Living with Diabetes While Pregnant Blood Sugar Ranges Diabetes out of Balance for Gestational Diabetes – Pregnancy

Living with Diabetes WHILE PREGNANT Approved by Glycemic Oversight Committee 12/12/17 Table of Contents What Is Gestational Diabetes .................... 2 Symptoms Of Low Blood Sugar .............. 13 What Can Happen To My Baby ................. 2 Insulin Therapy In Pregnancy .................. 14 Blood Sugar Ranges For How Your Insulin Works .......................... 14 Gestational Diabetes ................................. 3 Drawing And Injecting One Insulin ......... 15 Diabetes Out Of Balance, Mixing, Drawing And Injecting Insulin .... 16 Low And High Blood Sugar ....................... 3 Preparing And Injecting Insulin Requirement During Pregnancy ..... 4 With A Reusable Pen ............................... 17 Insulin Resistance In Site Selection And Rotation ..................... 18 Gestational Diabetes ................................. 4 Proper Use And Disposal ......................... 18 Dietary Guidelines For Gestational Diabetes ................................. 5 Sick Day Management ............................ 19 Carbohydrate Counting ........................... 6 Sick Day Food List ................................... 19 Examples Of Carbohydrates Morning Sickness .................................... 19 For Carb Counting .................................... 7 Ideas To Make You Feel Better ................. 19 Foods Low In Carbohydrates ..................... 8 Coping With Heartburn .......................... 20 Non Carbohydrate Foods.......................... 8 What Is Preterm Labor ............................ 20 Nutrition Labels ........................................ 9 Extra Test(s) ............................................ 21 Gestational Diabetes Meal Plan What To Expect After Delivery ................. 21 Recommendations ............................. 10-11 Reducing Your Risk After Eating Out Wisely ................................... 12 Gestational Diabetes .............................. 22 Exercise And Pregnancy .......................... 13 Healthy Start For My Baby ...................... 23 Stress Management ................................ 13 Breast Feeding Guidelines ....................... 23 Medications Used In Pregnancy .............. 13 References .............................................. 24 What Is Gestational What Can Happen Diabetes? To My Baby? It is a type of diabetes only in pregnancy Most babies are n Usually goes away after the birth of the baby. born healthy, but if n Usually detected at 24-28 weeks or the third trimester mothers’ blood sugar (all women are screened.) remains high, the n Normal hormone changes of pregnancy make some following problems pregnant women have higher blood sugar levels. could occur: n Difficult delivery What are the risk factors? n Possible C-section n Family history of diabetes n A high birth weight n Overweight before pregnancy n Baby gains too much fat n Older than 25 years n Baby may need to stay in hospital due to breathing n Previous baby weighing over 9 pounds problems, low blood sugar or jaundice n Previous still birth or miscarriage n Severe high blood sugars, birth defects or still birth n Gestational diabetes in another pregnancy Keeping the blood sugars close to normal helps protect n Member of an ethnic group with a high incidence of the baby from problems. We can help you. diabetes such as Native American, Hispanic, African American and Asian How can I protect my baby? n Causes: The hormones from the placenta work against Eat 5-6 small healthy meals and snacks every day the action of insulin. It is called “insulin resistance.” n Exercise daily As baby grows, more hormones are produced, causing n Test your blood sugar 4 times each day more insulin resistance. n Take your diabetes medication if needed PAGE 2 Living with Diabetes while Pregnant Blood Sugar Ranges Diabetes Out Of Balance For Gestational Diabetes – Pregnancy Fasting 1 Hour 2 Hours After Meal After Meal 60-95 < 140 <120 Hypoglycemia Hyperglycemia Low Blood Sugar High Blood Sugar Your provider will ask you to check your blood sugars 4 times each day. EARLY Blood Sugar 50-60 Several Blood 1. Right after you wake up in the morning (after an g Hunger Sugars >180 8-10 hour fast.) g Headache g Very thirsty 2. One hour after you start eating or drinking your first g Dizzy g Dry skin food in the morning. g Sweaty g Increased urination 3. One hour after your first bite of lunch. g Shaky g Very tired g 4. One hour after your first bite of dinner or supper. Grouchy g Increased 5. You could set a timer or alarm to go off after the heart rate start of your meal, about 1 or 2 hours, to remind you to check your blood sugar. LATE g Slurred speech Blood Sugar >240 NOTE: People who are not pregnant are allowed to SYMPTOMS g Confusion g Nausea have higher