July 24, 1999
Gestational Diabetes
Question from Ontario, Canada:
Please give me your opinion on the following blood sugar levels. I am 37 weeks pregnant, gestational diabetic and have been controlled by diet alone. This is my third pregnancy. With both of my first two babies, I was also gestational diabetic and controlled by diet alone. My first child weighed 8.2 lbs delivered by Caesarean because of failure to progress. My second weighed 9.12 lb and was delivered vaginally. Both are healthy children and had no problems with blood sugars at birth.
With this pregnancy my sugars 1 hour after meals average around 7.5. I am eating almost every 3 hours which includes the middle of the night. I eat approximately 2 bread servings at 3:00-4:00 A.M. and than measure my morning sugars at 7:00 A.M. as my fasting sugar. These morning sugars run 5.5 – 6.8. I have tried not eating in the middle of the night but this results in ketones in my urine. Questions:
Are these blood sugar levels dangerous to my baby or are they borderline? Given that I am 3 weeks away from delivery what is your opinion on introducing insulin?
I have read that 60% of women who have gestational diabetes develop diabetes in later life. Is there any research that shows if there is any relationship between use of insulin versus diet alone to control sugars in pregnancy and the development of diabetes in later life?
Answer:
The blood sugar values you are reporting are borderline. I usually recommend that fasting blood sugars be less than 105 mg/dl (approximately 5.8 mmol) and the 1 hour postprandial be less than 130 mg/dl (approximately 7.2 mmol). If your baby’s growth has not been excessive, the only benefit of starting insulin now might be to minimize the risk of neonatal hypoglycemia. The hypoglycemia is transient and usually well managed by the pediatricians.
There is documentation of the risk of developing future diabetes as you have pointed out. However, I am not aware if you are at greater risk if insulin is required versus diet alone.
OWJ
