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For Women with Diabetes: Your Guide to Pregnancy

Daily Blood Glucose Levels

You’ll check your blood glucose levels using a blood glucose meter several times a day. Most health care providers recommend testing at least four times a day. Ask your health care provider when you should check your blood glucose levels and check off the answers using the chart below.

“I check my blood glucose at least four times a day. The results show whether I need to change my meal plan or insulin to keep my blood glucose on target.”

I should check my blood glucose levels

  • fasting—when I wake up, before I eat or drink anything
  • before each meal
  • 1 hour after the start of a meal
  • 2 hours after the start of a meal
  • before bedtime
  • in the middle of the night—for example, at 2 or 3 a.m.

The daily goals recommended by the American Diabetes Association for most pregnant women are shown below.

When Plasma Blood Glucose
Before meals and when you wake up 80 to 110
2 hours after the start of a meal Below 155

Source: American Diabetes Association. Preconception care of women with diabetes. Diabetes Care. 2004;27(Supplement 1):S76–78.

When Plasma Blood Glucose
Fasting 105 or less
Before meals 110 or less
1 hour after the start of a meal 155 or less
2 hours after the start of a meal 135 or less
During the night Not less than 65

Source: American College of Obstetricians and Gynecologists (ACOG) Committee on Practice Bulletins. ACOG Practice Bulletin Number 60: Pregestational diabetes mellitus. Obstetrics and Gynecology. 2005;105(3):675–685.

You can keep track of your blood glucose levels using My Daily Blood Glucose Record. Write down the results every time you check your blood glucose. Your blood glucose records can help you and your health care team decide whether your diabetes care plan is working. You also can use this form to make notes about your insulin and ketones.

The A1C Test

Another way to see whether you’re meeting your goals is to have an A1C blood test.

Results of the A1C test show your average blood glucose levels during the past 2 to 3 months. Write the goal you and your health care team have chosen below.

Source of Recommendation Target Number
American Diabetes Association 4 to 6 percent—normal*
Less than 1 percent above the upper limits of normal*
American College of Obstetricians and Gynecologists No higher than 6 percent

*Normal values vary according to laboratory; check with your doctor.

Low Blood Glucose

When you’re pregnant, you’re at increased risk of having low blood glucose, also called hypoglycemia. When blood glucose levels are too low, your body can’t get the energy it needs. Usually hypoglycemia is mild and can easily be treated by eating or drinking something with carbohydrate. But left untreated, hypoglycemia can make you pass out.

Although hypoglycemia can happen suddenly, it can usually be treated quickly, bringing your blood glucose level back to normal. Low blood glucose can be caused by:

  • meals or snacks that are too small, delayed, or skipped
  • doses of insulin that are too high
  • increased activity or exercise

Low blood glucose also can be caused by drinking too much alcohol. However, women who are trying to get pregnant or who are already pregnant should avoid all alcoholic beverages.

Using Glucagon for Severe Low Blood Glucose

If you have severe low blood glucose and pass out, you’ll need help to bring your blood glucose level back to normal. Your health care team can teach your family members and friends how to give you an injection of glucagon, a hormone that raises blood glucose levels right away.

High Blood Glucose

High blood glucose, also called hyperglycemia, can happen when you don’t have enough insulin or when your body isn’t able to use insulin correctly. High blood glucose can result from

  • a mismatch between food and medication
  • eating more food than usual
  • being less active than usual
  • illness
  • stress

In addition, if your blood glucose level is already high, physical activity can make it go even higher. Symptoms of high blood glucose include

  • frequent urination
  • thirst
  • weight loss

Talk with your health care provider about what to do when your blood glucose is too high—whether it happens once in a while or at the same time every day for several days in a row. Your provider might suggest a change in your insulin, meal plan, or physical activity routine.

My Ketone Levels

When your blood glucose is too high or if you’re not eating enough, your body might make chemicals called ketones. Ketones are produced when your body doesn’t have enough insulin and glucose can’t be used for energy. Then the body uses fat instead of glucose for energy. Burning fat instead of glucose can be harmful to your health and your baby’s health. Harmful ketones can pass from you to your baby. Your health care provider can teach you how and when to test your urine or blood for ketones.

If ketones build up in your body, you can develop a condition called ketosis. Ketosis can quickly turn into diabetic ketoacidosis, which can be very dangerous. Symptoms of ketoacidosis are

  • stomach pain
  • frequent urination or frequent thirst, for a day or more
  • fatigue
  • nausea and vomiting
  • muscle stiffness or aching
  • feeling dazed or in shock
  • rapid deep breathing
  • breath that smells fruity

Checking Your Urine or Blood Ketone Levels

Your health care provider might recommend you test your urine or blood daily for ketones and also when your blood glucose is high, such as higher than 200 mg/dL.

You can prevent serious health problems by checking for ketones as recommended. Ask your health care team about when to check for ketones and what to do if you have them. Then check off the instructions below and fill in the blanks.

I should test my urine or blood for ketones

  • every day before breakfast
  • when I’m sick
  • when my blood glucose is _____________ or higher
  • other times: _________________________________

If you use an insulin infusion pump, your health care provider might also recommend that you test for ketones when your blood glucose level is unexpectedly high.

Your health care provider might teach you how to make changes in the amount of insulin you take or when you take it. Or your provider may prefer that you call for advice when you have ketones.


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