AultCare Gestational Diabetes Education Guide

Gestational Diabetes Education Guide

TAKING CARE OF YOUR GESTATIONAL DIABETES

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This booklet is intended for general information only. The content of this manual represents the views and content of the cited original authors and sources. CCS Medical is not responsible for any errors or omissions contained herein. This booklet is not intended to constitute medical advice. Readers should direct any medical questions to a competent healthcare professional. Individuals are recommended to consult with their physician before modifying their treatments, beginning an exercise program or changing their diet. Data not specifically cited herein compiled from: ADA (American Diabetes Association), ADCES (Association of Diabetes Care & Education Specialists), USDA (United States Department of Agriculture), ADA (Academy of Nutrition and Dietetics), AACE (American Association of Clinical Endocrinologists). CCS Medical assumes no responsibility for the misuse or incorrect use of any information contained herein. This booklet, and the information contained herein, is copyright protected by CCS Medical and cannot be reproduced without the express written permission of CCS Medical.

TABLE OF CONTENTS

Overview Introduction What Is Gestational Diabetes? What’s Happening Inside My Body? Why Did This Happen To Me? Wellness What Can I Eat? What Can I Drink? Staying Active Checking Your Blood Sugar Healthy Coping Postpartum After Delivery Should I Breastfeed? What’s Next?

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Taking Care of Your Gestational Diabetes Introduction If you have gestational diabetes, you may be confused. You might be unsure about what to eat, or you might be worried about checking your blood sugar. Gestational diabetes may seem like a lot to handle, but don’t worry. You can take care of yourself and your baby. Feeling upset about having gestational diabetes is common, and you are not alone. There is nothing you did wrong to make this happen, and there is a lot you can do to manage it. Your LivingConnected ® team is here to help you every step of the way. With the help of your healthcare team, you can have a healthy pregnancy and a healthy baby. This guide will help you learn to eat well, stay active, and check your blood sugar while you are pregnant. You will also learn how to take care of yourself and your baby after you give birth. You and your new baby can have happy, healthy futures.

What is gestational diabetes? Diabetes means “too much sugar in the blood.” When pregnant women have too much sugar in their blood, that is called “gestational diabetes.” Women who have diabetes while they are pregnant need extra care to stay healthy. Up to ten percent of pregnant women in the US have gestational diabetes. 1 It is one of the most common pregnancy issues. 2

What’s happening inside my body?

When you eat starchy or sugary foods, those foods are broken down into tiny bits of sugar. Then, the bits of sugar move into the bloodstream. It’s good to have some sugar in the blood, but not too much. To help keep our blood sugar level from getting too high, our bodies produce a hormone called insulin. Insulin helps blood sugar get inside the cells that need it for energy. Around 24 weeks (about 5 and a half months) of pregnancy, your body needs two or three times as much insulin as usual. Most women can make this extra insulin. However, some women are not able to make the extra insulin they need. Those women then develop high blood sugar. 1. https://www.cdc.gov/. Accessed 11.03.22 2. Casagrande, S. S., Linder, B., & Cowie, C. C. (2018). Prevalence of gestational diabetes and subsequent Type 2 diabetes among U.S. women. Diabetes research and clinical practice, 141, 200–208. https://doi.org/10.1016/j.diabres.2018.05.010

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Why did this happen to me? High blood sugar in pregnancy is not your fault. Don’t blame yourself or worry too much about why your blood sugar is high. The only thing we need to focus on right now is taking care of you and your baby. But since you asked, women who are at higher risk for gestational diabetes include: 3 • Being overweight • Not getting enough exercise • Age 35 or older while pregnant • Having more than one child • Having a parent, brother or sister with diabetes • Being of a certain race or ethnicity, such as Black, Hispanic, American Indian and Asian American • Having previously delivered a baby weighing more than 9 pounds • High blood sugar in another pregnancy • Polycystic ovarian syndrome (a medical condition)

What does gestational diabetes mean for me and my baby?

