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Suggest Remedy For Gestational Diabetes During 27th Week Of Pregnancy
Question: Respected Sir,
I belong to XXXXXXX and since my childhood days we have been visiting you and your wife for our medical problems. Right now I am settled in XXXXXXX and extremely confused about gestational diabetes. I am 27 weeks pregnant with twins. LMP 6 XXXXXXX 2015. I was diagnosed with high blood glucose level 145 random in august and my doctor gave me a diet plan to follow along with exercise which helped me keep my sugar levels in control. But now despite following diet and exercise my sugar levels are:
Fasting- 120 to 130
Before lunch and dinner- 100 to 115
2.5 hours after dinner- 140 to 160
Now doctor is insisting for insulin but I am confused if it will harm my babies. Please help. My age is 28 years and present weight is 77 kgs. Height is 5 feet. Also my hba1c in august was 6.5 and in October it was 6.1
I belong to XXXXXXX and since my childhood days we have been visiting you and your wife for our medical problems. Right now I am settled in XXXXXXX and extremely confused about gestational diabetes. I am 27 weeks pregnant with twins. LMP 6 XXXXXXX 2015. I was diagnosed with high blood glucose level 145 random in august and my doctor gave me a diet plan to follow along with exercise which helped me keep my sugar levels in control. But now despite following diet and exercise my sugar levels are:
Fasting- 120 to 130
Before lunch and dinner- 100 to 115
2.5 hours after dinner- 140 to 160
Now doctor is insisting for insulin but I am confused if it will harm my babies. Please help. My age is 28 years and present weight is 77 kgs. Height is 5 feet. Also my hba1c in august was 6.5 and in October it was 6.1
Brief Answer:
Insulin may be advisable.
Detailed Answer:
Hi,
Thanks for your question. I think you were asking a question to Dr Shankhdhar and since he is not available to answer this was assigned to me.
If you don't mind I am here with mentioning my opinion.
- 75 gram OGTT (Oral Glucose Tolerance Test) is the standard test for diagnosis of gestational diabetes.
- HbA1c of 6.5 in August (LMP 6 June) may denote possibility of pre-existing Type 2 diabetes or Pre-Diabetes state.
- But at this stage irrespective of type of diabetes Fsting blood sugar of 120 and more requires treatment, insulin is a preferred treatment option, though use of Metformin (Oral antidiabetic medicine) may be considered.
I personally may have preferred insulin.
- Usual capillary blood glucose (done by home glucometer) target for Gestational diabetes are-
Fasting < 95
1hour post meal <140 or
2 hour post meal < 120
Though these targets need to be individualized depending upon patient scenario, clinical examination.
- Continue diet and exercise as advised by your doctor.
- Weight loss is not recommended in pregnancy.
- Regarding harm to baby
+ Insulin from mother's blood wont cross placenta ie. it is not transferred to baby to cause any effect.
+ High blood sugar in mother's blood get transferred to baby which stimulates baby's pancreas to secret more insulin leading to state of hyperinsulinemia in baby which may be harmful to baby. So there is a need of strict blood glucose control in mother.
Hope this help you.
Regards,
Dr. Abhay Mali.
Diabetologist.
Insulin may be advisable.
Detailed Answer:
Hi,
Thanks for your question. I think you were asking a question to Dr Shankhdhar and since he is not available to answer this was assigned to me.
If you don't mind I am here with mentioning my opinion.
- 75 gram OGTT (Oral Glucose Tolerance Test) is the standard test for diagnosis of gestational diabetes.
- HbA1c of 6.5 in August (LMP 6 June) may denote possibility of pre-existing Type 2 diabetes or Pre-Diabetes state.
- But at this stage irrespective of type of diabetes Fsting blood sugar of 120 and more requires treatment, insulin is a preferred treatment option, though use of Metformin (Oral antidiabetic medicine) may be considered.
I personally may have preferred insulin.
- Usual capillary blood glucose (done by home glucometer) target for Gestational diabetes are-
Fasting < 95
1hour post meal <140 or
2 hour post meal < 120
Though these targets need to be individualized depending upon patient scenario, clinical examination.
- Continue diet and exercise as advised by your doctor.
- Weight loss is not recommended in pregnancy.
- Regarding harm to baby
+ Insulin from mother's blood wont cross placenta ie. it is not transferred to baby to cause any effect.
