Gestational Diabetes Ajee’lon Boyd (TL)

Lindsay Schwartz
EDUC 690: MNT-Limited Food Budget Meal Plans

1. Detailed description of medical diagnosis

○ Detailed description
i. Gestational Diabetes is a form of diabetes that is developed during
pregnancy. This form of diabetes affects both the mother and the fetus. It
can also cause the baby to have medical complications even after being
born. In the case of gestational diabetes, the mother’s body isn’t
producing enough insulin to support the fetus’ and her needs. Pregnant
women need about two to three times more insulin than when they are
not pregnant. Decreased amounts of insulin circulating in the body
causes a barrier to the efficient breakdown and use of carbohydrates.
Medication, diet, and lifestyle modifications are some tools that are used
to treat the condition. Diet and lifestyle modifications can also be used as
an intervention tool for those who may be at a greater risk of developing
Gestational Diabetes.
○ Risk Factors
i. Pre-pregnancy weight of 165 lbs BMI of 29.2 > 29 (obese)
1. Hereditary, environmental: Obesity is a risk factor that may lead
to gestational diabetes. Obesity has profound effects on the
body’s metabolism. Obesity leads to an increase of fat molecules
circulating in the blood and overall inflammation. This then leads
to a decrease in insulin sensitivity and decreases/impairs the cells
ability to respond to insulin levels.
ii. Mother has a history of T2DM. Aunts have a history of gestational
diabetes.
1. Hereditary: A family history of diabetes is an indicator that
gestational diabetes and possibly T2DM postpartum may occur.
The baby may also be at risk for developing diabetes. Variations
in several genes increase the risk of developing gestational
diabetes. The genes with these variations have also been known
to overlap with T2DM. The genes involved are primarily
associated with the development or production of islet cells in the
pancreas. They also play a significant role in insulin sensitivity and
production.
iii. Pt weighed 9lbs 10 oz at birth and all of her siblings weighed >9 lbs.
1. Hereditary: In gestational diabetes extra glucose in the blood
crosses the placenta and causes the baby’s pancreas to secrete
more insulin. This then causes the baby to gain more
weight/become enlarged which is called macrosomia. A very large
baby can cause birth complications such as the baby becoming
wedged in the birth canal, birth injuries, or lead to a C section
during birth. This also increases your baby’s risk of developing
diabetes. The baby also has a higher chance of being obese later
on in life.
iv. Pt has a sedentary job
Gestational Diabetes Ajee’lon Boyd (TL)
Lindsay Schwartz
EDUC 690: MNT-Limited Food Budget Meal Plans

1. Physical activity/environmental: Low levels of physical activity

may lead to weight gain and insulin resistance, leading to
diabetes. Based on current research, rapid weight gain in the early
stages of pregnancy can lead to an early increase in insulin
resistance. This then leads to the islet cells overworking.
v. Limited education
1. Socioeconomic status: limited knowledge about risk and how to
prevent/manage disease can lead to malnutrition for the mother
and the fetus. This is also because the lack of knowledge that the
mother may have can lead to increased weight gain and lower
nutrient intake during pregnancy. This can then be transferred
over to the baby and lead to delivery complications and increased
risk of obesity and developing diabetes in the future.
vi. Low income
1. Socioeconomic status and environmental: People with a lower
income have access to less resources than people with a higher
income. Food insecurity may result from this. It can be difficult to
afford nutrient dense, health promoting foods on a very low
budget. In addition, low income environments may consist of a
food desert, in which healthful, nutrient dense food is difficult to
find. If the mother becomes underweight, this can have a large
impact on the mother's health and can then be translated to the
fetus resulting in a low birth weight.
vii. High sugar, low protein, high carb diet
1. Diet: Diets high in sugar, refined carbohydrates, and low in protein
can lead to insulin resistance, weight gain, and are a contributing
factor to gestational diabetes.
viii. Cuban American
1. Ethnicity: Those of Hispanic, African American, Native American,
South or East Asian, and Pacific Islander descent are of higher
risk of developing gestational diabetes and T2DM. More
specifically, women of Hispanic (and other ethnic) descents have
a higher prevalence of obesity and thus have a higher risk of
developing gestational diabetes.

