World Diabetes Day is observed on 14 November and the theme for 2017 is Women and diabetes – our right to a healthy future.

Women are generally the primary caretakers in the family and play a central role in the long-term health status of children and other household members. The increase in lifestyle diseases, such as obesity, diabetes and heart disease, calls for a greater awareness of the importance of healthy food and drink choices to help attain and maintain a healthy body weight.

Pregnant women are also at risk of developing a specific type of diabetes, called gestational diabetes mellitus (GDM). This condition occurs during pregnancy and can lead to serious complications, placing both mother and child at risk of developing diabetes later in life.

Insulin resistance and increased blood sugar levels are common during pregnancy, and predispose some women to develop GDM. Poor blood glucose control in pregnancy can be detrimental to the mother's health, cause birth complications and put the baby at an increased risk of developing obesity and diabetes.

Know the GDM risk factors

GDM is more common in:

• Older women;
• Women who are overweight (BMI above 30);
• Women who smoke;
• Women who have developed GDM in previous pregnancies;
• Pregnancies that follow closely on one another;
• Women who have had a previous unexplained stillbirth;
• Women who have had a previous baby with a very high birth weight (4,5 kg or more);
• Women with an immediate family member (parent or sibling) with diabetes.

More about women and diabetes:

• Most cases of hyperglycaemia (high blood sugar levels) in pregnancy occur in low and middle income countries, where access to maternal care is often limited.
• Diabetes is the ninth leading cause of death in women globally, causing 2,1 million deaths per year.
• Women with type 2 diabetes are almost 10 times more likely to develop heart disease compared to women without the condition.
• Women with type 1 diabetes have an increased risk of early miscarriage or having a baby with malformations, and should receive specialised medical and nutritional therapy during pregnancy.
• Globally one in seven births is affected by gestational diabetes.
• Approximately half of women with a history of GDM go on to develop type 2 diabetes within five to ten years after delivery.
• Half of all cases of hyperglycaemia in pregnancy occur in women under the age of 30.
• Up to 70% of cases of type 2 diabetes could be prevented through the adoption of a healthy lifestyle.

Recommendations for South African women

South African women can follow these tips to reduce their chances of GDM during pregnancy:

• Maintain a healthy body weight and avoid being overweight;
• Do regular exercise;
• Don't smoke;
• Allow some space between pregnancies;
• Attend the six-week postpartum check-up and have a blood sugar test done.

Fifteen dietary recommendations to prevent and treat diabetes

1. Eat a variety of different foods during every meal to ensure that your diet contains sufficient nutrients and that it is more enjoyable.
2. Losing as little as 5-10% of your body weight improves insulin resistance. Lose weight if you are overweight, especially before a planned pregnancy.
3. Eat at least three balanced meals per day.
4. Drink at least six to eight glasses of water per day.
5. Increase you fibre intake by eating:
• whole wheat bread instead of white bread;
• oats, oat bran, or whole wheat cereals e.g. high-fibre cereal for breakfast;
• lots of vegetables and fruits;
• legumes (peas, lentils, beans and soya), and include barley, samp, brown rice and whole wheat pasta in your diet.
6. People with diabetes may benefit from food with a low glycaemic index (GI) or glycaemic load (GL), as long as it is incorporated into a balanced diet.
7. Limit your fat intake, especially saturated and trans fats. These include animal fats, full cream products, chocolate, coconut, hard margarine, baked goods (such as pies and cookies) and palm oils (e.g. coffee creamers and artificial cream). Rather include mono-unsaturated fats in limited amounts into your diet (e.g. use canola or olive oil instead of sunflower oil, or spread avocado or peanut butter instead of margarine on bread).
8. Eat fish two to three times per week and chicken more regularly than red meat. 
9. Follow a mainly plant-based diet and replace meat with legumes (peas, beans, lentils, soy and eggs). Small portions of meat can be eaten daily, however, avoid processed meat like polonies, Vienna sausages and sausage.
10. Eat at least five portions of fruits and vegetables every day and include as much variety as possible. Eat one fruit at a time and do not drink more than 125 ml fruit juice per day.
11. Try to ingest at least two cups of dairy (milk, cottage cheese or yoghurt) per day. It should preferably be low fat products, since they have all the protein and calcium, with less fat.
12. Use healthy cooking methods, such as boiling, steaming, baking/grilling in the oven and barbecuing, and limit the addition of any form of fat (e.g. margarine, oil, mayonnaise, cream and cheese) during food preparation.
13. Use small amounts of salt in food preparation and avoid adding extra salt at the table.  Rather use herbs, salt-free spices and flavouring. Avoid processed foods with a high salt content.
14.  Use alcohol in moderate amounts (one to two glasses a day) and always with a meal.
15. Manage your carbohydrate and sugar intake by limiting or avoiding cake, cold drinks, sweets, cookies, and sugar-sweetened desserts and drinks (including alcohol), which are very high in energy, but low in nutrients.

Access the South African Food Based Dietary Guidelines and recommendations for healthy eating and weight loss at: http://www.sun.ac.za/english/faculty/healthsciences/nicus/how-to-eat-correctly.

For more information, contact NICUS or a dietitian registered with the Health Professions Council of South Africa.

References from the scientific literature used to compile this document are available on request.

Photo: PIXABAY