All recommendations have been updated and reorganized to clarify management considerations for women with pregestational or gestational diabetes in the prepregnancy period, during pregnancy, and in the intrapartum and postpartum periods.
1.All women of reproductive age with type 1 or type 2 diabetes should receive advice on reliable birth control, the importance of glycemic control prior to pregnancy, the impact of BMI on pregnancy outcomes, the need for folic acid and the need to stop potentially embryopathic drugs prior to pregnancy [Grade D, Level 4 (1)]. 4.Women with type 2 diabetes who are planning a pregnancy should switch from noninsulin antihyperglycemic agents to insulin for glycemic control [Grade D, Consensus].
6.Women should be screened for chronic kidney disease prior to pregnancy (see Chronic Kidney Disease chapter, p. 9.Detemir [Grade C, Level 2 (24)] or glargine [Grade C, Level 3 (25)] may be used in women with pregestational diabetes as an alternative to NPH.
11.Women should receive adequate glucose during labour in order to meet their high-energy requirements [Grade D, Consensus]. 12.Women with pregestational diabetes should be carefully monitored postpartum as they have a high risk of hypoglycemia [Grade D, Consensus].
15.All women should be encouraged to breastfeed since this may reduce offspring obesity, especially in the setting of maternal obesity [Grade C, Level 3 (28)]. 17.If there is a high risk of GDM based on multiple clinical factors, screening should be offered at any stage in the pregnancy [Grade D, Consensus].
21.Receive nutrition counselling from a registered dietitian during pregnancy [Grade C, Level 3 (37)] and postpartum [Grade D, Consensus]. 22.If women with GDM do not achieve glycemic targets within 2 weeks from nutritional therapy alone, insulin therapy should be initiated [Grade D, Consensus]. 23.Insulin therapy in the form of multiple injections should be used [Grade A, Level 1 (20)]. 24.Rapid-acting bolus analogue insulin may be used over regular insulin for postprandial glucose control, although perinatal outcomes are similar [Grade B, Level 2 (38,39)]. 27.Women should receive adequate glucose during labour in order to meet their high-energy requirements [Grade D, Consensus]. 29.Women should be screened with a 75 g OGTT between 6 weeks and 6 months postpartum to detect prediabetes and diabetes [Grade D, Consensus].
I knew many other women pregnant with twins and the vast majority did not have GD, but it does heighten the risk.
That may seem like not many women to you, but when you think about how many pregnant women there are in the world at any give time you are NOT alone by far.
GD does not mean for certain that your babies will be born prematurely, overly large, and does not mean you WILL have any further complications during labor and delivery. However, if you lose the weight postpartum and go back to your former size or close, you have lower than a 1 in 4 chance of developing type 2 diabetes in the future. If you look back in my pregnancy journal you will see I was completely devastated with the GD diagnosis.
Also admittedly, the thought of pricking my finger 6 times a day, changing everything about my diet overnight, running to extra doctor appointments, and walking a tightrope looking at my levels on a meter all day long made me scared and feeling overwhelmed. It all may seem overwhelming but remember, it’s for such a short time when you think about it. NB: We use cookies to help personalise your web experience and comply with Irish healthcare law. This site contains information, news and advice for healthcare professionals.You have informed us that you are not a healthcare professional and therefore we are unable to provide you with access to this site. If these targets (also see table 2) cannot be met with diet and physical activity alone, insulin therapy must be considered. Health Service Executive – Guidelines for the Management of Pre-gestational and Gestational Diabetes Mellitus from Pre-conception to the Postnatal period. Do you agree that private hospitals should be paid via the NTPF to cut public hospital waiting lists? You will need a glucose meter, alcohol pads, sterile finger lancets and sterile test strips.
If your insurance plan doesn't pay for glucose meters, ask your doctor which meters he or she recommends. For someone who has severe diabetes, continuous blood sugar monitoring may be a viable option.
The following are some suggestions on when to do SMBG testing and how to use the results to improve your blood sugar control. If you get blood from your fingertip, try washing your hands in hot water to get the blood flowing. Recommendations for the best time of day to test your blood sugar depend on your medicine, mealtimes and blood sugar control. Portions of this article were developed as part of an educational program made possible by an unrestricted educational grant from LifeScan, Inc., makers of OneTouch Blood Glucose Meters. Portions of this article were developed by the American Academy of Family Physicians in cooperation with the American Diabetes Association.


