Gestational diabetes chart for blood sugar

Pregnancy Diabetes Chart or Gestational Diabetes Mellitus Chart

Developed by Medindia Content Team | Calculator reviewed by The Medindia Medical Review Team Last Updated on Feb 10, 2022

Medically, Gestational (jes-TAY-shun-ul) Diabetes Mellitus (GDM) is defined as glucose intolerance, which is diagnosed during pregnancy. It is reported to affect approximately 7% of all pregnancies. GDM can adversely affect both the mother and the baby; hence a diagnosis, if made, should be taken seriously.

Gestational (jes-TAY-shun-ul) Diabetes Mellitus (GDM) is a form of diabetes that affects approximately 4% of pregnant women. In India an overall prevalence of 9 to 18% has been reported. GDM can adversely affect both the mother and the baby; hence a diagnosis, if made, should be taken seriously.

The risk factors for GDM include A family history of diabetes, obesity or testing positive for glucose in the urine. Most pregnant women will undergo screening to check the blood glucose level. If the readings are high, they will be advised to undergo an Oral Glucose Tolerance Test. Blood samples are taken while fasting and also during one, 2 and 3 hours after having 100 gms of glucose. These samples are tested in the laboratory and the readings are interpreted.

Sample drawn after 100-gram glucose drink (glucose load)
Time of Sample Collection	Target LEVEL
Fasting* (prior to glucose load)	95 mg/dL (5.3 mmol/L)
1 hour after glucose load	180 mg/dL (10.0 mmol/L)
2 hours after glucose load	155 mg/dL (8.6 mmol/L)
3 hours after glucose load*	140 mg/dL (7.8 mmol/L)
INDICATION: If two or more values meet or exceed the target level, gestational diabetes is diagnosed.

Reported prevalence of GDM in a region depends on the methods and criteria used to establish its diagnosis. For example - WHO uses 75 grams of oral glucose load and not 100 gms as described above. It also suggests only two samples of blood one while fasting and the other at 2 hours after consuming glucose. This method is more cost effective and is used frequently in India.

The National Institutes of Health Diabetes Data Group (NDDG) from the USA (Diabetes 1979;28:1039) and the values established by Carpenter and Coustan (Am J Obstet Gynecol 1982;144:768-73) uses a 100 gram glucose load. Their diagnosis is based on four measurements (fasting, 1, 2 and 3 hr. glucose levels).

Over the years different investigators have come up with different values with small variations as shown in the chart below.

	NDDG(1979)	Carpenter & Coustan (1982)	Sacks et al (1989)
Fasting	105	95	96
1 hour	190	180	172
2 hour	165	155	152
3 hour	145	140	131

Remember that women diagnosed with GDM can develop diabetes later on in their life. Hence they are advised to undergo annual screening to enable early diagnosis or to rule out the condition.

References:

clinical.diabetesjournals.org/content/23/1/17.full.pdf
www.ncbi.nlm.nih.gov/pmc/articles/pmc2582643/
care.diabetesjournals.org/content/27/suppl_1/s88.full#sec-8
www.hawaii.edu/hivandaids/Gestational%20Diabetes.pdf

The charts in this article will help you understand the recommended ranges for blood sugar as well as for A1C.

Recommended blood sugar levels can help you determine whether your blood sugar is in a “normal” range.

However, your blood sugar target level may vary from the general recommendation due to:

your overall health
your age
the presence of other health conditions (known as comorbidities)
the length of time you’ve had diabetes

A doctor or healthcare professional will let you know what the target range should be for you, based on your health and medical history.

Recommended blood sugar range for adults with type 1 and type 2 diabetes and children with type 2 diabetes

According to the American Diabetes Association, these ranges are recommended for adults with either type 1 or type 2 diabetes and for children with type 2 diabetes:

Time	Recommended blood sugar range
Fasting (before eating)	80–130 mg/dL
1–2 hours after a meal	Lower than 180 mg/dL

Ranges are adjusted for children under 18 years with type 1 diabetes, pregnant people, and people with gestational diabetes, as outlined in the charts below.

Blood sugar range for children under 18 years with type 1 diabetes

The chart below shows the recommended blood sugar range for children under 18 years with type 1 diabetes.

