FAQ

I was just told that I have gestational diabetes. Should I be worried?
Gestational diabetes occurs in about 9% of pregnancies in Nova Scotia and higher in certain populations. It is a condition that happens in some women during pregnancy. You can be diagnosed with gestational diabetes and have a very healthy baby though having this condition means paying some attention. First, it is good to understand what gestational diabetes is.

General Guidelines for Women with Gestational Diabetes
(who are waiting for an appointment with a Dietitian)

What is gestational diabetes?

Screening for Diabetes During & After Pregnancy

Gestational diabetes is a type of diabetes that some women develop during pregnancy due to changing hormone levels in the placenta. Gestational diabetes makes it hard to control your blood glucose (sugar). Insulin is a hormone that helps the body put glucose away in the cell. It is not good for mom or baby to have too much glucose in the blood stream. During pregnancy, the hormones make it hard to make enough insulin. If the body cannot make enough insulin, blood sugars will rise. Controlling diet, staying active and testing blood sugars can help keep mom and baby healthy.

My test result showed I was really close to normal blood sugar level but I was told I still have gestational diabetes. What does this mean?
The test result just indicates potential problems. The result, if positive even slightly, means you need to take steps to control gestational diabetes and see what your blood sugars are through testing.

Why did I get gestational diabetes?
There are some risk factors in developing gestational diabetes:

being over 35 years of age
having a family history of type 2 diabetes
if you are overweight (Body Mass Index 30 or more) or gained greater than recommended weight for weeks of pregnancy
gestational diabetes in a previous pregnancy
had a large baby (greater than 9 lbs) at full term
have polycystic ovarian syndrome
from Aboriginal, South Asian, Asian, African, Middle Eastern or Mediterranean background

Sometimes there are no risk factors and you can still develop gestational diabetes

What happens if my blood sugars go too high?
High blood sugar levels can cause your baby to put on too much weight; especially around the belly. This weight gain can impact the baby's delivery at birth and health later on in life (obesity and chronic health conditions associated with obesity). Your baby may have problems managing its own blood sugars at birth and may not get enough nutrition if your blood pressure goes too high (gestational diabetes can cause high blood pressure during pregnancy).

Will my baby be born with diabetes?
No, a mother does not pass diabetes onto her baby directly. However, there is an increased risk for your baby becoming obese or developing type 2 diabetes later in their life.

Will my baby need treatment when he/she is born?
Managing your gestational diabetes can reduce the need for treatment of your baby at birth. Sometimes your baby may have low blood sugars and need to be given intravenous fluids or feeding to normalize their blood sugars. They may have problems with jaundice also. Speak with your doctor or midwife about these conditions before delivery.

I don’t feel like I have diabetes. Shouldn’t I have symptoms like other people with diabetes?
Usually there are no symptoms of gestational diabetes. This is why all women are screened for diabetes between 24 and 28 weeks or sooner if there are risk factors. Screening prevents complications from happening later in pregnancy.

What do I do now that I have gestational diabetes?
It is important to work with your healthcare team to manage blood sugar levels and keep them in the normal range during pregnancy. After your baby is born, gestational diabetes usually goes away. However, you do have a higher risk of developing type 2 diabetes in your next pregnancy and later in life.

Why aren’t pregnant women screened earlier than 24-28 weeks?
The hormones of pregnancy that make your body have less insulin often increase between 24-28 weeks. These hormones can keep increasing as pregnancy progresses so it is important to manage gestational diabetes until the end of your pregnancy. Diagnosing and treating gestational diabetes between 24-28 weeks can avoid complications later on in pregnancy. Some women with risk factors may be screened early (10-14 weeks).

What happens after my pregnancy if I have gestational diabetes?
Your blood sugars usually return to normal once your baby is born but you are still at higher risk of developing type 2 diabetes in the future. Your health care provider will give you a lab slip to screen for diabetes about 6 weeks after delivery. It is important to get this test done. The best way to avoid getting type 2 diabetes is to follow the advice given by your team on diet, lifestyle and controlling your weight.

Can I breastfeed after having gestational diabetes?
Absolutely! Having gestational diabetes will not impact your ability to breastfeed. Breastfeeding can help avoid low blood sugars in your baby at birth and may also help reduce your baby’s risk of being overweight and developing diabetes later in life.

How can I best manage gestational diabetes so that my baby and I are healthy?