blood sugars than you are…because they g Seizures g Vomiting are NOT pregnant. g Passed out Use Glucagon or call 911 BG <60 g Call doctor or Rule of 15/15 provider g 15 grams fast acting g Test blood sugar sugar such as 4 oz g Drink water juice, 5-6 lifesavers, g Take medication – 4 glucose tablets, do not omit 8 oz skim milk g Wait 15 minutes g Repeat blood sugar test g If >60 eat meal TREATMENT or protein with carbohydrate snack g Too much g Not enough medication medication g Missed meal or g Too much food snack g Illness or infection g Unusual or g Not enough exercise unplanned exercise CAUSES Tucson Medical Center PAGE 3 Insulin Requirement During Pregnancy Insulin Resistance In Gestational Diabetes During pregnancy, your body makes more hormones and goes through other changes, such as weight gain. These changes cause your body’s cells to use insulin less effectively, a condition called insulin resistance. Insulin resistance increases your body’s need for insulin a hormone produced by your pancreas. If your pancreas cannot make enough insulin, you will have gestational diabetes. All pregnant women have some insulin resistance during late pregnancy. However, some women have insulin resistance even before they get pregnant, usually because they are overweight. These women start pregnancy with an increased need for insulin and are more likely to have gestational diabetes. PAGE 4 Living with Diabetes while Pregnant Dietary Guidelines For Gestational Diabetes Eat 3 regular meals and 3 snacks every day. The ideal timing is to eat your meals and snacks that contain carbohydrates 2-3 hours apart. This allows your blood sugar levels to normalize between each meal. Drink at least six to eight 8-ounce glasses of water or sugar free, caffeine-free beverages every day. Eat a variety of non-starchy vegetables such as broccoli, cauliflower, cucumbers, carrots, etc. each day with your meals and snacks. Choose a variety of whole grain products, such 100% whole wheat bread, brown rice or whole wheat pasta. Eat a variety of lean meats with each meal and snack such as lean beef, lean pork, skinless chicken and turkey. You may also eat meat substitutes such as low fat cheese, low fat cottage cheese, eggs and peanut butter. Limit fish and shellfish to no more than 12 ounces per week. Products with low mercury concentration are safe to eat including: shrimp, canned light tuna, salmon, pollock and catfish. Avoid fish with high concentrations of mercury such as shark, swordfish, king mackerel and tile fish. Avoid drinking fruit juices or regular soda (unless your blood sugar is already too low.) Squeeze a fresh lemon into your water for variety. Use a water infuser pitcher with lemon, mint, cucumber or slices of strawberries. Avoid eating table sugar or concentrated sweets, such desserts, jelly, jams, honey, candy or syrup. Tucson Medical Center PAGE 5 Carbohydrate Counting Carbohydrate (carb) counting is simply counting the grams of carb from the foods you 1 carbohydrate choice = 15 grams eat each day. It is becoming a way of life for many people, and it works especially well for those with diabetes. By measuring the number of grams of carb in your meal plan, you can better control your blood glucose levels and weight. The main carbohydrate containing foods are starches, fruits, milk/yogurt and sugar/sweets. Almost all foods contain carbohydrates. The amount of carbohydrates in each product must appear in the 8 ounces milk = small apple = product label. Therefore, one must learn how to read 12 grams 15 grams food product labels. For those foods that do not have labels, such as fresh fruit, learning the appropriate portions sizes of the food is necessary. The amount of carbs you eat at a meal is more important than the specific foods. The key is to eat only the amount of carbohydrates you need each day at the right times. Of course, you want to eat healthy carbohydrates foods such as whole grains, beans, non-starchy vegetables, fresh fruits and low fat milk. Important Points to Remember Managing portion sizes is the most difficult part 1 teaspoon 1 tablespoon 1 ounce of carb counting, especially when eating out. It is Use this for oil and butter Peanut butter of cheese important to follow the recommended portion sizes as indicated on your meal plan. The rest can be taken home to enjoy later. Even the healthiest foods can increase your blood sugar level above the goal if you overeat. You may need to adjust the amount of carbohydrate you eat when you exercise. You should discuss this with your dietitian. If your blood sugar levels go too high or too low, you 3 ounce 1/2 cup 1 cup need to review what you ate, the portion size, the type To measure Equivalent to size of computer For cooked of food, and the time of day in relation to your meal your meats mouse. Use

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