June 10, 2003
Gestational Diabetes
Question from Culpeper, Virginia, USA:
I am 36 years old, 24 weeks into my fifth pregnancy, and I was diagnosed with gestational diabetes at 32 weeks into my fourth pregnancy (controlled with diet alone). I was diagnosed again with gestational diabetes 10 weeks into this one. I test my sugar at four times a day and have been controlling it with diet and exercise alone up to this point, but have been having fasting numbers of 94-105 mg/dl [5.2-5.8 mmol/L] for the last three weeks, and my doctor’s cutoff is less than 95 mg/dl [5.3 mmol/L]. All one-hour after meal numbers have been normal, and my A1cs have been 5.1-5.8%, but my doctor wants to put me on insulin because of my high fasting numbers. I realize these fasting numbers are a bit high, but my after meals numbers are normal. Do I still need insulin just because of the high fasting numbers even though my A1c shows that my overall average levels are normal?
Answer:
First of all, it is unusual to be diagnosed with gestational diabetes at 10 weeks into a pregnancy. I would be suspicious that you may have underlying type�2 diabetes. However, your hemoglobin A1c would not suggest excessive hyperglycemia. Nevertheless, it will be important to repeat your glucose testing after the baby is born.
Second, I would agree that your blood sugar values are fairly good. Your fasting is a bit high, but not excessive. In my practice, I would either try for some dietary adjustment or consider starting an oral agent (glyburide [a pill for Type 2 diabetes]) before using insulin.
OWJ
[Editor’s comment: Use of glyburide in gestational diabetes is not part of the approved label for this product. See the discussion about the use of oral hypoglycemic drugs for gestational diabetes at the Diabetes Monitor.
WWQ]
