BG Parameters

Hello

I have been a type 1 diabetic since the summer of 1997 and will be 30 in July. I'm trying to tighten up my blood glucose levels, possibly with a view to pregnancy this year. Please can you tell me if there is suggested range for people on DAFNE re- conception and pregnancy ?

I have seen parameters for non-DAFNE and these often include figures for after eating. Since starting DAFNE I don't normally test 2 hrs after eating and am wondering if I should start doing this now?

I am meeting a specialist nurse for people with diabetes tomorrow (for the first time) and don't know how clued up she will be on DAFNE. I moved to the borders of Surrey/Hampshire about 6 years ago from Leicester, where I'd done DAFNE, and they're not as familiar with it here.

Thanks for your guidance.
Joolie

The targets change, my hospital recommends no more than 5.5 before meals and no more than 7.8 1 hour after meals. Pregnancy is the only time DAFNE recommends post-meal testing at 1 hour. Some women find that it is helpful to adopt this prior to pregnancy.

Crikey, that sounds really tough. Guess I can't let it put me off though

Please see response below from Carolin Taylor, DSN and DAFNE Educator from Sheffield and Chair of the DAFNE Educator Group.

In Sheffield we recommend BG targets before & during pregnancy of:

Less than 6mmol/l before meals (but no lower than 4mmol/l)

Less than 8mmol/l 1hour after meals / at bedtime

This obviously does mean introducing BG tests after meals (not normally recommended for routine DAFNE); in practice we find that ladies frequently need higher QA:CP ratios in order to hit the target 1hr after meals and in many cases they also need to take their QA up to 1/2hr prior to eating to get the peak effect of the QA at the appropriate time. Consequently, BI may need to be reduced to prevent hypos between meals, or possibly low-GI snacks could be required.

I hope this helps.

Please see below response from Prof. Stephanie Amiel from King's College Hopsital London.

The targets for diabetes control IN PREGNANCY are tighter than for non-pregnancy and include targets for post meal glucose values. There is much uncertainly about the importance of the transient rise in blood glucose that occurs after meals for risk of diabetes complications but there is good evidence that controlling them in pregnancy has benefit for the baby. Therefore, in pregnancy only, we focus on post-meal glucose also. At King's we use targets that were shown to benefit babies of mothers with gestational diabetes, which is more like type 2 and where the risk of hypoglycaemia is much less - 3.5-5.5 pre-meal and 4 – 7 one hour after eating (very important NOT to correct if slightly higher than this post meal as hypo will occur – use post prandial values only to make future adjustments to premeal doses over next few days) – these targets can be very difficult for Type 1 where we sometimes relax to 90 min post meal testing!

But pre-conception there are no real data. We just know that having high averages (ie HbA1c) when booking for pregnancy (and the studies are old so booking tended to be at 12 – 16 weeks!) increases risk of poor pregnancy outcome.

We ask our patients to focus on getting HbA1c less than 7% if possible before conception and I then suggest DAFNE targets for pre-meal and conventional 90 min targets of 4.5 – 8. Sometimes this does mean abandoning some of the gains of DAFNE in that some people need to reduce CHO content of meals and even introduce between meal snacks to achieve this without hypo by next meal. To avoid weight gain, shifting calories from the meal to the snack, where this is necessary, is advised. It is fortunate that pregnancy only lasts 9 months!!

Hope it's working out for you. My experience is ancient (daughter now 23) but had best availble pregancy care, was great, my adice is carry lucozade at all times, thank goodness for modern test equipment, you'll get more hypos so be careful but the hassle is all worth it, it's a fabulous thing to do, go for it.