What is gestational diabetes, and how is it treated? 

You have been diagnosed with gestational diabetes. Put simply, this means that your blood sugar level is too high which increases the risk of complications during pregnancy and delivery. The good news is that your blood sugar levels can become close to normal if you change your diet and increase your physically activity. In some cases, it may be necessary to include insulin in the treatment of your gestational diabetes. 

Why should you prioritise an appointment with a dietician?

Shortly after you have been diagnosed with gestational diabetes, you will be contacted by phone about an appointment with a dietitian. The dietitian can help you cope with your diet to avoid high blood sugars and excessive weight gain during your pregnancy. The dietitian will in particular focus on the carbohydrates in your diet which you should neither avoid nor eat to many of. It is important that you prioritise making an appointment with the dietitian regardless of whether you have previously had gestational diabetes.     

Why carbs are important? 

Your unborn child needs the right amounts of nutrients and energy from dietary carbohydrates for foetal growth and brain development. Carbohydrates in the food you eat will be broken down into glucose (sugar) in your intestines, absorbed into the bloodstream, and transported directly to the placenta and further on to the foetus. If you eat too many carbohydrates and consistently have too high blood sugar levels, your foetus will gain too much weight and may become too large for its gestational age. If you completely avoid or eat too few carbohydrates, your foetus will not receive sufficient energy and nutrients for its growth and development. How much your blood sugar will rise after a meal will depend on the amount and type of carbohydrates you eat. Accordingly, it is important that you eat satisfactory amounts and types of carbohydrates and divide your daily carbohydrate intake into several meals in the course of the day.   

Where can you begin?

Before your consultation with the dietitian, you can begin by improving the carbohydrate quality of your diet. 
Carbohydrates are found in a wide array of both healthy and unhealthy foods.

1. Eat healthy carbohydrates
Choose carbohydrate foods which are digested more slowly, prompting a lower and more gradual rise in blood sugar. Slow-acting carbohydrates include those with a high content of dietary fibre (look for the wholemeal food label) and/or many visible whole grains and seeds. They are primarily found in the following foods: Rye bread; wholegrain bread with visible whole grains and seeds; wholegrain rice; brown or parboiled rice; wholegrain pasta; wholegrain bulgur; legumes (chickpeas, lentils, dried beans); thick-rolled oats; small, firm potatoes; and vegetables (e.g. different varieties of cabbage). Choose milk and other dairy products (maximum of 400 ml per day) plain or added noncaloric artificial sweeteners. Fruit is healthy but contains natural sugar (like dairy products) so limit your intake to 3 pieces per day (app. 300 grams), primarily the Nordic types (e.g. apples, pears, berries) and divide between 3 snacks. 

2. Avoid unhealthy / less healthy carbohydrates
Avoid carbohydrate foods which are digested quickly, prompting a high peak in your blood sugar level. Fast-acting carbohydrates are primarily found in starchy processed foods with a limited content of dietary fibre and with no visible whole grains and seeds (e.g. bread made from finely ground flour; thin-rolled grains including oats; porridge; mash; basmati rice; jasmine rice; sushi rice; plain pasta/spaghetti; couscous; and bulgur). Furthermore, high amounts of simple sugars are found in food products with added sugars such as candy; ice cream; cake; desserts; jam; dairy products with added sugar (e.g. fruit yoghurt); breakfast cereals with added sugar (e.g. honey honey-roasted muesli; granola; Coco Pops; Frosties; Guldkorn (popped wheat grains roasted in honey and brown sugar); Lion; Nesquik). Lastly, you should avoid food products with naturally occurring sugars such as dried fruit (e.g. dried figs; dates; raisins), exotic fruit (e.g. pineapple; mango; melon), soft drinks and juice.  

3. Eat frequently with a smaller carb load per meal   
Divide your carbohydrate foods into 3 main meals (breakfast, lunch, and dinner) and 2-3 snacks (late morning, afternoon, and possibly late evening) to limit the portion size of carbohydrate foods at each meal and thereby maintaining lower and more regular blood sugar levels over the day. 

4. Eat according to the T-plate model 
Use the T-plate method to limit the amount of carbohydrates in your main meals:

• Fill half (1/2) of your plate with vegetables
• Fill one quarter (1/4) with starchy carbohydrates (potatoes, rice, pasta, bread etc.)
• Fill one quarter (1/4) with fish, poultry, lean meat, eggs, tofu, or legumes

5. Be physically active every day 
Being physically active can lower your blood sugar. We recommend that you are physically active for at least 30 minutes a day. You can divide the 30 minutes into e.g. 2 x 15 minutes or 3 x 10 minutes every day.
You can for instance go for a walk or a bike trip after your main meals.

Before the visit at the dietitian 

We recommend that you prepare yourself before your appointment with the dietitian. Download the (Danish) app ”Kulhydrat” issued by the Danish Diabetes Association. You will be instructed in the use of this app by your dietitian. Write down any questions you may have with respect to your diet and any challenges with respect to coping with new healthier habits.  

Websites about gestational diabetes

Be critical about information from the internet if you search for knowledge about gestational diabetes prior to your visit appointment the dietitian. Many websites are not trustworthy. If you wish to learn more, we recommend the following websites:

• Gravid med diabetes (www.gravidmeddiabetes.dk) 
  Gravid med diabetes (“Pregnant with diabetes”) is both a website and an app. You can search for ”Gravid med diabetes” in app store or use the above link. Under ”settings”, you can change language into English or Swedish. This website/app is targeted at women experiencing diabetes during pregnancy, and it has been developed by healthcare professionals working with diabetes and pregnancy. 
   
• Videncenter For Diabetes (www.videnscenterfordiabetes.dk)
  Videnscenter For Diabetes (“Diabetes knowledge centre”) is a unit under Steno Diabetes Center Copenhagen that shares information and knowledge about diabetes for diabetes patients and health care professionals. Search for ”gestational diabetes” in the subject field. This website also provides several relevant videos in Danish, English, Arabic, and Urdu describing what gestational diabetes is, what you need to know about carbohydrates when you have diabetes and why, and which kind of, exercise is recommend when you have diabetes. Follow the link: www.youtube.com/@videncenterfordiabetes/videos