June 25, 1999
Gestational Diabetes
Question from the United Kingdom:
I am a 34 year old woman, and gave birth to my first baby last year. I was diagnosed with gestational diabetes when I was about 6 months pregnant. I took glucose tolerance tests and went on insulin. Thankfully, my baby was fine, and a good weight. This might not have been so, as my diabetes could have been found earlier. It transpired that my blood sugar levels were high when my “booking bloods” were taken, when I was just 7 weeks pregnant, but these results were ‘lost’ at the doctors surgery! Is it not unusual to develop gestational diabetes in the first trimester? I was not given a glucose tolerance test after I delivered, but left with my monitoring equipment, and told to do random tests 2 hours after eating. I did, and they appeared normal. I was then discharged by the diabetes clinic.
I might have put away my monitoring equipment for good, and forgotten the whole episode. But I decided, some 4 months after my baby’s birth, to get the equipment out again. Out of curiosity, I knew that people with diabetes handle colds differently to those without, and I had an awful cold. I found to my alarm that 2 hours after eating I was getting readings of 9.3, 9.2, 9.4 mmol/L. However, after my cold has gone, post eating readings are fine again. I decided to do some tests pre meals and find I am in the upper 6’s and into the 7’s before even eating in the morning (and climbing between meals, too). After meals, I’m fine. This is exactly the opposite to what happened to my blood sugars when I was pregnant. Then I soared after meals, and had to take Actrapid, but didn’t have to take any overnight insulin as my body was making enough background insulin to cope(readings of 4-5 mmol/L in the morning before eating). What is happening to me? If I do have diabetes on the strength of the new classification, how do I go back to the diabetes clinic and tell them what I believe without putting their noses out of joint?
I am so sorry my question is so long, but I really need advice. I am not overweight, but my Grandfather, Uncle, and Aunty on my Mother’s side all have mature onset diabetes. I eat a low sugar, vegetarian diet, but have a very stressful lifestyle. Can you tell me what part stress plays (I have heard it can send blood sugars soaring).
I would appreciate any advice from readers, too. My e-mail address is: [email protected]
If I think I may have diabetes, I will try to get referred to my GP to a larger unit in a training hospital a further distance away, as I think they may have access to newer information, with younger staff, rather than the small rural clinic I was going to. Do you think this is a good idea?
Answer:
To briefly answer your questions, I’d advise you to have your physician perform some exams to better study and define either your pancreas endocrine reserve (such as insulin or C-peptide response after glucagon, as well as your autoan tibodies status. This should be shown to a diabetologist or endocrinologist for proper diagnosis or further examinations.
MS
Additional comments from Dr. Quick:
It might appear, based on your elevated blood sugars when under physical stress, such as colds or pregnancy, plus your family history, that you might have Type 2 diabetes. In that case, the antibody levels would be “negative” (no antibodies present). In any case, I would think it prudent for you to maintain a reasonable meal plan, stay physically active (not too difficult when caring for a toddler!), and avoid overweight.
WWQ