Choose a healthy diet for you and your family now and in the future
Achieve a normal pregnancy weight gain
Be physically active, if possible
Test your blood sugars
Take insulin, if needed

This web page will assist you in managing gestational diabetes while working with your health care team.

Nutrition and Diet for Gestational Diabetes

Eating and Gestational Diabetes
Following a healthy eating plan is important and to:

Keep your blood sugars within target
Provide proper nutrition for you and your baby
Achieve proper weight gain during your pregnancy

Women with gestational diabetes are encouraged to:

Eat 3 balanced meals at consistent times
Eat small amounts often (for exmaple, every 2-4 hours)
Satisfy hunger
Include some healthy carbohydrates in every meal and snack
Choose foods that are varied and enjoyable

Choose foods that:

Are low in fat and high in fibre
Are healthy sources of carbohydrates (grains, cereals, pasta, rice, fruit)
Provide what you need during pregnancy: calcium (milk, cheese, nuts, tahini), iron (red meat, chicken, fish, chickpeas, tofu) and folic acid (dark green leafy and orange vegetables)

What are carbohydrates:

Carbohydrates are broken down into glucose and used by the body for energy
They are very important for you and your baby
To help manage your blood sugars, it is important to spread your carbohydrates over 3 small meals and 2-3 snacks each day. Consistency and moderation of carbohydrates is the key to helping your blood sugars
Timing of your meals and snacks is very important so that you have stable blood sugars and do not overeat at meals

Foods containing carbohydrates:

Multigrain or whole grain breads and breakfast cereals
Whole wheat, whole grain pasta, noodles and rice
Potato, sweet potato and corn
Legumes such as baked beans, red kidney beans and lentils
Fruits
Yogurts, milk

Carbohydrates that contain little nutritional value:

Sugar or sucrose
Soft drinks
Fruit juices (even 100 % fruit juice)
Cakes (and muffins) and cookies. It is wise to avoid these foods or eat in moderate amounts ( see below section on treats)

Do not restrict carbohydrates

Sometimes blood glucose levels can continue to be high, even with healthy eating and activity
It is important to follow your meal plan and not cut back too much on carbohydrates as the baby uses them as its main energy source

Fats
Fats do not affect blood sugars directly but too much can cause extra weight gain which can cause problems with blood sugars

Use healthier fats like canola and olive oils, unsaturated oils and margarines, avocados and unsalted nuts
Limit the amount of fat you eat, especially saturated fats by selecting lean meats, skinless chicken and low-fat dairy foods
Avoid takeaway foods and processed foods

Protein

Include protein with all meals to help keep your body healthy and for the growth and health of your baby
Protein can help you feel full longer and prevent overeating
Protein foods include lean meat, skinless chicken, fish, eggs and cheese, milk, yogurt, custards, and legumes (beans, lentils, chickpeas)

Healthy Plate
Draw imaginary lines on your plate to ensure a good balance of all food groups.

½ vegetables
¼ protein
¼ carbs

What Can I Drink

Water, plain mineral water or soda water is best - you can add a small bite size piece of fruit (lemon, lime, orange, melon, cherry) to add some flavor
Avoid juices, pop and energy drinks as they are high in sugar

What if I am still hungry?

Make sure you are eating according to the meal plan suggested by your dietician. If you are still hungry then choose larger portions of protein and unlimited portions of non-starchy vegetables

Can I still eat sweets like chocolate?

Sweet treats can be eaten on occasion but portion control is key
There are some treat options you can include as a substitute into your meal plan. Your dietitian can help with this.
Having a treat at a time of day when blood sugar runs in target range may be an option
Being active after a small treat may help keep your blood sugars in target
There are ways to work a treat into your meal plan without guilt so speak with your dietitian for ideas

Are artificial sweeteners safe in pregnancy? Health Canada has set out guidelines for the safety of artificial sweetners in pregnancy. The following is a list of sweetners that are considered safe in moderation in pregnancy. You can refer to the Health Canada website for more information about specific amounts. See pdf on sweeteners.

Aspartame (Equal / Nutrasweet)
Sucralose (Splenda)
Acesulphame
Stevia
Avoid saccharin, cyclamates (Sugar Twin or Sweet’N’Low)

Testing Your Blood Sugars

Testing Your Blood Sugars
Testing blood sugars at certain times of the day can help determine whether your meal plan and exercise plan is working well for you.

Hormones and blood sugar values
Hormones of your placenta are changing as you go through pregnancy. Blood sugars may be good at first but can still rise above normal as hormones increase. Differences in diet and activity can also raise blood sugars; it is for this reason that testing throughout your whole pregnancy is so important.

