April 6, 2005
Gestational Diabetes, Other
Question from Newark, Ohio, USA:
I am 37.5 weeks pregnant and was diagnosed with gestational diabetes at 28 weeks. Since 30 weeks, I have been on insulin. For the past several days, I have noticed a dramatic decrease in my insulin needs. I have even skipped my insulin shots after my meals for two days straight and my blood sugar levels have been normal. I even ate a piece of cheesecake and my one hour post snack was 108 mg/dl [6.0 mmol/L]. I am concerned that this might mean a breakdown in the placenta. Or, is this normal in some gestational patients? I get an NST (Non-Stress Test) twice a week and they all have looked good. How concerned should I be? I am greatly worried about the risk of stillbirth.
Answer:
You ask a very interesting question. I have wondered about this myself, but I have not been able to find a reference addressing this specifically. I did turn up an article from 1984 that showed that in women with preexisting diabetes, insulin requirements decreased after 36 weeks. It did not say anything about an increased risk for stillbirths in association with the decreased insulin need. In your case, there is good data stating that as long as the fetal testing remains reassuring, the risk for a stillbirth is significantly reduced. So, I would suggest continuing with the management already in place.
OWJ
