I just found out I have type 2 diabetes in August 2006. My health care provider put me on metformin, 500 mg, with diet and exercise. My A1c was 13% when I first found out I was diabetic. In January 2007, my A1c was 7.8. That was also when I found out I was pregnant and was taken off metformin and had to inject insulin to have tighter control over my blood sugars. Do most pregnant women, after giving birth, go back to what they took to control their diabetes before they got pregnant? I asked my endocrinologist if I would go back to taking metformin after my baby is born and she said that I probably going to have to inject insulin because my A1c was high. I think I should take the medication because before I was pregnant, I think I was doing pretty well going from an A1c of 13% to 7.8% in just five months with metformin, diet and exercise. I don’t want to inject insulin because I think I can do it without insulin. After I have my baby, should I talk to my health care provider about this situation if the endocrinologist thinks I should still inject insulin?

The name of the game is good blood sugar control. You may want to speak with your endocrinologist further about why they think you cannot improve your A1c below 7.8% on metformin. It is true that with delivery of the baby, insulin resistance goes down and it generally takes less medication to control glucose levels. However, the goal is an A1c less than 7%. Does that mean you can go from 7.8% on 500 mg twice a day to less than 7.0% on 1000 mg twice a day (the next dosage escalation)? That is not clear and that is why you have to work this out with your endocrinologist. There is the additional pressure of losing weight after the pregnancy that may add to the insulin resistance. Sometimes this does not come off so fast and leaves you requiring additional treatment after the baby’s birth. Did the endocrinologist do additional tests that would suggest you have type 1 and not type 2 diabetes? This requires communication. It will be difficult to have good care if you go to other providers if you get a response that is not popular. I think this is a toss-up and you need to talk to your doctors.

JTL