Time	Recommended blood sugar range
Fasting (before eating)	90–130 mg/dL
Bedtime and overnight	90–150 mg/dL

Recommended blood sugar range for pregnant people with type 1 diabetes

The chart below outlines the recommended blood sugar range for people who are pregnant and have type 1 diabetes.

Time	Recommended blood sugar range
Fasting (before eating)	Lower than 95 mg/dL
1 hour after a meal	140 mg/dL or less
2 hours after a meal	120 mg/dL or less

Blood sugar range for people with gestational diabetes

The chart below shows the recommended blood sugar range for people with gestational diabetes.

Time	Recommended blood sugar range
Fasting (before eating)	Lower than 95 mg/dL
1 hour after a meal	140 mg/dL or less
2 hours after a meal	120 mg/dL or less

Recommended blood sugar if you don’t have diabetes

For people without diabetes, the standard blood sugar range is the same, regardless of age or health condition. However, a doctor may set different goals based on your specific circumstances.

For instance, if you have several risk factors for diabetes, a doctor might want your blood sugar to be within a tighter range.

The standard blood sugar range for people who don’t have diabetes is outlined in the chart below.

Time	Recommended blood sugar range
Fasting (before eating)	99 mg/dL or below
1–2 hours after a meal	140 mg/dL or below

AIC is a measure of your average blood sugar over the past 3 months. To have your A1C measured, you’ll need a blood draw.

When sugar enters your bloodstream, it binds to a protein called hemoglobin. People who have high blood sugar have a higher percentage of the hemoglobin protein coated with sugar. Your A1C result will give you an indication of what percentage of your hemoglobin is bound to sugar.

In the chart below you can see whether your A1C result falls into a “normal” range or whether it could be a sign of prediabetes or diabetes.

Diagnosis	A1C result
Standard (“normal”)	Less than 5.7%
Prediabetes	Between 5.7% and 6.5%
Diabetes	More than 6.5%

It’s generally recommended that people with any type of diabetes keep their A1C below 7 percent.

However, other health conditions and health goals might change this. A doctor will let you know whether, based on your unique factors, you have a different A1C goal.

Keeping track of your blood sugar is one of the most important elements of diabetes management.

Careful monitoring of your blood sugar and knowing what may cause it to rise or fall can help you and a health team develop a diabetes care plan and set treatment goals.

Additionally, measuring your blood sugar can help you:

monitor how medications are impacting your blood sugar levels
determine how different meals and food choices impact your blood sugar
determine whether exercise or other lifestyle changes are impacting your blood sugar levels
keep track of your overall progress

Even if you don’t have diabetes, it’s a good idea to get your blood sugar checked periodically. A doctor might order a blood sugar test as part of an annual physical. If you have any risk factors for diabetes, you may need to get your blood sugar checked more often.

High blood sugar levels, known as hyperglycemia, can make you feel tired or thirsty and can even make your vision blurry. Many factors can cause a spike in your blood sugar, including:

stress
illness
taking too little insulin
eating large meals or eating more carbohydrates than usual
being less physically active than usual

Over time, high blood sugar can lead to serious complications such as:

nerve damage
kidney damage
eye complications

Fast-acting insulin

If your blood sugar is higher than recommended, you can bring it down by taking fast-acting insulin. Talk with a doctor about how much insulin you should take if your blood sugar is above a certain level.

However, you’ll want to be sure that you take into account any insulin you may already have in your body. Some types of insulin can take several hours to be fully absorbed, so you’ll want to avoid taking too much insulin if you still have some that hasn’t taken effect yet. This could cause your blood sugar to drop too low.

You’ll want to check your blood sugar within 15 to 30 minutes after administering insulin to make sure your blood sugar is coming down but not dropping too low.

Exercise

Another effective way to lower your blood sugar is to exercise. When you’re physically active, your body uses up excess glucose in your blood. However, if you have severe hyperglycemia, you should avoid exercise as it can speed up ketoacidosis, a potentially life threatening condition.

Talk with a healthcare professional if you’ve been having frequent spikes in your blood sugar levels. They may want to adjust your medications or work with you to develop a different diet plan.

