Please contact a Dietitian if you require further information or advice.

Telephone contacts: Dietetic Department - 9340 2795 KEMH Main Reception - 9340 2222, ask to page a Dietitian

KEMH Dietitians:
Anne Rae Pushpa Sivakumar Hanna Burbidge Amanda Cheong-Duryea Preeti Chauhan

KEMH Nutrition and Dietetics Department (updated February 2012)

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HEALTHY EATING FOR GESTATIONAL DIABETES

When you have Gestational Diabetes it is important to keep your blood glucose levels within the acceptable range.

Blood Glucose Goals

Before Breakfast less than 5.5 mmol/l

2 hours after each Main Meal less than 7.0 mmol/l

In order to better manage your Gestational Diabetes, it is important to understand how food, weight gain and exercise will impact your blood glucose levels.

Consider the following: 1. Enjoy A Variety Of Foods Everyday From The 5 Food Groups Am I eating the right foods for my pregnancy? Australian Guide to Healthy Eating page 3 2. Select Carbohydrates Carefully Carbohydrates foods and daily intakes page 4 Carbohydrate serves page 5 Carbohydrate foods and the Glycemic Index page 6 Carbohydrate snack options page 9 3. Eat Plenty Of Non-Starchy Vegetables And Proteins Balancing the quantities & creating varied and enjoyable meals page 10 Meal examples page 11 Non-starchy vegetables page 12 Spicy marinades to add interest to your meals page 12 4. Eat Less Fat Ways to trim the fat from your diet page 13 5. Be A Label Reader How much sugar or fat is OK? page 14 Sugars and Artificial Sweeteners page 15 6. Manage You Weight Gain During Pregnancy Page 16 7. Physical Activity page 16 8. Trouble Shooting For High Home Blood Glucose Readings page 17 9. Eating and Exercise Plans Sample Meal Plan page 18 Individualised Eating and Exercise Plan page 19 10. After The Birth Breastfeeding your baby page 20 Reducing the risk of developing diabetes - page 20

KEMH Nutrition and Dietetics Department (updated February 2012)

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Enjoy A Variety Of Foods Everyday From The 5 Food Groups

Am I eating the right foods for my pregnancy?

Eating a variety of nutritious foods will help to manage your Gestational Diabetes. The Australian Guide to Healthy Eating will help you to select the right quantities of foods from the 5 food groups. It is important that you eat a balanced diet to give you and your baby the nutrients you both need.

Refer to the KEMH pamphlet on Nutrition Fitness in pregnancy for more information Avoid alcohol, high risk listeria foods and fish high in mercury when pregnant
Source: adapted from the NHMRC- Australian Guide to Healthy Eating

KEMH Nutrition and Dietetics Department (updated February 2012)

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2.0

Select Carbohydrates Carefully

Carbohydrate foods and daily intakes

Carbohydrate foods are essential to a healthy diet for you and your baby. Once digested, carbohydrate foods are broken down to glucose which goes into your blood stream. The type, amount and frequency of your carbohydrate intake has a major influence on your blood glucose readings. Carbohydrates are found in large amounts in all fruits, starchy vegetables, breads, rice, pasta, cereals, lentils, legumes, milks and yoghurt. They are also found in foods made from flour, sugar and honey.

It is important to EAT carbohydrates Spread carbohydrate serves evenly over the day as part of your 3 main meals & snacks. Choose Low GI choices and Low fat options Combine proteins with your carbohydrates where possible

Daily Carbohydrate food Guide Breakfast MT Lunch AT Dinner 2-3 serves 1-2 serves 2-3 serves 1-2 serves 2-3 serves

Example

wholegrain cereal with low fat milk fresh fruit and low GI, high fibre crackers wholegrain bread with tuna and salad high fibre crackers with sliced low fat cheese and tomato pasta OR rice OR sweet potato with meat, vegetables and fresh fruit low fat, low sugar yoghurt

Supper

1-2 serves

Avoid Carbohydrates that have lots of added sugar or honey, that are made from refined white flour and foods with lots of added fat. Some examples include cakes, croissants, puddings, sweet biscuits, pastry, juice, soft drinks, cordials, lollies, chips, pizza, fried foods and take away.

