What is this information about?

This information is about healthy eating for people with type 2 diabetes who are also pregnant.

This booklet provides advice on maintaining a balanced diet during pregnancy while helping to control diabetes and manage weight.

If you have any questions about diet, pregnancy, or diabetes, please ask your midwife or dietitian.

Why have I been given this information?

You’ve been given this information to help you manage your type 2 diabetes during pregnancy.

 It provides guidance on:

• maintaining a balanced diet
• understanding blood glucose targets

This information will help you make informed decisions about your diet and health to ensure both you and your baby stay healthy throughout your pregnancy.

What blood glucose target should I aim for during pregnancy?

Keep your blood sugar within these ranges:

• Fasting: below 5.3mmol/L
• at one hour after you meals: below 7.8mmol/L

You can do blood sugar level check by doing a finger-prick test when needed.

What about if I use continuous glucose monitoring?

Keep your blood sugar within these ranges:

• 3.5 – 7.8 mmol/L

As shown in the picture below ranges are:

safe target range (green): 3.5–7.8 mmol/l

low blood sugar range (red): below 3.5 mmol/l

high blood sugar range (yellow): above 7.8 mmol/L

If you are using a continuous glucose monitor (CGM), try to keep your blood glucose levels within these ranges more than 9 times out of 10 (90% of the time).

What is Time in range (TIR)?

It is important to keep your blood sugar within your target range more than 7 times out of 10 (70% of the time). This is called Time in Range (TIR).

Time in range is how often your blood sugar stays within your target range, set by your healthcare team, usually between 3.5–7.8 mmol/L.

What are the recommended Time in Range (TIR) targets for diabetes management?

Try to keep your Time in Range (TIR) above 70%.

This means that more than 7 times out of 10, your blood sugar readings should be within the range of 3.5–7.8 mmol/L, or as set by your healthcare team.

What are the recommended Time in Range (TIR) targets for pregnant people with type 2 diabetes?

For type 2 diabetes during pregnancy, experts suggest aiming for:

• a TIR of 9 times out of 10 (90% of the time) within the range
• no more than 1 time in 20 (5% of the time) above the range (also referred to as Time Above Range – TAR)
• no more than 1 time in 25 (4% of the time) below the range (also referred to as Time Below Range – TBR).

How can I manage my Diabetes type 2 during pregnancy?

 You might:

• take tablets like Metformin to manage diabetes during pregnancy.
  
• inject insulin to control your blood sugar levels. Insulin can be:
  
  • Long-acting insulin once or twice a day
    
  • Rapid-acting insulin with meals.

Please ask your diabetic nurse if you would like more information about different types of insulin.

For the best results, aim for regular meals with consistent carbohydrate portions.

 If your meal has no carbohydrates, rapid-acting insulin is not necessary.

What should I do if I experience Hypoglycaemia?

Treat hypoglycaemia (or “hypo”) if your blood glucose level is below 3.5 mmol/L. Symptoms include:

• shaking
• feeling hot and sweaty
• confusion
• blurred vision
• hunger

Check your blood glucose to confirm it’s a hypo. If so, follow these steps:

Step 1
Consume 15-20g of rapid-acting carbohydrate, such as:

• 200ml Lucozade Original
• 150ml Cola or another non-diet fizzy drink
• 4-5 Dextrose tablets
• 3 heaped teaspoons of sugar
• 4 jelly babies

Step 2
Wait 5-10 minutes, then re-check your blood glucose. If it’s still below 3.5 mmol/L, repeat Step1.

Step 3
Once your blood glucose is above 3.5 mmol/L, have 15-20g of slower-acting carbohydrates, such as:

• 1 slice of bread
• 1 piece of fruit
• 200ml glass of milk

Which foods cause my blood glucose levels to rise?

We eat three main groups of nutrients: 

• Fats and proteins. These have little effect on your blood glucose levels. The amount of these that you eat, especially fat, can affect your weight though. Include some healthy fats and lean proteins in your meals to: 
  • help manage your glucose level after you have eaten 
  • help you to feel fuller for longer. 

• Carbohydrates. These are the foods that have the most effect on blood glucose levels. All carbohydrates are broken down into sugar (glucose). This glucose is taken into your blood stream and makes your blood glucose levels rise. You need a regular supply of carbohydrate, ‘fuel’, over the day. The insulin your body makes helps you to use this glucose for energy. 

The amount of glucose your body makes depends on the amount of carbohydrate you eat.

It is important to spread carbohydrate foods evenly over the day and to avoid large portions.

Blood glucose monitoring will help you to understand how different carbohydrate foods and portions affect your blood glucose levels. 

There are 4 main types of carbohydrate: 

• starch (for example, potatoes or pasta) 
• sugar (glucose or sucrose) 
• fruit sugar (fructose) 
• milk sugar (lactose). 

