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February 22, 2002

Gestational Diabetes

Question from Drummonds, Tennessee, USA:

I am 37 years old, 5 feet 7 inches tall, I weigh 236 pounds, and I am 20 weeks pregnant with my second child. I had gestational diabetes with my first, and I watched sugar intake only (not carbs). I only had my blood sugar levels checked once a month at my doctor's office, and I had a normal, vaginal delivery at 39 weeks with my son weighing 7 pounds, 9 ounces. This time I was tested at 10 weeks and failed the three-hour blood sugar test. I was given a 2000 calorie diet to follow and told to take my blood sugar two to four times a day. Some days, I could control myself and do well on the diet, but unfortunately, on other days I could not. My fasting blood sugar is usually 90-98 mg/dl [5-5.4 mmol/L], and my two- hour after meal levels are fine after breakfast and lunch, my dinner meal that concerns me. It seems that most of my readings lately are high (150-180 mg/dl [8.3-10 mmol/L], rarely a little higher). My obstetrician sent me to a specialist who has diabetes, and he told me to fax me my levels before each meal for three days, which I did. (Of course, I did well those three days with my eating. ) The specialist told me to stop going by the ADA diet because it had too many carbs and to follow a high protein, low carb diet because that was the only way to control my blood sugar. After he received my three days of blood test results, his office called back, said I was normal, there was no need to come back and no need to continue taking my blood sugar levels at home. I have not discussed this with my regular obstetrician, but I do know that she will definitely want me to continue taking my levels. How much damage am I doing to my body and, more importantly to my baby's health by having a high blood sugar my nightly? I have heard other doctor's say that the dangers lie in your blood sugar being too high consistently all day, everyday. So, does that mean that I am okay? I know I need to get my nightly numbers down, but I have been finding it very difficult. Any suggestions? My normal obstetrician says she is "ignorant" on most issues of diabetes beyond having normal blood sugar numbers and that is why she sent me to a perinatal specialist, but then he tells me I am fine. He did see my numbers and note that I did need to get my nightly numbers down, but he sees no need for insulin at this time). By the way, I just had an ultrasound done last week, and everything was normal. This has all been very confusing and depressing causing me to feel like I'm on a roller coaster out of control most days.

Answer:

An occasional elevation in blood sugar should not have a significant effect on the baby. The main concern in gestational diabetes with persistent elevation in blood glucose is a large baby. Since you seem to be getting varying results, I would suggest that you continue to test your blood sugar. If the values continue to remain elevated in the evening you have two choices. The first would be to start on insulin. Often, for someone in your situation, a single injection in the morning may be all you need. An alternative would be take a medication called glyburide [a pill for Type 2 diabetes]. Speak with your physician about this.

OWJ

[Editor’s comment: My concern would be that your blood sugar level will tend to go up as the pregnancy progresses, and more treatment may well be necessary. Keep checking those blood sugars! I might also suggest that if you are uncomfortable with what the specialist said, that you tell your obstetrician, and perhaps ask for a referral to another specialist next time (or even now, considering that your sugars will probably provoke more concern in a few months).

WWQ]