KEMH Nutrition and Dietetics Department (updated February 2012)

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Carbohydrate Serves
Use this list as a guide to estimating a serve of carbohydrate. Try to incorporate low GI & low fat food choices when you choose your carbohydrates. 15g carbohydrate = 3 teaspoons sugar = One serve of carbohydrate. Use standard cups and spoons to measure the quantities. Note: Foods that are not carbohydrates are meat, fish, poultry, eggs, reduced fat cheese, nuts and seeds. One serve of bread / crackers
1 slice bread bread roll English muffin 1 crumpet 2 rice cakes 4 corn thins 4 vita weats/crustkits 2 ryvita 2 sao crackers 2 shredded wholemeal biscuits med pita bread large Lebanese bread

One serve of cereal

cup dry oats / cup cooked oats cup high fibre breakfast cereal 1 weet bix / vita brits cup untoasted muesli cup all bran

One serve of starchy plant food

3 TBspn dry lentils/peas 2/3 cup cooked chickpeas/kidney beans 1/3 cup cooked rice or couscous cup cooked pasta 1/2 cup noodles 1 med potato 2 pieces sweet potato (80g cooked) can or 200g cooked lentils 1 cup parsnip 1 corn on the cob cup mashed potato 1/3 cup baked beans

One serve of fruit

1 medium fruit e.g. apple, pear, orange big piece of fruit e.g. banana or mango 2-3 small fruits e.g. plums, apricots unsweetened canned / stewed fruits cup of grapes / cherries 1 Tbsp raisins / sultanas 4 med dates / prunes / 8 halves of apricots 125 ml fruit juice 1 Tbsp spoon of honey / pure fruit jam

One serve of dairy

1 glass (300 ml) milk (fresh, long life or reconstituted dried) 1 cup calcium fortified soy milk cup unsweetened custard 200g natural / diet yoghurt 2 scoops of plain low fat ice cream

KEMH Nutrition and Dietetics Department (updated February 2012)

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Carbohydrate Foods and the Glycemic Index (GI)

The Glycemic Index (GI) is a way of ranking foods that contain carbohydrate according to the effect they have on blood sugar levels. The lower the GI of the food, the smaller the rise in the blood sugar levels. LOW: MODERATE : HIGH: (< 55): (56-69): (>70): sugars broken down slowly (Best Choice) sugars broken down moderately fast sugars broken down quickly

Foods cannot be judged on the basis of the GI alone. To gain the full benefits of a low GI diet consider the quantities of total carbohydrate and fat consumed at each meal and snack. The foods listed below are high in carbohydrates. Carbohydrates are healthy and important foods. Carbohydrates include breads, cereals, grains, starchy vegetables, legumes, fruits, juices, milk & yoghurt. Why is a Low GI eating plan recommended? It will prevent large fluctuations in blood glucose levels It will help you feel fuller longer and reduce hunger It will help you to manage your weight It will help you manage your blood fats It will lead to lower insulin levels

The food industry has the option of labelling products with the GI symbol. You will find the GI value of the food near the nutrition information panel, along with the word high, medium or low. See http://www.glycemicindex.com for an online food database For additional information and recipe ideas locate a copy of: The Low GI Family Cookbook by Dr Jennie Brand Miller The New Glucose Revolution by Dr Jennie Brand Miller. To switch to a low GI diet: Include at least one low GI food with each meal and snack. Use vinegar and lemon juice dressings/sauces. The acidity lowers the GI of carbohydrates. Do not overcook carbohydrate foods, this may increase the GI of carbohydrates. Include protein in your meals and snacks. Protein foods include lean meat, chicken, fish, egg, reduced fat cheese and legumes. Include Legumes (peas, beans and lentils) like Baked Beans, kidney beans, butter beans, chick peas, Three and Four Bean Mix. They contain both proteins and carbohydrates and are low in GI. Include lots of non-starchy vegetables and salads. SIMPLE FOOD SUBSTITUTIONS HIGH GI FOODS Bread (wholemeal or white) Processed breakfast cereals Plain biscuits and crackers Cakes and muffins Canned fruits Potatoes Rice Flavoured milks Commercial puddings, custards and ice cream CHANGE TO LOW GI Wholegrain breads grainy made with whole seeds Traditional Rolled oats or low GI cereals based on bran, psyllium, barley and oats. Biscuits made with fruit, wholegrains, oats or psyllium. Cakes and muffins made with wholegrains, oats, psyllium or fruit. Fresh temperate fruits (apple, pears, plums). Pasta or legumes. Doongara, Moolgiri, or Basmati. Plain low fat milk. Plain yoghurts, diet flavoured yoghurts. Homemade custard, low fat ice cream.

