Monitoring the glycaemic profile before conception

Intensive blood glucose concentration monitoring assists women with diabetes to achieve glycaemic targets (see Glycaemic targets before conception). Ideally, this should start before conception or, at the latest, as soon as pregnancy is recognised. Recording of dietary information can also help women and their healthcare providers to guide management decisions.

In the prepregnancy period, women with type 2 diabetes managed with diet and/or metformin should start routinely monitoring their blood glucose concentration before breakfast and after each main meal (ie four times daily). Women with type 2 diabetes treated with insulin should routinely monitor blood glucose concentration before and after each main meal (ie six times daily).

Women with type 1 diabetes should routinely measure blood glucose concentration before and after each main meal, and before bedtime (ie seven times a day).

In addition, all women treated with insulin should measure blood glucose concentrations:

• periodically between 2 am and 4 am to check for unrecognised nocturnal hypoglycaemia
• before driving
• before and after exercise (for women with type 1 diabetes)
• when symptoms of hypoglycaemia are suspected.

When used in combination with capillary (finger-prick) blood glucose concentration monitoring, continuous glucose monitoring (CGM) or flash glucose monitoring can help guide treatment of women planning pregnancy, particularly those treated with insulin. However, the cost of continuous glucose monitoring and flash glucose monitoring may be a barrier, unless subsidised. At the time of writing, the Australian Government subsidises continuous and flash glucose monitoring on the National Diabetes Services Scheme (NDSS) for women with type 1 diabetes who are actively planning pregnancy, pregnant or immediately post-pregnancy. For more information about continuous and flash glucose monitoring, see Interstitial fluid glucose monitoring systems.