○ Disease progression
i. Islet cell function and peripheral insulin resistance reduces insulin
sensitivity and secretory response. The Beta cells are no longer able to
meet the higher insulin needs during pregnancy which increases the
amounts of glucose in the blood. During the first first half of the pregnancy
the mother’s glucose is transferred directly to the fetus and during the
second half of the pregnancy the fetus begins to produce its own
hormones which are greater than that of the glucose coming from the
mother. This then require an increase (double the amount) of insulin. The
Gestational Diabetes Ajee’lon Boyd (TL)
Lindsay Schwartz
EDUC 690: MNT-Limited Food Budget Meal Plans

fetus is constantly exposed to the elevated blood glucose levels and this
causes the fetus to also increase insulin production. This then causes the
fetus to develop hyperglycemia, and possibly macrosomia and
hyperinsulinemia. For the mom, gestational diabetes can lead to
preeclampsia (hypertension), polyhydramnios (complications during
childbirth), delivery via C-section, and preterm delivery. Gestational
diabetes is treated with nutrition therapy or insulin therapy medicine.
2. Detailed description of prescribed diet:
○ How the diet manages the disease symptoms
i. Regulate/normalize glucose, lipid, and amino acid levels by controlled,
regular timed meals which will stabilize these factors. The goal is to
stabilize glucose levels to that of a pregnant non-diabetic women.
1. She can consult with her doctor about using a glucose meter to
monitor her blood sugar levels. Her doctor can also refer her to a
diabetes prevention program, RD, or diabetes educator on how to
properly use the meter and interpret her glucose levels and how
she should be eating to correspond with various glucose level
readings.
ii. Improve growth and development of fetus.
iii. Promote desired/normal weight gain and avoid weight loss of the mother.
1. First trimester-1-2 lbs Second & Third trimester .5-1 lbs/week
2. Pt should follow a low carb diet (minimum of 175g CHO) to
prevent excessive weight gain and control blood sugar levels.
a. 30-35 kcals/kg 20% protein, 40-45% CHO, and 35-40% fat
3. CHO should come from whole grains, one fruit or one serving of
milk at a time.
4. Limit intake of juice, desserts, and sweets.
iv. Control blood pressure
1. A switch from low sodium/processed foods to whole foods can
help reduce the amount of sodium within her diet which can
reduce the blood pressure levels, and thus lead to a decrease of
strain on her body and the fetus. A reduction in blood pressure
levels can also reduce the mothers risk of developing T2DM after
delivery as well.
v. Avoid starvation, ketosis, and diabetic acidosis
1. Starvation should be avoided as the fetus will need nutrients to
properly grow and develop.
2. Diabetic ketoacidosis occurs more rapidly in women with
gestational diabetes. It can cause a delayed diagnosis - which
may lead to difficulty with treatment.
3. Ketosis happens when there is a dearth of carbohydrates. Fat is
metabolized in its place for energy. Pregnant women need a high
energy diet to meet the needs of the fetus, and ketosis means that
her stores of glycogen are depleted. Organ development and
Gestational Diabetes Ajee’lon Boyd (TL)
Lindsay Schwartz
EDUC 690: MNT-Limited Food Budget Meal Plans

