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Suggest Treatment For High Blood Sugar During Pregnancy
Question: Hello Doctor,
My wife is 25 weeks pregnant and is 27 years old. About 4 weeks back, during her routine blood tests it was found that the sugar levels were high. The Gynecologist advised to have a controlled/healthy diet for 2 weeks and then check the sugar levels again after two weeks. The sugar levels continue to be same & high. The FBS is 108 mg/dL and the postprandial reading is at about 188 mg/dL. Have attached this copy for your reference.
The gynecologist has asked us to see a general physician and has said that insulin doses might be required. We will be seeing one in a day or two. Before t hat we wished to seek your opinion on what needs to be done now.
A doctor friend asked us to undergo some diabetes tests (HBA1C, serum insulin, serum c-peptide etc) Have attached this copy for your kind reference.
Note: Her both parents are diabetic and manage it by taking some tabs plus eating right. They are not required to take insulin.
My wife has been diagnosed with a low lying placenta and hence is on bed rest. So she doesn't exercise.
Please let me know what needs to be done as i am worried about the well being of my wife and the baby.
Thanks.
Warm regards,
XXXXXXX
My wife is 25 weeks pregnant and is 27 years old. About 4 weeks back, during her routine blood tests it was found that the sugar levels were high. The Gynecologist advised to have a controlled/healthy diet for 2 weeks and then check the sugar levels again after two weeks. The sugar levels continue to be same & high. The FBS is 108 mg/dL and the postprandial reading is at about 188 mg/dL. Have attached this copy for your reference.
The gynecologist has asked us to see a general physician and has said that insulin doses might be required. We will be seeing one in a day or two. Before t hat we wished to seek your opinion on what needs to be done now.
A doctor friend asked us to undergo some diabetes tests (HBA1C, serum insulin, serum c-peptide etc) Have attached this copy for your kind reference.
Note: Her both parents are diabetic and manage it by taking some tabs plus eating right. They are not required to take insulin.
My wife has been diagnosed with a low lying placenta and hence is on bed rest. So she doesn't exercise.
Please let me know what needs to be done as i am worried about the well being of my wife and the baby.
Thanks.
Warm regards,
XXXXXXX
Brief Answer:
Hello
Detailed Answer:
Dear XXXXXXX
Good day.
Thank you for writing to us. I noted your wife's history and attached reports. According to history, her parents have diabetes. She has elevated FBS and PPBS for pregnancy. Her HbA1c levels are okay. She need to undergo a test called GTT ( glucose tolerence test) if it is not allready done. We want to keep FBS below 95 and post prandial sugars below 130 in pregnancy. She need to do a GTT as soon as possible. Insulin and C peptide levels are okay and i wonder why it was done. That doesnt really add any value to our diagnosis and was probably unnecessary in her case.
She need to do regular exercise . I realize that she has low lying placenta and heavy exercise is not possible. Discuss with your gynecologist about the type f exercise which is permissible in her. Reduce her carbohydrate levels in food. Yu must meet a dietician with experience in gestational diabetes and an endocrinologist ( I advice you to meet an endocrinologist rather than a general physicin). We may need to give her a medicine called Metformin + Insulin to bring down her sugar levels.
It is important to control the sugar level so that the baby's growth is good. If sugars are high, baby can gain excessive weight and there can be other complications. But do not panick. The sugar levels are not dangerously high.
I advice you to meet an endocrinologis in XXXXXXX There are lots of them in XXXXXXX ( Ramiah hospital, St.Johns hospital, Vydehi institute, XXXXXXX Hridayalaya, MAnipal hospital etc). Few names are, Dr.Mala Dharmalingam, Dr. XXXXXXX Dr.Vageesh Iyer, Dr XXXXXXX XXXXXXX Dr.Kalra. Please contact one of them who is near to your house.
Kind regards
Binu
Hello
Detailed Answer:
Dear XXXXXXX
Good day.
Thank you for writing to us. I noted your wife's history and attached reports. According to history, her parents have diabetes. She has elevated FBS and PPBS for pregnancy. Her HbA1c levels are okay. She need to undergo a test called GTT ( glucose tolerence test) if it is not allready done. We want to keep FBS below 95 and post prandial sugars below 130 in pregnancy. She need to do a GTT as soon as possible. Insulin and C peptide levels are okay and i wonder why it was done. That doesnt really add any value to our diagnosis and was probably unnecessary in her case.
She need to do regular exercise . I realize that she has low lying placenta and heavy exercise is not possible. Discuss with your gynecologist about the type f exercise which is permissible in her. Reduce her carbohydrate levels in food. Yu must meet a dietician with experience in gestational diabetes and an endocrinologist ( I advice you to meet an endocrinologist rather than a general physicin). We may need to give her a medicine called Metformin + Insulin to bring down her sugar levels.
