Pregnancy, diabetes, and Jewish dietary law: the challenge for the pregnant diabetic woman who keeps kosher.
One system of management for the pregnant woman with Type I diabetes is to instruct her in the strategies of achieving and maintaining normoglycemia with the use of self blood glucose monitoring, split doses of insulin, and titration of insulin to cover the meal plan. Normoglycemia is achieved only when the meal plan is adhered to in a rigid fashion to facilitate the insulin dose surrounding the meal. A 30 kcal/kg diet is divided into three meals and three snacks, of which 40% is composed of carbohydrate. These frequent small feedings must be perfectly timed to meet the insulin injected. Such systems require 35 hours of intensified training to become skilled in the techniques of diabetes self-care, but still the regimen does not provide much flexibility. When a pregnant woman also wishes to honor her religious beliefs by keeping kosher and so following another set of rigid laws surrounding the meal plan, adherence to both sets of rules becomes a challenge. Specifically, attention to separating milk and meat and eating only kosher foods must be part of the program. This article describes not only the basic diabetes self-care method but also how to adapt the method to the laws of keeping kosher while sustaining normoglycemia.