1.The purpose of dietary treatment.
To control total calories and maintain reasonable weight gain of pregnant women. The ideal weight gain during pregnancy: 1.5-3kg before 12 weeks of pregnancy is appropriate; 0.3-0.5kg per week in the middle and late stages of pregnancy is appropriate; less than 8kg before 28 weeks of pregnancy. 8kg for obese people and 12.5kg for normal weight people.
Ensure the nutritional needs of the mother to enable normal growth and development of the fetus.
Ensure normal blood sugar, no hypoglycemia, hyperglycemia and starvation ketosis.
2. Patients are required to
Reasonable control of diet, exercise, and drug therapy.
Learn to self-monitor blood glucose: regularly monitor blood glucose (half an hour before three meals, two hours after three meals, and at night before bedtime) regularly check urine ketone bodies, blood pressure, and fetal development monitoring.
3.How to control the amount of food eaten
You should have a good idea of the type and quantity of food you eat every day. At the beginning of diet therapy, you should use a scale (spring scale or pole scale is recommended) to weigh the main and side dishes, and then put them in the tableware after cooking to see how much there is, so that you can estimate them according to the amount. It is best to bring your own set of special bowls, plates, spoons, etc., each time you eat to take out the food you should eat over time, you can develop the habit of eating according to the amount.
4, the correct choice of food
Cereals are the main source of carbohydrates, the main food. Including rice, noodles and other refined grains; corn, millet, buckwheat, oats and other coarse grains; sweet potatoes, potatoes and other mixed grains. Vegetables with starch as the main component as a side dish, should be counted in the amount of staple foods, these vegetables are lotus root, yam, rhizome, taro, lily, water chestnuts, cicely, chestnuts, etc.; in addition to soy beans, such as adzuki beans, mung beans, fava beans, kidney beans, peas, and their products vermicelli, vermicelli, etc., the main component is also starch, should also be counted as the amount of staple foods. Daily staple food must eat enough, not less than 300g (dry products); staple food to do rice, flour mixed consumption is good for health, that is, two meals a day rice staple food, a noodle staple food, or a rice staple food, two noodle staple food; staple food must be mainly refined grains, with coarse grains, mixed grains, to improve the nutritional value, never eat all coarse grains.
Vegetables must eat enough to more than 500 grams a day, and appropriate beyond the not particularly strict limits. To green leafy vegetables is good, not less than 50% of green vegetables. Sugar content of 3% or less of the following vegetables to choose from: cabbage, cabbage, spinach, rape, oleander, leeks, fennel, chrysanthemum, celery, skullcap, lettuce shoot, zucchini, tomatoes, winter melon, bitter melon, cucumber, eggplant, loofah, kale, lady’s mantle, collapsed cabbage, water spinach, amaranth, lobelia, mung bean sprouts, fresh mushrooms, water-soaked kelp, etc.
Choose high-quality protein, such as lean meat, poultry, fish and shrimp, eggs, milk, soybean products, etc. This is a high-protein, low-fat food. You should ensure a daily intake of one egg (50g) and one bag of milk (250ml). Milk contains a lot of calcium and vitamin B2.
Cooking oil with vegetable oil, no more than 20 grams is appropriate (1-2 spoons of oil).
Salt no more than 6 grams. Sauce, vinegar, onion, ginger, pepper, spices and other condiments can be used at will, but should not be excessive, to light is appropriate.
Cooking methods should be steamed, boiled, mixed, stewed, braised and fried, avoiding fried and candied foods. Avoid fried rice, fried noodles, etc.
Note on the consumption of fruits: If the blood sugar level is persistently high or fluctuates greatly recently, do not consume fruits temporarily. After blood sugar control is stable, you can eat some fruits in moderation. Fruits should not be combined with regular meals, and it is better to eat them as extra meals between two meals, choosing to eat them at 9:00-10:00 a.m. or 3:00-4:00 p.m. or before going to bed at night, so as not to make blood sugar too high, but also to prevent hypoglycemia. Fruits with relatively low sugar content and slow rate of raising blood sugar should be chosen. The latter may be different for different diabetics, and it is important to find the right fruit for you through blood sugar monitoring. Generally speaking: bananas, dates, lychees, persimmons, red fruits, hawthorn have relatively high sugar content; oranges, apples, pears have medium sugar content; melons, watermelons, strawberries, cherries, grapefruit have low sugar content and can be preferred; tomatoes and cucumbers have very low sugar content and can be eaten appropriately instead of fruits. The amount of fruit consumed daily should not exceed 200 grams, and at the same time must reduce the amount of staple food 25 grams, which is the food equivalence exchange approach, in order to keep the total daily calorie intake the same.