It is important to control the sugar level so that the baby's growth is good. If sugars are high, baby can gain excessive weight and there can be other complications. But do not panick. The sugar levels are not dangerously high.
I advice you to meet an endocrinologis in XXXXXXX There are lots of them in XXXXXXX ( Ramiah hospital, St.Johns hospital, Vydehi institute, XXXXXXX Hridayalaya, MAnipal hospital etc). Few names are, Dr.Mala Dharmalingam, Dr. XXXXXXX Dr.Vageesh Iyer, Dr XXXXXXX XXXXXXX Dr.Kalra. Please contact one of them who is near to your house.
Kind regards
Binu
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Hi, thank you for your prompt, detailed & forthright answer & also the references of the doctors...
Could you please tell me for these sugar levels what are the insulin levels required & for how long?
And what is the difference between the Actrapid & Mixtard 30? (both from novonordisk).
Which one of the above two insulin types will be better in our case?
Also wife is a bit uncomfortable with all the pricking that is happening for testing the sugar level using the glucometer. Right now testing four times a day (FBS, Post breakfast, post lunch & post dinner). Is there a method to measure the sugar levels but doesn't involve pricking 4 times a day!
Right now, I am unable to attach the prescriptions give by the doctors. I will do so in my next post. Unfortunately this is closing in 8 minutes time!
Thanks for bearing with me on this.
Thanks, XXXXXXX
Could you please tell me for these sugar levels what are the insulin levels required & for how long?
And what is the difference between the Actrapid & Mixtard 30? (both from novonordisk).
Which one of the above two insulin types will be better in our case?
Also wife is a bit uncomfortable with all the pricking that is happening for testing the sugar level using the glucometer. Right now testing four times a day (FBS, Post breakfast, post lunch & post dinner). Is there a method to measure the sugar levels but doesn't involve pricking 4 times a day!
Right now, I am unable to attach the prescriptions give by the doctors. I will do so in my next post. Unfortunately this is closing in 8 minutes time!
Thanks for bearing with me on this.
Thanks, XXXXXXX
Brief Answer:
Hello
Detailed Answer:
Hi XXXXXXX
It seems that someone has already prescribed her Insulin!!. In fact she didn't have overt diabetes and I would have waited for 1-2 weeks on diet alone. We need at least 4 times glucometer reading a day to see what time the sugar is going high and use insulin accordingly. I know that many physicians and gynecologists would treat diabetes in pregnancy with Mixtard. I wouldn't do so.
Some people may have only one high reading in a day after a meal and we may get away with an actrapid insulin just before that particular meal. However if she has high sugars after all meals, she would need either Mixtard twice daily or more elaborative insulin regimen. I have used insulin pumps also in pregnancy. Unfortunately, glucometer monitoring should be done in pregnancy.
Mixtard and Actrapid are different. ( infact Mixtard has Actrapid + another type insulin in it). Their action profiles are different. YOU WILL GET CONFUSED IF I DISCUSS FURTHER. IT IS BETTER TO TALK ABOUT IT THAN TYPE.
Please get treatment for diabetes from an endocrinologist rather than a physician or a gynecologist.
Regards
Binu
Hello
Detailed Answer:
Hi XXXXXXX
It seems that someone has already prescribed her Insulin!!. In fact she didn't have overt diabetes and I would have waited for 1-2 weeks on diet alone. We need at least 4 times glucometer reading a day to see what time the sugar is going high and use insulin accordingly. I know that many physicians and gynecologists would treat diabetes in pregnancy with Mixtard. I wouldn't do so.
Some people may have only one high reading in a day after a meal and we may get away with an actrapid insulin just before that particular meal. However if she has high sugars after all meals, she would need either Mixtard twice daily or more elaborative insulin regimen. I have used insulin pumps also in pregnancy. Unfortunately, glucometer monitoring should be done in pregnancy.
Mixtard and Actrapid are different. ( infact Mixtard has Actrapid + another type insulin in it). Their action profiles are different. YOU WILL GET CONFUSED IF I DISCUSS FURTHER. IT IS BETTER TO TALK ABOUT IT THAN TYPE.
Please get treatment for diabetes from an endocrinologist rather than a physician or a gynecologist.
Regards
Binu
Note: For more information on hormonal imbalance symptoms or unmanaged diabetes with other comorbid conditions, get back to us & Consult with an Endocrinologist. Click here to book an appointment.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Answered by
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