KEMH Nutrition and Dietetics Department (updated February 2012)

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BEST CHOICE LOW GI CHOOSE MORE OFTEN

Breakfast Cereals: Rolled oats / porridge (traditional) All Bran, All Bran Fruitn Oats, Natural / unsweetened muesli, barley bran, rice bran, oat bran, Guardian, Komplete, Special K, gluten free muesli (Freedom Foods), semolina, psyllium husks Breads: Heavy wholegrain breads, Burgen varieties, Vogels Honey and Oat, Tip Top 9 grain, Ploughmans Mixed Grain, Bakers Delight high fibre low GI, Bakers Delight wholemeal country grain, Continental Fruit Bread Wonderwhite Low GI, Tip Top Up EnerGI Wholemeal Turkish bread, tortilla, pumpernickel, stone-ground wholemeal, sourdough rye or wheat Crackers and Biscuits: Vitaweats Snack Right Fruit Slice Freedom foods low GI biscuits

GOOD CHOICE MODERATE GI CHOOSE SOMETIMES

Vita Brits, Sustain, Sustain breakfast cereal bar, Just Right, Nutrigrain, Weetbix, plain Mini Wheats, instant oats, Shredded wheat, Soytana

HEALTHY FOODS with a HIGH GI CHOOSE RARELY

Cornflakes, Rice Bubbles, puffed wheat, bran flakes, Sultana bran, blackcurrant Mini Wheats, breakfast bars, Fibre Plus, amaranth

Rye bread, Ploughmans wholemeal, wholemeal pita bread, wholemeal crumpet, taco shell

White bread, wholemeal bread Gluten free breads, bagels, English muffin, French baguette, pikelets, white pita bread

White Turkish bread, Lebanese bread

Ryvitas, Stoned wheat thins, wholemeal Saos, oatmeal digestive, oat-bran cruskits, shredded wheatmeal

Sao, white cruskits, water crackers, saladas, morning coffee, arrowroot, rice cakes, puffed crispbread, pretzels, melba toast, corn thins Rice pasta, canned spaghetti, corn pasta, gluten free pasta Millet, tapioca

Grains: Pasta: White or wholemeal pasta, egg fettuccini, Orgran split peas & soy pasta shells. Grains: Buckwheat, pearl barley, bulgur, Lungkow bean thread Noodles: Mung bean noodles, soba noodles (instant/Japanese), semolina, fresh rice noodles, 2 minute noodles (limit seasoning) Doongara / Sunrice Clever Rice, Moolgiri Rice

Gnocchi, couscous, polenta, Kraft macaroni cheese (boxed)

Udon noodles rice vermicelli

Basmati rice, long grain rice, wild rice, Mahatma premium classic rice, Sunrice medium grain brown rice, Doongara brown rice, Arborio risotto rice

Calrose rice, Jasmine rice, Sunbrown Quick Rice, instant rice, glutinous rice, Pelde brown or white rice, Sunrice sushi rice.

KEMH Nutrition and Dietetics Department (updated February 2012)

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BEST CHOICE LOW GI CHOOSE MORE OFTEN Starchy Vegetables: Sweet potato (orange colour), sweet corn, taro, yam, green peas

GOOD CHOICE MODERATE GI CHOOSE SOMETIMES New potatoes, Nicola potatoes

HEALTHY FOODS with a HIGH GI CHOOSE RARELY Nadine, Pontiac & Desiree potatoes (steamed, baked, boiled), Oven Fries (96% fat free), parsnips

Legumes: (peas/beans and lentils) Soy beans, kidney beans, baked beans, lima beans, chick peas, split peas, haricot green beans, butter beans, navy beans, lentils, engal gram dahl, black gram dahl. Dairy & Dairy Substitutes: Milk (choose low fat in preference) Low fat yoghurt (fruit or plain) Diet fruit yoghurt Yakult SoGood soy drink Low fat ice-cream Homemade Custard (reduced sugar), Trim reduced fat custard No Bake Egg custard mix Fruche 99% fat free Fruit and juices: Fresh: Apples, oranges, mango, pears, grapefruit, cherries, peaches, plums, grapes, nectarines, kiwi fruit, custard apples, strawberries, blueberries, banana, lemon, lime Tinned fruit: Pear, peach in natural juice Dried fruit: Apple, apricot, Khalas dates (sundried vacuum packed) 100% unsweetened Juice (limit a serve to cup / 125mls): apple, orange, grapefruit, prune, tomato Miscellaneous Extras: (use in small amounts) 100% fruit jam marmalade, strawberry honey (bush, red gum, yellow box, stringy bark, iron bark) nuts (high fat) hummus Vaalia yoghurt milk Vitari frozen fruit dessert Full fat ice-cream

