orally because your stomach
will digest it. It’s given as an injection using a small
needle just under the skin. If you need insulin, your
healthcare team will teach you how to inject safely.
See page 30 for more on insulin.

Side effects
All medications have side effects. You’re unlikely to
experience them all and may not even experience
any. The patient information leaflet – PIL – will tell you
about possible side effects. If you do have any of
them, speak to your healthcare team or pharmacist.

28   www.diabetes.org.uk                                                                                                                                                              Everyday life with gestational diabetes   29
Using insulin                                                                                                                  Need to know                             Need to know

                                                                                                                               • Change the place you inject. Don’t go to the
                                                                                                                                                                                                                                 Some questions
                                                                                                                                                                                                                                 Can I inject into my abdomen?
                                                                                                                                                                                                                                 You may be worried about injecting in this area while
                                                                                                                                 same place – rotate where you inject. This
                                                                                                                                                                                                                                 pregnant, but with a short (4–6mm) needle, you
                                                                                                                                 stops the build-up of small lumps under the
Your healthcare team may talk to you about                 • Inject the insulin. Make sure the plunger (syringe)                                                                                                                 can inject insulin into the fatty layer safely. Avoid the
                                                                                                                                 skin. These lumps don’t look or feel very nice,
using insulin to treat your diabetes. This doesn’t           or thumb button (if using a pen) is fully pressed                                                                                                                   area too close to your belly button. Speak to your
                                                                                                                                 and they make it difficult for your body to
mean that you’ve developed Type 1 diabetes.                  down and count to 10 before removing it.                                                                                                                            healthcare team if you have concerns.
                                                                                                                                 absorb the insulin properly.
You still have gestational diabetes, which is
                                                           • Let go of the skin fold (if you’re doing this) and                • Always dispose of needles in a special sharps                                                   Will injecting into my abdomen hurt my baby?
treated with insulin. Changing your treatment
                                                             dispose of the needle safely.                                       disposal bin, not a rubbish bin. It’s also where
doesn’t change your diagnosis.                                                                                                                                                                                                   Your baby is growing in the uterus, which is several
                                                           • Always use a new needle. Reusing a needle                           you need to put used lancets (the device used
                                                                                                                                                                                                                                 layers below the skin. Insulin needles are very short
How it’s taken                                               makes it blunt and painful to inject with.                          for a blood sugar test).
                                                                                                                                                                                                                                 and can’t touch your baby. Speak to your healthcare
You’ll need to inject insulin with a syringe or a                                                                              • Sharps disposal bins and needle clippers are                                                    team about shorter needles if you’re worried.
special pen. Your healthcare team will show you                                                                                  free on prescription. Talk to your clinic about
how. The places to inject are usually the thighs,                                                                                how to dispose of the boxes when they’re full.
buttocks and abdomen. You may be able to inject into
                                                             Tips for injecting
your upper arms, but check with your diabetes team           If you’re finding it difficult or painful to inject, then
first as this isn’t always suitable.                         speak to your nurse who’ll be able to help. It
                                                             shouldn’t hurt much and, as you get better at
These are the steps you’ll be shown:
                                                             it (and less worried), it will hurt even less. With
• Decide where you’re going to inject.                       confidence, it’ll become second nature.
                                                                                                                           Advertisement
• Make sure your hands and the place that you’re
  injecting are clean.
• If you’re using a pen, squirt out two units of insulin
  into the air. This makes sure the top of the needle
  is filled with insulin.                                                                                                Ready, steady, shop
• If the nurse has told you to do this, lift a fold
  of skin (but not so tightly that it causes skin
                                                                                                                         By purchasing from our shop you’re
  blanching or is painful), then insert the needle
                                                                                                                         supporting our fight for a world where
  at a 90-degree angle. You shouldn’t need to
                                                                                                                         diabetes can do no harm. All profits
  pinch up, unless you’re very thin – check this
                                                                                                                         raised will help fund our research which
  with the nurse beforehand.
                                                                                                                         is developing better treatments and
• Put the needle in quickly.                                                                                             taking us a step closer to a cure.                                                             To order these and search other items, go to
                                                                                                                                                                                                                        shop.diabetes.org.uk or call 0800 585 088,
                                                                                                                         With 4.5 million people in the UK living                                                       Monday to Saturday 8am–6pm.
                                                                                                                         with diabetes your support has never
                                                                                                                         been more important and means we’re                                                            Please quote GD1 when ordering by phone.
                                                                                                                         able to help more and more people.

                                                                                                                         Thank you.