5. The foods that should not be eaten are
Various sugars: white sugar, brown sugar, rock sugar, glucose, maltose, honey, chocolate, milk sugar, fruit sugar and preserves, canned fruit, soft drinks, fruit juices, sweet drinks, jams, ice cream, sweet cookies, cakes, sweet bread, sugar pastries and other foods.
Nuts food (peanuts, melon seeds, walnuts, almonds, pine nuts, hazelnuts) is the main component of oil (about 50%), and contains a certain amount of sugar, about 15 peanuts, or 25 sunflower seeds on the equivalent of 10 grams of oil, it should be eaten less or not, not to mention can not be used to fill the hunger, not only will make blood sugar, but also fat, increasing insulin resistance. If you eat, you should reduce the intake of cooking oil.
Foods that increase blood lipids: butter, lamb fat, lard, butter, cream, fatty meat.
All kinds of fried, deep-fried and crispy foods, as well as lard, chicken skin and duck skin should be eaten sparingly or not.
Prohibit the consumption of alcohol. Because of the high calorie content of wine, alcohol contained in wine does not contain other nutrients only for caloric energy. Beer contains 11 grams of sugar per 100 ml, which is easily absorbed and makes blood sugar higher, difficult to control and easy to increase weight. Beverages are recommended to use mineral water, soda, tea.
Quit smoking. Because smoke has the effect of stimulating the release of glucagon, but also tissue hypoxia, microcirculatory disorders.
6, limit the food eaten.
Limit the amount of cholesterol into, should not use or use less animal offal, such as heart, liver, kidney, brain, egg yolk, pine eggs, etc.. This kind of food is rich in cholesterol.
7.Adhere to less and more meals, regular and quantitative meals
To avoid a sudden rise in blood sugar, divide 5-6 meals a day, “three big meals, three small meals”. At least ensure three meals, do not two meals a day. The amount of staple food for three meals is 1/5 of breakfast, 2/5 of lunch and 2/5 of dinner. Patients who are injecting insulin should follow the doctor’s instruction to share 25-50g of staple food from the main meal to be eaten at meal time. Meal time: 9:00-10:00 a.m., 3:00-4:00 p.m., and at night before bedtime. The additional meal before bedtime, in addition to the main meal, can be served with 1/2 cup of milk or 1 egg or 2 pieces of dried tofu and other protein-rich foods to delay the absorption of glucose and prevent hypoglycemia at night.
8.The exchange principle of different foods according to “food exchange method”: (see food exchange method)
a. The foods in the “food exchange method” are all different food weights with a heat production of 90kcal, and foods with equal heat can be exchanged. Generally, the same kind of food is exchanged.
b. Meat, eggs, fish, poultry, beans and dairy products can be exchanged.
c. Patients with good blood sugar control can exchange fruits with staple foods.
d. Fruits are not exchanged with vegetables: fruits have high sugar content and cannot replace vegetables with fruits. Patients who eat fruits should not reduce the intake of vegetables.
e. Nuts contain high fat and it is recommended to eat less, if eaten then the intake of cooking oil should be reduced.
9.Diabetes diet rhyme a
The diet of diabetic patients is based on the principle of reasonable total amount and balanced nutrition. For the people, it is not easy to correctly grasp these two principles of scientific food selection. To facilitate the grasp, the diabetic diet is summarized in a song.
White water: Hot and cold boiling water, more is better. Oil and fat: one spoonful for one meal, according to the amount is appropriate.
Rice and noodles: a clever combination, a bowl is not too much. Salt: light diet, salt pickles do not eat.
Vegetables: green, red, yellow and white, eat more than one. Mixed grains: potatoes and mushrooms, a small amount of often eaten.
Fruits: sugar level, differentiate. Nuts: peanuts and melon seeds, occasionally eat less.
Fish: fish is better than meat, meat to poultry good. Candy: sweet candy, point to point.
Eggs: one a day, just enough. Fried: deep-fried and fried, not a little.
Soy milk: once a day, can’t do without. Smoking and alcohol: quit smoking and alcohol, insist on long.
10. Exercise therapy.
Start walking 10 minutes to half an hour after a meal, walking time 25-30 minutes. Exercise therapy is not suitable for those with preterm labor or combined with other serious complications.
11.Glucose control standard during pregnancy
Glycosylated hemoglobin should not exceed 5.5%. Glycosylated hemoglobin is not affected by the fluctuation of blood glucose momentarily high and low, and cannot reflect the recent blood glucose control level, but can reflect the average blood glucose level 1-2 months before blood sampling, which is a good indicator to reflect the long-term control of diabetes and has an important position in the prediction of long-term complications of diabetes.
