August 21, 2000
Family Planning
Question from Newburgh, New York, USA:
I am 24 years old. I was diagnosed four months ago with diabetes. The doctor is not sure if I am Type 1 or Type 2. I am currently trying to control my levels with Glucophage [metformin, a pill for Type 2 diabetes] 2000mg daily, Avandia [rosiglitazone, another pill for Type 2, from a different class] 16mg daily, and Actos [pioglitazone, a pill in the same class as Avandia] 30mg daily. I am also on a medication for high cholesterol. In spite of this medication, I am still getting fasting levels of up to 150 mg/dl [8.3 mmol/l]. My fasting levels were around 330 mg/dl [18.3 mmol/l] before medication. I have had two miscarriages and one premature birth at 26 weeks gestation. Could these problems have been caused by undiagnosed diabetes? I have also had periods 3 months or more apart, this has improved since I started taking the medication. Is the medication helping me to ovulate? Do Glucophage, Avandia, and Actos increase fertility? Is the medication doing enough or should I request insulin? I should also mention that I have been unable to achieve a pregnancy for four years now, even though I have been trying. Please help me answer these questions. I don’t feel comfortable asking my doctor and can’t switch doctors for insurance reasons.
Answer:
The diabetes may have contributed to the miscarriages, but they may have occurred due to other reasons. Diabetes does not directly cause pre-term delivery. It is usually due to associated risks of preeclampsia, poor fetal growth or poor placental function.
The oral hypoglycemic agents can improve ovulation and thus increase fertility. If you are considering another pregnancy then you should be started on insulin for glucose control. Failure to conceive can be due to many reasons other than infrequent ovulation. I would suggest that you consult with a specialist in infertility.
OWJ
