We hope that the following practical information on eating and staying well will help you feel positive and encouraged to stick to the gestational diabetes (GDM) diet. The GDM diet is basically a really healthy way of eating which can benefit the whole family. Read on for tips on everything from exercising, eating cake and dealing with hunger.
Written by Natasha Leader, Accredited Practising Dietitian & Credentialled Diabetes Educator
Last updated October 2011.
What’s the deal with carbs?
So you’ve just found out that you need to manage your daily carbohydrate (carb) intake. This can be a little tricky. Carbs are now a problem for you but also the solution. You need carbs and your baby needs carbs. Carbohydrates are our energy food. They are contained in many important food groups i.e. bread and cereals, fruits, vegetables and dairy. You can’t just cut them out or your diet would end up unbalanced and insufficient but too much of them means too much glucose in your bloodstream.
The answer is this. You need to eat a consistent and moderate amount of carbs regularly through the day.
Ideally you should be eating every 2.5-3hrs. Leaving a much longer gap means you might get too hungry and want to eat more when you finally do eat. Eating every hour means your body is going to find it too hard to keep processing all the time. Try having 3 meals and 3 small snacks through the day. These should be at times of the day that suit you.
Type & Amount:
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Choose nutritious or high-fibre carbs i.e. wholegrain breads and crackers, pasta, starchy vegetables such as corn and potato, legumes, low fat dairy milk and yoghurt and fruit. A fist-sized amount of carbohydrate is a good rule of thumb to go by until you see a dietitian. This is usually equal to about a standard cup measure (250ml). Avoid unnecessary carbs such as sugar, which includes lollies, soft drink, cordial and fruit juice. Advice varies but you should aim for 12 serves of carbohydrate per day, evenly spaced through the day i.e. 2-3 serves for meals and 1-2 carbohydrate serves for snacks. This helps ensure you can meet the overall nutrient requirements for pregnancy without overdoing it. (1 carb serve =15g total carbohydrate.)
Can’t fit all the food in?
Some women find it difficult to get used to having regular snacks as well as their meals. Many women were actually having more carbohydrate before, although it didn’t seem like it, because it was in high carb drinks and unnecessary sugars which they are now avoiding. If you are feeling full then try using your snacks to fit in your fruit requirement (2-3 pieces per day) and your dairy (3 serves per day). Don’t always look for the low carb options as you also need to make sure you are eating enough. Protein and non-starchy vegetables may fill you up and don’t cause problems with your glucose levels, but you and your baby need a certain amount of carbs. Be sure that you are eating adequate carbs regularly. Headache, tiredness, hunger, irritability and nausea can all be signs that you are not eating enough carbohydrate. (See ‘ketones’ in our Glossary section.)
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What if I’m still hungry?
Often women on the GDM diet still feel hungry and more than likely it’s because they aren’t actually eating the recommended daily amount of carbohydrate. First check you’re eating the recommended amount of carbs at all meals and all snacks. All the recipes here at GestationalDiabetesRecipes have the main carbohydrate containing ingredients listed in bold so you know what they are and can adjust to your diet. You can also add a little more protein to your diet, such as lean meat, tofu or eggs as this won’t affect your glucose levels and can make you feel far more satisfied. But too much additional protein can still affect your weight so don’t go overboard.
Non-starchy vegetables or ‘free vegetables’ are fine to eat as much of as you want. They will help to keep you feeling full but won’t affect your glucose levels or your weight and are full of nutrients for you and your baby.
Drinks such as diet cordials and diet/Zero soft drinks are acceptable if you want to drink something other than water (or some low fat milk). It is up to you whether you want to include foods that are artificially sweetened in your diet. There is no evidence they cause harm in pregnancy but many women still prefer to avoid them.
Certain condiments that you may use to cook with and flavour foods such as soy sauce, mustard, vinegar, lemon juice, chilli and garlic, are still okay. See the ‘free foods’ list below for more examples. You may feel extra hungry if you are eating bland foods because you aren’t sure what you can and can’t have.
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What if I just NEED cake?
