March 20, 2001
Gestational Diabetes
Question from New York, USA:
I am 35 weeks pregnant, and I have gestational diabetes, which has been controlled by diet for the past three months, although I have had about 15 high numbers, the highest being a two-hour postprandial of 141 mg/dl [7.8 mmol/L]. They were all due to my eating more carb. or sugar than I am allowed. I always try to eat more whenever I tested positive for ketones and sometimes I overdo it.
Last night, after a light dinner, my one hour postprandial blood sugar was 117 mg/dl [6.5 mmol/L]. I My ketones were between negative and trace, so I started eating again. I probably overdid it, and, when I tested two hour later, my blood sugar was 123 mg/dl [6.8 mmol/L]. It didn’t seem too high, but I was feeling really sick in my stomach which I believe was the sign for high blood sugar. I tested again a little later and got a 135 mg/dl [7.5 mmol/L], and remained in the 130s [mg/dl; 7.2 mmol/L] for three to four hours after my initial testing.
I have several questions:
Is it normal for the blood sugar to linger at the 130 mg/dl [7.2 mmol/L] level for that many hours?
Does that mean I might need insulin?
What is the blood sugar level and for how long does the blood sugar have to stay high in the mother for the fetus to start producing extra insulin to take care of the sugar?
How badly do these few hours of high blood sugar affect the fetus?
Does having 15 high readings in three months time sounds bad to you?
Answer:
It is unusual that your sugar remains elevated for so long. This may reflect a higher fat content in your meal along with insulin resistance due to pregnancy. Although It is only mildly elevated, it is probably enough to stimulate insulin production in the fetus. My approach is if a patient has more than two episodes of elevated blood sugars, and it is not correctable by adjusting the diet, then insulin is started. Another option would be to consider starting glyburide, which is an oral medication for treating diabetes. Ask your doctor about this.
OWJ
[Editor’s comment: Use of glyburide in gestational diabetes is controversial. See the discussion about the use of oral hypoglycemic drugs for gestational diabetes at the Diabetes Monitor.
WWQ]
