March 28, 2006
Gestational Diabetes
Question from Springfield, Missouri, USA:
I am 35 weeks pregnant and my doctor has been unclear on my potential diagnosis of gestational diabetes or borderline gestational diabetes. I was 144 mg/dl [8.0 mmol/L] on the one hour test and have now repeated the three hour test twice. Both times, my fasting rates were low, twice; the most recent level was 76 mg/dl [4.2 mmol/L]. My one-hour reading was fine, too, though I don’t remember the specific figure. It is the second and third hour levels that are slightly elevated and I’m trying to determine if this puts me at any real risk or not. The first three-hour test had my level elevated on the three-hour reading ONLY (I think it was 154 mg/dl [3.0 mmol/L]). All the other readings were normal. The second test had my two-hour level elevated at 170 mg/dl [9.4 mmol/L] and the three-hour level was 144 mg/dl [8.0 mmol/L]. My doctor indicated that she is not terribly concerned since the fasting levels have been consistently good. I’ve gained under 25 pounds so far and was not classified as overweight prior to pregnancy, though I am on the very high end of “normal” weight for my height. Do I have reason to be concerned? Should these numbers put me into any kind of risk category?
Answer:
The one hour test was elevated and thus it was appropriate to do the three hour test. One abnormal value does not make the diagnosis of gestational diabetes. It is necessary to have at least two elevated blood glucose values. However, some women will continue to have progressive insulin resistance. If the three hour test is then repeated, they may have more than one abnormal value. This appears to be the situation in your case. You do meet criteria for gestational diabetes. Since your values are only mildly elevated and you have a normal fasting blood glucose, I would suggest some diet adjustment that will control your calorie intake. It is not so much reducing your calories, but providing a better balance between carbohydrates, protein and fats. This may be enough to bring your blood sugar back into a more favorable range. If not, then an oral hypoglycemic agent may be all that is necessary. I doubt that you will require any insulin injections, particularly so late in the pregnancy.
OWJ
