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January 20, 2002

Diagnosis and Symptoms

Question from Portland, Oregon, USA:

During all three of my pregnancies (the last one was 13 years ago), I had gestational diet controlled diabetes, and, after my last one, I was told I was borderline and to watch my diet. I do have a family history of both type 1 and type 2 diabetes, but this never bothered me until recently. During the past year, I have had blood sugars as high as 200 mg/dl [11.1 mmol/L] when I eat any carbs such as a sandwich, but usually within two hours they are back at a reasonable level of 100-140 mg/dl [5.6-7.8 mmol/L]. What I have noticed though is at four to five hours afterward, my sugar has dropped all the way down to 50-70 mg/dl [2.8-3.9 mmol/L] which seems to cause me to be very fatigued all the time and feel ill. I thought as long as I could keep the two hour numbers in a good range that I was doing well. Is this something I should worry about?

Answer:

As a result of previous diagnoses of gestational diabetes, you are at increased risk for developing type 2 diabetes. I am not a big fan of the term “borderline” diabetes. You either have diabetes or you do not. Your doctor can share with you the definition of diabetes.

With regard to your question about the low sugars following meals, you should be treated according to symptoms. Some people have suggested that low sugars after meals is an example of dysregulation of insulin secretion and a risk for type 2 diabetes. Nonetheless, you remain at risk. I would recommend you address the symptoms with small frequent feedings, avoid foods that cause the worst symptoms, and keep up your exercise and weight reduction. No medication is really helpful in preventing or treating the post-meal sugar fall. An additional resource for you would be a referral to your local dietitian.

JTL