30   www.diabetes.org.uk                                                                                                                                                                                                                                   Everyday life with gestational diabetes   31

                                                                                                                         Diabetes UK is a charity registered in England and Wales (no. 215199) and in Scotland (no. SC039136). © Diabetes UK 2017
Notes

        Hypos &
        hypers

        In this chapter

        Hypos and hypers   34
Hypos and hypers
                                                                                                                      To find out how much you need to take, check the
                                                                                                                      food label to see how much carbohydrate it contains.           Need to know
                                                                                                                      It’s important to check as products and ingredients,
                                                                                                                                                                                                             Need to know

                                                                                                                      like the sugar and carbohydrate content, can change.           • Keep hypo treatments with you all the time.
                                                                                                                      If you’re not sure how much to take, speak to your
                                                                                                                      healthcare team.                                               • Check the carbohydrate content of your hypo
An important part of managing your gestational         Hypo signs                                                                                                                      treatment regularly, as products can change.
                                                                                                                      You should test your blood sugar level again 15–20
diabetes is understanding how your blood sugar                                                                                                                                       • If you have a hypo, don’t go for foods that are
                                                       They can come on quickly. Everyone has different               minutes after treating the hypo and treat again if your
levels are affected by the food you eat, the                                                                                                                                           high in fat like chocolate or biscuits. The fat
                                                       symptoms, but the most common ones are:                        level is still less than 4mmol/l.
exercise you do and any medication you take.                                                                                                                                           slows down how quickly the sugar is absorbed
Then, finding the best way to keep them within         • trembling and               • palpitations and               After a hypo, you may need to then eat or drink a                and they don’t work quickly enough.
the healthy range. This is a bit of a balancing act.     shakiness                     a fast pulse                   bit more: 15–20g of a slower-acting carbohydrate to
There’ll be times when your blood sugar levels                                                                        stop your sugar levels going down again. It could be           • Talk to your healthcare team if you have a
                                                       • sweating                    • lips feeling tingly                                                                             severe hypo or keep having hypos. They can
are higher or lower than your targets.                                                                                a sandwich, a piece of fruit, cereal or milk. O,r it could
                                                       • becoming anxious            • blurred vision                 be your next meal if that’s due.                                 look at your treatment and medication and
                                                                                                                                                                                       suggest changes.
Hypos                                                    or irritable
                                                                                     • feeling hungry
                                                                                                                      If you become unconscious                                      • Carry some diabetes ID with you, in case
The proper name for a hypo is hypoglycaemia,           • becoming pale
                                                                                                                      It’s pretty rare for gestational diabetes, but severe            you ever become unwell.
and it’s when your blood sugar level is too low.
That’s usually below 4mmol/l.                          Why they happen                                                hypos do happen and could mean you fall
                                                                                                                      unconscious. Then someone else needs to act
Not all women with gestational diabetes will have      You can’t always know why you’ve had a hypo,
                                                                                                                      quickly. These are the things they’ll need to do:
hypos, but you’re more likely to have a hypo           but these things make them more likely:
                                                                                                                      • Put you into the recovery position (on your side           Some questions
if you take insulin, or the tablet glibenclamide.      • you’ve taken too much diabetes medicine for
If you take any of these, it’s extra important                                                                          with head tilted back and knees bent).
                                                         the amount of carbohydrate you’ve eaten                                                                                   How will a hypo affect my blood sugar levels?
to know the symptoms of a hypo.                                                                                       • Call an ambulance, and tell the operator you’re
                                                       • missing a meal                                                                                                            After you’ve treated one hypo, you’re more likely
                                                                                                                        pregnant and have diabetes.
                                                       • exercising more than normal (or you didn’t                                                                                to have another one. That’s why it’s really important
                                                                                                                      • Make sure your family and friends know                     to continue regularly testing your blood sugar
                                                         plan to exercise)
                                                                                                                        that they mustn’t try to give you any food                 levels after a hypo.
                                                       • drinking alcohol on an empty stomach.                          or drink (or put anything in your mouth)
                                                                                                                        if you’re unconscious or unable to swallow.
                                                       Treating a hypo
                                                                                                                      Always tell your healthcare team if you’ve had
                                                       You need to act quickly as soon as you notice                  a severe hypo.
                                                       symptoms, or if a blood sugar test has shown

                                                                                                                                                                                                                                                           Hypos & hypers
                                                       your levels are too low.
                                                       If you don’t, it could get worse and you might become
                                                       confused, drowsy, or even fall unconscious or have a fit.        Tips for preventing a hypo
                                                       If you can, treat the hypo immediately by eating or drinking     1 Don’t miss a meal.
                                                       15–20g of fast-acting carbohydrate. This could be:               2 Eat enough carbohydrate.
                                                       • a sugary (non-diet)         • glucose gel.                     3 Eat more carbohydrate if you’re more active
                                                         drink                                                            than normal.
                                                                                     • if you find it easier,
                                                       • glucose tablets               you can have a small             4 Take your medication correctly.
                                                                                       carton of pure fruit
                                                       • sweets, like jelly babies                                      5 Test your blood sugar levels regularly
                                                                                       juice.

34   www.diabetes.org.uk                                                                                                                                                                                    Everyday life with gestational diabetes   35
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