Management of Diabetes During Pregnancy

Pregnancies complicated by gestational diabetes should be managed as follows:

Gestational diabetes

• Office visits at least every other week until 36 weeks, then every week.
• Daily self-blood glucose monitoring with fasting and 1-hr post-meal blood sugars initially; if target range blood sugars are obtained then testing may be decreased to 4 finger sticks on 2 or 3 days per week.
• An ultrasound at around 30-32 weeks to see if the baby is growing normally, and another one prior to delivery (at about 38 weeks) to estimate the baby's weight.
• Delivery should be planned near the due date and should not be allowed to extend too far beyond this.
• Twice a week non stress tests (fetal monitoring) should be started if the pregnancy is allowed to continue past 40 weeks.

Gestational diabetes requiring insulin

• Office visits to the doctor at least every other week until 36 weeks and weekly thereafter.
• Daily self-blood glucose monitoring with fasting and 1-hr post-meal blood sugars for the remainder of the pregnancy.
• Insulin therapy usually combining insulins with different rate of action with subcutaneous injections at least 2 to 3 times per day. Click here for more information on insulin.
• An ultrasound at around 30-32 weeks to see if the baby is growing normally and another one prior to delivery at about 38 weeks to estimate the baby's weight.
• Delivery should be planned around the due date and should not be allowed to extend too far beyond this.
• Twice a week non stress tests (fetal monitoring) should be started at around 32 -34 weeks unless clinically indicated for other obstetrical reasons sooner than this.

Pregestational diabetes types 1 or 2

• Office visits to the doctor at least every other week until 36 weeks and weekly thereafter.
• Daily self-blood glucose monitoring with fasting and pre-meal blood sugars for the remainder of the pregnancy.
• Initial laboratory studies in addition to prenatal labs will include a complete metabolic panel, thyroid function studies, a 24 hr urine collection to evaluate kidney function and an opthamological retinal (eye) examination.
• Insulin therapy usually combining insulins with different rate of action with subcutaneous injections at least 2 to 3 times per day. 
• An ultrasound at around 30-32 weeks to see if the baby is growing normally and another one prior to delivery at about 38 weeks to estimate the baby's weight.
• Delivery should be planned around the due date and should not be allowed to extend too far beyond this.
• Twice a week non-stress tests (fetal monitoring) should be started at around 28 - 32 weeks depending on the severity of vascular complications from the diabetes.