This site complies with the HONcode standard for trustworthy health information: verify here. A1c chart: understanding the ac1 test, A brief, yet informative article explaining the a1c test, the a1c chart and how they are used in diagnosing, managing and treating patients with diabetes. A1c chart & calculator using the dcct formula, A1c chart has a1c to bs conversion using dcct formula. American diabetes association – a true a1c chart, A1c measures the percentage of hemoglobin cells in your blood that have bonded with glucose molecules. A1c chart – diabetes community by diabetes hands, Josh, the chart should be used as a goal. Women with pregestational diabetes who also have PCOS may continue metformin for ovulation induction [Grade D, Consensus]. S129) [Grade D, Level 4, for type 1 diabetes (17) ; Grade D, Consensus, for type 2 diabetes].
If the initial screening is performed before 24 weeks of gestation and is negative, rescreen between 24 and 28 weeks of gestation.
Recommendations for weight gain during pregnancy should be based on pregravid BMI [Grade D, Consensus]. Use of oral agents in pregnancy is off-label and should be discussed with the patient [Grade D, Consensus]. Effectiveness of a regional prepregnancy care program in women with type 1 and type 2 diabetes: benefits beyond glycemic control.
Preconception care for diabetic women for improving maternal and fetal outcomes: a systematic review and meta-analysis.
Preconception care and the risk of congenital anomalies in the offspring of women with diabetes mellitus: a meta-analysis. Poor glycated hemoglobin control and adverse pregnancy outcomes in type 1 and type 2 diabetes mellitus: systematic review of observational studies.
Glycemic control during early pregnancy and fetal malformations in women with type 1 diabetes mellitus. Use of maternal GHb concentration to estimate the risk of congenital anomalies in the offspring of women with pre-pregnancy diabetes.
Glycaemic control is associated with preeclampsia but not with pregnancy-induced hypertension in women with type 1 diabetes mellitus. Strategies for reducing the frequency of preeclampsia in pregnancies with insulin-dependent diabetes mellitus.
Effect of pregnancy on microvascular complications in the Diabetes Control and Complications Trial. Maternal exposure to angiotensin converting enzyme inhibitors in the first trimester and risk of malformations in offspring: a retrospective cohort study. Central nervous system and limb anomalies in case reports of first-trimester statin exposure. Microalbuminuria, preeclampsia, and preterm delivery in pregnancy women with type 1 diabetes: results from a nationwide Danish study. Improved pregnancy outcome in type 1 diabetic women with microalbuminuria or diabetic nephropathy: effect of intensified antihypertensive therapy?
Twice daily versus four times daily insulin dose regimens for diabetes in pregnancy: randomised controlled trial.
Maternal glycemic control and hypoglycemia in type 1 diabetic pregnancy: a randomized trial of insulin aspart versus human insulin in 322 pregnant women. Glycemic control and perinatal outcomes of pregnancies complicated by type 1 diabetes: influence of continuous subcutaneous insulin and lispro insulin.
A comparison of lispro and regular insulin for the management of type 1 and type 2 diabetes in pregnancy.
Maternal efficacy and safety outcomes in a randomized, controlled trial comparing insulin detemir with NPH insulin in 310 pregnant women with type 1 diabetes.
Metformin therapy throughout pregnancy reduces the development of gestational diabetes in women with polycystic ovary syndrome. Breast-feeding and risk for childhood obesity: does maternal diabetes or obesity status matter?
Fasting plasma glucose versus glucose challenge test: screening for gestational diabetes and cost effectiveness.
Impact of increasing carbohydrate intolerance on maternal-fetal outcomes in 3637 women without gestational diabetes.
Postprandial versus preprandial blood glucose monitoring in women with gestational diabetes mellitus requiring insulin therapy. Recommendations for nutrition best practice in the management of gestational diabetes mellitus. Maternal metabolic control and perinatal outcome in women with gestational diabetes treated with regular or lispro insulin: comparison with non-diabetic pregnant women.