If gestational diabetes is not taken care of during pregnancy, it could cause these problems for your baby: • Low blood sugar during and after birth • Large birth weight (a baby weighing more than nine pounds) • A higher chance of being born too early And it could cause these problems for you during your pregnancy: • The need for a Caesarean section (C-section) due to a large baby that won’t fit through the birth canal • A higher risk of high blood pressure

3. https://www.mayoclinic.org/diseases-conditions/gestational-diabetes/symptoms-causes/syc-20355339

Do I need insulin shots?

Most women can change what they eat and increase their activity level. This will keep their blood sugar under control. As you get closer to your due date, your body will need more insulin. So, you could need insulin at the end of your pregnancy even if you don’t need it now. That’s why checking your blood sugar and staying in touch with your health care team is so important. If your doctor thinks you need insulin, they will tell you right away. If you need insulin, that doesn’t mean you have done something wrong. It just means you need to take another step to make sure you and your baby stay healthy and safe.

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What Can I Eat?

There are three main nutrients in food:

Carbohydrates

Proteins

Fats

The nutrient that will raise your blood sugar is carbohydrates. Proteins and fats have only a small impact on your blood sugar. You still need some carbohydrates. You just need to pay attention to how many carbs you eat. Foods that have carbohydrates are: • Breads • Cereals (hot or cold) • Starchy food like rice, pasta, crackers, corn, and potatoes • Fruit • Milk and yogurt • Beans and legumes (such as black beans, kidney beans, garbanzo beans, lentils) • Sweets and sugary foods, including honey and molasses

Plate Portions

To help you get full without raising your blood sugar too much, it helps to think about how to fill your plate.

Fill at least half of your plate with non-starchy vegetables: • Leafy greens, onion, cucumber

• Celery, peppers, tomatoes • Carrots, mushrooms, squash • Green beans, eggplant, okra • Spinach, snap peas, snow peas

Fill one-quarter of your plate with protein: • Chicken, turkey and eggs

• Fish: salmon, cod, tuna or tilapia (no swordfish) • Shellfish: shrimp, scallops, clams, mussels, or lobster • Lean beef: chuck, round, tenderloin • Lean pork: tenderloin, chop • Cheese or cottage cheese • Plant-based protein: edamame, tofu, tempeh

Fill the last quarter of your plate with carbohydrates: • One-half cup brown rice, quinoa, whole grain pasta, oats/oatmeal • Four to six crackers • One slice whole grain bread • One dinner roll • One-half cup beans (such as black beans, kidney beans, garbanzo beans, or lentils)

Add one small piece of fruit, about the size of a tennis ball

Add eight ounces of milk or 1 carton plain or light yogurt, if desired.

If you are still hungry, fill up on non-starchy vegetables and protein foods.

At breakfast, your hormones will make your blood sugar run higher. Avoid fruit and milk for breakfast. Instead, choose a whole grain and one to two ounces of protein.

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What Can I Drink? Many sweetened drinks have lots of carbohydrates. They will raise your blood sugar quickly. You will want to choose drinks that do not have sugar or carbohydrates, such as these: • Unsweetened hot tea or unsweetened iced tea • Unsweetened coffee (hot or iced) • Sparkling water, club soda • Flavored sparking water without added sugar • Water • Diet soda in moderation

Is it OK to snack with gestational diabetes?

Women with gestational diabetes need to eat three meals and three snacks each day. Space your meals and snacks two to three hours apart. You can always eat as many non-starchy vegetables as you want, any time of day. To keep your blood sugar from going up too much, combine a protein with a small serving of carbohydrate at each snack. Here are some ideas: • 4 crackers and a slice of cheddar cheese

• 1 slice of toast and 2 Tablespoons of peanut butter • Celery and carrot sticks with 2 Tablespoons of hummus • 1 small apple and a piece of string cheese • A hard-boiled egg and 15 grapes

Staying Active

Exercise is a great way to help lower your blood sugar. When you move, your muscles use the sugar in your blood for energy. That brings your blood sugar down.

Being active helps you stay in shape during pregnancy and makes delivery easier.