Broad beans

Vitasoy calcium enriched soy milk, rice milk

Tofu frozen dessert

Pineapple, apricots, pawpaw

Watermelon, lychees, rockmelon

Apricot in natural juice

Fruit canned in heavy syrup Australian dates

Sultanas, raisin, figs

Sugar, Capilano honey, Milo, Nutella, Popcorn (Greens)

Real Fruit bars, breakfast bars (apart from sustain)

KEMH Nutrition and Dietetics Department (updated February 2012)

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Carbohydrate Snack Options

There are many suitable snack options to choose from if you are advised to have snacks. To better manage your home blood sugar readings you may need to space out your carbohydrates over the day with 3 small meals & 3 small snacks. Eat some proteins with your low fat, low GI carbohydrates where possible. Below are some snack ideas.
1 serve of carbohydrate 2 serves of carbohydrates

Fruit: 1 medium apple, pear, peach, orange or banana, 3 apricots, 2 mandarins, to 1 cup grapes, or 1 circle of pineapple cup of dried fruits and nuts Salads and vegetables Vegetable sticks (carrots, celery, capsicum, snow peas) chutney, boiled egg and a fruit Cup of salad and a small tub of diet yoghurt/reduced fat plain yoghurt Breads and crackers: 1 slice of fruit/ raisin or multigrain bread with 1 tsp margarine/butter. 1 wholemeal crumpet toasted with low fat cheese and vegemite cup of baked beans 2 ryvitas or 4 small vitaweats (wholegrains) with reduced fat cheese, tomatoes and chives 1 cup of freshly popped popcorn without butter or sugar Snack Pack e.g.: 4 small savoury biscuits and vegemite or cheese spread 30 grams of pretzels Dairy: 1 small tub (200g) of diet fruit yoghurt / reduced fat plain 1 tub of fruche light or Nestle Blissful cup of low fat custard 1 cup of reduced fat milk 1 medium fruit with diet yoghurt or low fat custard 1 scoop of lite ice cream with a medium size fruit 1 cup of reduced fat milk with small amounts of Milo or Ovaltine Light Break. 2 oatmeal biscuits and a cup of reduced fat milk 1 small oat and fruit muffin and 1 small tub (200g) of diet fruit yoghurt/reduced fat plain yoghurt Fruit smoothes using 1 cup reduced fat milk and a fruit 1 cup of mixed fresh fruit and cup of low fat unsweetened custard

Cup of vegetable soup and a slice of multigrain bread or couple of vitaweats a corn on the cob and 1 small tub diet/ reduced fat plain yoghurt

One whole multigrain English muffin with low fat cheese, tomatoes and chutney cup of baked beans on multigrain toast 1 small bran muffin or fruit scone with thinly spread margarine/butter 1 small wholemeal pita bread with tomato salsa dip, or fresh salads and some flavoured tuna Avocado on a slice of multigrain toast and a glass of low fat milk 1 slice of raisin toast and a glass of reduced fat milk

Others: 2 slices of Snack Right or Arnotts Full o Fruit biscuits 2 oatmeal biscuits or Freedom Foods 97% fat free fruit biscuits 1 Snack Right fruit pillow or spicy fruit roll.

KEMH Nutrition and Dietetics Department (updated February 2012)

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Eat Plenty Of Non-Starchy Vegetables And Proteins

Balancing the quantities creating varied & enjoyable meals

About of a plate Proteins: Lean meat, skinless chicken, fish, eggs, nuts, tofu legumes and reduced fat cheese Lentils & legumes have both protein & carbohydrate About of a plate Carbohydrate: Pasta, rice, sweet potato, corn, potato, tacos, legumes, pancakes, flat breads, breads and noodles

About of a plate Non-starchy vegetables: Select a variety of green, orange, yellow and red vegetables. Raw or cooked. You may wish to flavour with aromatics & sauces: Garlic, fresh Chilli, lime, lemongrass, ginger, lemon, Balsamic vinegar, soy sauce, chilli sauce, fish sauce.

PLUS some carbohydrates as fruit, milk or yoghurt

Enjoy a variety of cuisines. There is no need to limit your scope of food. consider the underlying principles of healthy eating. These include: Serve up the right proportions of protein, carbohydrates and vegetables.