growth of the fetus may be affected and may lead to metabolic,

endocrine, mental, or cardiovascular disorders later in life.
○ How the diet manages progression
i. Control weight gain
ii. The goal of nutrition therapy for gestational diabetes is to promote
nutrition for the mother and the fetus while ensuring adequate energy
intake to promote appropriate and safe weight gain.
○ How the diet reverses or eliminates disease
i. Stabilizes blood sugar
3. MNT resources
○ I (Ajee) had previous experience with Gestational Diabetes through an internship
I completed in undergrad. I also did some research for a media assignment I had
to complete at the beginning of the year.
○ Lindsay attended a gestational diabetes counseling appointment during her
clinical experience.
○ We chose to use the books listed below, because they had been recommended
by Cindy in the beginning of the program as great resources and are industry
standard text books.
○ We chose to use the websites listed below because they are credible, peer-
reviewed sources.
○ Escott-Stump - Nutrition and Diagnosis-Related Care
○ Marcia Nelms-Nutrition Therapy and Pathophysiology
○ https://www.fda.gov/Food/ResourcesForYou/Consumers/ucm393070.htm
○ https://www.fda.gov/Food/ResourcesForYou/HealthEducators/ucm081785.htm
○ https://ghr.nlm.nih.gov/condition/gestational-diabetes#genes
○ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1742779/pdf/v079p00454.pdf
○ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3685567/
○ GolinHarris International. "Pregnancy weight gain may increase a woman's risk of
gestational diabetes."
4. Limitations in ADL for shopping, prepping, and eating
○ Maria likely has lower energy levels during her pregnancy, which may lead to a
reduced desire to go shopping and prepare food.
○ Her resources and kitchen equipment is limited - and she relies on her family
members for home cooked foods.
○ Maria’s usual diet is high in sugar and processed foods. When this food is the
norm, her taste is used to these particular flavors and it can be very difficult to
alter the diet to something more adequate for her condition.
○ Maria is working full time and is a single mother. This leads to stress and a
reduction in free time.
5. Prepare 7 days’ worth of menus for each family member within food budget
i. Breakfast: 2-3 CHO (30-45 grams)
ii. Snack: 1-2 CHO (15-30 grams)
iii. Lunch: 3-4 CHO (45-60 grams)
iv. Snack: 1-2 CHO (15-30 grams
Gestational Diabetes Ajee’lon Boyd (TL)
Lindsay Schwartz
EDUC 690: MNT-Limited Food Budget Meal Plans

v. Dinner: 3-4 CHO (45-60 grams)

vi. Snack: 1-2 CHO (15-30 grams

○ Prices are from Hannafords.

○ Sunday
i. Breakfast: 1/4 cups of Steel cut oatmeal (27g CHO) and ½ cup of low
fat milk, (6g CHO) 1 kiwi (10g CHO)
1. Breakfast total CHO: 43 grams
ii. Snack: 1 cup yogurt (11g CHO) with 1 crumbled graham cracker on
top (5 g CHO)
1. Snack total CHO: 16g CHO
iii. Lunch: 1 cup Lentil soup (20g CHO) with 1 small baked potato (29g
CHO) and greens (3g CHO)
1. Lunch total CHO: 52g CHO
iv. Snack: 2 Stalks celery (2g CHO) and 2 tablespoons of peanut butter
(6g CHO) with 1 cup cottage cheese (6 g CHO)
1. Snack total CHO: 14g CHO
v. Dinner: 2 cups salad (lettuce, tomato, dressing, carrots) (8g CHO)
topped with 1/2 cup beans (22g CHO) and ½ cup corn (15g CHO)
1. Dinner total CHO: 45g CHO
vi. Snack: 3 oz Pudding (20g CHO)
1. Snack total: 20g CHO
vii. Total day’s CHO: 190g