Pregnant women with gestational diabetes need 20-50 minutes of exercise at least 2 days per week. If you feel well, moving your body every day is a great idea. If you did not exercise before pregnancy, check with your doctor to make sure it’s OK to start now. Most pregnant women enjoy walking for exercise. Some women like prenatal aerobics classes, yoga, or swimming. When you exercise, don’t overdo it. If you are gasping for breath, you are working out too hard. Try to work out at a pace where you can still talk to a friend without getting out of breath. During your second and third trimester of pregnancy, don’t lie on your back. This may cut off the flow of blood to your baby, and it may also make you dizzy.

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Checking your Blood Sugar

Your doctor will ask you to check your blood sugar several times every day until your baby is born. Your doctor may ask you to check your blood sugar at these times: • First thing in the morning, before you eat or drink (this is called your fasting blood sugar) • One hour after the start of each meal • At bedtime • When you feel any of these symptoms

• Headache • Very thirsty • Sweaty (without exercising) • Confusion • Dizzy • Weak or shaky • Unusually tired or sleepy

What should your blood sugar levels be?

• Fasting or before a meal, blood sugar should be under 95 mg/dL • One hour after the start of a meal, blood sugar should be under 140 mg/dL • Two hours after the start of a meal, blood sugar should be under 120 mg/dL If your blood sugar is a little over the limit, don’t panic. Make a note of what you had to eat and drink at your most recent meal. Talk with your health care team about how to bring your blood sugar levels down. A CCS clinician will call to check on you to make sure you are OK if your blood sugar is: • under 54 mg/dL or • higher than 250 mg/dL • OR if you have high or low blood sugar patterns

Please call your doctor right away if you have:

• Bleeding • Pain • A sudden or severe headache • Sudden swelling • Fever • A decrease in your baby’s movements

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Healthy Coping

Pregnancy is an exciting time. It can also be a stressful time. You might feel like there are changes happening everywhere: inside your body, in your relationship with your spouse or partner, and in your extended family. You may be thinking about getting your home ready for your new baby, taking time off from work, or finding childcare. All these decisions can feel like too much. And when you add gestational diabetes to the mix, you may start to feel nervous, upset, or angry. If you can relate, try taking some extra time just for yourself each day. Some things that might help are: • Meditation or prayer • Picturing a happy scene in your mind

• Physical exercise • Deep breathing • Writing in a journal • Talking to a therapist • Humor: watching funny movies • Talking to a friend

If you think you might need more help than just the ideas listed here, don’t hesitate to ask. Reach out to your doctor or your CCS Diabetes Educator. We’re here to help you and we would be happy to help you find the resources you need to cope. Remember that gestational diabetes is not your fault. There’s nothing you did wrong to get this condition. We’re here to help you have a healthy pregnancy and a healthy baby.

POSTPARTUM

diabetes.” Get your blood sugar checked every year to make sure it’s OK. You may be able to reverse pre- diabetes by eating well and exercising. • If your blood sugar shows that you have diabetes, work with your doctor to manage it. Your CCS Dietitian can help you plan your meals. Your CCS Diabetes Educator can help you understand how to take care of yourself. If your blood sugar is normal after you give birth you still have a higher chance of getting type 2 diabetes later, and so does your baby. You can lower your risk of type 2 diabetes by eating a healthy diet and getting plenty of exercise. Ask for help if you need it. We’re here to support you. If you want to have another baby If you decide to have another baby, see your doctor before trying to get pregnant. Your doctor will check your blood sugar to make sure it’s OK. You’ll want to be as healthy as possible before you try for another baby. Staying Healthy To prevent type 2 diabetes in your future, continue these healthy habits after your baby is born: • Eat lots of non-starchy vegetables and lean meats • Limit sweets and sugary foods • Get regular exercise • Keep a healthy weight • See your doctor and get regular blood sugar checks

After Delivery

In the hospital

Babies whose moms have gestational diabetes sometimes have trouble with low blood sugar. In the hospital, your baby will need to have their blood sugar checked. Your nurse will check your baby’s blood sugar by pricking their heel. It’s normal to feel upset when you see your baby in pain. Know that blood sugar checks are needed to be sure your baby is safe. The extra checks will stop in a day or two, as soon as your healthcare team is sure that your baby’s blood sugar is not too low.

