Diet Gestational Diabetes Mellitus

The way to keep your blood sugar levels under control is to follow a specific meal plan. Good nutrition is very important during pregnancy if you've developed gestational diabetes mellitus. It is important to control the amount of carbohydrate by eating the same amount of carbohydrate along with some protein and fat at each meal.

Here are some general dietary guidelines:

Eat a variety of foods, distributing calories and carbohydrates evenly throughout the day. Make sure both your meals and your snacks are balanced.

Eat less carbohydrate at breakfast.

Do not skip meals or snacks. Your blood sugar will remain more stable if your food is distributed evenly throughout the day and consistently from day to day.
Include foods high in fiber such as whole-grain breads, cereals, pasta, rice, fruits, and vegetables. These foods are broken down and absorbed more slowly than simple carbohydrates, which may help keep your blood sugar levels from going too high after meals.

Protein helps to make you feel fuller, sustain energy, and give you better blood sugar control.
Try to eat a consistent amount of carbohydrate during each meal and snack.

Restrict  intake of foods and beverages that contain simple sugars such as soda, fruit juice, flavored teas and flavored waters, and most desserts – or avoid them altogether. These foods will  quickly increase blood sugar.

Gradually increase your activity level is also a good way to help keep your blood glucose levels at normal levels. You may need consult with your diabetes educator or practitioner regarding  proper diet and exercise.

Milk is high in lactose, a simple sugar, so you should  limit the intake you drink and find an alternative source of calcium.

Drink at least 8 cups (or 64 ounces) of liquids per day.
Include of iron-rich foods per day to ensure you are getting 30 mg in your daily diet. Sources of iron include enriched grain products (rice); lean meat, poultry and fish; leafy green vegetables and eggs.

If you have morning sickness, eat 1-2 servings of crackers, cereal or pretzels before getting out of bed; eat small, frequent meals throughout the day and avoid fatty, fried and greasy foods.

Add Vitamin A in your daily diet. Sources rich in Vitamin A include carrots, apricots, water squash, pumpkins, sweet potatoes, cantaloupe, spinach, turnip greens, and beet greens.

Avoid  drinking alcoholic beverages.

Do not try to lose weight during pregnancy,  to maintain both you and your baby  healthy.

Limit caffeine to no more than 300 mg. daily

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Treatment for Gestational Diabetes Mellitus (GDM)

Treatment for gestational diabetes mellitus (GDM) goals to keep normal blood glucose levels equal to those of pregnant women who don't have gestational diabetes.Gestational diabetes mellitus (GDM) can harm you and your baby, you have to seek treatment as soon as possible.Treatment for gestational diabetes mellitus (GDM) will involve special meal plans and scheduled physical activity including daily blood glucose testing and insulin injections.

Dietary therapy: Dietary therapy is the primary therapeutic strategy for the achievement.

Diet is the way of treatment in gestational diabetes mellitus whether or not pharmacologic therapy is implemented. You may need consult to your doctor, nurse educator, and other members of your health care team regarding treatment for gestational diabetes mellitus.

Obey with your treatment for gestational diabetes mellitus will give you a healthy pregnancy and birth.

Caloric restriction should be approached.

The most appropriate intervention would be exercise, which affects insulin resistance and, in the absence of either medical or obstetric complications. It is the most suitable intervention for gestational diabetes mellitus women.

Blood Glucose Monitoring. On commencement of self monitoring, at least one fasting and one 1 or 2 hour postprandial glucose level should be obtained daily.

Insulin therapy: The current recommendations of the American Diabetes Association for gestational diabetes mellitus treatment (2) state that insulin treatment should be initiated if diet therapy fails to maintain plasma glucose values equal to or lower than 5.8, 8.6 and 7.2 mmol/l under fasting conditions and 1 and 2 h after meals, respectively. In addition, Patients who have gestational diabetes mellitus (GDM) need insulin to achieve acceptable blood glucose control, underlining the importance of monitoring blood glucose to detect those who are at risk of developing overt diabetes.

Ultrasonography : Fetal ultrasound assessment is very important in gestational diabetes mellitus. In the case of true gestational diabetes mellitus, ultrasound gives a precise information about fetal weight, amniotic fluid volume, to detect fetal malformations, confirming fetal maturity, and also to detect and diagnose hydramnios.

Delivery:Prolongation of gestation past 38 weeks increases the risk of fetal macrosomia without reducing cesarean rates, so that delivery during the 38th week is recommended unless obstetric considerations dictate otherwise.

