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December 23, 2002

Genetics and Heredity

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Question from Pennsylvania, USA:

I’m 35 years old, 34 weeks pregnant, was diagnosed with gestational diabetes at 26 weeks, and I’ve been on diet and insulin since then. My obstetrician has only been concerned with my glucose levels and wanted to induce at 38 weeks, but this morning he called and wants an amniocentesis next week. If her lungs are mature, he will induce at 36 weeks because of my high insulin doses. I had leveled out for a while, but have had to steadily increase dosages in the last week. (I currently take 112 units per day.)

My fasting blood sugar is usually under 100-120 mg/dl [5.6-6.7 mmol/L], and after meals, I’m usually in the 130s mg/dl [7.2 mmol/L]. I saw my internist last week who did say this was a lot of insulin, but he’s had patients on more. I eat roughly the same meals each day and just watch the level increase. I can’t find any “average dosages” or anything like that on the net. Is this out of control? Does this indicate a 36 week induction? All potential issues for the baby have been very well explained (hypoglycemia, jaundice, breathing problems, suckling problems, etc).

Answer:

Generally speaking high insulin requirement is not an indication for delivery. Your blood sugar control appears acceptable, perhaps slightly elevated. There, may be other reasons that your doctor is considering early delivery (such as a large baby), and there is nothing wrong with his approach. The risk of complications from an amniocentesis is low, but I would suggest speaking with him further about this issue.

OWJ