September 10, 2000
Question from Staten Island, New York, USA:
I was diagnosed at 28 weeks with gestational diabetes. For a week, I tried to control it with diet, but after my weekly visit I was told to go on insulin. I am currently on 10 units once a day before dinner. I have had three doses already, and it seems that my fasting does not go below 100 mg/dl [5.6 mmol/L], and two hours after meals is between 120 and 135 mg/dl [6.7 and 7.5 mmol/L]. I was spilling into my urine yesterday and had a sonogram that indicated the baby was about four pounds, three weeks ahead of schedule weight-wise. I am totally distraught and do not know what to do. I'm trying really hard with my diet, but it seems that this isn't doing it. Any suggestions? I am totally freaked out about the whole situation. This is my second pregnancy, and although I had gestational diabetes as well as toxemia with my first, it was controlled with diet.
During this pregnancy you have developed a greater degree of insulin resistance than in the previous pregnancy. The diet alone is not adequate to control your blood sugar. In fact, you probably need more insulin and perhaps twice a day. Your physician should be reviewing your blood sugar values and will discuss this with you further. The growth of the baby is a typical pattern seen with gestational diabetes. As your blood sugar control improves, the rate of growth of the baby should slow down.
[Editor’s comment: If you are only on one shot a day of insulin, and having blood sugars above normal, there’s very little choice: go onto multiple shots, or start using an insulin pump. It’s unclear from your letter if you are seeing a specialist in endocrinology and diabetes already; if not, ask for a referral. Now.