Maintaining a special diet is exhausting and there is bound to be a time you are tempted to splurge. Or you may have your baby shower or Christmas to work around. While it would be ideal to avoid these temptations here are some tips if you are going to have something ‘extra’:
- Downsize: Instead of a slice of cake go for a cupcake or better still a mini-cupcake.
- Share: split a friand with a friend.
- Skip the icing: choose a plain cookie/biscuit instead.
- Reduce the carbs: have a scoop of gelato in a cup instead of a cone.
- Avoid the super rich ice-creams: Instead of a Magnum or Cornetto, have a Heart, a Dixie Cup or a Paddle Pop instead.
- A few squares of good quality chocolate can go a long way occasionally.
And if sweet stuff isn’t your thing:
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- Try salsa, fresh hummus or tzatziki dips with some vegetable sticks. That way you could also squeeze in some tasty cheddar with wholegrain crackers so you’re getting a serve of dairy in there too.
- A small bag of popcorn which has a heap less fat than a bag of chips.
What about the GI?
Glycaemic index (GI) can be a confusing concept. It is a measure of how fast a carbohydrate containing food breaks down into glucose when you eat it. A ‘high’ GI food breaks down to glucose fast and often spikes your glucose level too high as a result. A ‘low’ GI food breaks down to glucose slowly and will give a better glucose result as it is giving your pancreas more time to secrete insulin to help process the glucose. What can make things confusing is that you still need to consider how much of these foods you eat and realise that not all lower GI foods are healthy options.
Here is a basic overview of some common examples of lower and higher GI foods. Try to include a lower GI food with each meal/snack you have. (Please note, most brands listed here are Australian.)
Lower GI: Burgen, Tip Top 9 Grain, Bakers Delight Cape Seed, sourdough bread, Bakers Delight Low GI white.
Higher GI: White, wholemeal, some seed breads.
Lower GI: Guardian, All-Bran Original, Goodness Superfoods 1st range, raw muesli, rolled oats.
Higher GI: Weet-Bix, most flake cereals, instant oats.
Crackers & biscuits
Lower GI: Vita-weats, Snackright Fruit Slice, Shredded Wheatmeal, Rich Tea, Highland Oatmeal.
Higher GI: Sao, rice crackers and rice cakes.
Lower GI: Basmati rice, Doongara rice, all pasta, buckwheat, quinoa, bourghul (cracked wheat), hokkein noodles.
Higher GI: Jasmine rice, white and brown rice, couscous.
Lower GI: Kidney beans, baked beans, lentils, chickpeas/ garbanzo beans, butter beans/ lima beans.
Higher GI: Broad beans.
Lower GI: Apples, citrus fruit, pears, berries, stone fruit.
Higher GI: Melon, pineapple, ripe bananas.
Lower GI: Sweet potato/ yam/ kumara, new potato, Coles Carisma potatoes, Nicola potatoes, corn.
Higher GI: Most white potato varieties.
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Lower GI: Low fat milk, low fat yoghurt, low fat ice-cream, low fat custard, soy products.
Higher GI: Full cream ice-cream.
What about exercise?
Exercise uses up glucose to provide energy to your body, so exercise is an important part of managing your glucose levels. Just being on your feet helps so try to stay up or go for a walk for 10-15 minutes after your meals. If you do this, by the end of the day you’ll have managed over half an hour of movement. That’s all you need! Of course if you usually do more exercise you can continue with your usual routine. Other ways to help may be walking to the local shop instead of driving, doing some window shopping at your local centre or getting off the bus a stop or two earlier.
Pregnancy yoga, pilates, swimming, aquarobics, walking…whatever takes your fancy. High intensity exercise isn’t recommended when you are pregnant, so stick to low to moderate exercise that doesn’t make you huff and puff too much. So don’t start doing anything dramatically different. Instead, think about how you can include a bit more activity into your normal day. Keep in mind that too much exercise can limit too much of the baby’s energy source so you want the balance just right. Speak to your obstetrician or midwife if you need more advice on this.
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Why do I need to monitor my blood glucose levels?
