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Pregnant. Prescribed gyburide for diabetes. Worried for its side effect on baby

Mar 2013
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I'm 33 weeks pregnant and last week my Dr. put me on gyburide 2.5 because of my diabetes blood sugars running 98 fasting in the morning and around 155 after lunch and dinner. I haven't taken the medicine because I scared of the side effects. Are my FSBS high enough to be on meds? I was dx at 28 weeks at this late in my pregnancy what effects could my sugar have on my baby?
Posted Mon, 25 Mar 2013 in Women's Health
Answered by Dr. Aarti Abraham 3 hours later
Thank you for your query.

Firstly you need to be diagnosed as having gestational diabetes mellitus before starting on any medications.
A fasting plasma glucose level >126 mg/dl (7.0 mmol/l) or a casual plasma glucose >200 mg/dl (11.1 mmol/l) meets the threshold for the diagnosis of diabetes, if confirmed on a subsequent day, and precludes the need for any glucose challenge. As your values do not XXXXXXX this threshold, you should first of all undergo screening for that. Let me know if the screening tests for gestational diabetes mellitus have been done in your case, as FBS and PPBS are not used for diagnosis of the condition.

Women with clinical characteristics consistent with a high risk of GDM (marked obesity, personal history of GDM, glycosuria, or a strong family history of diabetes) should undergo a diagnostic oral glucose tolerance test ( OGTT ) . In low risk women, an initial screening by measuring the plasma or serum glucose concentration 1 h after a 50-g oral glucose load (glucose challenge test [GCT]) is done. An OGTT is done when the one hour value exceeds >140 mg/dl (7.8 mmol/l) .

If diagnosed with the condition, The goals of treatment are to keep fasting blood sugar < 95 and 1 hour post prandial blood sugar to be < 140 mg/dl . Your values are borderline ( that too without proper diagnosis first ), hence I do not see the need to start Glyburide as the first course of action.

All women with GDM should receive nutritional counseling, by a registered dietitian when possible, consistent with the recommendations by the American Diabetes Association.

The mainstay of treatment is diet and exercise, which should be the primary aim, after which, if the sugars are not controlled, you can think of oral medications or insulin.
Most of the time, eating properly can keep your blood sugar (glucose) levels from becoming too high or too low. Eating properly can also help you avoid needing medications / insulin for further management
Your doctor and dietitian will create a diet just for you, based on:
The type of calories you need
Your weight (pregnant women who are obese may need a diet with fewer calories that other pregnant women)
How far along you are in your pregnancy
How fast and how large your baby is growing
Your activity level
Remember that "eating for two" does not mean eating twice as many calories. You usually need just 300 extra calories a day (such as a glass of milk, a banana, and 10 crackers).

The best way to improve your diet is by eating a variety of healthy foods. You should learn how to read food labels, and consult them when making food decisions. Talk to your doctor or dietitian if you are a vegetarian or on some other special diet.
In general, your diet should be moderate in fat and protein and provide controlled levels of carbohydrates through foods including fruits, vegetables, and complex carbohydrates (such as bread, cereal, pasta, and rice). You will also be asked to cut back on foods that have a lot of sugar, such as soft drinks, fruit juices, and pastries.
You will be asked to eat three small- to moderate- sized meals and one or more snacks each day. Do not skip meals and snacks. Keep the amount and types of food (carbohydrates, fats, and proteins) the same from day to day.

Carbohydrates should make up less than half of the calories you eat.
Most carbohydrates are found in starchy or sugary foods, such as bread, rice, pasta, cereal, potatoes, peas, corn, fruit, fruit juice, milk, yogurt, cookies, candy, soda, and other sweets.
High-fiber, whole-grain carbohydrates are digested more slowly and are healthier choices.
While vegetables (such as carrots, broccoli, and spinach) contain carbohydrates, they add much more to your health than to your blood sugar. Enjoy lots of them.
Carbohydrates in food are measured in grams. You can learn to count the carbohydrates in the foods that you like and that you eat.

Eat 6 or more servings a day: one serving equals 1 slice bread, 1 ounce ready-to-eat cereal, 1/2 cup cooked rice or pasta, or 1 English muffin.
Foods like bread, grains, beans, rice, pasta, and starchy vegetables serve as the foundation of your diet. They are loaded with vitamins, minerals, fiber, and healthy carbohydrates.
It is important to chose carbohydrate sources with plenty of fiber. Eat whole-grain foods such as whole-grain bread or crackers, tortillas, XXXXXXX cereal, brown rice, or beans. Use whole-wheat or other whole-grain flours in cooking and baking.
Eat more low-fat breads, such as tortillas, English muffins, and pita bread.