Low blood sugar is defined as blood sugar below 70 milligrams (mg) per deciliter (dL). If your blood sugar drops too low, you might feel:

dizzy or light-headed
shaky
hungry
irritable
tired
unable to focus or concentrate

If your blood sugar stays low, you can become confused and have trouble speaking and seeing. Blood sugar that stays low for a longer period of time can lead to serious complications such as a coma or seizures.

The rule of 15

Low blood sugar is more common in people with type 1 diabetes. It’s recommended that you treat low blood sugar using the “15-15 rule.” You do this by following these steps:

Consume 15 g of carbohydrates and wait 15 minutes.
After 15 minutes, test your blood sugar.
If your blood sugar rises above 70 mg/dL, you can stop.
If your blood sugar is still below 70 mg/dL, consume another 15 g of carbohydrates and wait another 15 minutes.
Repeat these steps until your blood sugar returns to normal.

You can get 15 g of carbohydrates from 4 glucose tablets, half a cup of juice or regular soda, or a tablespoon of honey.

Let a doctor know if your blood sugar regularly falls too low. You might need to change the type or amount of insulin you take or the time at which you take it.

It’s also a good idea to make a note of the symptoms you experience during a low blood sugar episode and how long it takes for your blood sugar to recover. This information can help a doctor develop the right type of care plan for you.

Monitoring your blood sugar is a key part of diabetes management. Blood sugar levels that consistently fall within the recommended ranges are a sign that your medications, diet, and other diabetes treatments are working well.

Blood sugar ranges are general guidelines. You might have a slightly different recommended blood sugar range depending on your overall health, age, the length of time you’ve had diabetes, and other factors.

If your blood sugar levels frequently spike too high or drop too low, talk with a healthcare professional about making a change to your diabetes management plan.

Gestational diabetes in pregnancy - treatment and diagnosis of diabetes in pregnant women in Moscow, Clinical Hospital on Yauza

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Contents

IMPORTANT!

The information in this section should not be used for self-diagnosis or self-treatment. In case of pain or other exacerbation of the disease, only the attending physician should prescribe diagnostic tests. For diagnosis and proper treatment, you should contact your doctor.

Specialists of the Yauza Clinical Hospital diagnose and treat gestational diabetes and its complications. For a comfortable pregnancy and the safety of the expectant mother and baby, we exercise strict control over the blood sugar level of a pregnant woman, if necessary, prescribe a specially designed diet and medications.

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About 7% of pregnant women have manifestations of gestational diabetes. In 50% of cases, the disease is asymptomatic
Gestational diabetes in pregnancy significantly increases the risk of pregnancy complications for both mother and fetus
Perinatal mortality increases by 2-3% with a combination of diabetes mellitus and pregnancy

Pregnancy diabetes (gestational diabetes) is an increase in blood glucose that first occurs during pregnancy but is not high enough to warrant a diagnosis of diabetes mellitus. These are hidden disorders of carbohydrate metabolism that threaten to develop into diabetes mellitus.

Pregnant blood glucose norm

During pregnancy, all women experience changes in insulin sensitivity and glucose tolerance. This is fine. The difference between the norm and pathology in the degree of change.

Blood tests for diabetes during pregnancy - norm and pathology

If the test of venous blood taken on an empty stomach shows a glucose level of more than 5.1 mmol / l, this is the norm for pregnant women.
From 5.1 to 7.0 mmol / l - gestational diabetes.
If 7.0 mmol / l or more - diabetes mellitus.
Testing capillary blood (taken from a fingerstick) for the diagnosis of gestational diabetes mellitus is not recommended.
If during an oral glucose tolerance test (when 75 g of glucose is taken orally during the study) after an hour the glucose level is more than 10. 0 mmol/l, and after two hours the blood glucose level is in the range of 7.8-8.5 mmol/l - then for pregnant women this is a normal indicator.

To better understand what gestational diabetes, or diabetes in pregnancy, is, you need to talk a little about hormonal changes in the body in pregnant women.

