A woman with gestational diabetes requires control of hyperglycemia but must avoid hypoglycemic episodes.
Whole blood glucose targets for hyperglycemia:
(1) preprandial glucose <= 95 mg/dL (<= 5.3 mmol/L)
(2) one or both of the following:
(2a) 1 hour postprandial glucose <= 140 mg/dL (<= 7.8 mmol/L)
(2b) 2 hour postprandial glucose <= 120 mg/dL (<= 6.7 mmol/L)
Insulin therapy should be considered for a woman with gestational diabetes who exceeds these limits. The dose of insulin should be individualized based on nutritional intake. The dose requirements often increase as the pregnancy progresses.
If the fasting blood glucose in the morning is elevated, then consider NPH insulin at bedtime.
If the glucose is elevated prior to a meal, then consider a rapid or short-acting insulin prior to the meal.
The patient should regularly monitor her blood glucose and should take care to avoid excessive insulin therapy that can result in hypoglycemia.
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Purpose: To manage a pregnant woman with gestational diabetes.
Specialty: Endocrinology, Clinical Laboratory
Objective: compliance/adherence, prevention