+ High blood sugar in mother's blood get transferred to baby which stimulates baby's pancreas to secret more insulin leading to state of hyperinsulinemia in baby which may be harmful to baby. So there is a need of strict blood glucose control in mother.
Hope this help you.
Regards,
Dr. Abhay Mali.
Diabetologist.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Brief Answer:
May suggest to increase dose of metformin.
Detailed Answer:
Thanks.
As you are insisting for Tablet Metformin rather than injectable insulin.
In such scenario I may have suggested to take 1000 mg to 1500 mg of metformin depending upon clinical examination and tolerance.
I usually suggest to start Tab containing Metformin 500 mg once day and gradually increase to three times a day over a period of 7 to 10 days.
With Metformin treatment Blood sugar may take 1 to 2 weeks to come down.
As you are already in 7th month of pregnancy I may suggest to continue Metformin along with diabetic diet and regular exercise and regular checking of blood sugar levels.
If even after 2 weeks blood sugar does not come under target levels then I may suggest use of insulin along with Metformin treatment.
You should discuss all this with your treating doctor.
Hope this helps you.
Regards,
Dr Abhay Mali.
May suggest to increase dose of metformin.
Detailed Answer:
Thanks.
As you are insisting for Tablet Metformin rather than injectable insulin.
In such scenario I may have suggested to take 1000 mg to 1500 mg of metformin depending upon clinical examination and tolerance.
I usually suggest to start Tab containing Metformin 500 mg once day and gradually increase to three times a day over a period of 7 to 10 days.
With Metformin treatment Blood sugar may take 1 to 2 weeks to come down.
As you are already in 7th month of pregnancy I may suggest to continue Metformin along with diabetic diet and regular exercise and regular checking of blood sugar levels.
If even after 2 weeks blood sugar does not come under target levels then I may suggest use of insulin along with Metformin treatment.
You should discuss all this with your treating doctor.
Hope this helps you.
Regards,
Dr Abhay Mali.
Above answer was peer-reviewed by :
Dr. Yogesh D
So nice of you Sir. You have actually relieved me from all my worries. but please clear one more doubt. a dose of 1500 mg of metformin is safe for my babies or not? I hope metformin won't harm my babies. and I'll definitely discuss what you have advised with my gynaecologist and diabetologist.
Brief Answer:
Metformin is safe for your babies.
Detailed Answer:
There is adequate scientific data available on use of metformin in pregnancy.
Though metformin get transferred to baby from mother's blood, it do not have any adverse effect on baby.
In fact some studies showed beneficial effect of metformin on such babies.
It may prevent or post pone the development of Type 2 diabetes in such babies in adulthood.
Metformin is safe for your babies.
Detailed Answer:
There is adequate scientific data available on use of metformin in pregnancy.
Though metformin get transferred to baby from mother's blood, it do not have any adverse effect on baby.
In fact some studies showed beneficial effect of metformin on such babies.
It may prevent or post pone the development of Type 2 diabetes in such babies in adulthood.
Above answer was peer-reviewed by :
Dr. Vaishalee Punj
sir with the use of metformin 500 one tab at night for the past four days I can see that my readings have started lowering a bit. now fasting is 110, before lunch is 86, before dinner is 100 and 2.5 hours after dinner is 110. would you suggest increasing the metformin dosage at this stage. your advice has been valuable. thanking you in anticipation.
Brief Answer:
I may suggest to increase metformin to 1000mg per day.
Detailed Answer:
With this scenario, I may suggest to increase dose of Metformin to 1000mg per day. With regular monitoring of blood sugar levels.
Metformin rarely cause low blood sugar levels.
Hope this helps you.
In future you can directly ask questions to me on following link-
http://www.HealthcareMagic.com/doctors/dr-abhay-a-mali/69954
I may suggest to increase metformin to 1000mg per day.
Detailed Answer:
With this scenario, I may suggest to increase dose of Metformin to 1000mg per day. With regular monitoring of blood sugar levels.
Metformin rarely cause low blood sugar levels.
Hope this helps you.
In future you can directly ask questions to me on following link-
http://www.HealthcareMagic.com/doctors/dr-abhay-a-mali/69954
Note: For further follow up on related General & Family Physician Click here.
Above answer was peer-reviewed by :
Dr. Vinay Bhardwaj
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