August 20, 2004
Gestational Diabetes
Question from Waipahu, Hawaii, USA:
With my first child, I did not have gestational diabetes. I tested positive for gestational diabetes at about 11 weeks into my second and current pregnancy. A blood test, an A1c, determined that I did not have a pre-existing condition. Currently, I am 23 weeks and am on a special diet only (no insulin). I finger stick myself every day, four times a day.
My doctor’s office apparently uses a rule of thumb that if 20% of the values (over a one week or two week period) are high, you need to go on insulin. I had one bad week where almost exactly 20% of my values were over the minimum values (not all on the same day). Prior to that week and in the three weeks since, I have only had a maximum of about two high values per week. After discussing this with my husband, I refused to go on the insulin because I thought it was premature. Apparently, it will be harder to keep my blood sugar in line as the pregnancy progresses. Ultrasound shows that the baby is normal size. My weight gain is a little under what it should be (about two pounds), and my belly measurements are in line. These also added to my decision to not take insulin yet. My questions:
Even though a blood test showed that I did not have a pre-existing condition, am I at a higher risk for having diabetes after the pregnancy because I was diagnosed so early?
When would a diet not be enough for keeping sugar levels in control?
Does going on insulin increase the chances of a C-section? My daughter was a scheduled C-section because she was a side-ways breech. Would that change your answer?
What are “high” sugar levels that put a baby at risk? My doctor’s office says my sugar levels should be under 95 mg/dl [5.3 mmol/L] fasting and under 140 mg/dl [7.8 mmol/L] one hour after eating. But, they say that two or more values over 200, I should go immediately to the hospital. Is this correct?
Answer:
If you had an abnormal glucose test at 11 weeks, I would be concerned about preexisting diabetes or, at least, glucose intolerance, despite a normal hemoglobin A1c. After you deliver, you should repeat the glucose test. The goal of diet therapy is to keep your blood glucose in the normal range. I use 70-90 mg/dl [3.9 to 5.0 mmol/L] fasting and less than 130 mg/dl [7.2 mmol/L] at two hours. If the diet is not doing this, then you need to either be on insulin or an oral hypoglycemic agent such as glyburide.
Insulin does not increase your risk for a cesarean. If your baby is growing too fast, then, that will increase your risk for this procedure. With gestational diabetes, the main risk is excessive fetal growth. Even mild hyperglycemia can result in a large baby. If you have blood sugars over 200 mg/dl, you do not necessarily have to go to the hospital, but you should contact your doctor’s office to figure out ways to bring it down.
OWJ
