Management of diabetes in

Antenatal Pregnancy
AIM
To maintain two hour post prandial glucose level range
110-120 mg/dl and fasting Blood sugar 90-92 mg/dl

PRINCIPLE
Control of diabetes
Obstetric management
Timing of delivery
Specialied care for new born
Medical Nutrition Therapy(Meal plan)
 Indication: Two hour Post prandial sugar 110-
120mg/dl(under control)

Principles of meal plan

1. Avoid sugars and sweets
2. Avoid fasting and feasting
3. Eat to satisfy appetite
4. Eat more green leafy vegetables
5. Complex carbohydrates are preferred
Moderate exercise for atleast 30 minutes daily
 Dietary components

Carbohydrate(40)

Protein(20)

fat(40)

With increased fibre content and complex carbohydrate(Split

meal and split breakfast)

Calorie intake
Breakfast = 25%
Lunch = 30%
Dinner = 30%
(along with some snacks inbetween)
 Every two weeks once OGCT should be done
after breakfast
2 hrs Postprandial plasma glucose estimated
if <120 mg/dl continue meal plan and repeat it for
every 4 weeks
if >120mg/dl put her on insulin therapy
In overt diabetics
 Even on Oral Hypoglycemic drugs better switch it over to
Insulin therapy after confirmation of pregnancy
 Because of teratogenic effect of some drugs
 Some drugs are safer during pre-conceptional period e.g:
METFORMIN ,GLIBENCLAMIDE
First dose of insulin
Calculated according to patient’s age
→In the first trimester = weight *0.7 IU/kg
→In he second trimester = weight *0.8 IU/kg
→In the third trimester = weight *0.9 IU/kg
Insulin schedule
 Indicated when PPPG not controlled by meal plan or in
case of overt diabetes
 If >140mg/dl ,Start intermediate acting insulin (30 mins
before Breakfast) e.g:ISOPHANE
 Repeat Blood sugar tests every two weeks ,
 If under control ,continue for same
 If it is higher ,increase insulin dosage by 2 -4 units(30
mins before breakfast)
 If insulin dose >16 units /day ,split dose of insulin is
recommended.
For example ,if a woman requires 20 units , then
 12 units(mostly short acting insulin or REGULAR
INSULIN)
 8 units in the night( mostly intermediate acting insulin
)usually given post dinner
During insulin therapy ,
Both Fasting and Postprandial Plasma glucose levels should
be monitored at 2 weeks of interval
INSULIN TITRATION
Glycemic profile test
 Fasting (Before breakfast)
 Post breakfast
 Pre Lunch
 Post Lunch
 Pre Dinner
 Post dinner
 Early Morning sample(at 3 a.m.)
Totally 7 tests are done and insulin dosage are
titrated according to this
D.Santhosh kumar