○ Monday
i. Breakfast: 1 cup yogurt (11g CHO) with ½ banana (23g CHO) and 1
graham cracker crumbled on top (5 g CHO)
1. Breakfast total: 39g CHO
ii. Snack: 1 Tortilla (17g CHO) filled with 1 scrambled egg (1g CHO), ½
cup greens (3g CHO) and ¼ tomato (1g CHO)
1. Snack total: 22g CHO
iii. Lunch: 3 oz Tuna (0g CHO) salad made with 1 Tbsp plain yogurt (1g
CHO) on an English muffin (25g CHO) with 5 celery sticks (2 g CHO)
and ½ banana (23 g CHO)
1. Lunch total: 51g CHO
iv. Snack: 1 Apple (24g CHO) and 2 tablespoons of peanut butter (6g
CHO)
1. Snack total: 30g CHO
v. Dinner: Chicken meatballs (see recipe below, ¼ of recipe) (11g CHO)
with 1 cup spaghetti (37g CHO) and greens (3g CHO)
1. Dinner total: 51g CHO
vi. Snack: 1 oz serving fat free popcorn (22g CHO)
Gestational Diabetes Ajee’lon Boyd (TL)
Lindsay Schwartz
EDUC 690: MNT-Limited Food Budget Meal Plans

1. Snack total: 22g CHO

vii. Monday total: 215 g CHO

○ Tuesday
i. Breakfast: 1 Whole wheat English muffin (25g CHO) with 2
tablespoons of peanut butter (6g CHO) and ½ of a banana (23g CHO)
1. Breakfast total: 54 g CHO
ii. Snack: 3 cups fat free popcorn (22g CHO)
1. Snack total: 22g CHO
iii. Lunch: ¼ recipe (see attached) Chicken meatball (11g CHO) in 1
tortilla wrap (17g CHO) and ½ cup corn (15g CHO) and greens (3g
CHO)
1. Lunch total: 46g CHO
iv. Snack: 3 oz Pudding (20 g CHO)
1. Snack total: 20g CHO
v. Dinner: ¼ recipe (see attached) Lentil ‘sloppy joes’ (39g CHO) on 1
English muffin (25g CHO) with greens (3g CHO)
1. Dinner total: 65g CHO
vi. Snack: ½ banana (23g CHO)
1. Snack total: 23g CHO
vii. Total CHO: 230 g

○ Wednesday
i. Breakfast: breakfast burrito: 1 tortilla (17 g CHO), 1 egg (1g CHO), ½
cup of potatoes (24g CHO), low fat cheese, ½ tomato (2g CHO)
1. Breakfast total: 43g CHO
ii. Snack: 1 ounce serving fat free Popcorn (22g CHO)
1. Snack total: 22g CHO
iii. Lunch: 1 cup of bean soup (20 g CHO) with 1 English Muffin (25g
CHO)
1. Lunch total: 45 g CHO
iv. Snack: 3 whole wheat graham crackers (15g CHO) with 1 tablespoon
of peanut butter (3g CHO)
1. Snack total: 18g CHO
v. Dinner: Spicy chicken meatball (¼ recipe, see attached) (11g CHO)
salad – 2 cups salad (8g CHO), ½ cup of corn (15g CHO), 1 cup low
fat milk (12g CHO)
1. Dinner total: 46 g CHO
vi. Snack: 3 oz pudding (20 g CHO)
1. Snack total: 20g CHO
vii. Total CHO: 206g CHO

○ Thursday
Gestational Diabetes Ajee’lon Boyd (TL)
Lindsay Schwartz
EDUC 690: MNT-Limited Food Budget Meal Plans

i. Breakfast: 1 boiled egg (.5 g CHO) with 1 English muffin (25 g CHO)
with 2 tablespoons of peanut butter (6g CHO) and ½ cup of low fat
milk (6g CHO)
1. Breakfast total 37.5 g CHO
ii. Snack: ½ cup low fat cottage cheese (3 g CHO) and 1 cup fresh fruit
(15g CHO)
1. Snack total 18 g CHO
iii. Lunch: 1 cup Lentil soup (20g CHO), .5 cup low fat cheese (2 g
CHO), ½ cup pinto beans (18 g CHO)
1. Lunch total 40g CHO
iv. Snack:3 whole wheat graham crackers (15g CHO) with 1 tablespoon
of peanut butter (3g CHO)
1. Snack total 18 g CHO
v. Dinner: ground chicken taco: 6 oz ground chicken (0 g CHO) 3
tortilla (51 g CHO) with 1 cup cooked carrots (12 g CHO)
1. Dinner total 63 g CHO
vi. Snack: 3 cups fat free popcorn (22g CHO)
1. Snack total 22g CHO
vii. Total CHO 198.5 g CHO

