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Cardio Diabetes Medicine 2017 597

Insulin to Carbohydrate Ratio disorders, and impaired intellectual development.
The pre-meal insulin dose is calculated by insu- Mercury-contaminated fish
lin-to-carbohydrate ratio.Prandial or mealtime insulin
must match the amount of mealtime carbohydrate to Fish containing high levels of methyl-mercury, a
keep glucose levels in the target range before and potent human neurotoxin that readily crosses the
after eating. placenta and has the potential to damage the fetal
nervous system should be avoided. Prefer fresh lake
Choose where possible carbohydrate from low Gly- water fish to other sources.
cemic Index (GI) sources. Substituting low–glycemic
load foods for higher–glycemic load foods may mod- Lactation
estly improve glycemic control 5
Breast-feeding is recommended for infants of women
with preexisting diabetes or GDM. Lactating women
Vitamin and Mineral Recommendations have reported fluctuations in blood glucose related to
Adequate calcium, iron, folate, vitamin D, and mag- nursing sessions, often requiring a snack containing
nesium intakes are especially important in pregnancy. carbohydrate before or during breast-feeding.
400 μg /day of folic acid from fortified foods and /or Lactating type 2dm calorie requirement being total
a supplement, as well as food folate from a variety of calories provided in the 3 trimester + 200kcals/day,
rd
foods, is recommended for the prevention of neural not <1800kcals/day.
tube defects and other congenital abnormalities.
Protein recommendations being +18gm/day for first
Fiber and whole grains. 6 months and +25gms/day for following 6 months.
Recommendations for fiber intake for people with di- Provide adequate fluid, calcium& lactogogue rich diet.
abetes are like the recommendations for the general
14g/1000 kcals of TEI. Long-term therapeutic consideration:
Non-nutritive sweeteners. All patients with prior to GDM should be educated
regarding lifestyle management that reduces insulin
The use of products that are classified as Generally resistance that is including maintenance of normal
Recognized As Safe (GRAS) are acceptable during body weight by MNT and physical activity.
pregnancy in moderation.
Summary of Nutrition Recommendations
Stevia has recently received GRAS status; however,
there is little specific research on the use of stevia Gdm 6
during pregnancy. Saccharin crosses the placenta The primary goals of nutrition therapy for diabetes
and hence unsafe during pregnancy. during pregnancy are excellent glycemic control

* Non-Caloric/ Non-Nutritive Sweeteners- (Approved appropriate weight gain, and a nutrient-rich eating
by FDA) 6 pattern. Food plans should be culturally appropriate
* Acesulphame K PL * Avoid in Renal Failure / Hy- and individualized to consider the patient’s body hab-
perkalemia its, weight gain, and physical activity and be modified
as needed throughout pregnancy to achieve treat-
* Aspartame PL *Moderation (Avoid in Phenyl Keton- ment goals.
uria)
Conclusion
* Saccharin PL *Avoid as it crosses the placenta.
Medical nutrition therapy is a form of “Natural thera-
* Neotame PL *??
py with no side effects”. Taking care of women with
* Sucralose PL *Safe GDM by adequate nutrition advise and achieving
euglycemia in them is likely to prevent obesity and
* PL *-Pregnancy & Lactation,
glucose intolerance in their offspring.
Alcohol
No amount of alcohol consumption can be consid-
ered safe during pregnancy. Alcohol use during preg-
nancy increases the risk of alcohol-related birth de-
fects, including growth deficiencies, facial abnormal-
ities, central nervous system impairment, behavioral

Cardio Diabetes Medicine