Keys to Managing Gestational Diabetes in the Pharmacy

Developing in women during pregnancy and differing from preexisting or pregestational diabetes, gestational diabetes can affect up to 10% of pregnancies in the United States annually.¹ Although women with gestational diabetes usually see their blood glucose levels return to normal after childbirth, approximately 50% of these patients will develop type 2 diabetes.¹

Patients with gestational diabetes are at increased risk of hypertension during pregnancy. Babies of mothers with gestational diabetes are at higher risk for issues¹ such as large birth weight (9 lbs or more) and difficult delivery, low blood glucose, preterm birth, and type 2 diabetes later in life.

To diagnose gestational diabetes, a glucose challenge test is performed between 26 and 28 weeks of pregnancy. The patient drinks a glucose beverage and has blood drawn 1 hour later. Women who test positive will typically need a glucose tolerance test. A larger or more concentrated glucose drink is consumed, and blood is drawn 1, 2, and 3 hours afterward. Based on the results, the health care provider may suggest dietary changes followed by retesting in several weeks. If 2 or more readings are abnormal, the patient will receive a diagnosis of gestational diabetes.²

Gestational diabetes treatment can include dietary and exercise changes as recommended by the patient’s health care provider, as well as blood glucose testing and medication or insulin injections.¹ The American Diabetes Association recommends the following target blood glucose levels during pregnancy³:

• Before meals/fasting: ≤ 95 mg/dL
• An hour after a meal: ≤ 140 mg/dL
• Two hours after a meal: ≤ 120 mg/dL

“I think it’s important to remember that with the gestational population, it is likely their first exposure to being diabetic, so everything is new to them—and likely overwhelming, on top of being pregnant,” said Stephanie Redmond, PharmD, CDE, BC-ADM, founder and vice president of DrStephanie’s. Whereas patients with preexisting diabetes may need help managing their insulin doses, those with gestational diabetes are “starting from scratch with carb counting, how to inject insulin, and general diabetes education with targets,” Redmond added.

Redmond offered 5 tips to pharmacists helping patients manage gestational diabetes.

1. Reinforce the importance of medication and/or insulin adherence.

“Medication adherence is extra vital and important in this population,” she said. “This has short-term and serious implications; adhering to medications and/or insulin correctly can mean drastically different outcomes for their babies from birth.”

2. Take extra time to ensure patients pick up insulin and understand proper injection technique, storage, and timing.

Pharmacists can also counsel patients on managing hypoglycemia. “It may be worth a follow-up phone call if you see that they are not refilling their insulin on time,” Redmond explained. “Set expectations that they likely will need increasing insulin doses over time, which is normal. Remember that this is likely overwhelming, so every bit of education makes a meaningful difference.”

3. Encourage patients to use a continuous glucose monitor (CGM) if their insurance pays for it.

Pharmacists can help patients access a FreeStyle Libre coupon, which has a $0 co-pay for a 14-day trial. After that, if insurance does not pay for the Libre, an automatic coupon can be applied so that the patient pays $75 for a 1-month supply of 2 sensors. Because CGMs are dispensed at most pharmacies, pharmacists should become familiar with how to apply the CGM and how it works in order to better assist patients.

4. Educate yourself on dietary supplements.

“Consider that you may be a resource for their dietary supplement questions,” Redmond added. One recommended source for this education is a recent article published in Frontiers in Nutrition in April 2022.⁴

5. Spend time with your patients.

Pharmacists are noted experts in medications, but Redmond said some of the most valuable time spent with patients with gestational diabetes were times where she was able to provide counsel on dietary advice or drug affordability, and more as a “listening ear to their frustrations,” she said. “Sometimes, this is the most valuable time you can spend with them.”

References

1. Gestational diabetes. CDC. Updated August 10, 2021. Accessed October 10, 2022. https://www.cdc.gov/diabetes/basics/gestational.html 
2. Glucose tolerance test. American Pregnancy Association. Accessed October 10, 2022. https://americanpregnancy.org/healthy-pregnancy/pregnancy-health-wellness/glucose-tolerence-test/
3. Gestational diabetes and a healthy baby? Yes. American Diabetes Association. Accessed October 10, 2022. https://diabetes.org/diabetes/gestational-diabetes 
4. Ibrahim I, Bashir M, Singh P, Al Khodor S, Abdullahi H. The impact of nutritional supplementation during pregnancy on the incidence of gestational diabetes and glycemia control. Front Nutr. 2022;9:867099. doi:10.3389/fnut.2022.867099