Interactive diabetes case 11: A 34-year-old pregnant patient with type 2 diabetes – B2

ANSWER — Correct.

Frequent monitoring of blood glucose values is essential in pregnant women with type 1 and type 2 diabetes. Intensive management of postprandial glucose levels, which are elevated during pregnancy-associated diabetes, is associated with improved glycemia, a lower incidence of large for gestational age infants, and a reduced rate of cesarean delivery for cephalopelvic disproportion. The usual glucose profile during pregnancy-associated diabetes includes an exaggerated rise shortly after the meal and then a relatively precipitous fall. One-hour postprandial glucose testing may be superior to two-hour postprandial glucose testing in diabetic pregnancies and is preferred by this consultant. Checking at two hours is an acceptable alternative. (See "Pregestational (preexisting) diabetes mellitus: Antenatal glycemic control".)

What is your dietary prescription?

●You advise the patient to have three meals and three snacks a day. You advise a caloric intake of 30 kcal/kg per day (ie, 2400 kcal per day) to support the growing fetus. You advise that the diet contain no more than 40 percent of calories as carbohydrates to prevent postprandial hyperglycemia in a pregnant woman with diabetes. (See "Interactive diabetes case 11: A 34-year-old pregnant patient with type 2 diabetes – C1".)

●You advise the patient to have three meals and three snacks a day. You advise a caloric intake of 24 kcal/kg per day, in view of the presence of obesity (ie, 1920 kcal per day), versus 30 kcal/kg per day for a woman with optimal body weight. You advise that the diet contain no more than 40 percent of calories as carbohydrates to prevent postprandial hyperglycemia in a pregnant woman with diabetes. (See "Interactive diabetes case 11: A 34-year-old pregnant patient with type 2 diabetes – C2".)

●You advise the patient to have three meals and three snacks a day. You advise a caloric intake of 24 kcal/kg per day, in view of the presence obesity (ie, 1920 kcal per day), versus 30 kcal/kg per day for a woman with optimal body weight. You advise that the diet contain no more than 55 percent of calories as carbohydrates to prevent fasting hypoglycemia in a pregnant woman with diabetes. (See "Interactive diabetes case 11: A 34-year-old pregnant patient with type 2 diabetes – C3".)