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January 9, 2006

Gestational Diabetes, Insulin

Question from London, England:

I was diagnosed with gestational diabetes at 29 weeks and am now just over 35 weeks. Within one week, it was decided that my sugars were too high for diet control alone and I have been taking Humalog injections four times a day. My post meal readings, although very rarely over 10 mmol [180 mg/dl], are within range (4 to 7 mmol/L [72 to 126 mg/dl]) even after modifying my diet. As a result, my insulin usage has increased and I am now concerned about the high levels of insulin I am taking and the possible effect on my unborn child. Currently, I take 58 units of Humalog and 20 units of Humulin Insulatard before breakfast, 20 units of Humalog before lunch, 48 units of Humalog before dinner and 30 units of Humulin Insulatard before bed. Although my pre-meal levels are within ranges, about 85 to 90% of post meal levels are over 7 mmol/L [126 mg/dl] and we are now looking at increasing insulin again. Is there a limit and is it possible that insulin is just not working for me?

Answer:

It is very common in gestational diabetes for insulin requirements to increase as the pregnancy progresses. You are not doing anything wrong. Your body is just producing higher levels of the hormones that block the action of insulin. I have taken care of patients who required two times the amount of insulin that you are taking. The insulin does not cross the placenta and will not affect the baby. So, continue to work at keeping your blood sugar values within the appropriate range.

OWJ