Do however

Create low fat meals and use unsaturated oils.

Use wholegrains and select low GI carbohydrates.

Use quality produce and flavour with herbs and spices.

Follow the Australian Dietary Guidelines and 5 Food groups to guide your daily intakes. Refer to page 3

KEMH Nutrition and Dietetics Department (updated February 2012)

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Meal Examples

Spicy Mexican wraps

Stir fry lean strips of meat with red onion, capsicum and spicy salsa. Add a can of red kidney beans. Warp in a warmed wholemeal lavash bread and serve with a dollop of low fat natural yoghurt, diced tomato, grated carrot, shredded lettuce and reduced fat grated cheese.

Tasty fried rice

Brown onions, garlic and stir through a selection of vegetables such as broccoli, capsicum, runner beans. Add cashews and tofu along with cooked rice. Garnish with a sliced egg omelette.

Cous Cous delight.

Toss together cooked cous cous, cucumber, spring onions, mint, tomato, lemon juice and olive oil. Season with black pepper. Char-grill a steak and finely slice. Serve meat on a bed of cous cous, and with a side salad.

Healthy Pizzas

Spread a wholemeal Lebanese bread with a tomato based sauce and experiment with a selection of toppings such as sliced mushrooms, capsicum, olives, sliced eggplant, boccocini, and lean beef or chicken. Serve with a side salad.

Quick Pastas

Brown diced onions, crushed garlic with beef, lamb, chicken, salmon, tuna or pine nuts. Add grated zucchini and carrots. Mix in tomato paste, a can of diced tomatoes, basil and simmer. Toss through cooked pasta and fresh parsley.

Fresh Thai Beef Salad & noodles

Stir-fry lean beef strips with clear vermicelli noodles, add salad such as carrot, tomato, spinach, cucumber and toss through a dressing of fresh chilli, garlic, lime juice and Thai fish sauce.

Hearty soups

Brown onions then simmer vegetables of your choice until soft. Simmer with lean pork ribs or skinless chicken legs if desired Add a handful of macaroni to soup or serve with a wholegrain roll or steam rice. Top with low fat cheese or reduced fat yoghurt.

Tasty Pockets

Fill half a wholemeal pita bread with strips of tuna, salmon, tree nuts or egg. Add cucumber, tomatoes, capsicum and spinach leaves. Season with reduced fat plain yoghurt, chilli and coriander.

KEMH Nutrition and Dietetics Department (updated February 2012)

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Vegetables

These vegetables have very low levels of carbohydrates. Alfalfa sprouts Asparagus, fresh, canned Artichoke Bamboo shoots Broad beans Bean sprouts Beetroot, canned Broccoli Brussel sprouts Cabbage Capsicum Carrot Cauliflower Celery Choko Cucumber Dill pickles Egg plant French beans Garlic Gherkin Ginger root Kale Kholrabi Leek Lettuce Marrow Mushrooms Onion Okra Parsnip Peas Pumpkin Radishes Rhubarb Shallots Silverbeet Snow peas Spinach Swede Tomato Tomato Juice 100% Tomato puree, paste, flakes Tomato juice Turnip 100% Vegetable juice Water chestnuts Watercress Zucchini

Spicy Marinades To Add Interest To Your Meals

Rubbing spices and herbs into lean cuts of meat, chicken or fish before cooking will add flavour to your meals. Pan frying or char grilling are two easy ways to bring out the flavour.

Moroccan 2 tsp mild paprika 1 clove of crushed garlic 1tsp ground cumin 1tsp garam marsala 2-3 tsp olive oil

Greek rub Rosemary Lemon zest and juice 1-2 cloves of crushed garlic 2-3 tsp olive oil

Lemon and cumin Grated zest of 1 lemon 2 tsp cumin 1 crushed clove of garlic 2-3 tsp olive oil

Quick curry spice Roll meat fillet in 2-3 tsp curry powder, scatter on greaseproof paper then bake

Greek marinade 1 tsp paprika 2 cloves of crushed garlic 1 tsp of oregano 2-3 tsp olive oil Juice of one lemon

Note: trim off all visible fat or remove skin before cooking.

