I have been diagnosed with gestational diabetes since 20 weeks. I am now 36 weeks into my pregnancy. For the past few weeks, my sugar level, two hours after meals, has increased, but only during lunch time. My fasting and other level is always below 6.5 mmol/L [117 mg/dl]. The sugar level is not consistently high. It goes up and down, which is below 6.5 mmol/L [117 mg/dl]. Three days ago, the sugar level after lunch reached at 8.9 mmol/L [160 mg/dl]. I was told I needed insulin immediately. I checked again yesterday, but the level is once again below 6.5 mmol/L [117 mg/dl].

My sugar level is not consistently high, do I still need insulin? I am already 36 weeks pregnant and my doctor says that if it remains high, I will be induced at 38 weeks. Can’t I just wait two weeks instead of taking insulin? What is the minimum sugar level whereby insulin is necessary?

Ideally, your fasting glucose should be between 3.8 and 5 mmol/L [63 to 90 mg/dl]. Two hours after meals your blood sugar should be less than 6.7 mmol/L [121 mg/dl]. So, some of your values are elevated. This late in pregnancy there will not be a great benefit to the baby of tighter glucose control other than minimizing hypoglycemia in the newborn period. Rather than insulin, an option may be glyburide (an oral hypoglycemic agent). Discuss this with your doctor.

OWJ
Additional comments from Jane Seley, diabetes nurse specialist:

The blood sugar requirements in pregnancy are strict in order to reduce health risks for your baby. Your blood sugar before breakfast should be less than 90 mg/dl [5.0 mmol/L], and one hour after any meal should be less than 120 to 130 mg/dl [6.7 to 7.2 mmol/L]. If you are achieving these numbers at all times except after lunch, you could lower the carbohydrate content of lunch and see if that helps. It is important that you do not starve yourself and your baby in order to keep your blood sugar stable. About 60% of women with gestational diabetes wind up taking insulin sometime during the pregnancy, so you are in very good company. The needles are very tiny and pretty much pain-free if you do not re-use them. With the help of insulin, you can definitely control your blood sugar for the remainder of the pregnancy.

JS

[Editor’s comment: Please see our page on What is Gestational Diabetes?.

BH]