Once You Are Pregnant

Blood Glucose Management. The first step is to choose blood glucose targets for your pregnancy. The targets given in the box on page 370 are an example. Talk to your health care team about how to personalize blood glucose target ranges to your health and your lifestyle.

In the first trimester, targets are designed to help you minimize the risk of birth defects or miscarriage. In the second and third trimesters, the targets will help to prevent your baby from growing too large. If you have trouble staying in the range, or if you have frequent or severe hypoglycemia, talk to your health care team about revising your treatment plan or your targets.

Women with type 2 diabetes usually need to use insulin during pregnancy. So may many women with gestational diabetes. Women who use insulin will find that they need to increase their insulin dose over the course of the pregnancy to reach these targets. You may also need to make adjustments in the kind of insulin you take and how often you inject. Usually, the amount of insulin you take increases with each trimester.

This is because the hormones of pregnancy, which increase in effect over time, create more and more insulin resistance. Some women need to increase their insulin dose by as much as two or three times, especially in the last trimester. This does not mean that your diabetes is getting worse. You and your provider need to decide together when and how to make any changes in your insulin schedule or dose.

Sample Target Blood Glucose Ranges During Pregnancy You'll need to set blood glucose target ranges. Talk with your team about choosing target ranges to meet your needs. For instance, your first trimester goals may be a little higher.

• before meals: 60 to 90 mg/dl
• one hour after meals: <120 mg/dl

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Food and Exercise. Your eating habits may need to change during pregnancy to help you stay on target. And you also will want to make sure that you are eating foods that provide adequate nutrition for you and your baby. You will probably have a visit with your dietitian even before you become pregnant. In general, choose nutritious foods that are part of any healthy eating plan. Women with gestational diabetes may be able to manage their blood glucose levels more effectively by limiting their carbohydrate intake to 35 to 40 percent of calories.

Help with Nausea

• Eat dry crackers or toast before rising.
• Eat small meals every 2 1/2 to 3 hours.
• Avoid caffeine.
• Avoid fatty and salty foods.
• Drink fluids between meals, not with meals.
• Take prenatal vitamins after dinner or at bedtime.