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Gestational Diabetes Targets

Gestational Diabetes: Target Blood Sugar Levels

Gestational Diabetes: Target Blood Sugar Levels

Gestational Diabetes: Target Blood Sugar Levels Gestational Diabetes: Target Blood Sugar Levels It is important to keep your blood sugar levels in a healthy range during your pregnancy. Healthy blood sugar levels for women with gestational diabetes Note: If you have gestational diabetes, you may experience weakness, sweating, and hunger if your blood sugar level drops below 70 mg/dL. These are symptoms of hypoglycemia (low blood sugar), which can be serious if it is not treated. As soon as these symptoms develop, eat some food that contains sugar to raise your blood sugar level. Medical Review: Sarah Marshall, MD - Family Medicine & Alan C. Dalkin, MD - Endocrinology This information does not replace the advice of a doctor. Healthwise, Incorporated disclaims any warranty or liability for your use of this information. Your use of this information means that you agree to the Terms of Use . How this information was developed to help you make better health decisions. 1995-2012 Healthwise, Incorporated. Healthwise, Healthwise for every health decision, and the Healthwise logo are trademarks of Healthwise, Incorporated. NOTICE: This health information was not created by the University of Michigan Health System (UMHS) and may not necessarily reflect specific UMHS practices. For medical advice relating to your personal condition, please consult your doctor. Complete disclaimer Continue reading >>

Diabetes Mellitus And Pregnancy

Diabetes Mellitus And Pregnancy

Initiate testing early enough to avoid significant stillbirth but not so early that a high rate of false-positive test results is encountered. In patients with poor glycemic control, intrauterine growth restriction, or significant hypertension, begin formal biophysical testing as early as 28 weeks. In patients who are at lower risk, most centers begin formal fetal testing by 34 weeks. Fetal movement counting is performed in all pregnancies from 28 weeks onward. There is no consensus regarding antenatal testing in patients with gestational diabetes that is well controlled with diet. Monitoring fetal growth continues to be a challenging and imprecise process. Although currently available tools (serial plotting of fetal growth parameters based on ultrasonographic measurement) are superior to those used previously for clinical estimations, accuracy is still only within 15%. [ 95 ] In the obese fetus, the inaccuracies are further magnified. In 1992, Bernstein and Catalano reported that significant correlation exists between the degree of error in the ultrasonogram-based estimation of fetal weight and the percentage of body fat on the fetus. [ 96 ] Perhaps this is the reason no single formula has proven to be adequate in identifying a macrosomic fetus with certainty. Despite problems with accuracy, ultrasonogram-based estimations of fetal size have become the standard of care. Estimate fetal size once or twice at least 3 weeks apart in order to establish a trend. Time the last examination to be at 36-37 weeks' gestation or as close to the planned delivery date as possible. Select the timing of delivery to minimize morbidity for the mother and fetus. Delaying delivery to as near as possible to the expected date of confinement helps maximize cervical maturity and improves the Continue reading >>

Lower Treatment Targets For Gestational Diabetes: Is Lower Really Better?

Lower Treatment Targets For Gestational Diabetes: Is Lower Really Better?

Lower treatment targets for gestational diabetes: is lower really better? School of Public Health, Monash University, Melbourne, VIC, Australia. [email protected] Cairns Hospital and Cairns Diabetes Centre, Cairns, QLD, Australia. Proposed lower diagnostic thresholds and lower treatment targets for gestational diabetes have been controversial internationally. Intervention trials for the recently revised lower Australian treatment targets are currently lacking. While there may be benefits, lowering treatment targets may cause a number of harms including increased risk of hypoglycaemia in pregnant women, greater medicolegal risk for health practitioners, and heavier economic costs for the health system. Regional and remote care providers in particular will have greater costs, and may be overwhelmed in attempts to implement new treatment targets. An excessively glucose-centric focus may divert attention and resources from identifying and addressing other important and growing contributors to adverse pregnancy outcomes, such as obesity. Important groups such as Aboriginal and Torres Strait Islander Australians may not gain overall benefit from lowering treatment targets for gestational diabetes because of current low birthweights and the effect of social costs. It has not yet been established whether implementing lower treatment targets for gestational diabetes will create more benefit than harm. Implementation at this stage is premature. Continue reading >>