12.When is it necessary to use insulin in gestational diabetes? What is its importance?
With reasonable dietary control and appropriate exercise therapy, most patients with gestational diabetes can control their blood glucose in a satisfactory range, but care should be taken to avoid excessive dietary control, which may lead to starvation ketosis in pregnant women and occurrence of fetal growth restriction.
Gestational diabetes patients are treated with diet for 3-5 days, while the 24-hour terminal blood glucose (blood glucose profile test) of pregnant women is measured: including nocturnal blood glucose (or pre-bedtime blood glucose), 30 minutes before and 2 hours after three meals and the corresponding urinary ketone bodies. If the blood glucose is ≥5.6mmol/L before breakfast, 5.8mmol/L before lunch or dinner or 6.7mmol/L 2 hours after meal, especially if the starvation ketosis occurs after diet control and the blood glucose exceeds the limit with increased calorie intake, insulin therapy should be added promptly to control the blood glucose in a satisfactory range.
During pregnancy, insulin therapy should aim to mimic the secretion of insulin under normal physiological condition after basal and three meals.
Postprandial glucose control is more important than fasting glucose in reducing neonatal complications, so it is crucial to control postprandial glucose to the ideal range.
Insulin administration must be started in small doses, with an initial dose of 0.3-0.8 units/kg/day in most patients.
Adjustments are made once every 2-3 days in increments of 2-4 units, depending on blood glucose levels.
Since insulin resistance during pregnancy increases with gestational weeks, the dosage of insulin during pregnancy gradually increases with gestational weeks and is more pronounced at 28-32 weeks.
Insulins that can be used for combined gestational diabetes.
Novaline, Novaline R, Novaline 30R, Novaline 50R, Novaline N.
Novalure: the only insulin analogue approved by Chinese SFDA for use in combined gestational diabetes.
Insulin is originally a hormone secreted by the body itself, which is beneficial and harmless, not to mention non-addictive. The importance of insulin therapy is to reduce maternal and child complications and improve perinatal outcomes; a large amount of evidence from evidence-based medicine confirms that early use of insulin therapy is beneficial for protecting pancreatic beta cells, reducing or delaying the pathological process of maternal type 2 diabetes development in the postpartum period, and preventing the occurrence of type 2 diabetes in the offspring.
13. Be alert to hypoglycemia during insulin therapy
Carry candy and cookies with you. Most patients with blood sugar below 2.8 mmol/L have hunger, dizziness, panic, cold sweat and other discomforts, and should promptly test their blood sugar. If it is hypoglycemia, eat candy immediately.
14.Use of insulin after delivery
After delivery, with the delivery of the placenta, the hormones antagonizing insulin in the body decrease sharply and the need for insulin decreases significantly. Most patients with gestational diabetes no longer need to use insulin after delivery, and only a few patients still need insulin therapy.
Because breastfeeding can reduce the amount of insulin in diabetic mothers after delivery, breastfeeding should be encouraged in diabetic mothers.
15.Indication for hospital admission
If fasting blood glucose is still higher than 5.6mmol/L or 2 hours after meal is higher than 7mmol/L after 1-2 weeks of dietary treatment, the patient should be admitted as poorly controlled blood glucose, and medication should be given.
Comorbidities or complications: hypertensive disorders of pregnancy, FGR, hypohydramnios, infection, renal impairment, ketosis, etc.
It is recommended that pregnant women with GDM be admitted to hospital at 38 weeks of gestation and pregnant women with IGT at 39 weeks of gestation for delivery.
16.Postpartum follow-up
About 6 weeks after delivery, the endocrine changes can reach the stable state of the internal environment at the time of non-pregnancy, and most women have normal pituitary function at 4-6 weeks after delivery. Therefore, the gestational diabetes caused by physiological changes during pregnancy should be completely restored to normal at 6 weeks after delivery. Because the chance of diabetes (most of them are type 2 diabetes) and abnormal glucose tolerance increases significantly in the future, and the chance of recurrence of diabetes in another pregnancy increases. Therefore, 6-12 weeks after delivery, women should go to the endocrinology department of a general hospital to have a 75g glucose tolerance test for reclassification, so as to screen out some women whose blood glucose was abnormal before pregnancy but not clearly diagnosed, and to detect diabetes in time and refer them to internal medicine for treatment. Those with normal postpartum glucose tolerance test should undergo annual diabetes screening test, especially those with elevated fasting glucose levels during pregnancy. If you have symptoms, check in advance.
42 days postpartum checkups: OGTT, insulin release test, glycated hemoglobin, liver and kidney function, C-peptide, urine microprotein.