Glucose monitoring and insulin administration in the pregnant diabetic patient.

Over the past decade, it has been apparent that the degree of glycemic control achieved in the pregnant patient with diabetes mellitus significantly affects perinatal outcome. While several studies have documented excellent perinatal outcome with good glucose control, the incidence of neonatal morbidity still remains substantially greater than that observed in the general population. Physiologic or "tight" control appears to further reduce the incidence of macrosomia, hypoglycemia, and other indices of neonatal morbidity. The application of home glucose-monitoring techniques to pregnancies complicated by diabetes can result in optimal glucose control. While one small comparative series did not document improvement in perinatal morbidity, fewer admissions for diabetic control and decreased patient expense were observed in the group using home monitoring. After pregnancy, most patients continued to use home monitoring. This probably reflects the degree of patient enthusiasm and interest generated by self-care. Programs using home blood glucose monitoring and individualized insulin regimens in the management of diabetes may have their greatest impact if implemented prior to conception. The degree of glucose control during early embryogenesis appears to determine the incidence of congenital malformations in the offspring of insulin-dependent diabetic women. Continued careful assessment of the degree of glycemic control may enable the patient and her physician to plan the optimal time for attempting a pregnancy.