KEMH Nutrition and Dietetics Department (updated February 2012)

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Eat Less Fat

Ways to trim the fat from your diet 1. Reduce the spread on bread. These spreads account for about one-fifth of all the fat
we eat: Spread butter or margarine as thinly as possible. Switch to a low-fat spread e.g. light margarine, or use ricotta cheese, and cottage cheese (but not during pregnancy). Try bread and sandwiches without butter or margarine. 2. Use less fat in cooking: Avoid frying foods grill, dry-roast, boil, steam or microwave without added fats. When cooking with oil, use a pastry brush or kitchen paper to coat the base of the pan lightly instead of pouring in the oil. Try non-stick pans and low-fat sprays. Add flavour without fat use herbs, spices such as ginger and pepper, lemon juice, wine, garlic and onion to flavour meals. 3. Choose low-fat meats: Always choose lean meat and trim all visible fat before cooking. Try low-fat sausages, hamburgers and processed meats. Remove skin and any fat from chicken before cooking. 4. Switch to low-fat dairy products: Choose low-fat and reduced-fat milks. Low-fat milks such as skim milk have virtually no fat. Reduced-fat milks have only half the fat content of ordinary milk and calciumenriched milks have less again. Try some low-fat and reduced-fat cheeses. Cottage and Philidelphia cheeses are safe if the whole package is used up straightaway and/or only use clean utensils to serve each time. Ricotta and other soft cheeses are not safe when fresh but can be eaten cooked. Check the labels on other cheeses. A fat content of less than 10 per cent (or less than 10 grams per 100 grams) is excellent. 5. Choose low fat snacks: Substitute fresh fruit and sandwiches for high-fat snacks such as cakes, biscuits, chocolates and pastries. Choose sandwiches, rolls, salads, vegetable dishes instead of high-fat pies, pastries, pizzas and chips. 6. Avoid adding mayonnaise or oily dressings to salads. dressings or no-oil mayonnaise. Substitute with reduced-fat

7. Check the label before you buy processed foods. Fat can be added to foods in a variety of ways. Check the label for these ingredients: butter dripping tallow margarine shortening copha oil lard palm or coconut oil vegetable oil cream cocoa butter Choose foods with less than 10% fat (less than 10 grams per 100 grams). 8. Change recipes to reduce added fat: Use less oil when browning meat, fish and flavourings such as onions. Brush the pan, dont pour oil in. Use low-fat milk and cheese instead of regular milk and cheese in cooking.

KEMH Nutrition and Dietetics Department (updated February 2012)

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Be a LABEL Reader

How much sugar and fat is OK?

Ingredients are listed in order of quantity from largest to smallest. Look out for fat and sugar. SUGAR may also be listed as fructose, lactose, honey, sucrose, sugar, raw sugar, invert sugar, glucose syrup, malt, malt extract, dextrose, treacle, golden syrup, corn syrup, molasses, maple syrup, brown sugar, disaccharides, monosaccharides, polysaccharides, maltose, mannitol, sorbitol, xylitol FAT may also be listed as animal fat, shortening, beef fat, lard, dripping, cream, butter fat, tallow, coconut oil, palm oil, vegetable fat, chocolate, monoglycerides, milk solids, hydrogenated oils, margarine, carob, seeds, nuts, coconut.

Tips when choosing a product Step 1: check sugar content Aim for Sugar content being less than 10 grams per 100 grams (10 percent). In foods containing fruit aim for less than 25g per 100g (25 percent) Step 2: check fat content. Aim for Fat content being less than 10 grams per 100 grams (10 percent) For milk and yoghurt aim for less than 2 grams per 100g (2 percent) Saturated aim for as low as possible Trans less than 1 g per 100g (1 percent) Step 3: how much total carbohydrate should I eat? For a meal, about 30 to 45 grams of total carbohydrate is enough. For a snack, 15 to 30 grams of carbohydrate is enough.

NUTRITION INFORMATION Servings per package 24 Serving size: 30g (2 biscuits) 2 biscuits with cup (125ml) Per Serving ENERGY (kJ) (cal) PROTEIN (g) FAT (g) -Saturated (g) CARBOHYDRATE - Total (g) - Sugars (g) FIBRE (dietary) (g) SODIUM (mg) POTASSIUM (mg) THIAMINE (mg) RIBOFLAVIN (mg) NIACIN (mg) IRON (mg) 420 100 3.7 0.8 0.2 20.0 0.7 3.7 80 105 0.28 (25*) 0.4 (25*) 2.8 (25*) 2.5 (25*) Per 100g 1380 330 12.4 2.7 0.6 66.8 2.3 12.2 270 350 0.92 1.33 9.2 8.3 Whole Milk 750 180 7.8 5.5 1.6 25.7 6.4 3.7 152 298 0.33 0.61 2.91 2.61 So Good 740 175 8.0 5.1 0.6 25.9 2.7 4.3 130 280 0.34 0.61 3.36 3.13

* = Percent Daily Allowance

Misleading Nutrition claim: 97% fat free may be low in fat but high in sugar. Reduced fat may be still high in fat even if fat content is reduced. lite or light may refer to taste, texture or colour.

