December 26, 2000
Gestational Diabetes
Question from Sudbury, Massachusetts, USA:
I’ve had gestational diabetes based on home blood glucose monitoring since the early weeks of pregnancy. Now, at 28 weeks, my fasting blood sugars have climbed over the limit as stated by the high-risk team (100 mg/dl [5.6 mmol/L]), and my two- hour post-prandials are over the limits, too (140 mg/dl [7.8 mmol/L]). I can tell by home monitoring that the gestational diabetes is getting to be impossible to control with diet alone.
If I took another GTT (I ‘passed’ the last one, but have been monitoring any way), would it tell the doctors how much insulin I should take? Can the insulin dosage be determined from my home blood glucose monitoring logs? I’d rather not take the GTT again if it’s not going to help in the development of an insulin treatment plan.
How is insulin dosage to be determined? In short, can it be determined without another (torturous) GTT?
Answer:
It is not necessary to repeat the glucose tolerance test. If your blood sugars are not being controlled by diet alone, then insulin will be needed. Dosing is initially based on body weight.
One thing you may want to bring up with you physician is the use of glyburide (an oral hypoglycemic agent). There is a recent report in the New England Journal of Medicine (Oct. 19, 2000) about the use of this drug in pregnancy. It appears safe and might be a reasonable alternative.
OWJ
