Gestational Diabetes Mellitus: Therapy

General measures

  • Blood glucose (BG; blood glucose) should be adjusted to the following values:
Determination time Blood glucose value
Fasting 65-95 mg/dl (3.6-5.3 mmol/l)
1h postprandial (after meal). <140 mg/dl (<7.8 mmol/l)
2h postprandial < 120 mg/dl (< 6.7 mmol/l)
  • Blood glucose self-monitoring

Protocol of the first 14 days – 4-point protocol.

Tag morning sober afterbreakfast before lunch after lunch beforedinner afterdinner
1 x x x x
2 x x x x
3 x x x x
… x x x x
14 x x x x

If at least two measurements are elevated on at least two days, the 6-point protocol can be started immediately. 6-point protocol

Tag morning sober afterbreakfast before lunch after lunch beforedinner afterdinner
1 x x x x x x
2 x x x x x x
3 x x x x x x
4 x x x x x x
5 x x x x x

An adjustment of the self-checks is made at:

  • Nutritional therapy: one measurement tgl (in rotation), if the first two weeks under therapy yield inconspicuous blood glucose values
  • Insulin therapy: 4/6-point protocol.

Urine ketone measurement before breakfast in overweight pregnant women!

  • Strategies for birth preparation / birth / postnatal period.
    • Pregnant women with gestational diabetes should deliver at clinics that are diabetology-experienced; they should be informed of the benefits of delivering at centers with neonatology services
    • The pregnant women with gestational diabetes requiring insulin should necessarily deliver at clinics with neonatology
    • Sectio (cesarean section) should be recommended for an estimated birth weight of > 4,500 g
    • During labor, blood glucose should be 80-130 mg/dl (4.4-7.2 mmol/l); in insulin-dependent pregnant women, blood glucose should be checked every two hours
    • If gestational diabetes is diet-managed, blood glucose measurements can usually be waived
    • Pregnant women should be informed about the benefits of breastfeeding before delivery; exclusive breastfeeding for at least 4-6 months is recommended
    • If postpartum blood glucose levels are normal, an oGTT should be performed at 6-12 weeks; if glucose tolerance is impaired, diabetes should be diagnosed annually; if normal, diabetes should be diagnosed every 2-3 years; in any subsequent pregnancy, hyperglycemia should be diagnosed at initial presentation
  • Observance of general hygiene measures!
  • The following weight gain is recommended during pregnancy (based on pre-pregnancy BMI):
    • If underweight, 12.5-18 kg throughout pregnancy; 0.5-0.6 kg per week in the second and third trimesters (third trimester).
    • If normal weight 11.5-16 kg throughout pregnancy; 0.4-0.5 kg per week in the second and third trimesters.
    • If overweight 7-11.5 kg throughout pregnancy; 0.2-0.3 kg per week in the second and third trimesters.
    • In obesity 5-9 kg throughout pregnancy; 0.2-0.3 kg per week in the second and third trimesters.
  • Nicotine restriction (abstaining from tobacco use).
  • Alcohol restriction (abstaining from alcohol)
  • Review of permanent medication due topossible effect on the existing disease.

Regular check-ups

  • Regular medical check-ups including regular blood glucose tests after birth.

Note!One in two women who had gestational diabetes during pregnancy developed type 2 diabetes mellitus permanently within 8 years after delivery.Note:The first glucose tolerance test should be performed six to twelve weeks after delivery, according to the S3 guideline. If the result is unremarkable, measurements should be repeated every two to three years.

Nutritional Medicine

  • Nutritional counseling based on nutritional analysis
  • Nutritional recommendations according to a mixed diet, taking into account pregnancy and the disease at hand.
  • Observance of the following special dietary recommendations:
    • The following nutrient distribution is recommended for pregnant women:
      • Fat – 30-35 %
      • Carbohydrates – 40-50 %
      • Proteins – 20%
      • Dietary fiber > 30 g/d
    • Nutrients should be distributed over three main meals and 2-3 snacks.
    • The recommended calorie intake is (based on pre-pregnancy BMI):
      • For underweight 35-40 kcal/kg bw
      • At normal weight 30-34 kcal/kg bw
      • At overweight 25-29 kcal/kg bw
      • In obesity reduction to < 20 kcal/kg bw possible
  • Selection of appropriate food based on the nutritional analysis
  • See also under “Therapy with micronutrients (vital substances)” – if necessary, taking a suitable dietary supplement.
  • Detailed information on nutritional medicine you will receive from us.

Training

  • Diabetes education for the patient, including regular exercise and general lifestyle, is essential.