gestational diabetes questions

[rjglbws]

what is the standard in your area before insulin therapy is recommended......

fasting level?

1-hour postprandial?

2-hour postprandial?

is the 2-hour postprandial glucose level more significant than the 1-hour postprandial glucose level?

how many elevated glucose levels are needed in a week?

thanks ahead of time for your input.

[midwife2b]

Rare is the gestational diabetic who has an abnormal FBS. Usually come to find out they are herebefore undiagnosed type 2's.

Where I work insulin treatment depends on the style of the doc/NP and how they were trained. I learned to start insulin if 2 hr BS were consistently above 140 more than once a day. Start a bedtime dose of insulin for morning elevations and a morning dose for afternoon and evening elevations with a sliding scale of Regular Insulin. Calculations based on weight.

One endo doc always begins with 10U NPH at bedtime no matter what or where the glucose values are elevated. One of our maternal fetal medicine docs likes to use the longer acting insulins and supplement with sliding scale. We have a few who are doing oral meds now which is really helping patient compliance.

Our office sends all GDM and IDDM moms to an endocrinologist. We do not adjust their insulin at all. If their numbers are not good we get them in to see the endocrinologist or NP on that same day or next day if possible.