January 9, 2009
Hyperglycemia and DKA, Pregnancy
Question from Bahrain:
I am 31 years old. I have always been on the heavier side. I weigh 84 kg (185 pounds) and have just completed the 12th week of my pregnancy. The day I found out I was pregnant and did my test, I was diagnosed with diabetes. I was told that I may already have had diabetes because my dad has it. My one hour post-breakfast and post-lunch blood sugar was as high as 200 mg/dl [11.1 mmol/L], so I was told to take four units of insulin once a day. A week later, when I had my doctor’s appointment, my one hour post breakfast readings were still high, around 190 mg/dl [10.5 mmol/L]. The doctor then had me increase my insulin dosage to six units daily. Now, I am taking eight units in the morning and eight units before dinner. Is this considered a lot?
I exercise every day, 45 to 60 minutes but, somehow, after breakfast, my sugar is always high. I am worried because my post breakfast blood sugars are still elevated.
As I am pregnant, I am also taking folic acid, a multi vitamin, calcium and iron tablets prescribed by my obstetrician/gynecologist.
Today, two hours after breakfast, my blood sugar was 190 mg/dl [10.5 mmol/L]. My husband recommended that I drink water. I drank almost a liter and, by lunch time, one and a half hours later, my blood sugar had come down to 74 mg/dl [4.1 mmol/L]. Does drinking water help lower blood sugars or is it really a myth?
My baby seems fine and active in the ultrasound so far. I am taking care of my diet, too. I eat something sugar free if I am really craving ice cream or chocolates.
Is my condition serious?
Answer:
Based on your blood glucose results, I think that you had diabetes before you became pregnant. Typically, gestational diabetes occurs much later in pregnancy than 12 weeks. Your blood sugar values are high because you are not getting enough insulin. I start insulin based on body weight using a ratio of 0.7 units/kg. A person of your weight should be on about 60 units total each day. This is usually divided into two doses. You should check your blood glucose when you first wake up (before eating breakfast), just before lunch, just before dinner and one hour after each meal. Ideally, the fasting blood glucose should be between 70 and 90 mg/dl (3.8 and 5 mmol/L). One hour after a meal, the blood glucose should be less than 130 mg/dl (7.2 mmol/L). Since you had diabetes so early in pregnancy, there are potential risks to the development of the baby. Thus, it is important that you have an ultrasound examination of the baby to look for any evidence of heart defects or spine defects. These are the most common problems. However, most likely, the baby is doing well. It is important to keep your blood glucose values as close as possible to the ranges I noted above to prevent excessive growth of the baby. That could lead to problems with the delivery. It is good that you are taking the extra folate. Drinking water will not lower your blood glucose. Insulin is a growth factor, but you will gain weight from the pregnancy anyway. The extra stimulus from the insulin will not make a difference.
OWJ
