Role of insulin in DM with pregnancy

GDM is to be diagnosed  but frank DM is  to bed diagnosed preconceptionally
Criteria for diagnosis impaired glucose tolerance short of frank DM ? Ans: One should insist on GTT and reports and such reports should be as :-
Fasting >105 but below 126.
Post prandial 1hr >190 but above 130 (means impaired GTT).

Pp3hr>140 or some say 130 .
Two Or more values are diagnostic gem
What are the Threshold values for starting insulin ??
1) Fibs 105 or more 2) 1hr pp 140 or more 3) 2hr pp 130 or more
Dose of insulin
0.7u/kg/d from 6 wk to 18 wk
0.8 u/kg/d. 18 to 26 wk
0.9u/kg/d. 26 to 36 wk
1.0 u/kg/d. 36 to 40wk
Target sugar level
Fibs 90
Premeal 100
1hr pp 140
2hr pp 120
Bedtime 120
Simultaneously fetal monitoring should be done

In frank  DM the monitoring should be more frequent : like  3 Premeal levels and 3 post meal levels( 2 hours after meal) ,One can  start insulin following these formulas and can titrate according to her own levels. Once again the importance of diet and moderate exercise should be emphasised

Patients quite often even if  diagnosed diabetes before the index pregnancy often omits  T.metformin 500mg TDS even if she is aware due to added nauses of vomiting f Pregancy(NVP)..Therefore to conclude the poor compliance of Metformin in pregancy is the reason of switching over to insulin