Brief Answer:
I wouldn't start insulin yet...

Detailed Answer:
Hi,

Thanks for sharing your concerns here. I went through the details and reports attached with diligence. It would have been better to know whether or not she had diabetes in the past. I presume your answer to be no - she did not have diabetes in the past.

Based on this presumption, I deduce that she has glucose intolerant state due to pregnancy. Pregnancy increases resistance to insulin thereby giving to this condition.

Now, since she has glucose intolerance and not diabetes, I wouldn't start insulin yet. If she was to be my patient, I would recommend strict diabetic diet and lifestyle while I monitor her blood sugars monthly or every fortnight. This would be my plan of action.
That being said, there is no harm in starting insulin; it gives us better control on blood sugar while increasing spectrum of food intake.

I shall now answer your individual questions:
1. Does she really need to take insulin? - According to me, she doesn't need insulin. If you also do not like the idea of taking insulin for the aforementioned reasons, you can discuss with her treating doctor / second diabetologist and stop them.

2. How does it affect baby? - If you meant, how diabetes effect baby, then increase blood sugar are associated with large babies - your child can grow faster and larger giving rise to difficulties during delivery; head can grow unproportionate to the body; the liquour (amniotic fluid) can increase in quantity (polyhydramnios) and so on. Thus increased blood sugar is detrimental both on baby growth as well chances of normal delivery.

3. How to keep sugar levels low; what to eat and what not?
- Following a strict diabetic diet and life style is going to be the key with or without insulin. I see your doctor has listed some changes in the diet. More than knowing what to eat and what not, you need to learn "how much to eat".

Every food has a glycemic index. Food that have high glycemic index can irrationally increase sugar. She needs to restrict taking such products. Foods with high glycemic index include chocolates, sweet, ice cream, potato, food / salad dressing such as mayonnaise, papad, fruits like sethaphal, refined bread and cereals, fruit juice, coffee, watermelon, ripe banana, dates and so on. Those high glycemic index food needs to be restricted or avoided completely.
Low glycemic index food are relative safe and taken in moderate amounts. Low glycemic foods are green vegetables, whole grains/cereal, millet, lentils, chickpeas, XXXXXXX apricot, banana preferably unripe, milk, and so on.

With this data, you can balance her diet accordingly. You may also take help of dietician to balance her diet.

Hope that helps. Let me know if you need clarifications.

Regards

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Brief Answer:
Diet seems to be Ok....

Detailed Answer:
Hi,

As far as I see, except from days when she had insulin, I see her sugars are fairly constant.
a) A practical comment cannot be done over random blood sugar since the test is done at a random time.
b) Fasting sugars are almost under normal limits.
c) Post prandial blood sugars are much higher.

This is a clinical picture of glucose intolerance - a prediabetic state and that is why I usually do not prescribe insulin in such cases.

The changes in blood sugar especially the ones where the sugars are much lower are due to the effects of insulin. Her doctor's have rightly cut down the insulin doses. I would not encourage many changes to diet if the primary diet is balanced and sufficient when sugar levels are fluctuation. She can include low glycemic vegetables into her diet. Whole grain / cereal wheat chapathi/roti can be added instead of refined maida product perhaps for lunch meal too. You can include millets (ragi/bajra) - it is a XXXXXXX source of iron; additionally has low glycemic index. For better tuning of diet, you can talk to a nutritionist; off course when sugar levels stop to fall low.

As far as protein intake, it seems to be ok. That being said, there is no means for us to record the precise protein intake of growing fetus. Regular ultrasound scan during antenatal period will monitor the baby’s growth; and that would be a direct indicator of fetal nourishment.

Hope this helps. Let me know if you need clarifications.

Regards

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