Gestational diabetes guidance
Read our guide below to find out you what care to expect during the rest of your pregnancy and the postnatal period if you have gestational diabetes. It won’t answer every question you may have, so please write any concerns down and ask your midwife or doctor.
You can also download a PDF version of this patient information by following the link on the right.
How to use the GDM Health app to monitor your diabetes
GDm-Health is a free app that helps women with gestational diabetes (GDM) manage their blood glucose levels. It’s available for iOS and Android devices.
Step 1
Search and install GDM Health from your App store.
Step 2
Analytics content – press ‘Save and Continue.’
Step 3
Press ‘Agree.’
Step 4
Press Activate then on the next screen, enter the 9 digit activation code you’ll have received by text message or over the phone.
Step 5
Connect to Meter – turn on blootooth and wi-fi
Press ‘Set up Meter’
‘Aga Matrix’
This pairs the meter to your phone.
The meter should give you a code. Enter this code. The meter should now be set up.
Step 6
Once your app is activated and the meter connected, you’re ready to upload your readings. From this screen you can scroll down and click on each of the subjects to read more information.
Click on ‘request callback’ to get in touch, particularly when you’ve had 2 higher readings.
Click ‘Take BG Reading’ to input your readings.
Step 7
The first time you press ‘Take BG reading’ will you take you to this screen. Scroll through the instruction pages and see the video for taking a blood sample with the meter.
Step 8
On the next screen press ‘scan’, making sure your meter is also switched on. The readings should scan across. Under the ‘scan’ button you can also enter readings
manually. Once the reading shows on screen press ‘next’.
Step 9
Input your meal type. Press ‘next.’
Step 10
Now enter what you’ve eaten that meal. This is particularly important if you’ve had a high reading so we can offer dietary advice. Then press
‘finish.’
Step 11
The next screen should now show your readings at 100%. If you miss any of the recommended 3 readings a day this percentage will come down. Click
on the pink circle with 100% to show your readings.
Step 12
This screen shows your readings in graph format and list. Readings within normal range will show in green. Readings out of normal range will show in red.
Step 13
If you have your phone screen unlocked, if turned to landscape you can see your readings in relation to your meals.
Get more help on setting up the GDM health app
Watch the video below for more help on using the app and managing your diabetes at home.
Contacts for diabetes related queries only
Stoke Mandeville Hospital (SMH)
01296 255790, Monday to Friday, 8am to 4pm
Wycombe Hospital (WH)
01494 425575, Wednesday, 8am to 4pm
Labour ward triage
01296 316103
Day assessment unit (SMH)
01296 316106 or your community midwife for other pregnancy related queries.
Monitoring blood glucose levels
Breakfast
Alternate days either before or 1 hour after you’ve finished eating.
Lunch and evening meal
1 hour after finishing your meal every day.
Ranges
Before meals – less than 5.3mmol. After meals – less than 7.8mmol
If you have 3 or 4 high readings, please request a call back so we can review. This may just be for dietary advice or to review if medication starts or adjustments. We’ll aim to call back within 72 hours of your request.
Growth scans
Apart from regular blood glucose monitoring via the GDM Health app, we aim for you to have scans at 32 weeks and 36 weeks, along with a face-to-face clinic appointment.
However, if you remain diet controlled and had GDM in a previous pregnancy, you won’t need a scan at 32 weeks, only at 36 weeks.
Useful videos
How to inject insulin as an adult (Diabetes UK)
How to inject insulin (NHS)
What is gestational diabetes?
It’s a type of diabetes that happens during pregnancy. It happens when the body doesn’t produce enough insulin to balance the effects of the hormones produced by
the placenta so blood glucose levels rise higher than normal.
If it’s diagnosed early in pregnancy, it’s possible that diabetes has been present since before pregnancy.
During pregnancy, hormones are produced which tend to raise blood glucose (also known as ‘blood sugar’). In some people this effect is greater than others, resulting in gestational diabetes. It’s important to control blood glucose levels within certain limits to avoid weight and health problems for the baby at birth and beyond.
How will it affect my baby?
Your baby will not be born with diabetes. However, the high levels of glucose in your blood will cross the placenta and enter the baby’s blood, which isn’t good for
your baby. It may cause him/h
er to grow larger than normal which can make delivery difficult. We’ll minitor your pregnancy and blood glucose levels closely.
What’s the treatment?
We’ll refer you to the diabetes team where your blood sugar levels will be monitored on the GDM health app.
You’ll have a blood glucose meter and learn how to do your own blood glucose levels by finger pricking. You’ll need to do these tests 3 to 4 times per day and
record them on the GDM health app.
The aim will be to keep your blood glucose levels as follows:
- fasting or before meals 5.2 mmol/l or below
- 1 hour after meals 7.7 mmol/l or below.
What happens after the baby is born?
Gestational diabetes generally disappears after your baby is born but is likely to reoccur in any subsequent pregnancies. It may indicate an increased chance of developing Type 2 Diabetes in later life.
Exercise
Exercise helps you maintain good blood glucose control. Try and increase your level of activity through more walking or swimming. Check with your doctor first if you have any other pregnancy complications.