What To Expect With Gestational Diabetes

What To Expect With Gestational Diabetes

Blood glucose control is key to having a healthy baby A diagnosis of gestational diabetes can cast a shadow over the joys of pregnancy. While the vast majority of these cases end with a healthy baby and mom, gestational diabetes (high blood glucose during pregnancy in a woman who has never had type 1 or type 2 diabetes) does increase risks to the health of both baby and mother. Keeping blood glucose under control is crucial for women with gestational diabetes to help safeguard their babies and themselves. Gestational diabetes is caused by issues that arise as part of a normal pregnancy: hormonal changes and weight gain. Women whose bodies can't compensate for these changes by producing enough of the hormone insulin, which ushers glucose from the blood into cells to produce energy, develop high blood glucose and gestational diabetes. Overweight mothers are at a greater risk for the condition. In the United States, gestational diabetes is reported in somewhere between 2 and 10 percent of pregnancies, but it is now believed that the condition affects 18 percent of women in pregnancy. The larger number is the result of new criteria for diagnosis, not just skyrocketing rates. The American Diabetes Association began recommending this year that gestational diabetes be diagnosed with only one abnormal test result rather than two, the previous method, and this is causing more cases to be detected. Gestational diabetes usually appears roughly halfway through pregnancy, as the placenta puts out large amounts of "anti-insulin" hormones. Women without known diabetes should be screened for gestational diabetes 24 to 28 weeks into their pregnancies. (If high blood glucose levels are detected earlier in pregnancy, the mother-to-be may actually have type 2 diabetes, rather than gestati Continue reading >>

Managing & Treating Gestational Diabetes

Managing & Treating Gestational Diabetes

How can I manage my gestational diabetes? Many women with gestational diabetes can manage their blood glucose levels by following a healthy eating plan and being physically active. Some women also may need diabetes medicine. Your health care team will help you make a healthy eating plan with food choices that are good for you and your baby. The plan will help you know which foods to eat, how much to eat, and when to eat. Food choices, amounts, and timing are all important in keeping your blood glucose levels in your target range. Your health care team will help you make a healthy eating plan. If youre not eating enough or your blood glucose is too high, your body might make ketones . Ketones in your urine or blood mean your body is using fat for energy instead of glucose. Burning large amounts of fat instead of glucose can be harmful to your health and your babys health. Your doctor might recommend you test your urine or blood daily for ketones or when your blood glucose is above a certain level, such as 200. If your ketone levels are high, your doctor may suggest that you change the type or amount of food you eat. Or, you may need to change your meal or snack times. Physical activity can help you reach your target blood glucose levels. If your blood pressure or cholesterol levels are too high, being physically active can help you reach healthy levels. Physical activity can also relieve stress, strengthen your heart and bones, improve muscle strength, and keep your joints flexible. Being physically active will also help lower your chances of having type 2 diabetes in the future. Talk with your health care team about what activities are best for you during your pregnancy. Aim for 30 minutes of activity 5 days of the week, even if you werent active before your pregnancy. Continue reading >>

