When I was eight weeks pregnant, I was diagnosed diabetic, although no one was sure what type because of the pregnancy. I was put on insulin straight away and I injected four times a day. Once I was controlled, I felt wonderful, the best I had felt in years. Once I delivered, however, the doctors stopped all medication and, after four months, diagnosed me as type 2. I am now taking metformin 500 mg three times per day and it hasn’t controlled my blood sugars at all. How would I know if I was actually needing insulin instead of oral medication? It is now six months after delivery and I am feeling very fed up not being controlled like I was when pregnant. During my pregnancy, my blood sugars were between 4 and 7 mmol/L [72 and 126 mg/dl] and my A1c was 6.3. My blood pressure is also very high and I am taking atenolol, 50mg per day, to help control this. Is the diabetes contributing to this high level?

When you have diabetes that early in your pregnancy, it is likely you had diabetes prior to conception. I would be concerned that you may have an evolving form of type 1 diabetes. The reason for my concern is your inability to be controlled on oral agents. A hemoglobin A1c of 6.3% is not bad, but the highs you are noting suggest the metformin is not enough. There are usual sorts of tests that are done to try to differentiate type 1 from type 2 diabetes. C-peptide levels are low in type 1 diabetes and not type 2. Antibody levels, especially anti-GAD antibody, are high with type 1 diabetes. Please discuss your blood sugars with your physician so that a more aggressive forms of therapy can be pursued. If you really have type 1 diabetes, insulin is the appropriate form of therapy.

High blood pressure is not specifically related to the blood sugar. However, patients with type 2 diabetes may have a constellation of conditions that includes hypertension as part of the group. Others include dyslipidemia, obesity, irregular menses, elevated uric acid levels, etc. You should have a microalbuminuria test as well. If this is positive, you need to discuss with your physician about the use of a medication that projects your kidneys with your diabetes.

JTL