HIGH FIBRE: look for foods which contain wholewheat, wholegrain, bran, lentils, beans and dried peas. Aim for products with more than 5 g per 100g LOW SODIUM: look for no added salt or salt reduced products. Aim for less than 300 mg per 100g.

KEMH Nutrition and Dietetics Department (updated February 2012)

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SUGAR and Artificial Sweeteners?

SUGAR: A healthy diet for someone with diabetes can include some sugar. SUGAR is a concentrated form of carbohydrate e.g. cane sugar and honey. It is absorbed from food into your blood as glucose and used for energy, just like other carbohydrate.
Two examples of ways in which sugar can be incorporated into your diet: 1. Eat slightly less carbohydrate in the meal or snack, and allow yourself some sugar. Without sugar 3 weetbix, sweetener and cup milk With sugar 2+ weetbix, 1 teaspoon sugar and cup milk

2. Add a little sugar to a low GI meal or snack food choice. Without sugar 3 weetbix, sweetener and cup milk With sugar 1 cup porridge, cup low fat milk and 1 teaspoon sugar

SUGAR is low in vitamins, minerals & fibre and is often found in foods which are high in fat, like cakes and sweet biscuits these are not good choices.

ARTIFICIAL SWEETENERS:
pregnancy. These include;

Small amount of artificial sweeteners can be used safely in

Equal (also known as aspartame, 951 or nutrasweet) Splenda (also known as sucralose, 955) Acesulphame Potassium, 950) NOTE: Saccharin, 954 and Cyclamate, 952 are not recommended in pregnancy.

Poor Choices Coke, Pepsi, regular soft drinks More than 10 tsp sugar added to a can of drink.

Better Choices Diet Coke, Pepsi Max, Diet Sprite Coke zero, Spite zero It is still important to limit these drinks though. Water should remain the first choice of fluids

KEMH Nutrition and Dietetics Department (updated February 2012)

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Manage Your Weight During Pregnancy

It is important to manage your weight gain during pregnancy to optimise your home blood sugar control and improve maternal and child health outcomes. In the first trimester you may experience a total weight gain of around 0.5-2 kgs. Most of your weight will be gradually gained in the second and third trimester. It is best to gain weight within the recommended ranges based on your pre-pregnancy BMI (Body Mass Index). Your BMI is a measure if body fat based on weight and height. Your midwife, doctor or dietitian can help you to calculate your pre-pregnancy BMI. The recommendations below are only guidelines and you should discuss your individual situation with your health care provider.

Prepregnancy BMI Underweight Normal Overweight Obese

BMI range

Weight gain range (kilograms) 12.5-18 11.5-16 7-11.5 5-9

<18.5 18.5-25 25-30 >30

Pregnancy is NOT the time to place yourself on a restrictive diet. Having a healthy approach to eating is the best strategy to managing Gestational Diabetes.

7.0

Physical Activity

Managing home blood glucose readings in Gestational Diabetes includes being physically active. Never overdo your exercise and discuss you personal situation with your doctor. Being physically active includes activities such as Walking (briskly if possible) aim for around 15-30 mins Swimming Pregnancy hydrotherapy Low impact exercise tailored to pregnancy Pregnancy pilates or yoga

Physical activity is also useful for weight management, stress management, muscle strength and flexibility, relieving back pressure, improving circulation, preventing constipation and preparing the body for labour. Your choice of exercise should not cause you any pain. Dont overheat0 and drink plenty of water.

KEMH Nutrition and Dietetics Department (updated February 2012)

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Trouble Shooting For High Blood Glucose Readings

Most women with gestational diabetes will be set up with a blood glucose monitor to allow them to self manage at home. If your readings 2 hours after a meal are above the safety range, consider the following:

Could I have a smaller meal and include a snack?

Try reducing the amount of carbohydrates at the main meal by a quarter and shifting the food to a snack before or after the meal. Aim to spread out your carbohydrate intakes over the day. Dont miss main meals and aim to include 2-3 snacks over the day.