Your Glucose Tolerance Test (GTT) showed that you have gestational diabetes but it doesn’t tell how you’ll manage through the rest of your pregnancy. Fingerprick testing is the best way of monitoring the amount of glucose your baby is being exposed to. Your placental hormones increase throughout the pregnancy so how your levels look to start with may not be the same in a few weeks down the track. Ongoing monitoring is needed to keep an eye on things. Your doctor can also arrange additional laboratory tests to get further information about your diabetes control.
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What should my Blood Glucose Levels (BGLs) be?
It’s difficult to provide one number for all women. You may find that the blood glucose targets you are given or even the times you are asked to monitor vary from diabetes centre to diabetes centre. You are best guided by the health professional/s managing you. Typically you will check your blood glucose level when you first wake up in the morning and then after meals (either at one or two hours from the start of eating). You may also check after some snacks or before some of your other meals.
If your blood glucose levels are high after some meals you shouldn’t panic and over-restrict what you next eat. Instead, think about whether you accidentally had more carbohydrate than recommended or if there was some other reason that your level may have gone high. If you notice that you are almost always higher than the target you were given then you need to contact your health provider as insulin may be needed to ensure your baby is kept safe from the high blood glucose levels.
Please remember that undereating will not help you avoid taking insulin and is not the answer to high blood glucose levels. In fact it can cause other potential dangers for your baby (and is not healthy for you either. (See ‘ketones’ in our Glossary section.)
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'Free foods' or foods that won’t affect your blood glucose levels (BGLs)
Non-starchy vegetables such as celery, cabbage, capsicum, eggplant, zucchini, lettuce, spinach, asian greens, tomatoes, broccoli, cauliflower, brussels sprouts, squash, green beans, snow peas, avocado.*
These vegetables won’t cause weight gain and are full of nutrients you and your baby need. ( *With the exception of avocado which is very high in fat.)
Protein foods such as beef, lamb, pork, poultry, fish, seafood, eggs, nuts, seeds, tofu and cheese.
Including protein with your meals and some snacks can help you to feel fuller. They can often be a source of fat though, so take care not to go overboard and choose lean and low-fat versions wherever possible.
Condiments that are okay to cook with include: mustard, vinegars, tomato paste, Worcestershire sauce, chilli, lemon juice, lime juice, curry powder, all herbs and spices, soy sauce, fish sauce and oyster sauce. Select healthier condiment options that are lower in salt, added sugar and total fat.
Drinks such as water, soda water, plain mineral/sparkling mineral water and small amounts of tea, coffee, diet soft drinks and diet cordials.
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Healthy carbohydrate choices
Here is a basic list of healthy carbs. You’ll still need to check your carbs list (from your dietitian) for serving amounts.
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- Breads and crackers
- Breakfast cereals including porridge
- Pasta, noodles, rice
- Other grains such as couscous, bourghul (cracked wheat), buckwheat, quinoa
- Legumes such as baked beans, kidney beans, lentils, chick peas, butter beans
- Starchy vegetables such as corn, potato, sweet potato and to some extent pumpkin, carrot and peas
- Milk and yoghurt
Carbohydrates to avoid
Soft drinks, cordials, fruit juice, dried fruit in excess and lollies.
Also foods such as cakes, muffins, banana bread, slices, chocolate/cream biscuits, potato chips/ hot chips and chocolate. These are all very high in fat as well as containing carbohydrate so they need to be avoided as much as possible and if consumed, only in very small amounts and infrequently.
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Does fat matter?
Fat does matter. Although it doesn’t directly raise blood glucose it does do the following.
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- It makes it harder for your insulin to work so indirectly can result in higher BGLs.
- It may contribute to excessive weight gain making it harder for your diabetes to be managed
- It may increase your cholesterol which in combination with GDM can further the accelerated (over)growth of your baby and
- It’s not good for your heart. While you don’t need to be fanatical about following a strict low fat diet you need to be sensible. It is recommended that everyone over the age of 2 years eat low fat dairy. Choose lean meats and avoid excessive amounts of fats, whether oil, butter or margarine. High fat items such as pastries, fried foods and creamy things should be limited. And bad news for the sweet-tooths but most other high fat items such as cakes and slices tend to have too much carb anyway to be able to include in a GDM diet.