When you go home

Most of the time, gestational diabetes goes away soon after birth. Your doctor will probably check your blood sugar about six weeks after you give birth, at your check-up. • If your blood sugar is normal, that’s great! But you still have a higher chance of getting type 2 diabetes later in your life. Get your blood sugar checked every three years to make sure it’s OK. Eating well and staying active are important for keeping your blood sugar normal. • If your blood sugar is high, but not high enough for diabetes, that is “pre-

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Should I Breastfeed?

Benefits of breastfeeding Breastfeeding is healthy for you and your baby, now and in the future. Your milk is perfect for your newborn baby, and it changes to match your baby’s needs as they grow older. These are some of the benefits of breastfeeding for babies: • Easier to digest than formula: less spit-up, diarrhea, and constipation • Breastfed babies get a boost to their immune system through their mother’s milk • Breastmilk helps premature babies with brain development

• Breastfed babies have less risk of SIDS (crib death) • Breastfed babies have a lower risk of type 1 diabetes 4 • Breastfed babies have less risk of becoming overweight • Breastfed babies have fewer ear infections

And these are some of the benefits of breastfeeding for moms: • Breastfeeding helps your uterus shrink down to the size it was before your pregnancy • Breastfeeding can delay the return of your period. (Talk with your doctor before having sex.) • Breastfeeding for two months can cut your risk of type 2 diabetes in half.

4. https://diabetes.org/diabetes/gestational-diabetes/diabetes-breastfeeding#:~:text=But%20the%20good%20news%20is,the%20risk%20by%20 almost%20half Accessed 1/30/2023

When is breastfeeding NOT safe?

Breastfeeding is not recommended for moms and babies with these health conditions: • Human immunodeficiency virus (HIV) • Active tuberculosis (TB) • Chickenpox (contracted 5 days before delivery, until 2 days after delivery) • COVID-19 (talk to your doctor about the latest advice) • Drug use (talk to your doctor about alcohol use) • Use of some medications (talk to your doctor) • Use of some vitamins and nutritional supplements (speak with your doctor) Getting started with breastfeeding Breast milk usually comes in about two days after giving birth. But having high blood sugar can make it take a little longer for your milk to come in. If you have a C-section, that can also delay your milk production. Moms who don’t expect the delay may feel like breastfeeding is not going well. But when you know what to expect, you can be prepared to get breastfeeding off to a great start. To help your milk come in as quickly as possible, nurse your baby within the first hour after giving birth. Keep nursing at least every 2-3 hours, even if you aren’t yet making milk. Let your baby stay on each breast as long as they want to nurse. When you nurse your baby, your body gets a signal that says, “I need to make milk!” Breastfeeding takes some getting used to, but it should not hurt. If you have pain with nursing, ask for help from your hospital’s lactation consultant right away.

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What’s Next? High blood sugar in pregnancy comes with some risks right now. It also means there are some risks for you and your baby in the future. Here are those future risks: • Your baby has a higher risk of becoming overweight • You and your baby both have a higher chance of getting type 2 diabetes • There is a higher chance that you will have high blood sugar if you become pregnant again If that sounds stressful, don’t worry. Just because you have some increased risks doesn’t mean that you have an unhealthy future. You can do a great job of taking care of yourself and your baby while you’re pregnant. We’ll be with you every step of the way to help make sure you have a healthy pregnancy and a healthy baby. We’ll make sure you know what you need to eat and how important it is to make time to be active. We’ll help you learn about insulin if you need it, and we’ll be an extra pair of eyes watching over your blood sugars to make sure they stay right where you want them. You can do a great job of taking care of yourself and your new baby after you give birth, too. Talk with your healthcare providers and plan to eat healthfully and live an active life. The end of your pregnancy is the perfect time to begin a lifetime of healthy habits for your new family.

We’re here for you, Mom.

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