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December 12, 2001

Family Planning

Question from St. Louis, Missouri, USA:

I am 29, was diagnosed with type 2 diabetes 14 months ago (which I probably have had since my teenage years), now treated with pills, diet and exercise, and my last hemoglobin A1c was 5.9%. I am also on Atenelol for hypertension and Elavil (for relief of peripheral neuropathy). I am 5 feet nine inches tall and have lost 25 pounds in the last year. I am very concerned about my disease and have been taking necessary steps to keep under tight glucose control. I am considering pregnancy and would like to understand what my goals are. I am worried about contraindications and birth defects because of all the medications I am on now and the fact that in 1998, I broke my tail bone. I am also concerned that I am not losing the weight fast enough for me to consider pregnancy in the next two years. Does this mean that I will have to have a C-section, and be bedridden for the last four months of pregnancy?

Answer:

It looks like you have significantly improved your glucose control. When you decide to try and conceive, then you should switch over to insulin prior to trying for a pregnancy. The blood pressure medication you are taking is a beta-blocker. This category of drug is usually not recommended during pregnancy, although it is used. Similarly, beta-blockers are not recommended in diabetes. Therefore, as with the insulin, I would suggest switching over to blood pressure medication more compatible with pregnancy. You may want to discuss this with your physician. Elavil should not be used prior to conception and during the first trimester unless you absolutely need it. The broken tail bone does not mean you need a cesarean section or should be at bed rest.

You might ask your doctor about checking a C-peptide level to determine if you are still making some insulin. If you are making insulin, then a significant drop in your weight (50-60 pounds) may reduce you need for insulin injections and even the oral medication you are taking now.

I strongly suggest that you meet with an obstetrician who specializes in high-risk pregnancies prior to trying to conceive. That doctor can give you more details about your management during the pregnancy, then I can cover here.

OWJ

[Editor’s comment: See Planning a pregnancy , at the Diabetes Monitor, for some additional thoughts.

WWQ]