Campaign Targets Women With Gestational Diabetes

Campaign Targets Women With Gestational Diabetes

Home Health and Fitness News Campaign targets women with Campaign targets women with gestational diabetes By Paula Wolfson | @PWolfsonWTOP May 9, 2016 5:07 am 05/09/2016 05:07am Christine Leonard, shown here with her sons Ben, 8, Joel, 5 and Matthew, 2, suffered from gestational diabetes. "Each time, I thankfully, was diagnosed early," Leonard says. (Photo provided by Christine Leonard) WASHINGTON Christine Leonard developed gestational diabetes when she became pregnant with her three sons. Each time I, thankfully, was diagnosed early, said the proud mom from Arlington, Virginia. But even though the condition disappeared after she gave birth, Leonard remains vigilant in large part because studies have shown that women who develop gestational diabetes are at high risk forType 2diabetes later in life. I think it is real important to try to stay ahead of it as much as I can, she said, adding she continues to get her blood sugar levels tested on a fairly regular basis during her annual physical exam. It is something I will be really aggressive about monitoring for the rest of my life, Leonard said, noting that diabetes is easiest to treat when caught early, before complications occur. Leonard, unfortunately, is the exception to the rule. Far too many women who develop gestational diabetes do not keep tabs on their blood sugar levels after giving birth. Current evidence suggests that less that 50 percent of women are getting the test done postpartum, and this is resulting in an increase in the number of women with undiagnosed Type 2diabetes, said Dr. Sara Iqbal, a high-risk pregnancy expert at MedStar Washington Hospital Center. It is estimated that 10 percent of women with gestational diabetes are diagnosed with Type 2soon after delivery. Over 10 years, the risk shoots up Continue reading >>

Diagnosis And Management Of Gestational Diabetes Mellitus

Diagnosis And Management Of Gestational Diabetes Mellitus

Gestational diabetes occurs in 5 to 9 percent of pregnancies in the United States and is growing in prevalence. It is a controversial entity, with conflicting guidelines and treatment protocols. Recent studies show that diagnosis and management of this disorder have beneficial effects on maternal and neonatal outcomes, including reduced rates of shoulder dystocia, fractures, nerve palsies, and neonatal hypoglycemia. Diagnosis is made using a sequential model of universal screening with a 50-g one-hour glucose challenge test, followed by a diagnostic 100-g three-hour oral glucose tolerance test for women with a positive screening test. Treatment consists of glucose monitoring, dietary modification, exercise, and, when necessary, pharmacotherapy to maintain euglycemia. Insulin therapy is the mainstay of treatment, although glyburide and metformin may become more widely used. In women receiving pharmacotherapy, antenatal testing with nonstress tests and amniotic fluid indices beginning in the third trimester is generally used to monitor fetal well-being. The method and timing of delivery are controversial. Women with gestational diabetes are at high risk of subsequent development of type 2 diabetes. Lifestyle modification should therefore be encouraged, along with regular screening for diabetes. Evidence for screening, diagnosing, and managing gestational diabetes mellitus has continued to accrue over the past several years. In 2003, the U.S. Preventive Services Task Force1 (USPSTF) and the Cochrane Collaboration2 found insufficient evidence to recommend for or against screening for or treating gestational diabetes. However, a subsequent randomized controlled trial (RCT) found that screening and intervention for gestational diabetes were beneficial.3 Nonetheless, in 2008, Continue reading >>

Gestational Diabetes

Gestational Diabetes

Patient professional reference Professional Reference articles are written by UK doctors and are based on research evidence, UK and European Guidelines. They are designed for health professionals to use. You may find the Type 2 Diabetes article more useful, or one of our other health articles. This article deals only with gestational diabetes. There is a separate Diabetes in Pregnancy article, which provides information about pregnancy in women with pre-existing diabetes. Gestational diabetes mellitus (GDM) is any degree of glucose intolerance with its onset (or first diagnosis) during pregnancy and usually resolving shortly after delivery[1]. Pregnancy hormones decrease fasting glucose levels, increase fat deposition, delay gastric emptying and increase appetite. However, over the course of pregnancy, postprandial glucose concentrations increase as insulin resistance increases. This is normally countered by an increased production of insulin but in women with GDM there is an insufficient compensatory rise[2]. There is no clear agreement on diagnostic criteria[3]. Pregnancy hyperglycaemia without meeting GDM diagnostic criteria affects a significant proportion of pregnant women each year and is associated with a range of adverse pregnancy outcomes[4]. The National Institute for Health and Care Excellence (NICE) recommends that GDM should be diagnosed if the pregnant woman has either[5]: Fasting plasma glucose level of 5.6 mmol/L or above; or Two-hour plasma glucose level of 7.8 mmol/L or above. Although the World Health Organization (WHO) now recommends that HbA1c can be used as a diagnostic test for diabetes, it is currently not recommended for diagnosis during pregnancy[6]. Many of the problems associated with GDM are common to established diabetes in pregnancy - hype Continue reading >>