Carbohydrates 

Foods containing carbohydrates: 

• sugar. For example, glucose and fructose 
• breakfast cereals and cereal based products 
• fruit and fruit juices 
• pasta and grains. For example, rice, couscous, bulgur wheat 
• all types of bread and bread products 
• milk and milky products. For example, yoghurt and ice cream 
• pulses. For example, peas, beans and lentils 
• potatoes and yams 
• snacks such as biscuits, cakes, crisps and cereal bars 
• confectionary such as sweets and chocolates 
• pies, pasties, and pastry products. 

Portion sizes for carbohydrates 

• At mealtimes, aim to have no more than 1 fist sized portion (or 30-40g) of starchy carbohydrate. 
• Try to limit snacks to no more than 10g carbohydrate. (Please ask your dietitian for a low carbohydrate snack list for some ideas). 
• Choose low GI (glycaemic index) starches whenever possible. These are broken down into sugars more slowly and cause less of a rise in your blood glucose. 
• Eat regular meals. 
• Sugary foods should be kept to a minimum. 
• Replace larger portions of starchy foods with extra vegetables or low-fat proteins such as chicken, fish, beans and pulses. 

What portion size of different carbohydrate food types will provide 30g of carbohydrate?

What do I need to know about eating at breakfast time?

You have been asked to test your blood glucose levels before your breakfast and one hour after all meals. 

It is harder to control your blood glucose after breakfast than it is for other meals. This is because your placenta makes high levels of hormones around breakfast time, especially in the third trimester of your pregnancy. 

You are likely to need to eat less carbohydrates at this time of the day.

Do try: 

• eating more protein-based foods at breakfast time. These can help you to feel fuller for longer. Try to eat protein sources for breakfast, for example eggs, cheese, nuts, nut butters or plain yoghurt. 
• splitting your breakfast into two sessions. 

For example, have half of your usual breakfast when you get up and then have the other half as a mid-morning snack. 

What breakfasts could I have that contain 20 to 35g of carbohydrate (CHO)

Breakfasts that contain 20 to 35g of Carbohydrate

What is the Glycaemic Index (GI)?

The glycaemic index is a measure of how quickly a carbohydrate food is broken down into sugar. It also tells you how much and how quickly it then changes your blood glucose levels.

• High GI foods are broken down into sugars very quickly. They cause a rapid rise in blood glucose levels. You will often feel hungry again soon after eating these foods.
• Low GI foods are broken down into sugars much more gradually. They cause a more gradual rise and fall in blood glucose levels and help you to feel fuller for longer.

They are a more slow-release source of energy.

The effect of eating high and low GI foods on your blood glucose levels is shown in this graph:

Do choose low Glycaemic Index (GI) starchy foods. Low GI starchy foods release glucose very slowly into the blood, which is good for controlling your blood glucose level.

Avoid large amounts of foods with a high glycaemic index.

Which foods are in the low, medium and high GI categories?

You can see which types of foods from the different food groups have a low, medium or high GI below:

What small changes to my diet can I make that will help to control my gestational diabetes?

It may seem like a challenge to change your eating pattern and cut back a lot on what you eat. Do try these small changes which can make a real difference:

Try these small changes which can make a real difference

Meal	Current choice	Try instead
Breakfast	White toast with jam	Granary toast with peanut butter or porridge with milk
	Fruit juice	A piece of fruit
Snack	Chocolate biscuit	Nuts or Savoury oat/ rye biscuit
Lunch	Brown bread ham sandwich, crisps and low fat yoghurt	Ham and 2 high fibre crackers, small fruit portion, veg sticks with dip or hummus

Meal	Current choice	Try instead
Snack	Crisps	Mashed avocado or handful of savoury popcorn/unsalted nuts/seeds
Evening meal	Cheese and pasta bake with garlic bread	Small amount of wholemeal pasta bake with added vegetables or side salad
	Fruit pie and custard	Handful of fresh or frozen fruit with Greek yoghurt or small amount of custard made with sweetener or sugar free jelly
Evening snack	Sugar coated cereal with milk	High fibre cereal with milk or handful nuts
Drinks	Sugary drinks	Diet drinks/fruit tea/ fruit infused water

Vegetables

Why is it important to eat plenty of vegetables?

Fruit and vegetables are full of vitamins that are very good for you and your baby. Aim for at least 5 portions of fruit and vegetables a day. They also have lots of fibre, which helps to fill you up and helps to prevent constipation which can sometimes be a problem in pregnancy.

Filling up on vegetables at your main meal is important to help to prevent too much weight gain.

Do aim to have:

• Half the plate filled with vegetables or salad
• A quarter of the plate taken up with starchy food
• Another quarter taken up with a source of protein or with a portion of meat, fish, tofu or beans.

