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April 6, 2006

Hypoglycemia, Pregnancy

Question from USA:

I'm now four months pregnant and my endocrinologist told me to get my readings down into the 60 to 100 mg/dl [3.3 to 5.6 mmol/L] range. When I tried, my blood sugar would just continue to drop, mainly when I was sleeping. He didn't discuss any insulin changes or diet changes, nothing. He just told me that I was doing better than I had been, even when my readings were dropping down into the 30s mg/dl [1.7 to 2.2 mmol/L] and twice within a week I had dropped to below that and needed a glucagon shot. What should I do?

Answer:

Your endocrinologist is being a bit overaggressive with your insulin management. To give you some perspective, in my practice, I recommend a fasting glucose of 70 to 90 mg/dl [3.9 to 5.0 mmol/L], a pre meal blood sugar less than 100 mg/dl [5.6 mmol/L] and one hour post meal less than 130 mg/dl [7.2 mmol/L]. I also tell my patients that they will not always achieve this and to not fret too much over an occasional high glucose value. It will not have a huge impact on the pregnancy. In fact, at this point in pregnancy, I would prefer some hyperglycemia (mild) over profound hypoglycemia (to the point of needing resuscitation). So, I would suggest that you raise your concerns with your obstetrician and endocrinologist to better adjust your glucose control. Changes in both insulin dosing and diet may help.

OWJ