The hormones produced by the placenta cause the body to resist the action of insulin.
Insulin requirements may increase two or three times during pregnancy.
Gestational Diabetes continued
Some women’s bodies are not able to produce sufficient insulin to keep the blood glucose in the acceptable range and this is gestational diabetes.
A1GDM – controlled with diet and exercise.
A2GDM – requires oral med &/or insulin also
Diagnosis of Gestational Diabetes
Time of test
Fasting (before glucola)
1 hr after
2 hr after
3 hr after
Blood Glucose Level
>= 95 mg/dL
>= 180 mg/dL
American Diabetes Association: Clinical Practice Recommendations 2009
Type 1 or Type 2 in Pregnancy
Important for women with pre-existing diabetes to be in good blood glucose control for 3 months prior to planning a pregnancy.
A1c < = 7% * Fructosamine < 265
Type 2 (Metformin and Acarbose are category B all other oral agents are category C. Insulin still the preferred.
Fasting <or= 90mg/dl
1 hr post meal <or= 130mg/dl
Main source of fuel for our body.
Metabolized into glucose.
Most efficient source of energy for our body.
Provide important vitamins, minerals and fiber.
Medical Nutrition Therapy
Dietitian assesses caloric needs for good growth and development for the baby and normal weight gain for the mother.
Carbohydrate counting is the preferred way to manage blood glucose control.
15 grams of carbohydrate equals one carbohydrate serving.
During pregnancy most women will receive
30 grams of carbohydrate at breakfast.
45-60 grams of carbohydrate at lunch and supper.
15-30 grams of carbohydrate at snack time.
Consistent Carbohydrate Intake
It is important that patients taking insulin and/or medications that stimulate insulin production, eat most of the carbohydrate containing food from their meal.
Carbohydrate servings that are not eaten should be replaced with another carbohydrate food or drink.
Carbohydrate Serving (15 grams) 1 Tbsp sugar 4 oz regular pop 3 graham cracker squares ½ cup corn ½ cup oatmeal 1 cup vegetable soup ½ cup ice cream ½ cup unsweetened canned fruit ½ cup potatoes 1 container light yogurt 4 oz apple 7 saltine crackers 1 cup milk ½ cup fruit juice 1 slice of bread
Causes of Unstable Blood Glucose
Lack of proper medication treatment for blood glucose.
Stress of the hospital admission.
Disease process (pregnancy, infection, steroids, brethine)
Poor dietary intake (incorrect portions of foods, incorrect selection of foods, poor oral intake)
Sliding scale insulin is reactive instead of proactive .
With sliding scale insulin, glycemic control is rarely assessed.
Sliding scale insulin involves a “one size-fits-all” approach.
Sliding Scale Insulin
We test the patient’s blood glucose and it is 160 mg/dl before lunch.
Currently the patient would be covered with 2 units of insulin (Reacting to elevated blood glucose).
We do not take into consideration what the patient is going to eat that will raise the blood glucose.
Sliding Scale Insulin continued
We often do not look at what the patient’s current treatment is: diet, oral agents and/or insulin and sliding scale insulin. (Be proactive. Is there a need to change the patient’s current diabetes medication regimen?)
The weight of the patient is not considered or how insulin resistant the patient is. (one-size-fits all)
Basal insulin provides background insulin but does not cover the peaks in blood glucose at meal times.
NPH is used as the basal insulin in pregnancy.
If patient is mixing then the NPH and Novolog would be given at breakfast and supper.
Novolog, Humalog or Apidra are the rapid acting insulins that are designed to cover the peaks in blood glucose at meal times.
They have a rapid onset and last approximately 4 hours.
Rapid acting insulin is given within 5-15 minutes before the patient eats the meal.
Why Consider an Insulin Pump
Provides more precise insulin dosing-within 0.025 of a unit.
Offers improved insulin absorption with continuous delivery.
Helps you plan for and maintain tighter blood glucose control for a healthier pregnancy.
Maternal Effects of Diabetes
C/Section, forceps or vacuum
Fetal Effect of diabetes
Hypo or hyperglycemia
Delayed lung maturity
Neonatal Effects of Diabetes
CHILDHOOD: learning disabilities
Type 2 diabetes
Better blood glucose control will improve patient outcomes.
Easier labor and delivery.
Decrease in infections.
Decrease in length of stay.
References “ American College of Endocrinology Position Statement on Inpatient Diabetes and Metabolic Control”, Endocrine Practice. Vol. 10, No. 1, 2004. American Diabetes Association Clinical Practice Recommendations 2009. Davidson, J., et al. Gestational Diabetes Caring for Yourself and Your Baby. International Diabetes Center, 3 rd edition, 2005.
References continued Diabetes Forecast. 2007 Resource Guide. Slocum, J. and Biastre, S. Gestational Diabetes, A Core Curriculum for Diabetes Education, Diabetes in the Life Cycle and Research. American Association of Diabetes Educators, 5 th edition, 2003. The Paradigm Platform of Insulin Pumps, Medtronic 2004.