Where is the line before I need meds?

[froggymogs 0]

Hello, 

I am 29 weeks and this is my second pregnancy with Gestational Diabetes and as a result I was diagnosed very early (14 weeks).  My glucose readings were very good until the last couple weeks which makes sense since this is about the time most women are diagnosed.  However this pregnancy has been very different from my last one, so I'm not sure what to do.  With my first GD pregnancy I was able to keep my sugars in range with diet, but eventually had to go on insulin to allow more carbs due to excessive weight loss.  This time I've maintained my pre pregnancy weight, so no worries about not enough carbs, but recently started having some high (between 96-105) fasting readings.  My midwife isn't concerned yet because it's not consistently high, still in the 80's many mornings.  But definitely getting harder to control, and having highs more often than I'm used to.  At what point have your docs drawn the line and put you on meds?  And which meds are used?  I did insulin last time, but my midwife said pills are getting more common now.  Any ideas?

[NoraWI 4,809]

Since you haven't had any responses, here I go. Keep in mind that it has been 49 years since my last pregnancy and I was not diabetic at that time. But using common sense, I would say that insulin should be the only treatment when you are pregnant. And the only deciders on the issue of when to start using insulin are your health team, although you should certainly discuss this with them if it worries you. There are no hard cut lines to cross such as a certain number in fasting BG. It is all a progression and should be considered in context. Talk with your doctor about this. A midwife may be knowledgeable but the doctor is a better source of information in this case (and I don't say that very often).

[samuraiguy 4,981]

I'm the wrong guy to ask about that line because my current healthcare team is comfortable leaving me off meds until I go over an A1C of 6.4, but I do know the stress of worrying your numbers are going too high and the routine of maintaining them can make your numbers even higher. What I did was write down the reasons why I want my BG levels at a certain level, what's comfortable for me and will then present them to my healthcare team at my next A1C if I'm not in my target range. Once your doctor knows your specific concerns then they can "talk you off the ledge" and negotiate when to add medication or insulin at a time that's more comfortable with you.  More of it has to do with what you're comfortable with, but with in reason, i.e. I would like my A1C as close to 5 as possible, under 5.7 if I can, but realize just keeping it under 6 makes me statistically the same risk as a non-D for the majority of the harmful side effects. I managed to get my healthcare team to agree that if I go over an A1C of 6 I should look at possibly adding back meds because I told them my body already took damage when I was pre-D to D and didn't want to repeat the cycle all the way to 6.5.

[Erpi 9]

The guidelines for blood glucose control in pregnancy are different. You want fasting under 5.3 (sorry I can't do the conversion right now) and post meals under 7.6. Insulin is usually first-line, as it does not cross the placenta and is safer, but many mds are giving glyburide in pregnancy--this is usually because it's easier to educate someone about how to take a pill than proper insulin dosing. But you have a lot more control using insulin, and there is a much better safety profile in pregnancy.