Diabetes management in pregnancy

Indian Guidlines

Diagnostic Criteria

1-HR-PP > 190
2-HR-PP > 120

Glycemic targets in pregnancy

	FBS	2HRPP	HbA1C
Pregestational DM	90	120	6.5
Gestational DM	95	120	6.5

Pregnancy & diabetes - Risks:

• Diabetes in pregnancy may increase the risk of obesity and type 2 diabetes in offspring later in life.
• Pregestational diabetes (PGDM) confer greater maternal and fetal risk than Gestational diabetes (GDM). Risks are:
  • Spontaneous abortion
  • Fetal anomalies
  • Preeclampsia
  • Intrauterine fetal demise
  • Macrosomia
  • Neonatal hypoglycemia
  • Neonatal hyperbilirubinemia
• Women with type 1 diabetes are at high risk for hypoglycemia
• Women with type 1 diabetes are at risk for ketoacidosis at lower blood glucose levels than in the nonpregnant state

Anti Diabetic drugs in pregnancy

• All sulfonylureas (Preg. Cat-c) are contraindicated in pregnancy.
• Metformin (Category-B) may be preferable to insulin for maternal health if can control hyperglycemia. Metformin increase risk of prematurity, but has lower chances of hyoglycemia & weight gain. For preg > 20wks. Max-dose = 2gms/d. Long-term outcomes in offspring not known.
• Voglibode is Category-B
• Most insulins are category B, except glargine, glulisine, and degludec are category C.
• Sitagliptin, Vildagliptin, Saxagliptin, and linaglipti are category-B
• Exenetide & liraglutide are Category C.

Drug	Preg. Category
Insulin-R	B
Lispro	B
Aspart	B
NPH	B
Detemir	B
Glulisine	C
Glargin	C
Degludec	C
Inhaled Ins	C
Sulfonylurea	C
Metformin	B
Voglibose	B
Sitagliptin	B
Vildagliptin	B
Saxagliptin	B
Linagliptin	B
Exenetide	C
Liraglutide	C

• If 2HR-PP-BSugar > 200, then start Insulin-Mix 8units
• Between 120-160 → 4 units
  Between 160-200 → 6 units
  More than 200 → 8 units
• If FBS > 95, then split the insulin dose in 2 doses (eg 2units AM & 4units PM)
• If 2-HR-PP continues > 120, the increase morning dose of insulin
• Monitor BSugar on alternate days.