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October 17, 2002

Family Planning

Question from Brooklyn, New York, USA:

I have type 2 diabetes treated with insulin, and I want to become pregnant. Although, I try to monitor my sugar as much as possible, after I eat, it goes into the 200s mg/dl [11.1 mmol/L] for about two hours. In addition, I do not tolerate anything lower than 100mg/dl [5.6 mmol/L], and at work, I prefer to keep it at around 150 mg/dl [8.3 mmol/L] to avoid lows. If I am unable to keep the numbers normal all the time, is that dangerous for my unborn child? One doctor that I consulted suggested that as long as I keep it under 160 mg/dl [8.9 mmol/L] that is good, but all the literature appears to contradict this. I am very scared and want to do the right thing. Please advise.

Answer:

The better your glucose control, the less likely you will have problems with pregnancy. Therefore, I would suggest that you meet with your endocrinologist and tell her or him that you are considering pregnancy. Then you can work on improving your blood sugar values prior to conception.

Ideally, fasting values should be 70-90 mg/dl [3.6-5 mmol/L] with post meal readings less than 130 mg/dl [7.2 mmol/L] at one hour, and 120 mg/dl [6.7 mmol/L] at two hours. If you have an occasional value that exceeds these limits, it is not the end of the world. Just do your best. You also may want to consider using an insulin pump.

In addition, you should start taking folic acid supplementation. This should reduce the risk of spina bifida in the baby. The amount I recommend you should be taking is 5 mg per day, and you will need a prescription from your doctor for this.

OWJ

[Editor’s comment: See The Diabetes Monitor: Planning a pregnancy.

SS]