What ideas can I try that will help me to eat extra vegetables?

Ideas to include extra vegetables in your diet include:

• Have salad with your meal
• Boiled vegetables on the side if you are having a ready meal
• Add extra vegetables into stews, curries, and pasta sauces
• Chop up vegetables like carrots and celery and have them as snack
• Include pulse and vegetable-based soups
• Add beans and pulses to meals to help you feel fuller. They are also low calorie and count as one of your 5 a day

Can I eat fruit?

Fruit is an excellent, nutritious snack and is full of vitamins and fibre.

Do eat whole fruit rather than fruit juice. Fruit juice and smoothies have a large amount of fruit sugar.

Try to have no more than 150ml per day but you may have to cut out these drinks altogether if having them causes your blood glucose levels to rise too high. If you do have fruit juice, try to have it with a meal and consider diluting it with water.

Do have fruit as a snack instead of crisps, biscuits, or chocolate. You can have two to three portions of fruit each day.

A portion of fresh fruit is about a handful. For example, one apple, one small banana, a handful of grapes or two satsumas.

A portion of dried fruit is around one tablespoon.

Some examples of low carbohydrate fruits are berries or small fruits like plums, satsumas, and kiwis. Try to spread eating fruit out over the day and do not eat more than one portion at a time as they contain natural sugars (fructose). This will help to control effects on blood glucose.

1 portion fresh fruit = 80g                 1 portion dried fruit = 30g

Should I gain or lose weight if I’m pregnant and ‘eating for two’?

No. Some people believe that because they are pregnant, they should be eating lots more to feed the growing baby but you do not need to eat much more than you would usually.

It is more important that you eat the right balance of foods.

Controlling your weight gain will help to control your diabetes and help your baby’s development.

Do not aim to lose weight during pregnancy. If you were overweight before you became pregnant you should try to keep your weight stable and avoid gaining lots of weight. Your dietitian or midwife can discuss the right level of weight gain for you based on your weight before or at the beginning of pregnancy.

How much weight gain should I expect during pregnancy? This depends on your BMI (Body Mass Index) before you were pregnant (pre-pregnancy BMI) and whether you have a single

or twin pregnancy.

What do the different levels of BMI mean?

• Under 18.5 = underweight
• 18.5-24.9 = normal range
• 25-29.9 = overweight
• More than 30 = obese

What are the top tips for stopping me gaining too much weight when I’m pregnant?

To avoid gaining too much weight when you’re pregnant do:

• eat regular meals, 3 times a day
• limit portion sizes (follow the handy portion guide on 6)
• eat plenty of vegetables and salad
• snack on a piece of fruit instead of crisps, biscuits, cakes
• eat less fat. For example avoid pastry, fried foods, chocolate, biscuits, butter, cream.
• eat more fibre. Do this by including plenty of vegetables and fruit, and choosing wholegrain options.
• drink plenty of water.
• be active, for example go for a 30 minute walk each day.

Avoid sugary foods and drinks.

Can exercise help me to control my blood glucose?

Yes, regular exercise can help improve blood glucose control.

Do try to do some moderate exercise, such as a 30 minute walk every day

Should I use ‘Diabetic’ foods to help me to control my blood glucose?

No. You may see specially made ‘diabetic’ foods such as chocolates or biscuits. These are not recommended because they:

• can still affect your blood glucose levels as they often contain some starchy carbohydrate even if they are sugar free
• can sometimes have more total carbohydrate than non ‘diabetic’ foods
• can be high in fat and calories
• are expensive
• can have a laxative effect.

How can understanding food labels help me?

Using food labels can be a useful way to check if a food is high or low in fat, sugar, and salt. Try looking at ‘per 100g’ on the food label.

Do choose mostly foods that are low in sugar, fat, saturated fat, and salt.

What counts as a high or low amount per 100g for the different nutrients?

Do look at ‘per 100g’ on a label to compare different brands of a food. You may not always be able to find a low sugar (less than 5g) version of a product but checking labels can help to choose the best option.

For example, if you pick up three different breakfast cereals, yoghurts, or jarred sauces you can look at the sugar per 100g for each of them and pick the one with the lowest amount of sugar.

Which other nutrients should I make sure I’m having?

Folic Acid

Folic acid supplements help to prevent spinal cord problems in the growing baby. You should take a daily 5mg folic acid supplement from the time you stop contraception to the 12th week of pregnancy. 

Calcium

It is very important to have plenty of calcium. This helps your baby’s bones to develop and protects your bones.

Do aim to have three portions of a dairy food each day.

Examples of one portion are:

• a glass of milk or milk alterative fortified with calcium (200ml)
• small pot of yogurt (check sugar content) or 3-4 tbsp. Greek or plain natural
• 40g or 1-2oz of cheese.

