February 14, 2001
Gestational Diabetes
Question from Florida, USA:
I have been diagnosed with gestational diabetes. My doctor wants me to immediately go on insulin, but however I am resisting since I know that going on insulin will make it only more likely that I will be subjected to induction or C-section, both of which I am trying to avoid. I have been watching my diet carefully (eliminating as many sugars as possible) and monitoring my blood sugar at different times throughout the day. It seems to stay in the range of 94-117 mg/dl [5.2-6.5 mmol/L] before meals and around 128 mg/dl [7.1 mmol/L] post-prandial. I have yet to see it go over 130 mg/dl [7.2 mmol/L]. I am also walking after meals to keep from “crashing”. Is insulin necessary? I have noticed that right before eating (about two hours after the last meal) I tend to get a bit light-headed, but my sugar isn’t low then, and I don’t want to risk fainting from hypoglycemia.
I am considering changing doctors anyway because my doctor did not explain anything about gestational diabetes (all the information I have found has been on-line), and he told me that “diet would not make any difference”, a statement I question. What is your opinion?
Answer:
Trying a diet first is always worthwhile. However, if the fasting blood sugars are greater than 105 mg/dl [5.8 mmol/L] and/or the postprandial is greater than 130 mg/dl [7.2 mmol/L] at one hour or 120 mg/dl [6.7 mmol/L] at two hours, then insulin should be started.
You may want to speak with your physician about taking a medication called glyburide. There was a recent article in the New England Journal of Medicine reporting its use in pregnancy.
OWJ
[Editor’s comment: See Family Planning for young women with diabetes for additional information about the possible use of glyburide in women with gestational diabetes.
WWQ]
