During this module, we are going to take a look at what it means to manage your diabetes, instead of your diabetes managing you. We are going to look at items such as:

1. General Guidelines
2. Proteins
3. Fats
4. Carbohydrates
and putting these together in a Meal Plan.

Each section of the module is represented on this plate. Click on each portion of the plate to take you to that section.

There are some General Guidelines that you should keep in mind when managing your gestational diabetes. We will go over some different things that you need to remember.

When choosing meals and snacks, there are some things to consider.

1. It is important to have small, frequent meals every 3-4 hours when you are awake.
2. You should also choose a wide variety of foods. Remember to include all of the food groups and a rainbow of colors when choosing foods.

Also remember to use artificial sweeteners in moderation.

It is best to stay away from sweetened 'sugary' beverages. Click on the different beverages to see if they count as 'sugary' beverages.

Thumbs Down means stay away. Thumbs Up, it's ok.

Remember to eat a combination of at least 5 fruits and vegetables daily. However, you should not eat any fruits in the morning hours.

It is also important to choose whole grains, and while we are on the subject of breakfast; you should limit the amount or completely skip cereal for breakfast.

A bedtime snack is very important. When choosing this snack, be mindful of the carbs and proteins. It is best to stay around 15 grams of carbs and 7 grams of protein when selecting this snack. Some possible snack choices are fruit - like a small apple with 2 tablespoons of peanut butter, low-fat yogurt with no sugar added, a few pretzels (about 3/4 of an ounce), or 6 saltine crackers with 1 slice of chicken or turkey. Remember to add proteins to your bedtime snack. If you have questions about snacks, ask your dietitian or diabetes educator.

You also want to include a source of protein with all of your meals and large snacks.

You need to make sure you eat foods that are lower in fat and cholesterol.

Choose lean meats.
Use low-fat cooking techniques like baking, broiling, grilling, or boiling.
Look for heart-healthy fats.
Use herbs and spices to flavor your foods instead of using oils and butter.

Pick which foods you think are low in fat and cholesterol.

Limit processed foods due to the excessive sodium content found in many of these products.

It is also a very good idea to stay away from alcohol altogether.

Get moving! Any activity is better than none.

Please get consent from your doctor before you start doing any exercise or other similar activities.

You need to strive for 20-30 minutes of light activity most days of the week. The goal is to accomplish 150 minutes of exercise per week.

There are some useful websites to track this in the resources tab of this module.

Get moving! Any activity is better than none.

Let's take a look at your monitoring and medication needs.

Checking your blood sugar regularly is especially helpful in determining if medications are needed in addition to your meal plan to control your blood glucose.

Let's take a look at how to use your glucometer. Press 'Play' on the video.

Some general recommendations for when to test your blood sugar are:

- At least 4 times a day: before breakfast and 1 or 2 hours after every meal.
- Any time you feel like you may have low blood sugar.
- Your doctor may recommend checking before and after each meal if you have Type 1 Diabetes or uncontrolled Type 2 Diabetes.

- Remember to bring your blood glucose logs and glucometer to every doctors appointment.

You might be wondering what kind of glucometer you should use. Well, there are numerous different kinds to choose from. Look at the options on the screen and choose the one that you feel is the best.

Now you might be asking yourself, "How am I going to pay for these supplies?"
Your insurance may cover all or part of the needed supplies.
Medicaid will also cover your Diabetes testing supplies.
Other insurance may cover a small portion as well.
If neither of these apply to you, please use what you can afford as monitoring is extremely important.

There are some target glucose levels that you need to stick to when managing diabetes in pregnancy. These levels include some technical terms. Please check the glossary of the module if there are any terms that you are unfamiliar with.

Your A1c, a hemoglobin that is checked every 3 months to determine average range of blood sugars, should be below 6.0%
Fasting blood sugar should be between 60 and 90. This is when the patient's blood sugar is checked first thing in the morning, before eating or drinking.
It is also important to test blood sugars 1 hour or 2 hours after you begin eating a meal. This is known as postprandial. At 1 hour, the level should be between 100-129. At 2 hours, the level should be less than 120, according to the ADA.
Blood glucose levels should also be checked before meals (pre-meal values). This level determines how much insulin is needed at the time of the meals. The acceptable pre-meal value range for this is 70-99.
Ideally, you want to aim for an average daily blood glucose between 88-105.

We need to take a look at medications that may be necessary during your management of your diabetes. Insulin or pills may be needed in addition to the meal plan to keep your blood glucose levels controlled.

Most women prefer pills but need to know that sometimes insulin work better. Insulin has been used in pregnancy for decades.

Please watch the video on the screen.

If you happen to find yourself at a fast food restaurant, you must be very careful with your choices. Here is a list of options that you may encounter at these places.

You may also need some help when it comes to making choices with Fruit, Dairy, and Vegetables. Here are some recommended serving sizes for these.

And, of course there is going to be the time when sweets come calling. In some cases, you can answer this call, but you must be prepared when you do so. Here is a helpful guide.

Proteins will help maintain blood sugar control, but other than that, they have no direct effect on blood sugar levels.

When someone thinks of protein, they typically think of meat. This is generally the case, but there are a few items that you may not be aware of. For instance, while poultry, beef, and fish are all proteins, you may not know that cheese, eggs, and tofu are as well. It is important to have a good understanding of what a protein is.

A serving size is equal to 3 ounces. As a reference, think of a deck of cards. This is about what 3 ounces looks like.

Remember to make lean choices when selecting proteins. These items include such things as skinless chicken, turkey, baked fish, egg whites and low fat cheeses.
Avoid higher fat proteins such as pork chops, fried meats, bacon, sausage, pepperoni, bologna, and salami, among others.

