I am a 31 year old Indian woman, and I was not sure whether I had diabetes before pregnancy or not. When I went for my first checkup (around nine weeks into my pregnancy), the doctor mentioned that I have more sugar level in urine, and I need to do a fasting and two-hour blood glucose test. After the test was done, they said I have a very high blood sugar level, and I need treatment. My fasting sugar was around 10 mmol/L [180 mg/dl]. Now I am on diet and taking insulin after consulting the diabetes educator and dietitian. My questions are:

How can we make out whether I had diabetes before pregnancy or not?
Does gestational diabetes happen in the beginning of pregnancy?
What are the levels I need to maintain before and two hours after each meal? My doctor has suggested to keep them at 4-6 mmol/L [72-108 mg/dl] before each meal and if it is below 5 mmol/L [90 mg/dl] I need not have to take insulin dose. Two hours after each meal to maintain 6-8 mmol/L [108-144 mg/dl] mmol/l. Are these the correct ranges?

Gestational diabetes usually does not appear until around 24 weeks gestation (sometimes a bit earlier). If you had hyperglycemia as early as nine weeks, then that would be suggestive of preexisting diabetes. One way to confirm this would be to measure a hemoglobin A1c value. With prolonged hyperglycemia, this test should be elevated. However, a normal value would not absolutely rule out glucose intolerance. You will need to have a formal glucose test after you deliver to determine if you truly have persistent diabetes.

I recommend that you maintain a fasting blood sugar of 4-5 mmol/L [72-90 mg/dl] and a two-hour after meal value less than 7 mmol/L [126 mg/dl]. You should not skip your insulin shot if your blood sugar value is less than 5 mmol/L [90 mg/dl]. Instead, take your shot, eat and recheck a blood sugar level in 30 minutes to an hour. Be sure to discuss with your doctor about how to detect low blood sugar and how to treat it.

Since you appear to have hyperglycemia early in the pregnancy, some additional testing of the baby would be useful. In particular your doctor should order an ultrasound to evaluate the fetal anatomy (specifically the spine and the heart). Also the growth of the baby should be followed closely during the pregnancy, since babies of mothers with diabetes can become very large if the mother’s blood sugar is not well controlled.

OWJ

[Editor’s comment: See Planning a pregnancy , at the Diabetes Monitor, for some additional thoughts.

WWQ]