Glycemic control during pregnancy in women with diabetes

Glycemia control (blood glucose level) for people with diabetes is currently a daily routine, such as washing or eating. However, it is structured [1] self-monitoring of blood glucose that gives the patient and the doctor an understanding of the individual effects of various foods, insulin doses and physical activity on blood glucose and the ability to correctly change treatment tactics to improve disease control and prevention of its complications.    

Why it is important to control glucose levels
During pregnancy, structured self-monitoring is more relevant than ever. Even well-selected and well-established treatment regimens for diabetes mellitus before pregnancy have to be constantly adjusted due to sharp hormonal changes during the expectation of the baby. In addition, depending on the time of day and the gestational age, the need for insulin, which is necessary for the absorption of glucose from various food products, and sensitivity to this hormone, are constantly changing. However, in a pregnant woman without diabetes, fluctuations in blood glucose levels during the day are within very narrow limits, from 3.3 to 6.6 mmol / L.

In the presence of diabetes, the main source of the complicated course of pregnancy is an increased level of blood glucose. Studies convincingly prove that stable compensation of diabetes 2-4 months before conception and while waiting for a child not only dramatically reduces the risk of any consequences, but also often allows them to be completely avoided. Typically, pregnancy lasts about 40 weeks, counting from the first day of the last menstruation. If a woman did not plan a pregnancy, then most often she finds out about her 2-3 weeks after the delay of the next menstruation. With decompensated diabetes, the menstrual cycle can be irregular, and a woman learns about pregnancy much later, already at the 2nd or 3rd month. By this time (until the 7th week), all vital vital internal organs of the fetus have already been laid, organ systems begin to form. Therefore, all possible complications in a child associated with decompensation of diabetes in the mother can develop already by the time the pregnancy is actually established. That is why it is so important to have a normal blood glucose level even before it occurs. Therefore, pregnancy planning for diabetes primarily means the exclusion of the possibility of its occurrence until the achievement and maintenance of stable compensation of carbohydrate metabolism for at least 2-4 months before conception.  

Self -monitoring
In order to achieve stability of the course of diabetes, it is necessary to carry out self-monitoring of blood glucose at least 7-8 times a day: on an empty stomach, before and after main meals, before bedtime and at 3 a.m. What determines the need for such a frequency of analyzes? The fact is that for the normal development of the fetus, a woman with diabetes should have almost the same blood glucose levels as a pregnant woman without diabetes. Therefore, the latest recommendations of leading diabetes organizations for expectant mothers with diabetes set target glycemia.  

Self-monitoring criteria recommended for pregnant and pregnant women with diabetes

* Algorithms for specialized medical care for patients with diabetes mellitus, 2013

These values ​​can only be achieved with constant self-monitoring using individual devices – glucometers. The use of other means of control, giving an “approximate” level of blood glucose during pregnancy is unacceptable. Even a slight, but chronic increase in blood glucose levels is the main reason for the development of diabetic fetopathy – a complex of severe complications and illnesses of the child associated with decompensated maternal diabetes during pregnancy. In addition, poor compensation of diabetes provokes acute maternal diabetes complications, such as ketoacidosis or severe hypoglycemia. Only after receiving the exact result of the blood glucose level with the glucometer can you react in time to its increase: make an additional injection of insulin, choose the right dose of the drug correctly, change the diet and the intensity of physical activity.   

Compensation of diabetes in many respects depends on the accuracy of the readings of the meter, since the obtained measurement results serve as a guide for changing the treatment plan. During pregnancy, it is most optimal to use blood glucose meters calibrated by blood plasma. The indicators of such devices correspond to the reference methods of high-class laboratory equipment, which allows you to determine the level of blood glucose in each individual case with maximum accuracy. 

Does the above mean that the expectant mother with diabetes should quit her job, her hobbies and devote herself to planning and pregnancy completely to control blood sugar? Of course not! The use of modern glucometers, such as Accu-Chek Mobile, allows not only quickly and almost painlessly to obtain reliable and accurate blood glucose results, but also to do so with maximum comfort and invisible to others. The uniqueness of the meter is the complete rejection of the use of single test strips and their further disposal. The technology without test strips makes it possible to simplify the process of measuring blood glucose as much as possible and make it possible to carry out it almost anywhere and anytime (at work, in a cafe, in public transport), without attracting the attention of others. The Accu-Chek Mobile contains a test cassette with 50 tests on a continuous tape, as well as a piercing device with lancets in the drum, that is, all the components necessary for measuring glycemia are integrated in one device. Therefore, the process of measuring glycemia requires fewer simple steps to obtain an accurate result: you do not need to get a strip, change the lancet, and also dispose of them each time (drop, pick, etc.). The test cassette and drum with lancets are in the meter until all 50 tests and 6 lancets are used.  

In the Accu Chek Mobile glucometer, you can program a reminder about the need to measure glucose levels 1 hour, 1.5 hours or 2-3 hours after a meal, which is especially important during pregnancy when eating foods that are different in glycemic index. In addition, in the program of the device it can be noted when each indicator of blood glucose was measured – before or after a meal, setting the target range of glycemia so that the glucometer informs about the results above or below the target values. Included with the meter is the user access to a USB cable for connecting the device to a computer. Now, at any convenient time, you can see reports on the level of blood glucose displayed in the form of detailed and intuitive graphs; there is no need to scrupulously record the measurement results in a self-monitoring diary. Joint data analysis with the doctor will help to quickly identify problem areas and make the right decisions to change the treatment. A large amount of memory, the calculation of average glycemia over the past few days, weeks and months, a graphic display of glycemia before and after meals, the ability to transfer data to a personal computer – these new generation glucometer capabilities allow young women with diabetes to feel comfortable in the modern world and safe in an exciting 9 months of pregnancy.  

You can hear the opinion that a healthy child with diabetes of the mother is an accident, luck, an isolated case. In fact, this is a huge work and patience of the future mother, and with the help of modern technologies – a really achievable result.