Causes of gestational diabetes

Hormonal changes that occur during pregnancy are associated with increased production of large amounts of steroid hormones. Some of them, such as cortisol and progesterone, have a significant effect on cell receptors, increasing their resistance to insulin.
This leads to an increase in blood glucose levels and requires a significant increase in insulin production by the pancreas. In cases where the compensatory capacity of the pancreas is not enough, sugar metabolism gets out of control and a condition called gestational diabetes or gestational diabetes develops.
This condition occurs quite often. Between 3 and 10% of pregnant women develop pathological insulin resistance leading to gestational diabetes.
Unlike diabetes mellitus diagnosed before pregnancy, pathological insulin resistance that occurs during pregnancy does not cause fetal malformations and in most cases does not require insulin treatment. But, nevertheless, uncompensated gestational diabetes can significantly complicate the course of pregnancy.

Specialists of the Yauza Clinical Hospital diagnose, treat and prevent diabetes in pregnant women and its complications, such as impaired fetal growth. The doctors of the Clinical Hospital on the Yauza strictly control the blood sugar level of a pregnant woman, if necessary, prescribe a specially designed diet. This ensures a comfortable pregnancy and the safety of the expectant mother and baby.

Pregnancy diabetes - consequences for the child

Large disproportionate fruit. The most important and frequent complication of gestational diabetes is fetal growth failure. Developing in conditions of increased blood glucose levels, which penetrate the fetoplacental barrier, the fetus is forced to compensate for the increased sugar level with its own insulin. Due to the fact that the structure of insulin and growth hormone are very similar, high levels of insulin stimulate the growth of the fetus. The problem is that a large fetus develops. In such a fetus, body proportions differ from those of normally developing newborns, in which the volume of the head is larger than the volume of the shoulder girdle. In fetuses with uncompensated gestational diabetes, the size of the shoulder girdle predominates, and the size of the abdomen increases. This leads to the fact that during childbirth after the fetus's head passes through the birth canal, the shoulders can get stuck (shoulder dystocia) and the child, along with the mother, can be severely injured or die.

Polyhydramnios or oligohydramnios. In addition, in gestational diabetes, the balance of the amount of amniotic fluid can be disturbed and either polyhydramnios or oligohydramnios develops. This is a serious risk factor for intrauterine fetal death or premature birth.

Underdevelopment of the lungs. In gestational diabetes, the lungs of the fetus mature later, as the production of surfactant (a special lubrication of the inner walls of the alveoli, where oxygen is exchanged in the lungs) is disrupted. Therefore, premature birth in gestational diabetes is especially dangerous.

Hypoglycemia and metabolic disorders in the fetus. Due to the constant increased production of its own insulin during pregnancy, immediately after birth, the child is in a state of hypoglycemia with electrolyte imbalance, which threatens his life.

All this dictates the need for the earliest possible detection of gestational diabetes in pregnant women, the level of sugar in the blood of a pregnant woman and to prevent the development of complications.

Diagnosis of diabetes in pregnant women at the Yauza Clinical Hospital

Signs of diabetes in pregnant women

Gestational diabetes in pregnancy is not usually associated with the classic symptoms of diabetes, such as thirst or excessive urination (polyuria).

Pregnancy tests for diabetes mellitus

First phase. At the first visit of a pregnant woman to a doctor at any time, she is tested for glucose levels in venous blood - fasting glucose, regardless of food intake, glycated hemoglobin. This is the first phase of research to detect diabetes mellitus or gestational diabetes in pregnant women. If diabetes mellitus is detected, the patient is referred for observation and treatment to an endocrinologist.

Second phase. For a period of 24-28 weeks, all patients who did not show identified disorders of carbohydrate metabolism at the first study are called for a glucose tolerance test (PGTT) to detect "hidden diabetes". This is done because the occurrence of gestational diabetes is associated with the development of insulin resistance under the influence of hormones produced by the placenta. Therefore, in the vast majority of cases, gestational diabetes develops in the second half of pregnancy after 24 weeks, when there is a peak in the production of placental hormones.

