Global guideline on pregnancy and diabetes - International ...

<strong>Global</strong> Guideline on Pregnancy and Diabetes
If at all possible, self-monitoring of blood glucose (SMBG) should be done frequently.
For women with pre-existing diabetes this will relate to their previous pattern of
testing and the type of insulin regimen they are using.
Adjust the dose of oral glucose-lowering agents or insulin on the basis of
self-monitoring results, HbA 1c
and experience of hypoglycaemia, and be prepared
to change from oral glucose-lowering agents to insulin if required.
Other diabetes-associated problems
Examine eyes at first prenatal visit and each trimester.
Monitor blood pressure and advise/treat accordingly, avoiding ACE inhibitors and ARBs.
Management of gestational diabetes
Advise on risks of adverse pregnancy outcome and how these may be reduced.
Instruct in self-monitoring of blood glucose (to be used four times daily, fasting and
1 h after each meal), and advise on lifestyle modification.
If agreed glucose control targets are not met within 1 to 2 weeks of initiation of
lifestyle management, offer glucose-lowering medication. Insulin has been, and is likely
to remain, the treatment of choice but there is now adequate evidence to consider
the use of metformin and glibenclamide (glyburide) as treatment options for women
who have been informed of the possible risks. Combination therapy has not been
specifically studied.
Do not use routine measurement of HbA 1c
for management.
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