○ Friday
i. Breakfast: ½ cup cottage cheese (3 g CHO) with 1 English muffin (25
g CHO) 2 tablespoons of peanut butter (6g CHO) and ½ cup of low
fat milk (6g CHO)
1. Breakfast total 40 g CHO
ii. Snack: 3 oz pudding (20 g CHO) ½ cup fresh fruit (7.5 g CHO)
1. Snack total 27.5 g CHO
iii. Lunch: 3 oz Tuna (0g CHO) salad made with 1 Tbsp plain yogurt (1g
CHO) on 1 tortilla (17 g CHO) with 5 celery sticks (2 g CHO) and ½
banana (23 g CHO)
1. Lunch total: 43g CHO
iv. Snack: 3 whole wheat graham crackers (15g CHO) with 1 tablespoon
of peanut butter (3g CHO)
1. Snack total 18 g CHO
v. Dinner: 1 medium sized baked potato (39g CHO), ½ cup pinto beans
(18 g CHO), .25-.5 cup low fat cheese (1-2 g CHO) and ¼ cup salsa
(3g CHO)
1. Dinner total 62 g CHO
vi. Snack: 8 carrot sticks (8g CHO) 5 celery sticks (2g CHO) 2 Tbsp of
peanut butter (6g CHO)
1. Snack total 16g CHO
vii. Total CHO 206.5 g CHO
Gestational Diabetes Ajee’lon Boyd (TL)
Lindsay Schwartz
EDUC 690: MNT-Limited Food Budget Meal Plans

○ Saturday
i. Breakfast: ½ banana (23g CHO) with 2 Tbsp of peanut butter (6g
CHO) on 1 tortilla (17 g CHO)
1. Breakfast total: 46 g CHO
ii. Snack:3 cups fat free popcorn (22g CHO)
1. Snack total 22 g CHO
iii. Lunch: Ground chicken lettuce wraps: 6 oz ground chicken (0g
CHO) 4 medium/large lettuce leaves (2 g CHO) 4 tomato slices (1g
CHO) 1/2 cup salsa (6g CHO) ½ cup corn (15g CHO) ½ cup pinto
beans (18 g CHO)
1. Lunch total 42 g CHO
iv. Snack: 5 celery sticks (2g CHO), 1/2 cup fresh fruit (7.5 g CHO)
and 2 Tbsp of peanut butter (6g CHO)
1. Snack total 15.5 g CHO
v. Dinner: Taco salad: 6 oz ground chicken (0g CHO) 10 medium-large
lettuce leaves (5 g CHO) 4 tbsp dressing (4g CHO) 1/2 cup corn (15g
CHO) and ½ cup cooked carrots (6g CHO) 1/2 cup salsa (6g CHO) ½
cup of low fat milk (6g CHO)
1. Dinner total 42 g CHO
vi. Snack:3 oz pudding (20g CHO)
1. Snack total 20g CHO
vii. Total 187.5 g CHO

Weekly cost: $34.68

Grocery list and prices:

Oats: $1.99
Milk: $1.59
Yogurt: $1.49
Lentils: $1.49
Peanut butter: $1.99
Celery:$0.99
Beans: $0.69
Corn: $0.79
Lettuce: $1.99
Dressing: $1.79
Kiwi $1.00
Graham crackers: $1.99
Tuna: $0.99
Apple: $0.99
Ground chicken: $3.49
Spaghetti: $1.00
Popcorn: $0.99
English muffin: $2.00
Gestational Diabetes Ajee’lon Boyd (TL)
Lindsay Schwartz
EDUC 690: MNT-Limited Food Budget Meal Plans