Glucose tolerance test

It is carried out to detect pathological insulin resistance, characteristic of latent diabetes in pregnant women. Pregnant women undergo a two-hour test, only in the laboratory.
During the 3 days leading up to the test, the woman should eat her usual diet, including carbohydrates (>150 g of carbohydrates per day), maintain her usual physical activity. The evening before testing, dinner should include 30-50 grams of carbohydrates.
On the day of the study, before the analysis, you should not smoke and take medications that can affect the level of glucose (vitamins, glucocorticoid hormones, iron preparations, which include carbohydrates, beta-agonists, beta-blockers). You can drink water.
Venous blood is taken on an empty stomach (after 8-14 hours of fasting, usually in the morning, before breakfast).
Then the patient takes a glucose solution (75 g).
And they take blood in an hour and two after the sugar load. Normally, the level of glucose in the blood after a sugar load should not exceed an hour later - 10 mmol / l, after 2 hours - 8.5 mmol / l.
If manifest diabetes mellitus is detected, the patient is referred to an endocrinologist, gestational diabetes mellitus is treated by an obstetrician-gynecologist or therapist.

Glucose tolerance test contraindications

Strict bed rest for a pregnant woman (until doctor's approval).
Pronounced toxicosis of pregnant women (with nausea and vomiting).
Acute infectious or inflammatory disease.
Exacerbation of chronic pancreatitis.
Dumping syndrome (syndrome of resected stomach).

Prenatal diabetes monitoring

Blood glucose monitoring, self-monitoring diary

When diagnosing gestational diabetes, it is necessary to establish strict control of sugar levels throughout the subsequent pregnancy and during childbirth. To do this, regularly examine the blood for sugar (glucose). In addition, the patient conducts self-monitoring using a glucometer.

It is recommended that a pregnant woman keep a diary of observations in which to record:

blood glucose level (normal <5.1 mmol/l),
the presence of ketone bodies in the urine, which is determined by test strips sold in a pharmacy (normally, ketone bodies are absent),
blood pressure readings (normal <130|80 mmHg),
fetal movements,
body weight,
diet.

Expert ultrasound

Conducting an expert ultrasound examination reveals signs of intrauterine suffering of the fetus (diabetic fetopathy), polyhydramnios. Most often, this is a sign of chronically elevated blood glucose levels, penetrating into the blood of the fetus. This requires urgent correction of the diet and normalization of the level of glycemia (blood sugar). If necessary, insulin therapy.

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Treatment of gestational diabetes

Diet for gestational diabetes

In most cases, it is sufficient to follow a special diet recommended by a nutritionist based on the body mass index of the pregnant woman and her taste preferences. The effectiveness of diet therapy is determined by the maintenance of normal blood glucose levels. Diet in pregnancy diabetes recommends:

Avoid simple carbohydrates - sweets, pastries, white bread, honey, sugar, jam, sweet drinks and fruits, ice cream.
Limit complex carbohydrates - cereals (semolina, rice - exclude), potatoes, corn, legumes, durum wheat pasta. Distribute their intake evenly over several meals throughout the day to eliminate starvation (causes the formation of ketone bodies).
Eat enough protein - meat, fish, seafood, poultry, mushrooms, eggs, hard cheese, dairy and sour-milk products of medium fat content (3-5%).
It is necessary to enrich the diet with fiber and vitamins - greens, vegetables (except for boiled carrots and beets), sweet and sour berries (excluding grapes).
Correctly choose fats, do not exceed their amount recommended by the doctor - vegetable oils (add to ready-made meals), nuts, seeds. Animal fats (butter, sausages) - limit.
When cooking, boil, stew, steam and bake dishes. Don't fry. Do not deep fry.

A detailed menu for a pregnant woman with gestational diabetes will be compiled by a doctor, taking into account the individual characteristics of each particular woman.
It is not worth using table No. 9 in its pure form for pregnant women with diabetes mellitus due to a significant restriction of its calorie content.
In detail, what you can eat with diabetes in pregnant women will be told by the doctor at an in-person consultation.

Pharmacotherapy

In cases where the diet fails to achieve the desired control of the level of glycemia in the blood, there are signs of a negative effect on the fetus - they resort to prescribing drugs - insulin. In case of diabetes in pregnant women, antidiabetic drugs in tablets should not be used. Insulin therapy is prescribed by an endocrinologist. Pregnant women with diabetes who are on insulin therapy are jointly managed by an endocrinologist, an internist and an obstetrician-gynecologist.

