Gestational diabetes medical therapy
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
Overview
Specific treatment will be determined by the physician(s) based on:
- age, overall health, and medical history
- extent of the disease
- tolerance for specific medications, procedures, or therapies
- expectations for the course of the disease
- opinion or preference [1]
Treatment for gestational diabetes focuses on keeping blood glucose levels in the normal range. Treatment may include:
- special diet
- exercise
- daily blood glucose monitoring
- insulin injections
- there is evidence that certain oral glycemic agents such as glyburide are safe in pregnancy, or at least, are significantly less dangerous to the developing fetus than poorly controlled diabetes. However, few studies have been performed as of this time.
Medical Therapy
Diet and Exercise
All women diagnosed with GDM require nutritional counseling for the appropriate amount of weight gain during pregnancy as well as dietary control. Women with a normal BMI [20-25], can consume about 30kcal/kg/d while those who are obese [BMI >25-34] should restrict their diet to 25 kcal/kg/d and those that have a BMI >34 should consume 20kcal/kg/d or less. These patients should restrict fat intake and substitute simple or refined sugars in their diet to more complex carbohydrates. Moderate amount of non-weight bearing exercise is an important adjunct to dietary advice. It is recommended that pregnant women exercise for about 20-30 minutes everyday or at least most days of the week. It is a critical point in time for changing the lifestyles of these women since they are at a high risk for development of type 2 diabetes.
Insulin therapy
Insulin therapy in patients with GDM is based on pre-pregnancy BMI. Women who are lean before conception, the insulin dose requirement is 0.8U/Kg and for the obese women it is 0.9-1U/kg. There is insufficient evidence available regarding the safety of the insulin analogues, Aspart and Lispro hence regular human insulin is the treatment of choice and can be combined with intermediate or basal insulin such as NPH/ lente/ ultralente. There isn’t enough data regarding the safety of the long acting insulin glargine in pregnancy.
Oral Hypoglycemics
The use of oral medications is considered when diet and exercise do not adequately control blood sugars. Some studies have recently evaluated the safety and efficacy of Glyburide (sulphonylurea) after the first trimester for treatment of GDM. The older sulphonylureas were not recommended for use in pregnancy because they crossed the placenta. Glyburide only minimally crosses the placenta. It has been shown that it is as effective as insulin, more cost effective than insulin and safe for use in pregnancy. Both American Diabetic Association [ADA] and American college of Obstetricians and Gynecologists [ACOG] await more research related to the effect of glyburide on maternal and perinatal outcomes before approving its use. There is inadequate data in regards to the safety and efficacy of other oral antidiabetic medications such as Metformin, thiazolidinediones and Acarbose.
References
- ↑ "Gestational Diabetes". An overview of gestational diabetes, including risk factors and treatment. University of Maryland Medicine. 2003. Retrieved 2006-11-29. Unknown parameter
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