Brief Answer:
No issue. Keep diabetes under control

Detailed Answer:
Dear XXXX,

Eating mutton thrice a week is no issue during pregnancy. The proteins from eggs are also of a very good quality and you may think of adding them to your diet. The other very good form of protein is bean sprouts. They are good proteins and very easy to digest. However, the problem with any vegetarian protein is with the amino acids. Still instead of eating only one type of high protein diet, you may have variety of food.

There are 9 essential amino acids required by human body. Amino acids are the tiniest components of proteins. If all 9 essential amino acids are present simultaneously, then only all of them are utilized. Even if one is missing, all of them are discarded by the metabolic system of the body. This is known as 'all or none phenomenon'. There is no vegetarian single food component which contains all nine amino acids; hence in vegetarian diet, blending of the different items is needed to make all 9 essential amino acids complete. Contrarily, the meat or most of the non-vegetarian food contains all 9 essential amino acids; hence easier to be utilised.

You can eat meat or any other non vegetarian food to your diet for the foetal weight growth. If you can digest that, no problem. Take care to eat well cooked food to avoid any infection and/or indigestion of the food.

Try to gain at least one more kg of the foetal weight, ideally double it, before you go into labour. In fact, the babies of the diabetic mothers are supposed to be overweight and still behaving like premature babies.

Have you kept your diabetes under control? What are your fasting and post meal blood sugar levels? How much is your HbA level? I hope you are not anaemic. How much is your haemoglobin level? I would appreciate if you provide me with all this information and upload your reports for my review so that I can advise you further if needed.

I hope you will be satisfied with this information. If so, you may please post a good review with 5 starts. If you wish to have any more information, I am always available for you, XXXX.

Dr. Nishikant Shrotri

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Brief Answer:
Iron + Protein supplementation with BSL monitoring needed

Detailed Answer:
Dear XXXX,

Diabetes mellitus is a genetic disorder and cannot be cured; however can be managed by appropriate diet and medicines.

Please eat high protein, less carbohydrate and low fat diet. In the carbohydrates, avoid simple sugars like glucose, sucrose, etc. Fructose does not require insulin for metabolism. It is present in most of the fruits and honey (pure). Complex sugars might cause less harm. As per your weight, get the caloric requirement calculated from a dietician or a Diabetologist.

Once you are diagnosed as diabetic, it is not necessary to go for Glucose Challenge test every time. Estimation of fasting and post meal (2 hours after food) blood sugar levels will help you to monitor the dose of medicines you have been prescribed. I would advise you to buy a Glucometer which will be a handy tool to monitor your blood sugar levels. Moreover, the cost of glucometer BSL estimation is much less than the laboratory charges. Urine sugar is not of much use during pregnancy as even the normal blood sugar levels in pregnancy may show sugar in urine.

What anti-diabetic medicines you are put on? What dose?

Pregnancy itself is a condition which leads to dilution of the blood. Therefore throughout the pregnancy - 12 weeks onwards, you have to consume iron and folic acid tablets with high protein diet. Low weight of your foetus can be attributed to the anaemia also along with deficient diet.

Haemoglobin is composed of two parts - haem which is formed by iron and globin is a protein. Therefore along with the iron, high protein diet is necessary. In my previous message, I had given you detailed information about protein intake. You have to take iron in the form of medicines in addition to the iron rich diet. Chillies, coriander, jaggery, fresh green leafy vegetables, lentils, red fruits and vegetables are good sources of iron. Due to diabetes, you cannot take jaggery, however you can consume sufficient quantity of the rest of the items.

I think this advice should help you. If you want any further explanation or information, please feel free to ask me, XXXX.

Dr. Nishikant Shrotri

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Brief Answer:
Deworming

Detailed Answer:
Dear XXXX,

You are taking good diet during your pregnancy. There was no necessity to discontinue coconut water. I am not clear how are you making your proteins, apart from the meat and egg white. If you are aware of a recipe called as Thalipeeth, it is indeed a good high protein preparation. I hope you are consuming sufficient number calories; i.e. 2250 - 2500 calories everyday. It is indeed difficult for a pregnant woman to consume much food at one time as the growing uterus limits the distensibility of the stomach. Hence, the dictum is to have small but frequent feeds. Eat every 3 hours. This will provide your body the required quality and quantity of food. Consume at least two glassful of milk in two divided doses. Avoid tea and coffee. In the fruits, avoid XXXXXXX banana, berries, grapes and chikkoo.

In spite if such a balanced diet, if your haemoglobin is low, you have to think of some other cause of anaemia. Intestinal worms are common causes of anaemia not responding to iron treatment. Please deworm yourself. Some of the deworming medicines are having bad effect on the foetus; hence take the medicines only with your Obstetrician's advise.

Please monitor your blood sugar level and accordingly titrate the dose of anti-diabetic medicine (whichever you are taking). I would have appreciated if you had informed me your anti-diabetic treatment.

I hope this guides you sufficiently; however if you want any more information, please ask me.

Dr. Nishikant Shrotri

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