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July 8, 1999

Family Planning, Medications: Pills for Diabetes

Question from Louisiana, USA:

I was diagnosed 3 weeks ago with Type 2 at the age of 31 (fasting range 140-150). I am trying to get pregnant. My general practitioner had prescribed Glucophage [metformin, a pill for Type 2 diabetes] but told me not to take it until I spoke with my OB/GYN. My OB/GYN told me to go ahead and take it, because the risks of uncontrolled diabetes were worse than the risks from the Glucophage. However, I have since read that Glucophage should not be taken during pregnancy. Was my doctor's advice accurate? (I am planning to wait until the numbers go below 100, but I am concerned about "surprises".)

Answer:

I am very uncomfortable with the advice you’ve apparently been given.

You should be on insulin now, rather than pills, as the stresses of pregnancy will inevitably raise your blood sugar, and you will need the insulin for sure during the latter half of the pregnancy.

Plus, you need to realize that the best possible blood sugar control means the lowest possible risk of miscarriage or deformities early in pregnancy. Therefore, you should not wait till the glucose is below 100, but until the glycohemoglobin is normal (this can take 3 or perhaps many more months).

You will have a high risk pregnancy, and should be cared for by a team including a obstetrician who is comfortable dealing with high-risk pregnancies, and a diabetes specialist.

WWQ