Proteins should be eaten with every meal and large snack, especially at bedtime.

Carbohydrates are very important when it comes to managing your gestational diabetes. In fact, carbs are a macronutrient that have the largest effect on blood glucose levels.

Here is a selection of different foods. Please click on the item or items that you feel need to be considered when figuring carbs, and then click 'submit'.

As we stated earlier, when choosing starches, it is important to select ones that contain 100% Whole Grains. Read food labels carefully.

You also want to choose high fiber foods when building your meal plan. These high-fiber foods should add up to 20-35 grams a day.

When picking out your milk and other dairy products, be sure to look for the low-fat options. These are the ones that you will want to get.

Also, if you purchase canned fruit, select the options that are in their own juice, not syrup.

You might be asking yourself how you can measure your carbs. One carb serving equals 15 grams, or half a cup. This is about what can fit in the palm of your hand.

For more information on carbohydrate counting and what counts as a serving, click on the American Diabetes Association logo. There is also an Exchange List book that your dietitian or diabetes educator can give you.

There are some guidelines that you need to follow when it comes to meals and snacks.

Your Breakfast goal should be 35 grams of carbs, or 2 servings. Remember, no fruit or cereal.
For lunch and dinner, keep it to 45 grams of carbs, or 3 servings.
And for snacks, they should be 1-2 servings (15-30 grams).

Make healthy choices.

Now, let's take a look at the food nutrition labels for carb counting.

We have all seen these labels before, but now they have different meanings for you.

The first thing you want to do is look at the serving size and servings per container. Adjust the size of the serving to fit your meal plan.
You want to look at the Total Carbohydrates. There is no need to look at the Sugars because these are included in the Total Carb count.

In this example, this food item has 41 grams of carbohydrates per serving. The recommended amount of carbs for a snack is 15 grams. Therefore, if a person was to eat a complete serving of this item, then we would divide the total grams by the recommended grams to give us the number of servings of carbohydrates. For this food item, we take 41/15 = 2.7 servings of carbohydrates. You would need to adjust how much you eat based on this calculation.

After all of these things have been considered, you must decide if that item fits into your meal plan. Ask your registered dietitian if you need help using the information on food labels.

It is always best to try and limit the number of carbs you consume. Now that we have discussed different ways to do this, here are a few options along with appropriate servings.

Fats have a minimal effect on blood sugars. That does not mean that one should eat whatever they want when it comes to fats, however. Let's take a look at some good fats and bad fats.

Serving sizes of fats tend to vary, but a good guide is that a serving size is typically the size of a thumbnail. Let's take a look in the refrigerator at some different types of fats that you need to be aware of.

Click on the refrigerator to take a look inside.

There are three different categories of fats. There are monounsaturated, polyunsaturated, and saturated fats. Monounsaturated are better for you than polyunsaturated and polyunsaturated are better than saturated. In fact, it is actually best to avoid saturated fats altogether if you can.

For this example, we will look at the different ways to prepare chicken. Click and drag the chicken over the different cooking methods to see which ones you should use.

Now that you know what to look for regarding fats, here are some options and their respective serving sizes. Be sure and pay special attention to the Monunsaturated Fats Section. Use this as a guide when making your choices.

Meal planning is one of the most important things you can do when managing your gestational diabetes.

The first thing you need to remember is that you want to choose a wide variety of foods from each of the food groups to make sure you get the nutrients you need. A good rule of thumb for this idea is to 'eat the colors of the rainbow' and we are not talking about Skittles.

Here we have three different plate options for you to choose from. Please click on each of the plates to find out if it would fit into your meal plan when managing gestational diabetes.

After you have completed this task, click 'next' to look at a planning table for your day.

Here is a table to let you know what your carbohydrate limits for each meal and snack throughout the day. You can also click the button on the screen to take you to the USDA SuperTracker site.

Now, let's look at some example plates.

Now, what we need to do is create a plate. Here we have a standard dinner plate. First, you want to divide this plate in half. Next, you want to divide of those sections in half. You should have 3 sections to your plate as you see in the illustration.

First, let's start with breakfast. Remember, breakfast should consist of 35 grams of carbohydrates. This can include 1 slice of brown toast, 1 cup of 2% milk, and 2 eggs (or a scoop of scrambled eggs).

For lunch, you can have up to 45 grams of carbohydrates. A great example plate for this meal would be 2 slices of bread, an apple, about 2 ounces of turkey (3 slices), 1 slice of American cheese, lettuce, tomatoes, and unlimited water.

Now comes dinner. Just as it was at lunch, you are allowed 45 grams of carbohydrates. A dinner plate might look like this: small baked potatoes, 1 slice of garlic bread (<3 ounces), unlimited vegetables, a piece of chicken about the size of a deck of cards, and a 1/2 cup of fruit.

One 12-ounce can of regular soda has about 150 calories and 40 grams of carbohydrate. This is the same amount of carbohydrate in 10 teaspoons of sugar! Diet sodas are acceptable in moderation.

Tea is ok by itself, but only if it is unsweetened. Sweet tea can be just as dangerous as soda.

Water is the purest of beverages. There is no sugar and no calories.

Low-fat milk is a healthy drink choice. It provides more calories and carbohydrates than the other recommended choices, but it also provides important vitamins and minerals. Remember to control your portion size when it comes to milk.

Some sports drinks are equivalent to a fruit drink in that they have high amounts of sugar and carbohydrates.

Some fruit juices are high in sugar. If you choose to drink juice, make sure it is 100% juice with no sugar added. Juice contains a lot of carbohydrates in a small portion, so keep track of this in your meal plan.

Actually, any of the glucometers on the screen are acceptable, as are many others.