Eat 3 - 5 servings a day: one serving equals 1 cup leafy, XXXXXXX vegetables; 1 cup cooked or chopped raw leafy vegetables; 3/4 cup vegetable juice; or 1/2 cup of chopped vegetables, cooked or raw.
Choose fresh or frozen vegetables without added sauces, fats, or salt. You should opt for more dark XXXXXXX and XXXXXXX yellow vegetables, such as spinach, broccoli, romaine, carrots, and peppers.
Eat 2 - 4 servings a day: one serving equals 1 medium whole fruit (such as a banana, XXXXXXX or orange); 1/2 cup chopped, frozen, cooked, or canned fruit; or 3/4 cup fruit juice.
Choose whole fruits more often than juices. They have more fiber. Citrus fruits, such as oranges, grapefruits, and tangerines, are best. Opt for fruit juices without added sweeteners or syrups.
Choose fresh fruits and juices, which retain more of their nutritional value than frozen or canned varieties.

Eat 4 servings a day: one serving equals 1 cup milk or yogurt, 1 1/2 oz. natural cheese, or 2 oz. processed cheese.
Choose low-fat or nonfat milk or yogurt. Yogurt has natural sugar in it, but it can also contain added sugar or artificial sweeteners. Yogurt with artificial sweeteners has fewer calories than yogurt with added sugar.
Dairy products are a great source of protein, calcium, and phosphorus (to keep calories and cholesterol in check, though, choose low-fat dairy products).

Eat 2 - 3 servings a day: one serving equals 2-3 oz. cooked meat, poultry, or fish; 1/2 cup cooked beans; 1 egg; or 2 tablespoons peanut butter
Choose fish and poultry more often. Remove the skin from chicken and XXXXXXX Select lean cuts of beef, veal, pork or wild game.
Trim all visible fat from meat. Bake, roast, broil, grill, or boil instead of frying.
Foods from this group are excellent sources of B vitamins, protein, iron, and zinc.

Sweets are high in fat and sugar, so keep portion sizes small.
Eat sweets that are sugar-free.
Ask for extra spoons and forks and split your dessert with others.

Go easy on butter, margarine, salad dressing, cooking oil, and desserts. But don't cut fats and oils from your diet entirely. They provide long-term energy for growth and are essential for brain development.
In general, you should limit your intake of fatty foods, especially those high in saturated fat such as hamburger, cheese, bacon, and butter.

Your doctor, nurse, or dietitian may ask you to keep track of what you eat. Maintain a food diary.
It is important to monitor blood sugar regularly, going for atleast weekly fasting and post prandial blood sugar levels, and aiming to keep them within normal limits.
Walking is usually the easiest type of exercise, but swimming or other low-impact exercises can work just as well. Exercise is an important way to keep blood sugar in control, and physical activity in pregnancy has been found to decrease the risk of developing gestational diabetes.

As she is having breathlessness on walking, she can try walking slowly instead of brisk walk. More important is the total number of calories burnt, and not the speed of walking.

If diet and exercise fail to achieve target blood sugars, then oral antidiabetic drugs / insulin maybe added later on.

Regarding the risks to your baby,
Uncontrolled gestational diabetes may be associated with an increase in the risk of intrauterine fetal death during the last 4–8 weeks of gestation. Although uncomplicated GDM with less severe fasting hyperglycemia has not been associated with increased perinatal mortality, GDM of any severity increases the risk of fetal macrosomia. Neonatal hypoglycemia, jaundice, polycythemia, and hypocalcemia may complicate GDM as well. GDM is associated with an increased frequency of maternal hypertensive disorders and the need for cesarean delivery. The latter complication may result from fetal growth disorders and/or alterations in obstetric management due to the knowledge that the mother has GDM.

Women with GDM are at increased risk for the development of diabetes, usually type 2, after pregnancy. Obesity and other factors that promote insulin resistance appear to enhance the risk of type 2 diabetes after GDM, while markers of islet cell-directed autoimmunity are associated with an increase in the risk of type 1 diabetes. Offspring of women with GDM are at increased risk of obesity, glucose intolerance, and diabetes in late adolescence and young adulthood.

I hope I have provided an elaborate answer, and please feel free to ask any further questions.
All the best and be well.
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