Diagnosis of diabetes during pregnancy

Diagnosis of diabetes during pregnancy is a difficult task as pregnant mothers can be suffered from all four types of diabetes. Recognition of the exact type is essential for the definitive management.
WHO diagnostic criteria;
1. One abnormal sugar level (fasting blood sugar/random blood sugar) in symptomatic patients or two abnormal values (taken two weeks apart) are needed to diagnose diabetes.
A) Fasting Blood Sugar(FBS) > 7mmol/l (126mg/dl)
B) Random Blood Sugar(RBS)> 11.1mmol/l(200mg/dl)

2. Glucose Tolerance Test (GTT)needed for borderline cases and for GDM
A) Method for adults; 75g glucose in 300 ml water should be given. Then blood sugar level should be measured 2 hours after the ingestion of glucose.
B) Method for children; 1.75g/kg body weight given and blood sugar measured after 2 hours.

• If the 2 hour sugar level is greater than 11.1mmol/l, patient can be labeled as diabetes.
• This test can be used to diagnose the gestational diabetes as well. This is the diagnostic test during 24-28 weeks of pregnancy.



Diagnosis of type 1 diabetes
Usually these patients know that they are diabetic before they become pregnant. They are typically diagnosed during an episode of hyperglycemia, ketosis and dehydration. Type 1 diabetes is diagnosed only rarely during pregnancy and is most often accompanied by unexpected coma because early pregnancy may provoke diet and glycemic control instability in patients with occult diabetes. Therefore as a precaution, a pregnancy test should be performed in all reproductive-aged women admitted to the hospital for blood sugar management.
Diagnosis of type 2 diabetes

This is very difficult to diagnose as severe form of gestational diabetes mimic type 2 diabetes. If the first trimester HbA1C value of 8% is highly suggestive of preexisting type 2 diabetes, definitive diagnosis of type 2 diabetes must be made after pregnancy using the 75-g, 2-hour glucose tolerance test.

Diagnosis of gestational diabetes

Gestational diabetes (GDM) is a state of carbohydrate intolerance of varying degrees and it is first recognized during pregnancy with a probable resolution after the end of pregnancy. Diabetes, glucose intolerance or insulin resistance may have existed before the pregnancy. GDM is not the same as Type 1 or Type 2 Diabetes. Glucose Tolerance test is used to diagnose this condition