Management Of Gestational Diabetes Mellitus

Management Of Gestational Diabetes Mellitus

Gestational diabetes mellitus is a common but controversial disorder. While no large randomized controlled trials show that screening for and treating gestational diabetes affect perinatal outcomes, multiple studies have documented an increase in adverse pregnancy outcomes in patients with the disorder. Data on perinatal mortality, however, are inconsistent. In some prospective studies, treatment of gestational diabetes has resulted in a decrease in shoulder dystocia (a frequently discussed perinatal outcome), but cesarean delivery has not been shown to reduce perinatal morbidity. Patients diagnosed with gestational diabetes should monitor their blood glucose levels, exercise, and undergo nutrition counseling for the purpose of maintaining normoglycemia. The commonly accepted treatment goal is to maintain a fasting capillary blood glucose level of less than 95 to 105 mg per dL (5.3 to 5.8 mmol per L); the ambiguity (i.e., the range) is due to imperfect data. The postprandial treatment goal should be a capillary blood glucose level of less than 140 mg per dL (7.8 mmol per L) at one hour and less than 120 mg per dL (6.7 mmol per L) at two hours. Patients not meeting these goals with dietary changes alone should begin insulin therapy. In patients with well-controlled diabetes, there is no need to pursue delivery before 40 weeks of gestation. In patients who require insulin or have other comorbid conditions, it is appropriate to begin antenatal screening with nonstress tests and an amniotic fluid index at 32 weeks of gestation. Screening for gestational diabetes mellitus is widely practiced despite lack of evidence that it prevents adverse perinatal outcomes. Although the disorder affects approximately 2.5 percent of pregnant women1 and has been the subject of extensive res Continue reading >>

Management Of Pregnancy Complicated By Diabetes

Management Of Pregnancy Complicated By Diabetes

Preconception Care AACE guidelines specify that preconception care is important for all women with preexisting type 1 diabetes mellitus (T1DM) or type 2 diabetes mellitus (T2DM) or previous gestational diabetes mellitus (GDM). One of the primary goals of preconception care is to educate patients about strategies to maintain adequate nutrition and glucose control before conception, during pregnancy, and in the postpartum period.1 Intensive glycemic management of women with diabetes prior to conception and throughout pregnancy has been shown to confer significant health benefits to both mother and child.2 When women with diabetes establish normoglycemia before pregnancy and maintain it through the first trimester, the risk of complications (eg, congenital anomalies and spontaneous abortion) is comparable to levels for women without diabetes.3 Glycemic Targets Glycemic targets during pregnancy are defined in the 2011 AACE guidelines, shown in the table below. For all glucose management protocols, AACE recommendations stress that patient safety must be the first priority.1,4 Table 1. AACE and ADA Glycemic Target Guidelines for Pregnant Women With GMD, T1DM, or T2DM1,5 Glucose Increment Patients With GDM Patients With Preexisting T1DM or T2DM Preprandial, premeal ≤95 mg/dL (5.3 mmol/L) Premeal, bedtime, and overnight glucose: 60-99 mg/dL (3.4-5.5 mmol/L) Postprandial, post-meal 1-hour post-meal: ≤140 mg/dL (7.8 mmol/L) or 2-hour post-meal: ≤120 mg/dL (6.7 mmol/L) Peak postprandial glucose 100-129 mg/dL (5.5-7.1 mmol/L) A1C ≤6.0% ≤6.0% Table 2. Expert Recommendations for Glycemic Target Guidelines for Pregnant Women With GMD, T1DM, or T2DM*1,5,6 Some experts recommend more stringent goals, in particular, for patients on insulin therapy, to prevent maternal and fetal Continue reading >>