Comparison of an insulin analog, insulin aspart, and regular human insulin with no insulin in gestational diabetes mellitus.
Prospective observational study to establish predictors of glyburide success in women with gestational diabetes mellitus. Comparative placental transport of oral hypoglycemic agents in humans: a model of human placental drug transfer. Comparison of glyburide and insulin for the management of gestational diabetes in a large managed care organization. Effects of early breastfeeding on neonatal glucose levels of term infants born to women with gestational diabetes. Association of breast-feeding and early childhood overweight in children from mothers with gestational diabetes mellitus.
Lactation intensity and postpartum maternal glucose tolerance and insulin resistance in women with recent GDM: the SWIFT cohort.
Anybody can potentially get gestational diabetes during pregnancy, more especially if you are carrying multiples. Only your testing will tell you for sure as I didn’t really notice any symptoms myself. Normally the body makes and uses insulin for energy without any problem, but in the case of gestational diabetes you are not producing enough insulin and the sugar builds up in your blood and it doesn’t get used by your body for fuel. I believe it may show itself during pregnancy and you may be diagnosed later, but only if you were going to be diagnosed anyway. One of these tests is called an A1C test, which reflects your blood sugar (or blood glucose) control over the past 2-3 months. Using a blood glucose monitor to do SMBG testing can help you improve control of your blood sugar levels. Food and Drug Administration (FDA) has approved meters that work without pricking your finger. With these systems, blood sugar is measured constantly through a sensor placed beneath the skin that transmits information.
Testing times are based on the kind of medicine you take and on how well your blood sugar levels are controlled. When you are sick, even without eating, your sugar levels may run high, so testing is important. Continue testing more often until you have maintained your SMBG goal values for at least 1 week, or until your doctor advises you that more frequent testing is no longer necessary.
Women with microalbuminuria or overt nephropathy are at increased risk for development of hypertension and preeclampsia [Grade A, Level 1 (17,18)] and should be followed closely for these conditions [Grade D, Consensus].
I couldn’t understand why I had it, and worried about the effects on my babies to be. Just make sure to follow all instructions to assure both you and your babies are happy and healthy, ask questions and demand answers. Testing your A1C level every 3 months is the best way for you and your doctor to understand how well your blood sugar levels are controlled. Different meters work differently, so be sure to check with your doctor for advice specifically for you. However, with some meters, you can also use your forearm, thigh or the fleshy part of your hand.
You may also want to keep track of what you have eaten, when you took medicine or insulin, and how active you have been during the day. If you don’t allow all of that extra glucose to get to your babies, they will be of normal size. Every person who has diabetes should have a blood glucose monitor (also called a home blood sugar meter, a glucometer, or a glucose meter) and know how to use it.
You'll also check it more often when you feel sick or stressed, when you change your medicine or if you're pregnant. Most people will be able to get through this with only diet changes and some increased exercise. If you want to pay a little more money, you can get a meter that stores the results in its memory. Talk with your doctor about what is a good range for your blood sugar level and what to do if your blood sugar is not within that range. Nobody wants to have gestational diabetes, but it’s not a death sentence or anything.




Blood glucose monitoring in gestational diabetes
Hypoglycemia diabetes treatment


Comments

  1. 27.02.2014 at 20:40:53


    7.9 before suggary drink and than a small amount of water for.

    Author: A_ZER_GER
  2. 27.02.2014 at 13:44:59


    Used in combination with mealtime insulin Patients with type.

    Author: Hellboy
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    Author: Lovely_Girl