Pregnancy management of women with preexisting diabetes

Aspects that should be considered in the management of preexisting diabetes are same as for the management of GDM but there are differences as well. Therefore recognition of the exact type of diabetes is the fact which matters the management. Followings are key points that should be considered in the management of GDM.
1. Dietary therapy
2. Glucose monitoring
3. Insulin therapy


Dietary therapy

The goal of dietary therapy is to avoid single large meals and foods with a large percentage of simple carbohydrates. A total of 6 feedings per day is preferred, with 3 major meals and 3 snacks to limit the amount of energy intake presented to the bloodstream at any interval. Examples include foods with complex carbohydrates and cellulose, such as whole grain breads and legumes. Carbohydrates should account for no more than 50% of the diet, with protein and fats equally accounting for the remainder. For women who are obese (BMI >30 kg/m2), a 30-33% energy restriction ([25 kcal/kg/d] actual weight) has been shown to reduce hyperglycemia and plasma triglyceride levels with no increase in ketonuria.


Glucose monitoring

The availability of capillary, glucose, and chemical test strips has revolutionized the management of diabetes, and these should now be considered the standard of care for pregnancy monitoring. The discipline of measuring and recording blood glucose levels prior to and after meals clearly has a positive effect on improving glycemic control.

Individualize the frequency and timing of home glucose monitoring. A typical schedule involves capillary glucose checks upon awakening in the morning, 1 hour after breakfast, before and after lunch, before dinner, and at bedtime. Place emphasis on gaining and sustaining compliance with the target glucose levels mentioned above. Meticulous glycemic control requires attention to both pre-prandial and postprandial glucose levels.

Insulin therapy

The goal of insulin therapy during pregnancy is to achieve glucose profiles similar to those of nondiabetic pregnant women. Given that healthy pregnant women maintain their postprandial blood sugar excursions within a relatively narrow range (70-120 mg/dl), the task of reproducing this profile requires meticulous daily attention by both the patient and physician.