New Thresholds For Diagnosis Of Diabetes In Pregnancy

New Thresholds For Diagnosis Of Diabetes In Pregnancy

Share Midwives should diagnose women with gestational diabetes if they either have a fasting plasma glucose level of 5.6 mmol/litre or above, or a 2-hour plasma glucose level of 7.8 mmol/litre or above, according to NICE. Midwives should diagnose women with gestational diabetes if they either have a fasting plasma glucose level of 5.6 mmol/litre or above, or a 2-hour plasma glucose level of 7.8 mmol/litre or above, according to NICE. Updated guidelines on diabetes in pregnancy lower the fasting plasma glucose thresholds for diagnosis, and include new recommendations on self-management for women with type 1 diabetes. Around 35,000 women have either pre-existing or gestational diabetes each year in England and Wales. Nearly 90 per cent of the women who have diabetes during pregnancy, have gestational diabetes, which may or may not resolve after pregnancy. Rates have increased in recent years to due rising obesity rates among the general population, and increasing number of pregnancies among older women. Of the women with diabetes in pregnancy who do not have gestational diabetes, 7.5 per cent of women have type 1 diabetes, and the remainder have type 2 diabetes, both of which have also increased recently. Following a number of developments, such as new technologies and research on diagnosis and treatment of gestational diabetes, NICE has updated its guidelines on diabetes in pregnancy. Diagnosis Among the new recommendations are that a woman should be diagnosed with gestational diabetes if she has either a fasting plasma glucose level of 5.6 mmol/litre or above, or a 2-hour plasma glucose level of 7.8 mmol/litre or above. NICE says this could help tackle current variation in the number in the glucose levels used for diagnosing gestational diabetes, and may lead to an incr Continue reading >>

Thresholds For Diagnosing Gestational Diabetes

Thresholds For Diagnosing Gestational Diabetes

Hospitals do not have to use the recommendations listed below and so different targets for diagnosis are used all over the UK & Ireland. As a result, all this can cause a lot of confusion! Diagnosis test target levels England & Wales: Diagnose gestational diabetes if the woman has either: a fasting plasma glucose level of 5.6 mmol/litre or above or a 2‑hour plasma glucose level of 7.8 mmol/litre or above. [new 2015] Diagnosis test target levels Scotland: The adoption of internationally agreed criteria for gestational diabetes using 75 g OGTT is recommended: fasting venous plasma glucose ≥5.1 mmol/l, or one hour value ≥10 mmol/l, or two hours after OGTT ≥8.5 mmol/l. Women with frank diabetes by non-pregnant criteria (fasting venous glucose ≥7 mmol/l, two hour ≥11.1 mmol/l) should be managed within a multidisciplinary clinic as they may have type 1 or type 2 diabetes and be at risk of pregnancy outcomes similar to those of women with pre-gestational diabetes. Diagnosis test target levels Ireland: HSE guidelines: A diagnosis of gestational diabetes is made when one or more values are met or exceeded Fasting 5.1mmol/L 1 hour 10.0mmol/L 2 hour 8.5mmol/L Borderline diagnosis can have very different meanings when it comes to gestational diabetes. It could mean that following your GTT your fasting or post glucose levels were: Just below the threshold targets Bang on the threshold targets Just over the threshold targets Bearing in mind that test threshold levels differ from one hospital to another, this could be a huge difference in actual blood glucose levels and therefore what is classed as a borderline diagnosis in one hospital may be a clear positive diagnosis result in another. Our point of view is that if you have been told to monitor your blood glucose levels, Continue reading >>

