Diabetes diet - diabetes in pregnancy
This document is part of the ACI Diet Specifications for Adult Inpatients. It is not to be used for patient education.
Aim
To provide a nutritionally adequate diet that optimises blood glucose and gestational weight gain in pregnant women with diabetes.
Characteristics
The usual goals of treatment for diabetes in pregnancy include tighter blood glucose targets with less fluctuation than the goals for non-pregnant women.
Moderate energy, with 40-50% energy from carbohydrate and < 10% energy from saturated fat, total fat 30-35% energy. Includes one low glycaemic-index (GI) food (GI≤55) at each meal and snack. Ensures a set level of carbohydrate at each meal and mid-meal (30-45g per main meal and 30g per mid-meal). Added refined sugars are to be minimised to ensure nutrient density.
All foods need to comply with NSW Food Authority guidelines on food safety in pregnancy. Fish offered must comply with Food Standards Australia New Zealand guidelines on mercury in pregnancy
Indications
Pregnant women with Type 1, Type 2 and Gestational Diabetes Mellitus. This diet is for use where strict carbohydrate portion control is specified.
Nutritional adequacy
Nutritionally inadequate.
Precautions
It is appropriate to serve patients with diabetes from regular unrestricted menus, with consistent amounts of carbohydrate at meals and snacks. Special sugar-free foods are not required but artificially sweetened foods and beverages are allowable in modest amounts.
The energy level and carbohydrate distribution may be individually determined by the dietitian, but a typical meal plan would include the following number of 15g carbohydrate portions per meal.
| Meal | 15 portions per meal |
|---|---|
| Breakfast | 2.5 |
| Morning tea | 2 |
| Lunch | 3 |
| Afternoon tea | 2 |
| Dinner | 3 |
| Supper | 2 |
Compared to other diets for diabetes, there is not a range of carbohydrate portions allowed. This is to avoid inconsistency day to day.
Default mid-meals should provide two carbohydrate portions (e.g. full sandwich or fruit and yoghurt) and be nutrient dense with particular reference to calcium.
Paediatrics
Generally not suitable for use in paediatrics. May be suitable for adolescents under dietetic supervision.
Specific menu planning guidelines
| Allowed | Not allowed | |
|---|---|---|
| Hot main dishes | Main dishes ≤15g fat, ≤5g saturated fat and ≤30g carbohydrate per serve Lean meat, skinless chicken, fish, eggs (thoroughly cooked) Soy products, e.g. tofu, textured vegetable protein (TVP) Cooked legumes Low-mercury fish, e.g. canned tuna and salmon Dishes with added soft cheese (e.g. ricotta / fetta) are allowed if cooked | Main dishes >15g fat, >5g saturated fat and >30g Carbohydrate per serve Fatty meat (e.g. bacon, sausages, hamburger mince), offal Deep-fried and shallow fried meals Shark (flake), billfish (broadbill, swordfish, marlin), orange roughy (deep sea perch), catfish |
| Sauces, gravies | Gravies and sauces with <1.5g fat and <5g carbohydrate per serve Cranberry and mint sauces in small amounts | Cream-based sauces Gravies and sauces with >1.5g fat and >5g carbohydrate per serve |
| Starchy vegetables / pasta / rice | All dishes with <1.5g saturated fat per serve Dishes prepared without added fat, or made with small amounts of mono or polyunsaturated oil (e.g. mashed and steamed potato, sweet potato) Use low-GI rice (e.g. basmati or doongara) if possible (see GI website for full list) | Dishes with >1.5g saturated fat per serve Fried or roasted vegetables with added saturated fat |
| Vegetables | All vegetables* <1.0g saturated fat per serve Vegetables prepared without added fat (e.g. plain steamed or boiled), or made with small amounts of mono or polyunsaturated oil | Dishes with >1.0g saturated fat per serve |
| Soups | Low-fat soups (≤5g fat and ≤1.5g saturated fat per serve) | Soups with >5g fat and >1.5g saturated fat per serve |
| Sandwiches | ≤15g fat and ≤5g saturated fat per serve Made with monounsaturated or polyunsaturated margarine Sandwiches using allowed fillings including pasteurised meats (i.e. sous vide or cooked in bag and sliced are acceptable with correct food hygiene practices) Canned fish, hard cheese Thoroughly cooked eggs | Butter Cold processed meats (e.g. ham, salami, chicken) (unless pasteurised) Smoked salmon Soft and semi-soft cheese (e.g. brie, camembert, ricotta) Pâté Sprouted seeds (e.g. alfalfa) |
