Management of Gestational

Diabetes
Goals:
achieve normoglycemia
prevent ketosis
provide adequate weight gain
contribute to fetal wellbeing

Initiate home blood glucose monitoring and nutrition counselling

Target Blood Glucose levels:
Fasting: 60-90 mg/dl
1 hr postprandial: <140 mg/dl
2 hr postprandial: <120 mg/dl
Normal Weight Gain: 10-12 kg

STEP 1: Medical Nutition

Therapy
Calorie distribution: 3 meals and 3 snacks
Breakfast: 10% of total calories , Lunch: 30% , Dinner: 30% ,
Snacks: 30%
Carbohydrate intake: 35-40%
Protein: 25%
Fat: <30%
Women with GDM should be advised to choose, where possible,
carbohydrates from low glycaemic index sources, lean proteins
including oily fish and a balance of polyunsaturated fats and
monounsaturated fats.
Women with GDM whose pre-pregnancy BMI was above 27 kg/m2
should be advised to restrict calorie intake (to 25 kcal/kg/day or
less) and to take moderate exercise (of at least 30 minutes daily).

STEP 2: Oral Hypoglycemic

Agents
Hypoglycemic
therapy should be considered for women with GDM if diet and exercise fail to

maintain blood glucose targets during a period of 12 weeks AND/OR ultrasound

investigation suggests incipient fetal macrosomia (abdominal circumference above the 70th
percentile) at diagnosis.
Glyburide: increases tissue insulin sensitivity.Side effects: heartburn, hypoglycemia, skin
allergies
Metformin: decreases hepatic glucose output, improving peripheral glucose uptake, thus
reducing insulin resistance

STEP 3: Insulin
Given subcutaneously
If FBS is high, an intermediate acting insulin is given at bedtime.
if the postprandial blood glucose high, short acting insulin is given before the meals
if both fasting and postprandial blood glucose high, an intermediate acting insulin is given
before breakfast and at bedtime and a short acting insulin is given TID before meals
Dosing: dependant on SMBG and individual requirements
Short-acting: lispro and aspart (Starting dose 2-4 U) (peak activity 2-4 hrs)
Control of basal levels: NPH levels (Starting dose 6-8 U) (peak activity 5-12 hrs)