No advice, but you may want to read this
Here's an excerpt:
Well, call me a curmudgeon, but I don't believe enough in the research on "gestational diabetes" or believe in the validity or effectiveness (as far as preventing macrosomia) to believe in encouraging routine post-prandial testing.
The only client I can imagine "I:" think should be monitoring her glucose levels -- would be a woman with overt diabetes -- and then, she would NOT be my client, but would be referred to a specialist!
So... I can't give you any advice on which numbers to use. The fact that the numbers vary so widely in recommendation is because the research is so dang lousy. Really disgustingly lousy. And I like to quote -- or paraphrase -- The Guide to Effective Care which complains that the issue of "gestational diabetes" has been adopted with so little data that it is essentially experimentation on pregnant women and "in any other field would be considered unethical"!
Here's the deal.... research shows that restricting calories and carbohydrates will not make a statistical difference in size of the baby. Restriction of calories and carbs PLUS INSULIN "will" make a difference, but only of about 4 to 8 ounces which is not likely to be "obstetrically significant".
Any "research" you see which claims otherwise is probably based on a dozen or couple dozen moms -- read the abstracts yourself -- or on "I had this client once".
Diabetes is diabetes. A woman has it or she does not. Diagnosing gestational diabetes based on a the rather arbitrary numbers developed for GTTs is not accurate - - because the test itself is inaccurate and because there are no "normal" values set for pregnant women (who metabolise sugar differently from non-pregnant testees) There are only "abnormal" numbers based on non-pregnant people (white men) and on the guesses of various care-providers.
Diagnosing GD because the woman has a history of big babies makes no sense to me! It DOES make sense as a marker for diabetes --- because diabetic moms may tend to have larger babies -- but what about the very normal moms who are genetically programed to have big babies? they WILL have big babies -- if those babies are genetically programed to be big -- and we risk harming the mother and the baby by restricting the calories they need for their best health. They WILL have big babies anyway! Those are the facts -- and that's what the data shows.
Research does show that "normal" pregnant women need a certain level of calories and carbohydrates for optimal pregnancy health. Are we gonna deny the research proven to be true, and manipulate her diet -- depriving her of the optimum nutrition -- based on flimsy research and anecdote -- in spite of data which PROVES that diet manipulation is not effective at preventing macrosomia? [Editor's note - Macrosomia is defined as a big body relative to overall size, i.e. a "really fat" baby. Macrosomia has nothing to do with head size. "Big babies" have proportional bodies, which aren't truly macrosomic.]
A diabetic woman needs careful monitoring -- including blood-checks after every meal -- because her bloodsugars will swing wildly and jump HIGH HIGH HIGH - -- probably well into the two hundreds. But the woman called "gestatational diabetic" doesn't swing outside of the normal swing -- she has NORMAL bloodsugars for a pregnant woman -- yet the numbers are arbitrarily lowered BEYOND the normals (even normals for non-pregnancy) -- in order to "control" a nonexistent problem!
I'm sorry to grumble, whine, and complain like a petulant child. Just call me the "GD Curmudgeon".
I test my clients for DIABETES by running a random venous blood sugar when I do their labs... or if they are high risk or symptomatic I send them for a venous postprandial. IF those results are abnormal, then we deal with it -- by consultation and referral -- because she has diabetes.
If she doesn't have diabetes, then she doesn't have diabetes. And that is the end of tests as far as I'm concerned -- unless some overt signs/symptoms appear or there is some clinical reason for further testing.