| Salads, dressings | All salads* ≤15g fat and ≤5g saturated fat per serve (including the dressing) Low-joule dressings, or dressings made with mono or polyunsaturated oils are preferred | All salads >15g fat and >5g saturated fat per serves (including the dressing) Sprouted seeds (e.g. alfalfa) |
| Breads, cereals | Wholegrain / wholemeal breads (preferably grainy low-GI breads) White bread may also be available Breakfast cereals containing <23g carbohydrate per serve Higher-fibre breakfast cereals only (>3g/serve, e.g. rolled oats, muesli, bran cereals, Guardian®) At least two low-GI cereal choices per breakfast (see GI website for full list) | Sweet breads and pastries e.g. croissants Highly sugared breakfast cereals (>30% sugar, unless primarily from added fruit) Breakfast cereals containing >23g carbohydrate per serve and <3g fibre per serve |
| Spreads | Yeast spread, peanut butter Monounsaturated and polyunsaturated margarines | Jam, honey and sweet spreads Saturated fats (e.g. butter, cooking margarine,) Pâté |
| Hot breakfast choices | Any item containing <20g carbohydrate and <3g saturated fat per serve Hard boiled or hard poached egg Scrambled egg Mushrooms, baked beans, tomatoes | Any item containing more than 20g carbohydrate and 3g saturated fat per serve Fried egg, bacon, sausages Hash browns Pancakes, hotcakes and waffles Canned spaghetti |
| Fruit | Unsweetened fresh*, frozen or canned fruit in natural juice Dried fruit if <15g carbohydrate per serve | Canned fruit in syrup Fruits that cannot be readily sanitised to reduce pathogen load e.g. strawberries and rockmelon |
| Yoghurt | Yoghurts with <5g saturated fat and <30g carbohydrate per serve | Yoghurts with >5g saturated fat and >30g carbohydrate per serve |
| Desserts | Desserts with ≤2g saturated fat and ≤30g carbohydrate per serve | Full-fat ice-cream High-fat and sugar pastries and pies Soft serve ice cream Desserts containing >2g saturated fat and >30g carbohydrate per serve |
| Milk and cheese | All unsweetened milks and calcium-fortified milk alternatives (e.g. soy or nut beverages) Hard cheese <5g fat per serve Pasteurised cottage cheese | Grain derived milk alternatives (e.g. rice or oat beverages) Flavoured milk drinks Cheese spreads, soft and semi-soft cheese (e.g. ricotta, brie, camembert) Unpasteurised dairy products |
| Beverages | Water, tea, coffee, low-joule soft drinks or cordial, plain mineral water All unsweetened milks and calcium-fortified milk alternatives (e.g. soy or nut beverages) Fruit juice with no added sugar (1 serve per day) | Regular soft drinks and cordial, flavoured mineral water, alcoholic drinks Flavoured milk drinks Grain derived milk alternatives (e.g. rice or oat beverages) |
| Biscuits | Plain low-fat biscuits and crackers with ≤2g saturated fat per serve (e.g. Granita™, Shredded Wheatmeal™, Milk Coffee™, Milk Arrowroot™) Muesli bars (less than 2g sat fat and 30g carbohydrate per serve) | Biscuits and crackers with >2g sat fat per serve e.g. Cream or chocolate biscuits |
| Miscellaneous | Herbs and spices if cooked or appropriately sanitised Nuts Artificial sweeteners, pepper, salt | Cream, sugar Potato crisps, chocolate Milo™ and malted milk powders |
| Celebratory foods, special occasions | 20g chocolate easter eggs on Easter Sunday |
References
- American Diabetes Association Guide to Nutrition Therapy for Diabetes; Second edition, 2012
- American Diabetes Association. Planning meals. [accessed 26 August 2015].
- Glycemic Index Foundation, University of Sydney. The GI Index and GI database. [accessed 26 August 2015].
- Dietitians Association of Australia. Nutrition manual. 9th ed. Canberra: DAA; 2014.
- Dietitians Association of Australia. Evidence based practice guidelines for the nutritional management of type 2 diabetes mellitus for adults. Canberra: DAA; 2006.
- NSW Food Authority. Pregnancy and food safety. [accessed 26 August 2015].
Change log
| Change date | Section updated | Change |
|---|---|---|
| April 2021 | Title of Specification | Title changed from Diabetic diet - diabetes in pregnancy to Diabetes diets - diabetes in pregnancy |
| September 2022 | Specific menu planning guidelines | Created a new food group row under Miscellaneous, titled Celebratory foods, special occasions |
| September 2022 | Specific menu planning guidelines – Celebratory foods, special occasions | In Allowed, added 20g chocolate easter eggs on Easter Sunday |