February 22, 2006
Diagnosis and Symptoms, Hyperglycemia and DKA
Question from Bromley, Kent, United Kingdom:
I am from the United Kingdom and was diagnosed with gestational diabetes at around 25 weeks. Initially, this was controlled by diet, but as the pregnancy progressed, I started taking injections of Insulatard. I was controlling my blood sugars well, in the 4 to 7.5 mmol/L [72 to 135 mg/dl] range until around 35 weeks. At this point, my blood sugars rose sharply and my insulin requirements also increased. I was struggling to keep my post meal levels down and was about to go onto NovoRapid insulin to deal with the post-meal highs.
Around two weeks ago, I gave birth naturally at 36 weeks. After the birth, I stopped taking insulin, but, since then, my blood sugar levels have been rising sharply with fasting levels from 5 to 9 mmol/L [90 to 162 mg/dl] and post meal levels of around 18 mmol/L [324 mg/dl]. I am very concerned about this and have been advised to go back on the Insulatard but this is still not dealing with my post-meal highs.
What is causing my blood sugar levels to remain so high? Is it likely that I have diabetes? What medication would be indicated to deal with this? I am currently breast feeding. Will the high blood sugars be harming my baby?
Answer:
The elevated blood sugars will not harm your baby. The glucose content in the milk is not changed that much.
The issue is whether you have diabetes. The fact that your blood sugars have not reverted back to normal is strong evidence that you may have type 2 diabetes. It is usual practice to have a 75g oral glucose tolerance test at the postpartum check-up around six to eight weeks to verify that glucose tolerance is back to normal. Given your high sugars, you need to communicate with your physician to make sure that insulin is required and at what dose. Oral medications would have the disadvantage of crossing into the baby’s milk.
JTL
