acceptable blood glucose numbers?

[kate3]

I aim for very tight control for my diabetic patients. I like fastings under 95 and post parandials less than 110 (definitely no higher than 120).

Good luck.

[cristeen]

I took a workshop on GD recently from Gail Hart, and she discussed the studies that have been done indicating that tight control of diabetics actually causes more health problems than loose control.

The ADA recommendation for fasting glucose levels is 115 for non-pg. Pg women may have a slightly higher level, but most doctors use a lower number.

The numbers have been artificially lowered by doctors who want more women to fall into the "at risk" category so they get more money for treating them. Not because there's any scientific reason for the lowering. I'd go with the number from 2005, they're more in line with the research.

[kate3]

This article might help you-it has a lot of good information on GDM in general and recommendations for glucose control during pregnancy, post partum, and in long-term follow-up.

http://care.diabetesjournals.org/cgi...plement_2/S251

The numbers have been artificially lowered by doctors who want more women to fall into the "at risk" category so they get more money for treating them.

Source?

[maxmama]

Originally Posted by kate3

I aim for very tight control for my diabetic patients. I like fastings under 95 and post parandials less than 110 (definitely no higher than 120).

Good luck.

Source? Because these aren't the ACOG or ADA standards.

Also, you sound quite condescending when talking about what you "like" and what YOU "aim for". Have you ever been GDM? Ever checked your sugars five times a day, or used insulin four? It's very difficult. I see my role as a HCP to facilitate the client's meeting of goals, not to say "I like this for my patients". How is that different from an OB of the '50s saying "I like my girls to stay on the thin side in pregnancy"?

[kate3]

Also, you sound quite condescending when talking about what you "like" and what YOU "aim for".

My intention was not to be condescending-just to show that how I practice does differ from ACOG and ADA. I am very much aware that the numbers I posted are different from national guidelines (see that article I linked). After 18 years of working with moms who have GDM I have learned what seems to work best and I was sharing that opinion. I never thought my choice of pronoun would cause a stir!

But to answer your question: I have checked my BS 5 times a day (yes, it hurts and yes, it is disruptive). I am completely aware of the disruption a diagnosis of GDM causes and the learning curve that is associated with managing it. But it is also well documented that very good glucose control (normal sugars, not hypoglycemia) is associated with a significant decrease in adverse outcomes. Excellent glucose management can be the difference between a low intervention normal delivery and a baby that stays with mom and a medically managed (or surgical) delivery and a baby that spends days in the NICU. So many pregnancy complications cannot be prevented or well managed once they occur: PIH, PTL, PROM, previa, abruption, etc. This one can be.

[mousebandit]

How would you practitioners feel about a level of 84 about 2 hours after eating a typical meal? Is that too low, or is that just fine? (I know this isn't exactly in line with the current discussion, but hoping to get a little insight here!)

THANKS!

Tracey Mouse

[crazy_eights]

Originally Posted by cristeen

I took a workshop on GD recently from Gail Hart, and she discussed the studies that have been done indicating that tight control of diabetics actually causes more health problems than loose control.

I love Gail Hart. Any studies you can link us to?

[crazy_eights]

Originally Posted by kate3

This article might help you-it has a lot of good information on GDM in general and recommendations for glucose control during pregnancy, post partum, and in long-term follow-up.

http://care.diabetesjournals.org/cgi...plement_2/S251


Source?

From your link:

High-risk: Perform blood glucose testing as soon as feasible, using the procedures described above if one or more of these are present:

* Severe obesity
* Strong family history of type 2 diabetes
* Previous history of: GDM, impaired glucose metabolism, or glucosuria

I find it interesting in light of all the info coming out that glucosuria doesn't mean much in pregnancy due to changes in glomerular filtration.

ETA a quote from a mainstream medical text:

Glycosuria is more common during pregnancy because of the lowering of the renal threshold for glucose excretion.

The increase in the glomerular filtration rate delivers an overwhelming glucose load to the renal tubules. Reabsorption, which is normally complete, is thus compromised.