Am I eating too much carbohydrate?

Carbohydrates are important but they should not dominate all meals and snacks. Make sure you balance intakes with protein and non-starchy vegetables.

Could I choose a better type of carbohydrate?

Select where possible low fat and low GI (e.g. wholegrain products) carbohydrates. Try to combine protein foods with carbohydrates.

Was the meal high in fat?

Fats can interfere with the bodys ability to process glucose, and the effect can be seen for many hours after a meal. Try to avoid deep fried and fatty takeaway meals such as pizza, burgers and chips.

Have I missed my daily physical activity today?

Maintain a daily routine of pregnancy appropriate exercise as this will help to regulate your blood glucose control, your appetite and your weight.

Other things to consider:

Is your testing technique correct? Did I wait 2 hours after a meal before testing? Are your hands clean? Do you need to check your meter with the Diabetes Nurse Educator? Are you ill? Do you have a fever? Are you under emotional or physical stress?

KEMH Nutrition and Dietetics Department (updated February 2012)

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9.0

Eating and Exercise Plan

SAMPLE MEAL PLAN CHANGE THIS

Breakfast Rice Bubbles with full cream milk 2 toast (white) spread with margarine 1 egg and bacon Orange juice Tea with full cream milk Morning Tea Tea/coffee/soft drink Tea / coffee / low calorie drink round sandwich (low fat cheese, tomato and wholegrain bread) add extra non-starchy vegetables if hungry Lunch Roast beef with fat chips Vegetables with added butter Jelly with fruit and cream Afternoon Tea nil 2 oatbran Cruskits + low fat cheese add salad vegetables if hungry Dinner Luncheon meats Mixed salads with rich mayonnaise White bread roll Choc chip ice-cream Supper Full cream milk with Milo and 1 teaspoon of Low fat/skim milk with 1 teaspoons of Milo sugar. Biscuits 1 piece fruit Salmon/tuna (in brine or water) Lots of mixed coloured salad vegetables with crushed garlic and balsamic vinegar dressing 1 cup of Macaroni and kidney bean salad Roast beef (lean cuts) 1 sweet potato (steam/microwave) Lots of red, yellow, orange & green vegetables Diet jelly with fruit and low fat yoghurt Rolled oats with low fat/skim milk 1 multigrain toast spread thinly with margarine 1 egg (not fried), grilled tomato & mushrooms 1 piece fresh fruit Tea with low fat/skim milk

TO THIS

KEMH Nutrition and Dietetics Department (updated February 2012)

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Individualised EATING & EXERCISE PLAN Name: ___________________ Date: _______

What I usually Do Breakfast

Changes I need to make

During the morning

Lunch

During the afternoon

Dinner

During the evening

Exercise

KEMH Nutrition and Dietetics Department (updated February 2012)

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10.0 After the Birth

Once you deliver your baby, your gestational diabetes should resolve. You will be asked to go for a repeat Glucose Tolerance Test at 6 weeks post delivery to confirm that things are back to normal. You will however have a 40% risk of developing Gestational Diabetes in your next pregnancy 50% risk of developing Type 2 Diabetes in the future

Breastfeeding your baby

Your baby will not be born with diabetes. It is however important for you to maintain good blood glucose control leading up to labour. After the birth, you should aim to breastfeed your baby as soon as possible. By placing your baby to your breast immediately after the birth, your baby will instinctively attach to your nipples. Feeding baby frequently is important. The World Health Organisation and the National Health and Medical Research Council, strongly encourage exclusive breastfeeding for the first 6 months after birth. With the gradual introduction of solids at around six months, breastfeeding should be maintained for as long as you and your child desire. There are significant health benefits to be gained by breastfeeding your baby for at least 2 years. Breastfeeding and providing good food choices in your childs diet from an early age will set the foundations for good health.

Reducing the risk of developing diabetes

To reduce your risk of developing Gestational Diabetes in your next pregnancy or Type 2 diabetes later in life, consider the following: Eat a balanced Healthy Diet limits fats, select low GI carbohydrates and include an abundance of non-starchy vegetables daily.

Exercise regularly aim for 30-45 mins daily

Maintain a healthy weight and waist line - Healthy BMI range (18.5 25)

Regular medical checks advise you General Practitioner that you are at high risk of developing Type 2 diabetes in the future.

KEMH Nutrition and Dietetics Department (updated February 2012)

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