Being active immediately after eating
Being active for 10 to 15 minutes just after eating can make your post meal glucose level as much as 2 mmols/L lower. This can help achieve the post meal glucose target.
This can be going for a walk or being active around the house or workplace.
Avoid being inactive immediately after eating.
Dietary advice
Excessive weight gain during pregnancy will affect your health and increase the risk of having a large baby. The aim of the diet is to help you to keep your blood glucose levels within safe limits for the development of your baby during pregnancy.
You’ll be advised on what your target blood glucose readings are and adjusting what you eat will help you to reach these targets.
With gestational diabetes it is important to eat regularly, aim for three meals a day with 3 snacks a day (1 small snack in between meals). Ensure you eat a balanced diet. Try to eat foods from all the food groups.
If dietary measures aren’t enough to control your blood glucose at normal levels, the diabetes team may recommend metformin tablets. Some women will
also need insulin injections as well.
Healthy eating advice in pregnancy
It’s important to have a balanced diet including foods from each of the following 5 food groups.
Starchy foods
Include: potatoes, sweet potatoes, pasta, noodles, rice, yam and fufu, plantain, semolina, maize, flour and foods made with flour such as bread, chapattis, crackers, rice cakes and dumplings.
These starchy foods give you energy and should make up part of each meal. To help your blood glucose choose wholemeal, wholegrain and high fibre varieties. These are good sources of folate and are needed for the growth of your baby.
Drink at least 6 to 8 glasses of fluid without sugar (1½ -2 litres) daily to help avoid constipation and to ensure you are well hydrated.
Sugary foods
Include: sweets, toffees, mints, full-sugar drinks (squash and pops), milkshakes, smoothies, cakes, biscuits, glucose, granulated sugar, brown sugar, jaggery, honey, golden syrup, maple syrup, jam, ice-cream, ice-lollies, sweet puddings, cakes, and chocolate.
Avoid these foods and drinks as they increase blood glucose levels rapidly.
Fruit and vegetables
Avoid fruit juice, including no added sugar fruit juice, as the natural sugar (fructose) in the fruit juice will raise your blood glucose levels quickly.
Fruit contains natural sugars so spread it out throughout the day. Don’t eat several pieces at the same time. Aim for 2 portions of fruit a day (at separate
times).
Aim for at least 3 portions of vegetables a day (eg 1 handful with lunch and 2 handfuls with dinner).
Meat, fish and alternatives
Protein: Foods such as meats, fish, eggs, and cheese do not directly affect blood glucose. It’s important to include moderate amounts in a balanced, healthy diet.
Vegetarian protein sources include lentils, pulses, beans, tofu, Quorn, and paneer.
Protein can help to fill you up for longer and help to slow down the release of glucose into the bloodstream, if combined with carbohydrate-containing foods at mealtimes.
Bulking up meals with more protein and vegetables/salad.
More protein foods such as meat, fish, chicken, cheese, eggs, tofu, Quorn, pulses, and vegetables will fill you up more and stop you feeling hungry. These foods also flatten out the post meal glucose rise. They help achieve the post meal glucose targets whilst avoiding dips in glucoses later.
Dairy foods
Milk and yogurts contain a natural carbohydrate called lactose which will affect blood glucose if taken in large amounts. By spreading these throughout the day in moderate amounts there will be less effect on blood glucose levels which reduces the carbohydrate load.
A lower carbohydrate alternative would be soy-based milks/yogurts fortified with calcium. Cheese will not affect your blood glucose levels.
Eating the right amount of carbohydrate
It’s important to eat enough carbohydrate to provide enough energy and nutrition to support a healthy pregnancy. But eating too many carbohydrates can raise your blood sugars.
Different carbohydrates can have very different effects on blood glucose levels after eating. Choosing the right type of carbohydrate can make all the difference to keeping the 1-hour post meal glucose below the target of 7.8mmols/l.
Unrefined, high in fibre carbohydrates with a low glycaemic index (below 55) create a slower and lower rise in glucose levels after eating.
Carbohydrates are better when you eat smaller quantities with meals. We generally recommend:
- 30g for breakfast
- 40g to 50g per meal for lunch and dinner
- 10 to 15g for snacks.
Good breakfast choices
Options include:
- 1 slice whole-wheat toast (C15g) with a topping, for example, poached or scrambled eggs / mushrooms / tomato / cheese / ham / bacon / avocado.
- 1 small pot yoghurt (C13g) with one small, chopped fruit or cup of berries (C7g) topped with nuts / seeds
- 25g jumbo porridge oats (C15g) soaked overnight in crème fraiche and 1 cup berries (C7g), top with nuts / seeds
- 40g jumbo porridge oats (C25g) cooked with water and single cream added to taste.
Examples of suitable fruit portions
These include:
- a large handful of strawberries, blueberries, raspberries, blackberries or cherries
- 10 grapes, 2 plums, 3 dried apricots, 2 satsumas, half a mango
- 1 small banana, apple, orange, peach or nectarine.
For a full list of the refined carbohydrates to avoid and those to try instead by food group, see the pdf version of this leaflet by following the link on the right.