Question

Scenario: you are working as a registered nurse in a large women’s clinic. YL, a 28-year-old Asian woman arrives for her regularly scheduled appointment. She is in her 26th week of pregnancy and is a primigravida. After examining the patient, the nurse midwife tells you to schedule YL for a glucose challenge test. You review YL’s chart and note she is 5 feet, 3 inches tall and weighs 143 lbs; her pre-pregnancy body mass index was 25. Her father has type 2 diabetes mellitus, and both paternal grandparents had type 2 DM. You enter the room to talk to YL.

Laboratory test results:

Time of test	Value	Normal Range
0730	109 mg/dL	Less than or equal to 92 mg/dL
0830	213 mg/dL	Less than or equal to 180 mg/dL
0930	162 mg/dL	Less than or equal to 153 mg/dL

Medical nutrition therapy is the primary treatment for the management of gestational diabetes. Because treatment must begin immediately, you call the dietician to come see YL. You also schedule YL to meet with other members of the diabetes management team later in the week.

1. What is the goal of nutrition therapy?
2. Describe a usual diet used in treating gestational diabetes.
3. Why is nutrition therapy for a woman with gestational diabetes higher in fat and protein than for a woman who is not pregnant?
4. Women with gestational diabetes cannot metabolize concentrated simple sugars without a sharp rise in blood glucose. Name 5 examples of simple sugars you would teach YL to limit.
5. Complex carbohydrates do not cause a rapid rise in blood glucose when eaten in small amounts. Identify 5 foods from this group.

During the meeting with the dietitian, YL gives a diet history that is high in noodles and rice with little protein. She informs the dietitian she is lactose intolerant but can have dairy products occasionally in small portions.

6. Is it important that YL take a calcium supplement along with her prenatal vitamins?
7. YL is instructed to monitor her fasting blood glucose first thing in the morning and 2 hours after every meal. What are the purposes of this request?
8. YL is instructed to complete ketone testing using the first-voided urine in the morning. What is the rationale for this request?
9. YL asks whether having gestational diabetes will hurt her baby. How will you respond?
10. At the conclusion of the visit, you need to evaluate your teaching. Which statement made by YL indicates that clarification is necessary?

1. “I will stay on the diabetic diet described by the dietitian.”
2. “I will monitor my glucose levels at least four times each day.”
3. “I need to stop exercising because I will need more carbohydrates.”
4. “I should immediately report any ketones in my urine.”

11. YL states that she plans to have another child soon and asks you if she will develop gestational diabetes with that pregnancy. Select the best response.

1. “Yes, once you develop gestational diabetes, you will develop it with all future pregnancies.”
2. “No, there is no further risk for development of gestational diabetes if you get pregnant again.”
3. “If you lose weight and do not eat any sweets before your next pregnancy, you will not develop gestational diabetes again.”
4. “There is a risk for recurrence of gestational diabetes in the next pregnancy. Let your health care provider know that you had gestational diabetes with this pregnancy.”

Answer 1

Goals of Medical Nutrition Therapy:

• Optimal nutrition and weight gain for fetus and mother
• maternal euglycemia
• Reduction in risk for diabetes related complications in mother and the infant.
• Minimize the maternal and infant morbidity and mortality rates
• Delaying the onset of type 2 Diabetes Mellitus

Diet plan for Gestataional Diabetes:

What to Eat

Identify what foods may elevate blood glucose levels. The diet should be combination of three macronutrients: carbohydrates, proteins, and fats.

Carbohydrates

Carbohydrates provide energy and nutrients to our body. They are of 2 major types: sugars and starches which increases the blood glucose level, and fibres which doesnot increase the blood glucose level but helps in digestion. Carbs rich in minerals and vitamins should be chosen.

Good carbs:

• Raw fruits e.g.: berries, watermelon, mango
• Starchy vegetables, e.g.: like peas, corn
• Non-starchy vegetables (low in carbs and high in fiber) , e.g.: lettuce, broccoli
• Legumes e.g.:, chickpeas, lentils
• Whole grains
• Nuts
• Seeds, e.g.:quinoa,flax
• Dairyproducts, e.g.: milk, yogurt

Avoid:

• table sugar
• artificial sweeteners
• refined floor and packaged food products
• canned foods

Protein

Protein constitutes the building blocks of body components like muscles, skin, and bones. They are also abundant in nutrients. Proteins will not increase blood glucose levels but in excess amount may keep them high for long.

Good for you:

• Lean protein,e.g.: eggs, turkey
• Plant protein, e.g.: dried beans, nuts

Avoid:

• Read meat,
• Processed non veg products
• Raw that contains high mercury levels

Fat

Fat is required for energy, cell growth, as well as proper temperature control.

Good for you:

• Unsaturated fats, e.g.: olive oil

Avoid:

• Saturated and trans fats, e.g.: butter,fatty beef

How Much to Eat

The portion size should be moderated. Plate method is a widely accepted portion size control .

Plate Methods

On a 9-inch plate, imagine 3 sections, which contain:

• 50% non-starchy veggies
• 25% lean protein
• 25% carbohydrates

+ a small side bowl of fresh fruits or yogurt

Why is nutrition therapy for a woman with gestational diabetes higher in fat and protein than for a woman who is not pregnant?

The growth and development of the fetus and gestational development require protein and fat than a woman who is no pregnant.

Women with gestational diabetes cannot metabolize concentrated simple sugars without a sharp rise in blood glucose. Name 5 examples of simple sugars you would teach YL to limit

• table sugar
• cakes and pastries
• corn syrup
• packed fruit juice concentrates
• jams

Complex carbohydrates do not cause a rapid rise in blood glucose when eaten in small amounts. Identify 5 foods from this group.

• corn
• oats
• brown rice
• whole wheat

Is it important that YL take a calcium supplement along with her prenatal vitamins? YES

YL is instructed to monitor her fasting blood glucose first thing in the morning and 2 hours after every meal. What are the purposes of this request?

To know the hike in blood glucose due to a meal

YL is instructed to complete ketone testing using the first-voided urine in the morning. What is the rationale for this request?

To check for diabetic keto acidosis.

Answers are given beyond the necessary number of questions. All the best. Stay safe.