For women with diabetes, nutritional counseling should include adequate dietary intake, frequent glucose monitoring, insulin management to meet the growth needs of the fetus, maintaining optimal blood glucose levels, and preventing ketosis and depletion of the mother's nutrient stores. The demands of pregnancy may impose a need for insulin in pregnant women whose condition was controlled through diet alone in the nonpregnant state. Because of hormonal changes during the first and second half of pregnancy, changes to the diet and the insulin dosage may be necessary.
Gestational diabetes occurs only during pregnancy and usually resolves after pregnancy. It occurs in 5-10% of pregnancies and most commonly arises after 20 weeks of gestation. Gestational diabetes can be treated largely through nutritional care and moderate exercise to achieve weight control. Nutritional recommendations are to limit protein intake to 15% of total calories, consume 55% of total calories as carbohydrate, and limit fat intake to 30% or less of total calories. Cholesterol intake should be 300 mg/day or less, simple carbohydrate intake should be limited, and sodium intake should not exceed 1000mg/1000kcal. Insulin is rarely needed, although blood glucose levels should be monitored daily.
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