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January 6, 2005

Gestational Diabetes, Insulin

Question from Wilsonville, Oregon, USA:

I have gestational diabetes and I'm six months pregnant. I've been taking NPH at night but, my fasting numbers are still higher then my doctor wants (around 95 mg/dl [5.3 mmol/L]. I'm not comfortable continuing to raise my dosage. Why can't I just eat nuts throughout the night, around 10 p.m. 2 a.m. and 6 a.m., if I take my readings before each snack to make sure I'm under 120 mg/dl [6.7 mmol/L]? I'm up that often anyway. I called my diabetes counselor who said I wouldn't have accurate fasting numbers then. Why do I need fasting numbers? My after meal numbers are okay.

Answer:

I get the impression that your doctor wants you to be truly fasting through the night. In pregnancy, I have learned that this is not always possible. When a pregnant woman is hungry, she eats. Also, a fasting blood glucose of 95 mg/dl [95.3 mmol/L] is acceptable. What is important is to keep your blood sugar in a reasonable range (70 to 100 mg/dl [3.9 to 5.6 mmol/L] before meals and less than 120 mg/dl [6.7 mmol/L] two hours after a meal (or less than 130 mg/dl [ 7.2 mmol/L] at one hour)). Thus, if you are the type who snacks frequently, rather than eating three regular meals a day, you may just have to check your blood glucose more often to be assured that it is not too high. It is unlikely that you will drop your blood sugar too low with a little more NPH. Your body has glucose reserves that can be used readily if your blood sugar begins to drop and you will be aware of this, so, you can eat something in response.

OWJ