Physical activity

Patients are recommended regular physical activity - walking in the fresh air (at least 150 minutes per week), swimming.

Prenatal diabetes - childbirth

With a compensated course of gestational diabetes, normal development of the fetus and the condition of the woman, childbirth is carried out in time in a natural way. The question of early delivery, caesarean section may arise if there are relevant indications from the mother or fetus.

Specialists of the Yauza Clinical Hospital have included mandatory fetal development screenings and tests to diagnose sugar metabolism disorders in the pregnancy monitoring program. Recommendations are given on a special diet for women with manifestations of gestational diabetes. If necessary, strict glycemic control is carried out throughout pregnancy, ensuring its successful completion and the birth of a healthy child.

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More What is gestational diabetes mellitus (GDM) and how is it different from normal diabetes?

- GDM is a first-time and detected increase in blood sugar during pregnancy. As a rule, failure occurs due to the sugar-boosting effect of pregnancy hormones. This diagnosis differs from type 1 and type 2 diabetes mellitus in that it disappears after childbirth.

At what time and during which examinations is gestational diabetes detected?

- In the first half of pregnancy, according to the fasting blood sugar level (normally it should be up to 5 mmol / l), from the 24th to the 32nd week - using an oral glucose tolerance test with 75 g of glucose (OGTT-75), which administered to all women if their fasting blood sugar level is below 5. 1 mmol/L. If fasting sugar is 5.1 and above, then the test can be omitted - this indicator is already enough to establish a diagnosis.

Do I need to prepare for the test somehow?

- No, you need to stick to your usual diet. The last meal should contain carbohydrates - cereals, pasta or stewed vegetables.

Who is at risk?

“Pregnancy itself is a risk factor for GDM, as pregnancy hormones increase blood sugar. The high-risk group automatically includes women with GDM that manifested in a previous pregnancy, those who are overweight and obese, as well as those who have close relatives with type 2 diabetes mellitus. In addition, the birth of a child in a previous pregnancy weighing more than 4 kg also indicates a tendency to develop GDM.

Why is the fasting sugar requirement different for pregnant and "regular" people?

- During pregnancy, the nighttime production of glucose by the liver decreases, because the developing fetus takes glucose and amino acids from the mother, which are necessary for its synthesis in the liver. Therefore, the norm of sugar for pregnant women is lower. The norms were revised not so long ago, since as a result of monitoring 25,000 pregnant women, a twofold increase in complications in the fetus with sugar during pregnancy above 5 mmol / l was revealed.

Why is uncorrected GDM dangerous for mother and child?

- In the short term - the immaturity of the baby's organs at birth, premature birth, hypoglycemia of newborns. In the long term, maternal nutrition and blood sugar levels affect the formation of prenatal predisposition to obesity, increase the risk of developing type 2 diabetes and cardiovascular diseases by 50%. If left untreated, gestational diabetes increases the risk of preeclampsia by four times.

What is the peculiarity of the GDM diet and what to do if it does not work? Are many pregnant women afraid that insulin will become addictive and they will not be able to give it up after childbirth?

- The diet depends on the individual characteristics of the woman, but in general, it is important for everyone to remove foods with a high glycemic index, rich in saturated fats from the diet, evenly distribute carbohydrates throughout the day, limiting their intake at breakfast. In the absence of normoglycemia on the background of the diet, insulin preparations are prescribed, since they do not cross the placenta and are the safest during pregnancy. After childbirth, insulin is immediately canceled, no addiction to the drug occurs. It is not insulin that should be feared, but dangerous blood sugar figures for the development of the child.

How to choose a glucometer and when to measure sugar?

- The doctor will help you decide on the model of the glucometer. Sugar control in pregnant women is performed on an empty stomach and an hour after the main meals. If necessary, the endocrinologist will prescribe more frequent monitoring.

Should a childbirth diagnosed with GDM take place in a specialized maternity hospital?

- Often yes, since the medical staff must have experience in delivering such patients and nursing newborns. According to the International Diabetes Federation, every 6th child is born to a mother with gestational diabetes.