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Maternal Complications of Gestational Diabetes Mellitus (GDM)

Diabetic ketoacidosis (DKA). In gestational,  DKA resulted from diabetes mellitus at lower blood glucose level (i.e., <200 mg/dL) and more rapidly then in nonpregnant diabetics. The pathophysiology of DKA is relative or absolute insulin deficiency.

The resulting hyperglicemia and glucoseuria lead to osmotic diuresis, promoting urinary potassium, sodium, and fluid loss. Insulin deficiency also increases lipolysis and hepatic oxidation of fatty acids, producing ketones and eventually causing metabolic acidosis.

Hypoglycemia that is serios enuogh to require hospitalization.

Rapid progression of microvascular and atherosclerotic disease.

Nephropathy.

Diabetic retinopathy.

Preterm labor and delivery.

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Signs and Symptoms of Gestational Diabetes mellitus (GDM)

There are some symptoms that you may experience but may not have attributed it to gestational diabetes as of yet. These include:

A feeling of being hungry, all the time with an increased hunger pain.

Thirsty that has increased and is constant.

Gain weight gain significantly

Frequent urination (which is often a symptom of pregnancy, too)

Blurred vision

A large fetus

Excess amniotic fluid.

Repeated detection of glucose in the urine, or repeated urinary tract infections.

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How can I know if I have Gestational Diabtes Mellitus (GDM)?

Generally, a pregnant woman is tested for gestational diabtes mellitus (GDM) between the 24th and 28th weeks, but if strong risk factors such as obesity, family history, or a personal history of gestational diabetes mellitus are present, screening can be performed at the first visit.

Patient will have a screening test that involves drinking a sugar or glucose beverage and having the blood glucose level tested one hour later. If the blood glucose level is greater than 130 mg/dl, a three-hour glucose tolerance test may be recommended to confirm the diagnosis of gestational diabetes mellitus. In patients at high risk for gestational diabtes mellitus with a normal GTT can be performed at 32 to 34 weeks to identify later-onset diabetes.

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Gestational Diabetes Mellitus (GDM) Risk Assessment

Low Risk

• Age younger than 25 years old
• Not a member of an ethnic with increased risk for type 2 DM (Hispanic, African, Native American, South or East Asian, or Pacific Islander Ancestry)
• BMI <25; normal weight at birth
No history of abnormal glucose tolerance
No history of poor obstetric outcomes
No first degree relatives with DM

High Risk

• Severe obesity
• Strong family history of type 2 diabetes
• Previous history of gestational diabetes mellitus, impaired glucose metabolism, or glucosuria

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Types of Gestational Diabetes Mellitus (GDM)

Diabetes in pregnancy can be classified as Type1 and type 2 or gestational diabetes mellitus (GDM).

Type 1

• Formerly known as juvenile-onset or insulin-dependent Diabetes Mellitus (DM)
• Pathophysiology is absolute insulin deficiency.
• Patients are at risk for severe hypoglycemia and DKA.
• Increased risk for chronic microvascular disease at an early age.

Type 2

• Formerly known as adult-onset or non insulin dependent DM.
• Pathophysiology is tissue resistance to insulin.
• Patients may develop hyperosmolar coma. DKA is rare.
• Lower incidence of microvascular disease during reproductive age range

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Overview

Gestational diabetes mellitus (GDM) is defined as glucose intolerance of various degrees that is first detected during pregnancy.Diabetes mellitus is the most common medical complications of pregnancy. As the incidence of type 2 DM increases, cases of gestational diabetes mellitus.

Universal screening for gestasional diabetes mellitus is standard in the United States. whether by patient history, clinical risk factor, or laboratory testing. Testing is typically performed at 24 to 28 weeks, but if strong risk factor such as obesity, family history, or a personal history of gestasional diabetes mellitus are present, screening can be performed at the first visit. Not all patients require screening via blood glucose testing.
Mother and neonatal complications of gestasional diabetes mellitus are increased with both gestational and pregestational diabetes mellitus, but the incidence is much higher in pregestational diabetes mellitus and with poor glycemic control. Fetal glucose levels are similar to maternal blood glucose levels, and both fetal hyperglycemia and hypoglycemia have important effects. Maternal compications are increased with gestasional diabetes mellitus.

Thus, Gestational diabetes mellitus provides a unique opportunity to study the early pathogenesis of diabetes and to develop interventions to prevent the disease.The initial prenatal visit should include a detailed history and physical examination, and electrocardiogram ( for women older than age 30, smokers, or hypertensives), and 24 hours urine collection for protein and creatinin clearence.
Postpartum management of gestasional diabetes mellitus mother depends on the severity and type of DM.

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