Question from Cumberland, Rhode Island, USA:

I had my first child at age 32, and had gestational diabetes that was controlled (not super well, but “well enough” according to the obstetrician) by diet alone. My daughter was 8 pounds 4 ounces and healthy. Eighteen months later I became pregnant with child number two. I flunked the 1 hour screen, but passed the 3 hour GTT [glucose tolerance test]. They never re-tested, but from what I’ve read, they probably should have. My second daughter was healthy and 8 pounds 2 ounces. I have no numbers from any of the test results. I don’t know if I kept any of my self-monitoring results from diet control and random testing.

I’m now about six weeks pregnant with my third child. Prior to pregnancy, my HbA1c was 5.5. My general practitioner told me to start daily monitoring right away because of my risk factors (age, previous GDM, overweight, borderline hypertensive). My insurance company sent me a free blood glucose meter. My fasting blood sugars are 89-105 mg/dl [4.9-5.8 mmol/L]. My one-hour postprandial blood sugars are: 105 – 134 mg/dl [5.8-7.4]. One two-hour postprandial was 132 mg/dl.

Since this is very early in a pregnancy, I’m concerned that almost none of my one-hour postprandial blood sugars are less than 120 mg/dl [6.7 mmol/L]. Should I be preparing myself mentally for insulin this time around? How much worse is insulin than lancets? Can one take oral anti-diabetics for gestational diabetes?