Patient's question:
Detected gestational diabetes, self-testing blood sugar at home every day. After a week, it's usually below 6.7, with only rarely a couple of times exceeding 6.7. Is this considered acceptable?Doctor's answer:
Standard for blood glucose control during pregnancy: Fasting 3.3-5.6, 30 minutes before meal 3.3-5.8, 2 hours after meal 4.4-6.7, nighttime 4.4-6.7. So your blood glucose control is not very good.Guidance: The safety of oral hypoglycemic drugs during pregnancy has not been sufficiently confirmed, and they are currently not recommended. Insulin is the primary medication for controlling blood glucose. The dosage currently has no uniform standard, generally starting with a small dose and adjusting based on the condition, pregnancy progression, and blood glucose levels to strive for normal blood glucose control. Additionally, dietary management should be noted.
The goal of dietary control for gestational diabetes patients is to provide sufficient calories and nutrients for both the mother and fetus, allowing for appropriate weight gain in the mother and fetus, achieving ideal blood glucose control, preventing gestational hypertension, and reducing the occurrence of premature birth, miscarriage, and difficult labor.
Nutritional needs are the same as those of normal pregnant women, but it is essential to pay more attention to calorie intake, the distribution ratio of nutrients, and meal distribution. Additionally, it is advisable to avoid sweet and high-fat foods and increase dietary fiber intake.
Pay attention to calorie needs
During the early stages of pregnancy, there is no need to increase calories significantly. In the middle and later stages, it is necessary to increase by 300 calories per day based on the calorie needs before pregnancy. Weight loss should be avoided during pregnancy, as it may increase ketone bodies in the mother, which can have adverse effects on the fetus.
Pay attention to meal distribution
Meal distribution is crucial for maintaining stable blood glucose levels and preventing ketoacidosis. Eating large amounts of food at once can cause a rapid rise in blood glucose, and prolonged fasting can easily lead to ketone production. Therefore, it is recommended to eat small, frequent meals, dividing the daily food intake into 5–6 meals. It is particularly important to avoid a long gap between dinner and the next morning's breakfast, so a snack before bed is recommended.
Consume the correct type of carbohydrates
Carbohydrate intake is intended to provide energy, maintain normal metabolism, and prevent ketone production. It should not be assumed that avoiding starchy foods can control blood glucose or weight, leading to completely skipping meals. Instead, it is advisable to avoid sugary drinks and sweets that contain sucrose, sugar, fructose, glucose, rock sugar, honey, or maltose to prevent rapid post-meal blood glucose spikes. If needed, a small amount of sugar substitute can be added, but it should be a harmless type for the fetus, such as Acesulfame K. It is recommended to choose unrefined staple foods with higher fiber content, which can be more beneficial for blood glucose control, such as replacing white rice with brown rice or whole-grain bread or buns. Pregnant women with gestational diabetes often have higher blood glucose levels in the morning, so the amount of starchy foods in breakfast should be reduced.
Focus on protein intake
If sufficient nutrition was consumed before pregnancy, there is no need to increase protein intake in the early stages of pregnancy. During the second and third trimesters, protein intake should be increased by 6 grams and 12 grams per day, respectively, with half of it coming from high biologically available protein sources, such as eggs, milk, red meat, fish, and soy products like tofu and soy milk. It is best to drink at least two glasses of milk daily to ensure adequate calcium intake, but milk should not be used as a substitute for water to avoid excessively high blood glucose.
Pay attention to fats
Cooking oil should primarily be plant-based, and fried, deep-fried, or fried foods, as well as animal skins and fatty meats, should be reduced.
Increase fiber intake
Within the permissible portion range, consume more high-fiber foods, such as replacing white rice with brown rice, increasing vegetable intake, and eating fresh fruits instead of fruit juice. This can slow down blood glucose rise, aid in blood glucose control, and provide a greater sense of fullness. However, it is crucial not to consume fruits in unlimited quantities.