What to Do If You Are Told That Your Blood Sugar Is High When You Are Pregnant

What to Do If You Are Told That Your Blood Sugar Is High When You Are Pregnant

Once you are pregnant, you will often be told to undergo diabetes screening in the second trimester (usually at 24 to 28 weeks) when you are setting up your file. The classic method is to do an oral glucose tolerance test (OGTT).

What to Do If a Pregnant Mother Finds That Her Blood Sugar Is Abnormal

With the outbreak of diabetes and the relaxation of the two-child policy, older pregnant women have become the focus of diabetes screening. Many obstetricians and gynecologists often apply for blood sugar monitoring when pregnant women go to the hospital for the first time. As a result, many pregnant women are told that their blood sugar is abnormal shortly after they are confirmed to be pregnant. They are transferred to the diabetes (endocrinology) department or an experienced gynecologist.

How Do I Usually Deal With It When I Am Working in a Maternal and Child Health Care Institution?

I will first add her as a WeChat friend, "You can leave a message or call me if you have anything." Facing these big girls who have just gotten married and are still ignorant, and their parents or parents-in-law who follow them, a WeChat connection is also a kind of humanistic care.

Then, I will recommend my WeChat public account to her. I would tell her to find time to read the articles about hyperglycemia during pregnancy, just hoping that she, who just knew about high blood sugar, would take fewer detours.

Then, I would tell her to go home and monitor her blood sugar for 2 to 3 days: fasting blood sugar + 2 hours after three meals, and keep records.

"Hasn't fasting blood sugar been tested with venous blood in the hospital? Why do we need to test finger blood sugar?" When faced with questions, I would tell her: This does not mean that the hospital's venous blood is inaccurate, but mainly to exclude stress-induced hyperglycemia caused by anxiety, tension, fear, and other emotions when going to the hospital for examination.

I would tell her the specific method of monitoring blood sugar 2 hours after a meal: this meal should be eaten as usual, and don't deliberately eat less because of fear of high blood sugar, which is a cover-up; start timing from the first bite of staple food, and measure blood sugar 2 hours later; when pricking the finger to collect blood, be sure not to squeeze blood, which is one of the main factors leading to errors in finger blood sugar monitoring; measure after three meals, and measure for 2 to 3 consecutive days; be sure to record, and return for a follow-up visit after 3 days.

Three States of Hyperglycemia During Pregnancy

According to the classification and diagnostic criteria for hyperglycemia during pregnancy in the "Guidelines for the Prevention and Treatment of Type 2 Diabetes in China (2020 Edition)," three states are proposed: gestational diabetes, overt diabetes during pregnancy, and pre-gestational diabetes, accounting for 83.6%, 8.5%, and 7.9% of hyperglycemia during pregnancy, respectively.

Pre-gestational diabetes refers to diabetes that has been diagnosed before pregnancy; both overt diabetes during pregnancy and gestational diabetes are abnormal glucose metabolism discovered during pregnancy without knowing one's glucose metabolism status before pregnancy. The main difference between them is the degree of blood sugar: if it meets the diagnostic criteria for diabetes in non-pregnant people, it is overt diabetes during pregnancy; if it does not meet the diagnostic criteria for diabetes in non-pregnant people, and the blood sugar at 0, 60, and 120 minutes in the oral glucose tolerance test reaches any of 5.1 mmol/L, 10.0 mmol/L, and 8.5 mmol/L, respectively, it can be diagnosed as gestational diabetes.

Compared with overt diabetes during pregnancy, the hyperglycemia state of pre-gestational diabetes is generally more serious. Since the existence of hyperglycemia is known before pregnancy, insulin treatment is often started before pregnancy. The blood sugar level of overt diabetes during pregnancy is also high, but there are no obvious symptoms or no examination to confirm the diagnosis; gestational diabetes is a relatively mild abnormal glucose metabolism.

Based on the difference in abnormal glucose metabolism, the necessity of insulin treatment is different. Generally speaking, pre-pregnancy diabetes > overt diabetes during pregnancy > gestational diabetes.

Treatment Plan Based on the Three States of Hyperglycemia During Pregnancy

If the patient is a patient with pre-pregnancy diabetes, the blood sugar monitoring is not up to standard, or the history of diabetes is denied before pregnancy, and the blood sugar level 2 hours after a meal is above 10.0-11.1 mmol/L, it is recommended to be hospitalized for intensive learning and observation, and most of them need insulin to start treatment; if the blood sugar level 2 hours after a meal is 7.0-9.0 mmol/L, it is recommended to be hospitalized for learning diet and exercise management. The former generally has a longer hospitalization time than the latter. If the patient's fasting blood sugar is less than 5.3 mmol/L and the blood sugar is less than 7.0 mmol/L 2 hours after a meal, it can be observed, because the above guidelines point out that since fasting blood sugar gradually decreases with the progress of pregnancy, a simple fasting blood sugar greater than 5.1 mmol/L in early pregnancy cannot be diagnosed as gestational diabetes and needs to be followed up.

What Knowledge and Skills Should "Sugar Mothers" Master?

1. Monitor Blood Sugar

   • Buy a blood glucose meter, learn the precautions for monitoring blood sugar, and minimize operational errors. It is recommended to buy a 33G blood glucose meter blood collection needle, because the blood collection needles configured for general blood glucose meters are mostly 26 or 28G, and the 33G blood collection needle is thinner and less painful.

2. Learn About Diabetes Diet and Exercise Management

   • Prepare a food scale, weigh food, and make records. Transition the understanding of diet management from books to practice, including the variety, quantity, combination, meal distribution, meal order, and other related contents of the diet. Start exercising about 45 minutes after a meal, mainly in the form of walking, and exercise for 20 to 30 minutes after a meal, which is very helpful for stabilizing postprandial blood sugar control.

3. Weight Management

   • For obese diabetic patients, in the early stage of pregnancy, they should control their weight appropriately on the basis of ensuring nutrition, which is very helpful for blood sugar management in the middle and late stages. You should know the importance of weight management in the middle and late stages.

4. Learn Insulin Injection Techniques

   • If you need to use insulin, you need to learn insulin injection (including insulin varieties, insulin purchase, insulin installation, insulin storage, selection of insulin injection sites, rotation, inspection, etc.). Some patients might need long-acting insulin such as Levemir FlexPen, which is convenient and helps maintain stable blood glucose levels.

5. Understand Hypoglycemia

   • Not only should you know about high blood sugar, but you should also know the harm of hypoglycemia, early identification, and routine treatment.

6. Precautions Before and After Delivery

   • You should know weight management and blood sugar monitoring after delivery, prevention of neonatal hypoglycemia, etc. These are the contents that medical care should guide during hospitalization and that diabetic patients should learn.

At present, high blood sugar during pregnancy is very common in clinical practice. With the above relevant knowledge and skills, "sugar mothers" can have a normal pregnancy under the premise of good blood sugar control. Leveraging tools like the Levemir FlexPen can make insulin management easier and more effective for those requiring insulin therapy.