Timing of blood sugar testing
Your health team will provide you with a blood sugar meter and teach you how to use it. Testing involves a small finger poke which the value is logged in a book. The timing of your test is important. Test before meals noting the time; then test one hour after your meal –after finishing your last bite of food. Note the time and the value in your log book.

Normal Blood Values for Pregnancy
Blood sugar target values are a little lower for pregnancy than people who have diabetes but are not pregnant.

Before meals(fasting): 3.8 to 5.2 mmol/L

One hour after meals: 5.5 to 7.7 mmol/L

Two hours after meals: 5.0 to 6.6 mmol/L

Comparison of blood sugar meter to lab meter
To ensure your meter is working properly and giving accurate results, you will be asked to take your meter to the lab and compare blood sugar readings from your meter to the labs meter. The tests need to be done within 5 minutes of each other. A small difference in values is normal.

Blood sugar test schedule Generally you will need to test your blood sugars before and after 1-3 meals per day. To start, you may be asked to test before and one hour after breakfast one day before and one hour after lunch the next day and before and one hour after supper the next day. Repeat this schedule on days going forward. If your blood sugars are high with any of these meal readings you may be asked to test more often at times of the day.

Higher blood sugar readings Your team will be looking for a pattern of higher readings. Your dietitian will review your blood sugars and determine whether changes can be made to diet and exersize to bring the readings closer to target. If your blood sugars are sometimes high, there is no need to panic. Continue to test and watch for trends. If diet and exercize cannot keep blood sugars in target you may need insulin. It is important not to restrict your diet to avoid insulin as this is not healthy for you or your baby.

Medications if Needed

Even when you follow the gestational diabetes nutrition guidelines and have a healthy level of activity, your blood sugars may not return to normal. Hormones of pregnancy make it hard for your body to make the right amount of insulin. When this is the case you may need insulin by injection. Currently diabetes pills are not recommended during pregnancy therefore insulin injection is the only option.

Arrangements will be made by your health team for education if insulin is needed. The number of insulin injections and doses you will need will depend on records of what you are eating so the health team can suggest the proper insulin dose. You will be keeping in close contact with your health team and may have more appointments and tests to ensure you and your baby are healthy. The idea of insulin can be very worrisome for some patients but remember it is safer to be on insulin than to have high blood sugars. Your health team can answer all your questions about insulin if and when it is needed.

Exercise and Activity

Exercise and activity is an important part of managing your gestational diabetes as long as your doctor is okay with you being active. Moving around or going for a short walk (10 minutes) after a meal can really help your blood sugars after a meal. It is recommended to include 30 minutes of daily physical activity. It is not necessary or advised to exercise excessively. If you were exercising before, you should be able to continue your usual level of exercise and activity. Some ideas for activity to try are pregnancy yoga or pilates, swimming, walking are just a few ideas. If interested in beginning an activity program, be sure to consult with a physiotherapist or health care professional about how to safely start and progress throughout pregnancy.

Regular physical activity can help control your blood glucose (sugar) levels. It can also help you:

Boost your energy
Sleep better
Reduce stress
Reduce pregnancy back and joint discomfort associated with pregnancy
Prepare for childbirth
Get your body back faster after childbirth

After Baby is Born

Your Emotions and Gestational Diabetes
Learning that you have gestational diabetes may cause you to feel worried or anxious. These are common feelings to have. Once you get more information, you should start feeling better because most women with gestational diabetes can have a very healthy pregnancy. Learning about gestational diabetes can be a bit overwhelming but your health team is here to support you.

Learning to manage your stress will also go a long way. It is best to find relaxation techniques, interests and hobbies as a means of dealing with the stress rather than over-eating especially high fat or sweet foods. Stress can also impact your activity level and may affect your blood sugars. It is important to seek support from family, friends and your health team to deal with these issues.

Additional Nutrition Resources

Meal Planning

Eating Affordably

Healthy Weight Gain and Gestational Diabetes

Excess weight can make it hard to manage blood sugars and affect the amount of insulin made by the body. It is for this reason that following a healthy diet and being active is so important. The amount of weight gain recommended in pregnancy depends on your weight before you were pregnant though you may notice your weight gain slows down or drops a bit once you make lifestyle changes. As long as you are following the suggested nutrition guidelines by your health team, these weight changes should not be of concern. Speak with your health team if you are concerned about your weight.

Patient Education Library

Pregnancy