Diabetes And Pregnancy

Diabetes And Pregnancy

Key Messages Pregestational Diabetes All women with pre-existing type 1 or type 2 diabetes should receive preconception care to optimize glycemic control, assess complications, review medications and begin folate supplementation. Care by an interdisciplinary diabetes healthcare team composed of diabetes nurse educators, dietitians, obstetricians and diabetologists, both prior to conception and during pregnancy, has been shown to minimize maternal and fetal risks in women with pre-existing type 1 or type 2 diabetes. Gestational Diabetes Mellitus The diagnostic criteria for gestational diabetes mellitus (GDM) remain controversial; however, the committee has chosen a preferred approach and an alternate approach. The preferred approach is to begin with a 50 g glucose challenge test and, if appropriate, proceed with a 75 g oral glucose tolerance test, making the diagnosis of GDM if ≥1 value is abnormal (fasting ≥5.3 mmol/L, 1 hour ≥10.6 mmol/L, 2 hours ≥9.0 mmol/L). The alternate approach is a 1-step approach of a 75 g oral glucose tolerance test, making the diagnosis of GDM if ≥1 value is abnormal (fasting ≥5.1 mmol/L, 1 hour ≥10.0 mmol/L, 2 hours ≥8.5 mmol/L). Untreated GDM leads to increased maternal and perinatal morbidity, while treatment is associated with outcomes similar to control populations. Highlights of Revisions 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. New criteria have been added for the screening and diagnosis of GDM (Figures 1 and 2). Figure 1 Preferred approach for the screening and diagnosis of gestational diabetes. Figure 2 Alternative approach f Continue reading >>

Gestational Vs Reg Diabetes Target Numbers

Gestational Vs Reg Diabetes Target Numbers

Gestational vs reg diabetes target numbers Does anyone know why the target blood glucose numbers for abnormal readings for gestational diabetes is different from what the American Diabetes Association recommends with regular diabetes? For example, for gestational diabetes, the target numbers for abnormal readings are typically: The American Diabetes Association has the following target numbers for abnormal readings: My guess is because our diabetes is affecting a fetus, not just an adult body. I believe that if a person with type 2 diabetes got pregnant, she would have to follow the GD guidelines. But this is just my guess. Yes I've been a diabetic for 16 years and first time being pregnant. Since being pregnant my endocrinologist has instructed me to follow all the guidelines and sugar level goals the same as if I were just diagnosed with Gestational diabetes. With the pregnancy, everything has to be way more controlled than before because of growing baby and all that pregnancy affects on your body. Hope that helps with the confusion! I was also told it is because a pregnant woman has more blood running through their body which means that a pregnant woman's sugar levels would run lower than normal Because a type one diabetic actually does not produce insulin. Those numbers are giving the patients some leeway considering they do the job of their pancreas 24/7 until they die. Gestational diabetes is temporary and is more of a resistance to the insulin your pancreas is making. Those numbers are easier to achieve sometimes without even having to inject insulin. I know for me, my OB would dearly love to see fasting under 90, post meal no higher than 120. But those are non-diabetic numbers and trying to achieve that (though it is possible to a point) would drive anyone nuts Continue reading >>

Diabetes In Pregnancy

Diabetes In Pregnancy

Gestational diabetes does not increase the risk of birth defects or the risk that the baby will be diabetic at birth. Also called gestational diabetes mellitus (GDM), this type of diabetes affects between 3% and 20% of pregnant women. It presents with a rise in blood glucose (sugar) levels toward the end of the 2nd and 3rd trimester of pregnancy. In 90% if cases, it disappears after the birth, but the mother is at greater risk of developing type 2 diabetes in the future. Cause It occurs when cells become resistant to the action of insulin, which is naturally caused during pregnancy by the hormones of the placenta. In some women, the pancreas is not able to secrete enough insulin to counterbalance the effect of these hormones, causing hyperglycemia, then diabetes. Symptoms Pregnant women generally have no apparent diabetes symptoms. Sometimes, these symptoms occur: Unusual fatigue Excessive thirst Increase in the volume and frequency of urination Headaches Importance of screening These symptoms can go undetected because they are very common in pregnant women. Women at risk Several factors increase the risk of developing gestational diabetes: Being over 35 years of age Being overweight Family members with type 2 diabetes Having previously given birth to a baby weighing more than 4 kg (9 lb) Gestational diabetes in a previous pregnancy Belonging to a high-risk ethnic group (Aboriginal, Latin American, Asian or African) Having had abnormally high blood glucose (sugar) levels in the past, whether a diagnosis of glucose intolerance or prediabetes Regular use of a corticosteroid medication Suffering from ancanthosis nigricans, a discoloration of the skin, often darkened patches on the neck or under the arms Screening The Canadian Diabetes Association 2013 Clinical Practice Gui Continue reading >>

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