March 3, 2004
Diagnosis and Symptoms, Pills for Diabetes
Question from Charles Town, West Virginia, USA:
I am 28 years old and have cystic fibrosis. I just recently gave birth to my first child. During the pregnancy I developed gestational diabetes. I have continued to monitor my fasting and postprandial blood sugars since giving birth 6 months ago, but now have some questions.
My hemoglobin A1c was 4.5 three months ago. My fasting morning blood sugars are between 85 mg/dl [4.7 mmol/L] and 95 mg/dl [5.3 mmol/L], but my one hour postprandial readings are between 140 mg/dl [7.8 mmol/L] and 185 mg/dl (10.3 mmol/L], while my two hour readings are almost always between 120-155. If I indulge in anything like fast food or favorites, like hot chocolate or gummi bears, my one hour reading goes as high as 210 mg/dl [11.7 mmol/L].
At what point do doctors usually initiate drug treatment? My physician says my numbers aren’t that bad and, if they were, they would treat me with Prandin. What is more important when deciding a plan of care, hemoglobin A1c or daily blood sugar monitoring? If my hemoglobin A1c is fine, do they not worry about my postprandial numbers? How long is “too long” for blood sugars to remain elevated
Answer:
Cystic fibrosis poses interesting challenges with regard to diabetes mellitus. I have several patients who have similar glucoses. We have initiated treatment on the basis of concern from a vascular point of view. Also, these individuals have improved their overall condition with improvement in their post meal glucoses. I would speak with your physician and discuss the options, either medication or insulin with him/her.
ABS
