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MS WordPerinatologist Corner - C.E.U/C.M.E. Modules
Diabetes In Pregnancy Series
Sponsored by The Indian Health Service Clinical Support Center
PART 2: Management, delivery, and postpartum
3. Monitoring: glucose, renal, and eye
Case continued
Ms. Kanulie is provided with a reflectance photometer, test-strips, lancets, and intensive diabetic education. She is instructed to measure her fingerstick capillary glucose every morning fasting, as well as three times a day, 2 hours after every meal. She is advised that the goal is to keep her FBS <95 mg/dL, 1-hour glucose < 130-140 mg/dL, and her 2-hour post-prandial glucose <120 mg/dL. She is appointed for the following week and brings in this glucose log:
Day |
FBS |
breakfast 2-hr PPG |
lunch 2-hr PPG |
dinner 2-hr PPG |
1 |
109 |
201 |
134 |
157 |
2 |
104 |
194 |
162 |
139 |
3 |
99 |
187 |
144 |
171 |
4 |
101 |
175 |
"forgot" |
129 |
5 |
122 |
222 |
109 |
122 |
6 |
103 |
144 |
124 |
117 |
7 |
96 |
169 |
119 |
- |
Monitoring: glucose, renal, and eye
Scanning the first week of reported values it appears that her fasting blood sugars and her 2-hour post- breakfast sugars are all out of the target range, but that her post-lunch and post-dinner sugars have largely come into the desired limits with diet alone.
It would probably be appropriate to reinforce diet and exercise, with particular attention to the morning meal, and see her again in another week. On the other hand, since her FBS are all out of range, one might predict that she will still need something more than diet. You compliment Ms. Kanulie on her progress and encourage her to keep up her efforts.
If Ms. Kanulie had been pre-existing diabetic or does get treated with insulin, then she would be a candidate for careful monitoring of renal and eye complications, both of which are known to advance during pregnancy. (Meltzer et al)
