ADA, ACOG and NICE recommend the initiation of insulin
therapy, if nutrition therapy fails to achieve blood glucose targets
in women with GDM24-26 after assessing the response to a meal
plan for 2 weeks if FPG > 90 mg/dL and 2-hour PG > 120 mg/
dL.
54 Insulin may be started at diagnosis along with a meal plan
if FPG > 120 mg/dL and 2-hour PG > 200 mg/dL.
8 The ACOG
guideline recommends initiation of insulin in women with GDM
with an ultrasound abdominal circumference greater than 75th
percentile at 29-33 weeks of gestation.25 The ADA guideline on the
initiation of insulin recommends initiation of insulin to achieve
FPG ≤ 105 mg/dL (5.8 mmol/L) or 1-hour PG ≤ 155 mg/dL (8.6
mmol/L) or 2-hour PG ≤ 130 mg/dL (7.2 mmol/L).24