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May 3, 2001

Gestational Diabetes

Question from Ogden, Utah, USA:

I am 32, pregnant with my fourth child, and I had gestational diabetes with all, controlled by diet only for the first two and a low dose of insulin twice a day during my third pregnancy. As soon as I found out that I was expecting, I started my diet and monitoring my blood sugars which were okay until last week when my fasting jumped to 105-122 mg/dl [5.8-6.8 mmol/L]. My Certified Nurse Midwife and diabetes counselor feel I should start on insulin, although both agree that this is very early (I'm not even 12 weeks). Does this sound appropriate to you? If so, does my having to start so early increase my chances of having diabetes after the birth?

Answer:

If your fasting and postprandial blood sugar values are persistently elevated, then this will need management. Since it is starting so early, I am suspicious that you may be developing type�2 diabetes. I would suggest checking a hemoglobin A1c. If it is elevated, then that would suggest long standing hyperglycemia. Certainly after your pregnancy, you should be re-screened for diabetes.

OWJ