November 23, 2005
Question from Marion, Ohio, USA:
I’m 33 years old and 16 weeks pregnant. I started checking my blood sugar a week ago because I had gestational diabetes with my second pregnancy (this is my fourth) and my father had diabetes, diagnosed in his late 60s. My numbers were high to begin with, fasting numbers in the 120s mg/dl [6.7 to 7.1 mmol/L], but my two hour post meal numbers were less than 130 mg/dl [7.2 mmol/L]. After a week of dietary changes and exercise, my fasting is now around 110 mg/dl [6.1 mmol/L] and my post meals are even better.
Do you feel these numbers are a major risk? Would I need to go on insulin if they do not go down further? I know that as pregnancy progresses, controlling my blood sugar will become more difficult. I’m seeing a midwife now and want to continue seeing her; I don’t want to get sent to the obstetrician if I can avoid it. She wants the numbers to come down, but isn’t overly concerned at this point. I opted out of the glucose tolerance test because, obviously, I have a problem with blood sugar; I don’t feel the test would give me more information.
I did have an A1c test done and it was 5.5. My assumption is that this is gestational diabetes and not preexisting diabetes. Would this be a fair assumption in your opinion?
You probably have some degree of insulin resistance. Since it is happening early in pregnancy, it is possible that this may represent a preexisting condition even though the hemoglobin A1c is normal. You could forgo the glucose tolerance test, but I would encourage you to keep testing your blood sugars during the pregnancy. The parameters I use are a fasting between 60 and 90 mg/dl [3.3 and 5.0 mmol/L], premeal less than 100 mg/dl [5.6 mmol/L] and one hour after a meal less than 130 mg/dl [7.2 mmol/L] (or 120 mg/dl [6.7 mmol/L] at two hours). If you cannot achieve these most of the time, then additional management may be indicated. You may do well with an oral agent such as glyburide. However, if that does not work, then insulin may be necessary. I would suggest a visit with the midwife’s obstetrical consultant for an opinion.