If you do not include dairy foods in your diet do include 3 portions of calcium rich foods per day. Examples include:

• 3 – 4 tbsp. fortified plant based yoghurt
• 200ml plant based milk alternative. This should be fortified with calcium and not be organic.
• 60g tofu
• 2 slices calcium fortified bread
• 1/2 tin sardines or 50g whitebait.

Iodine

You need iodine for your body to produce thyroid hormones. These hormones help with your baby’s brain and bone development.

Foods containing iodine include pasteurised milk, pasteurised dairy products, and fish. It is likely that if you eat these foods regularly you will be getting enough iodine. If you don’t, please discuss this with your midwife, GP, or dietitian.

Vitamin D

Do take a daily supplement of Vitamin D (10 micrograms) when you’re pregnant or breast feeding.

If you already take a pregnancy multivitamin, check the label. If it has at least 10 micrograms of Vitamin D, you do not need to take a separate Vitamin D supplement.

If you do need extra Vitamin D, you can buy a supplement which has 10 micrograms from a pharmacy or supermarket.

Some people qualify for free vitamins through the Healthy Start scheme. Ask your health professional for more information about the Healthy Start scheme.

Iron

A diet with plenty of iron will help to prevent you becoming anaemic. The best source of iron is red meat, such as beef or lamb.

Try to include this at least twice a week, and make sure it is well cooked.

Other good sources of iron are:

• fortified breakfast cereals
• kidney beans and other beans & lentils
• green leafy vegetables
• wholemeal bread.

If you have been prescribed an iron supplement, when you take it, have something with vitamin C in it, such as a piece of citrus fruit, at the same time. This helps your body to take in (absorb) and use the iron.

Avoid drinking tea or coffee at the same time as having your iron supplement as this can stop it from being absorbed properly.

Other Important Nutrients

Fish oils are good for your heart health and for your baby’s development. Aim for one to two portions a week of oily fish.

These fish count towards your 1 to 2 portions:

• salmon
• sardines
• pilchards
• trout
• mackerel
• kippers.

Avoid shark, marlin, and swordfish altogether when you are pregnant because of the mercury content.

Tinned tuna is not an oily fish but do not eat more than four 140g tins of tuna a week.

Can I have caffeine when I am pregnant?

Do limit your caffeine intake to less than 200mg a day when you are pregnant.

This guide will give you an idea of caffeine contents, but these vary between brands:

• mug of tea: 75mg
• mug of instant coffee: 100mg
• mug of filter coffee: 140mg
• can of diet cola: 40mg
• chocolate (50g bar): 10-25mg

What can I do to reduce the amount of caffeine that I’m having?

You can reduce the amount of caffeine you are having by:

• choosing decaffeinated teas, coffees and soft drinks rather than the caffeinated version
• trying fruit ‘teas’. Limit these to a maximum of 4 cups per day
• drinking more water
• trying ‘no added sugar’ squash or ‘sugar free’ flavoured water.

Which foods should I avoid during pregnancy and why?

Do avoid:

• liver and liver products such as liver pate. Liver is very high in vitamin A. High amounts of vitamin A can be harmful to the growing baby.
• alcohol. Alcohol can seriously damage the growing baby.

foods which can cause Listeria infection including:

• soft ripened cheeses, such as Camembert, Brie, goats’ cheese.
• mould-ripened cheeses
• unpasteurised milk
• pate (meat & vegetable)
• pre-cooked or ready prepared foods that will not be reheated, such as pre made salads, or quiche.
• smoked or cured fish which has been produced at a cold temperature (cold smoked) or raw fish, including sushi. For example, smoked salmon, gravlax or sushi unless they have been cooked until steaming hot.
• These foods can sometimes have bacteria, which cause Listeria infection. Listeria can infect the growing baby and be very damaging.
• raw eggs and undercooked poultry. These foods can contain Salmonella bacteria. Salmonella infection can be very harmful during pregnancy.
• shark, marlin, and swordfish. These fish contain levels of mercury that are too high during pregnancy.

Can I breast feed or chest feed?

Breastfeeding is recommended for all mothers. It may have a protective effect for your baby’s future health and development.

Having diabetes does not affect this choice. Breast-feeding can help you to lose weight.

Your insulin or medications requirements will drop significantly after delivery so please liaise with your diabetes team for help regarding dose adjustment.

Hypoglycaemia episodes can be more common during breast feeding if you are taking insulin so you may need to adjust your insulin doses or have some extra carbohydrate snacks. Discuss with your diabetes team.

Who should I contact if I need further information or support after I’ve read this information or would like to give feedback?

If you have any questions about diet, pregnancy and diabetes please ask your midwife or dietitian.