Women with diabetes and their infants are at increased risk (probably greater than 1 in 5) of developing potentially serious problems during pregnancy and parturition (birth), such as congenital malformations, premature labor and delivery, large infants, infant respiratory distress, infant hypoglycemia, stillbirth, and even maternal death, if the diabetes is not carefully monitored and treated.



Normal blood sugars typically run between 60 and 110 in the fasting state and may go as high as 140 to 160 after meals. For a woman who is pregnant, a normal blood sugar is typically between 50 and 100 in the fasting state and as high as 120 to 130 after meals. When we treat women who are diabetic and pregnant, we like to keep their blood sugars equal to or less than 120 all the time, and around 100 or less most of the time.



The first step in treating diabetes is a careful dietary program supervised if possible by a registered dietitian. By dividing up one's intake into frequent multiple smaller meals and snacks, one distributes the calories throughout the day and this helps to minimize the swings that occur in blood sugar levels after meals. Simple sugars that are rapidly absorbed into the bloodstream usually must be avoided. The goal of dietary therapy is to allow appropriate weight gain during pregnancy yet maintain the blood sugar in an acceptable range. Some moderate regular exercise after meals may also be helpful in controlling blood sugar levels.



Like diabetes in other situations, the best current monitoring method is the use of home blood glucose self-testing equipment. With a small lancing device and special testing strips, the blood glucose level can be measured directly by the diabetic person herself. These blood sugar levels should be recorded and brought in with the patient when she visits her physician.


Another test to access diabetic control over the 1 to 2 months immediately prior to the date of the test being obtained is a glycosylated hemoglobin level. A glycosylated hemoglobin level measures the per cent(%) of hemoglobin molecules in the blood that have sugar molecules attached. Hemoglobin is the red pigment in red blood cells that helps to transport oxygen. The level of hemoglobin in the blood is constant, but new red blood cells are being continually created and old red blood cells are being continually destroyed. On average, the half life of any hemoglobin molecule in the bloodstream is about 60 days. Sugar molecules in the blood can attach to hemoglobin molecules in such a way that they can't detach themselves, and this is called glycosylated hemoglobin. All of us have a few per cent of the hemoglobin molecules in our blood with sugar molecules attached. This normal range for glycosylated hemoglobin varies from lab to lab but in general is about 4% to 6%. Diabetics, however, who have on average higher than normal blood sugar levels over the last 1 to 2 months(the life span of hemoglobin in the bloodstream) will have more sugar molecules attached to the hemoglobin molecules and therefore have higher glycosylated hemoglobin levels (anywhere from 6% up to about 14%). Diabetics in good control, on the other hand, may have normal glycosylated hemoglobin levels.


Revised 9/08




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