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October 1, 2006

Diagnosis and Symptoms, Gestational Diabetes

Question from North Carolina, USA:

I have PCOS and am 33 weeks pregnant. I failed the one hour glucose test but passed the three hour GTT 100%. My question is related to the fact that I see an endocrinologist for my PCOS and hypothyroidism. He said that although I passed all my blood draws for my three hour GTT, my blood sugars were "slightly borderline," that because of my PCOS, my insulin resistance is playing a larger factor in this equation. The doctor gave me a glucometer to check my sugars one hour after each meal and said that it should be below 120 mg/dl [6.7 mmol/L]. I have been doing this and have an average of about 114 mg/dl [6.3 mmol/L]. However, I have been monitoring the high ones: I have had five checks in the 120s mg/dl [6.7 to 7.1 mmol/L], two checks in the 130s mg/dl [7.2 to 7l.7 mmol/L], two checks in the 140s and 150s mg/dl [7.8 to 8.8 mmol/L], and one check in the 160s [8.9 to 9.3 mmol/L]. The rest have been in the normal range. I have also been watching my diet. I think the results of these higher numbers were because of being slack on what I was eating, more chips than normal, pizza, syrup, macaroni and cheese, or too many carbohydrates in one meal. I am not exercising. I am in a kind of dilemma in that my OB/GYNs seem to feel that my endocrinologist is being "a bit extreme" that my sugars should be below 120 mg/dl [6.7 mmol/L] one hour after eating, especially since I passed the three hour GTT. They say that all people have random high sugars and pregnant women will even more so. They seem to believe that I am fine. But, my endocrinologist also knows what he is talking about and seems to see it as concerning enough for me to be checking my sugars and watching my food intake. So, I feel conflicted by the two viewpoints of the different doctors. When I have the occasional random high sugar, which is about once every other day or third day, I get very scared, but then I think that I do not have gestational diabetes so I shouldn't be worried. I have mentioned these "concerns" to both the obstetricians and the endocrinologist and they don't seem to see eye to eye. Therefore, I have decided to keep watching my diet, keep checking my sugars, but trying not to worry. Should I call them immediately though because I have these random high sugars? I am measuring only a week further than 32 weeks and I have only gained 19 pounds. I am 132 pounds right now.

Answer:

The postmeal glucose parameter that I use is less than 130 mg/dl [7.2 mmol/L] at one hour after eating or less than 120 mg/dl [6.7 mmol/L] two hours after a meal. This is fairly standard and in agreement with your obstetrician. It does appear that your glucose level is sensitive to diet. Thus, at this point, I would recommend continuing close monitoring of your calorie intake and the sources of the calories. You may consider consultation with a dietitian for some guidance, to make sure that you are also maintaining an adequate calorie intake for pregnancy. Since your values on the three hour test were “borderline,” there is a chance that you may develop true gestational diabetes later in the pregnancy. So, do not be too surprised if in the next few weeks you have more glucose values that exceed the above limits. If that is the case, then you will probably do well with an oral hypoglycemic agent (glyburide) as opposed to insulin injections. A discussion between your obstetrician and endocrinologist may be helpful both in terms of maintaining collegiality as well as making sure that everyone is in agreement with your management.

OWJ