Blood Glucose Targets, Hypos & Ketoacidosis


Encourgaing patients to keep a tight check on their blood sugar levels gives them the best chance of a normal pregnancy and a healthy baby.


The following video explains about the importance of testing blood glucose, and advice about watching out for problems which may arise such as hypos and ketoacidosis.

 "Individualised targets for self-monitoring of blood glucose should be agreed with women who have diabetes and are planning to become pregnant, taking into account the risk of hypoglycaemia" (NICE Clinical Guidelines)


All about Targets! Getting it just right..

Below is a general guide but remember that blood glucose targets are individual and as such should be discussed with every patient, working together with their diabetes care team to agree on achievable targets.

Before Breakfast 3.5 to 5.9 mmol/L
One hour after meals      Less than 7.8mmol/L
Two hours after meals Less than 6.4mmol/L


 "Reassure women that any reduction in HbA1c level towards the target of 48 mmol/mol (6.5%) is likely to reduce the risk of congenital malformations in the baby....

Strongly advise women with diabetes whose HbA1c level is above 86 mmol/mol (10%) not to get pregnant because of the associated risks" (NICE Clinical Guidelines)


All about Hypos! Too low...

  • During pregnancy hypos can be more frequent and harder to recognise, especially during the first 3 months.
  • Regular blood glucose testing is important. Blood glucose should be tested at least 4 times a day.
  • Remind women with diabetes to always test their blood glucose before driving, and before going to bed. Occasionally, they may also need to test through the night too.

"If a woman with diabetes who is planning to become pregnant needs intensification of blood glucose-lowering therapy, advise her to increase the frequency of self-monitoring of blood glucose to include fasting levels and a mixture of pre-meal and post-meal levels" (NICE Guidelines 2015)

  • Regular meals can help to manage hypos.
  • Due to the risk of hypos, blood glucose needs to be monitored and if doing any exercise, this should be taken into account.
  • Ensure your patients are aware of treatments for hypos, particularly a sugary drinks or a gel containing glucose and if they are being treated with insulin, an injection called Glucagon can be used.
  • Visit the Diabetes UK website for more info on treating hypos.


All about Ketoacidosis! Too high...

Ketoacidosis can occur without feeling seriously unwell, making it a dangerous condition, which, if not treated, can be fatal to the unborn baby. If ill, vomiting or if blood sugar is greater than 10mmol/L, urine should be tested for ketones. Any more than a small amount of ketones in urine means that the patient needs to get checked out and treated by their GP or a member of their diabetes care team. More information on signs and symptoms can be found here.


Sick day rules for Type 1 and Type 2 diabetes can be found here (type 1) and here (type 2).


Which of the following are signs and symptoms of hypoglycaemia?

How would you treat mild hypoglycaemia?

How would you treat moderate to severe hypoglycaemia?



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