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SA JOURNAL OF DIABETES & VASCULAR DISEASE
REVIEW
VOLUME 8 NUMBER 2 • JUNE 2011
57
a long-acting insulin (for the control of the endogenous hepatic
gluconeogenesis).
27
There is no major difference in the glycaemic
control of either continuous subcutaneous injections and the
multiple-dose injection regimen.
27
The major risk of insulin therapy
is hypoglycaemia, including hypoglycaemia unawareness.
27
The attainment of optimal glycaemic control is extremely
complicated and is influenced by multiple factors, e.g. the transient
insulin resistance of the early morning, and the increased insulin
resistance of advancing pregnancy, especially after the second half
of pregnancy.
27
There are large fluctuations in blood glucose levels
during the day in diabetic patients, even in patients with apparently
normal pre- and postprandial blood sugar levels.
The optimal values for pre- and postprandial blood sugar levels
are 3.3 mmol/l to 5.0 mmol/l and 5.5 mmol/l to 7.0 mmol/l (two
hours), respectively (as set by the American Diabetes Association).
The route of administration can be either by multiple-dose injections
or continuous subcutaneous infusion.
During labour, insulin can be administered by infusion or
subcutaneous injection every two hours. The target blood sugar
level is in the region of 4.8 to 8 mmol/l.
27
One needs to be vigilant for
symptoms of hypoglycaemia and possible electrolyte abnormalities.
Insulin requirements are radically diminished following delivery
of the baby. All hypoglycaemic therapy should be stopped in GDM
patients immediately post-delivery.
2
Antenatal management of diabetes in pregnancy
For this, please go to www.nice.org.uk/CG063.
2
Postnatal management
Oral hypoglycaemicagents (metformin, glyburideandglibenclamide)
can be recommenced post-delivery. Other oral agents should
preferably be avoided while the mother is breastfeeding.
2
All GDM
patients should be screened six weeks post-delivery to exclude
diabetes mellitus.
Conclusion
Great strides have been made in the diagnosis and management of
hyperglycaemia in pregnancy, with an important paradigm shift to
focusing on outcomes for mother and baby in the short and long
term. The IADPSG consensus statement is a critical step towards
achieving international uniformity in diagnosis of hyperglycaemia
in pregnancy, thereby facilitating research comparison(s). The
addition of oral hypoglycaemic agents to the treatment of diabetes
in pregnancy has greatly enhanced quality of life and choice for the
patient without compromising outcomes for the mother or baby.
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