Banana: $0.50
Pudding: $0.99
Tortilla: $1.79
Potato: $0.50
Egg: $1.89
Tomato: $0.50
Cottage cheese: $1.79
Carrots: $1.79

6. Three low cost quick to prepare recipes

○ Lentil sloppy joe on whole wheat bun
○ Breakfast Burrito
○ Chicken meatballs and spaghetti
Gestational Diabetes Ajee’lon Boyd (TL)
Lindsay Schwartz
EDUC 690: MNT-Limited Food Budget Meal Plans

Lentil Sloppy Joes

Cook time: 30 minutes Servings: 4

Ingredients:
● 1 Cup lentils
● 2 cups water
● 2 Tbsp olive oil
● ½ onion
● 2 cloves garlic or 2 tsp garlic powder
● 1 15 ounce can of tomato sauce
● 2 tsp chili powder
● 1 tsp cumin

Directions:

1. Add liquid and lentils to a saucepan over medium-high heat.

2. Bring to a low boil, then reduce heat to a simmer and cook uncovered for about 18 minutes. Drain off
any excess liquid and set aside.
3. Heat a large skillet over medium heat. Once hot, add oil, onion and garlic. Sautè for 4-5 minutes,
stirring continuously, or until the onions are tender and slightly browned.
Next add tomato sauce, chili powder, cumin, and paprika (optional). Stir to combine.
4. Once the lentils are cooked, add them to the same skillet, and stir to combine.
5. Continue cooking the mixture over medium-low heat until completely warmed through and thick,
stirring occasionally - about 5-10 minutes.
6. Taste and adjust flavor as needed, adding more chili powder and/or cumin for smokiness.
7. Serve the mixture on toasted buns.

Adapted from Minimalist Baker

https://minimalistbaker.com/vegan-sloppy-joes/
Gestational Diabetes Ajee’lon Boyd (TL)
Lindsay Schwartz
EDUC 690: MNT-Limited Food Budget Meal Plans

Breakfast Burrito
Serves 4, cook time 30 minutes

Ingredients:
● 4 tortillas
● 4 eggs
● 2 tsp oil
● 2 potatoes
● 1 cup low fat shredded cheese
● 1 tomato, chopped
● 1 cup spinach, sauteed (optional)
● ¼ avocado (optional)
● 1/2 cup salsa
● 2 tsp chili powder
● 2 tsp paprika
● 1 tsp pepper

Directions:
1. Cook potatoes in boiling salted water until tender, about 10 minutes.
2. Whisk eggs with pepper. Heat saute pan over medium heat with 1 tsp oil. Cook egg
mixture until cooked through, about 5 minutes. Set aside.
3. Add the remaining tsp of oil in the saute pan and heat the potatoes. Add the paprika and
chili powder.
4. Heat tortillas in microwave.
5. Place all ingredients in the tortilla. Serve warm.
Gestational Diabetes Ajee’lon Boyd (TL)
Lindsay Schwartz
EDUC 690: MNT-Limited Food Budget Meal Plans

Chicken Meatballs
Serves 4, 12 minutes to prepare

Ingredients:
● 1 lb ground chicken
● 1 egg
● ¼ cup grated cheese
● ½ cup bread crumbs
● 1 garlic clove, minced
● 1 tsp olive oil
● 2 tsp dried Italian seasonings

Directions:
1. Knead together all ingredients except the olive oil.
2. Form 1 inch balls with the mixture.
3. Heat a nonstick pan over medium high heat, add the olive oil to the pan.
4. Add the meatballs to the pan and cook on all sides until seared and brown,
approximately 8 minutes.
5. Ensure that the temperature of the meatballs is at or above 165 F.

Adapted from Genius Kitchen

http://www.geniuskitchen.com/recipe/chicken-meatballs-for-spaghetti-and-meatballs-52420