From the Guidelines
For a fit and well 26-week pregnant woman presenting with hypoglycemia, immediate treatment with 15-20 grams of fast-acting carbohydrates is recommended, such as 4 ounces of fruit juice, 1 tablespoon of honey, or 3-4 glucose tablets, as stated in the most recent guidelines 1.
Key Considerations
- After 15 minutes, blood glucose should be rechecked; if still below 70 mg/dL, repeat the carbohydrate treatment.
- Once blood glucose normalizes, provide a small protein-containing snack to maintain levels.
- This woman requires prompt evaluation to determine the cause of hypoglycemia during pregnancy, which is unusual in non-diabetic pregnant women.
- Potential causes include gestational diabetes with insulin overtreatment, inadequate caloric intake, excessive exercise, or rarely, conditions like insulinoma.
Management and Prevention
- Regular meals with balanced carbohydrates, proteins, and fats are important to prevent recurrence.
- Blood glucose monitoring should be initiated, with target fasting levels below 95 mg/dL and post-meal levels below 140 mg/dL at 1 hour or 120 mg/dL at 2 hours, as recommended by recent guidelines 1.
- Hypoglycemia during pregnancy requires attention as it can affect both maternal and fetal wellbeing, with the developing fetus relying on consistent maternal glucose levels for growth and development.
Additional Recommendations
- Referral to a registered dietitian is important in order to establish a food plan and insulin-to-carbohydrate ratio and to determine weight gain goals, as suggested by recent studies 1.
- Due to increased red blood cell turnover, A1C targets in pregnancy should be ideally <6% (42 mmol/mol) if this can be achieved without significant hypoglycemia, but the target may be relaxed to <7% (53 mmol/mol) if necessary to prevent hypoglycemia, as stated in recent guidelines 1.
From the Research
Hypoglycemia Treatment Options
- The treatment of hypoglycemia in a 26-week pregnant lady can be managed with various options, including glucagon and dextrose 2.
- A systematic review and meta-analysis compared the effectiveness of glucagon with dextrose and found that glucagon is similarly effective to dextrose in relieving hypoglycemia 2.
- Another study compared the use of 10% dextrose (D10) with 50% dextrose (D50) in the treatment of out-of-hospital hypoglycemia and found that D10 may be as effective as D50 at resolving symptoms and correcting hypoglycemia, with fewer adverse events 3.
Dextrose Concentration
- A randomized controlled study compared the efficacy and safety of 10%, 25%, and 50% dextrose in the treatment of hypoglycemic patients and found no difference in the median time to achieve a Glasgow Coma Scale (GCS) of 15 in all three treatment arms 4.
- The study also found that the total median dose administered in the 10% and 25% groups was lower than in the 50% group, and the proportion of patients who received the maximum dose of 25g was higher in the 50% group 4.
Pregnancy Considerations
- Insulin analogs, such as insulin lispro, have been studied in pregnancy and found to be safe and effective in women with diabetes 5.
- Oral hypoglycemic agents, such as glyburide and metformin, have also been used in pregnancy, but more research is needed to determine their safety and efficacy in pregnant women with type 2 diabetes 5.