Dr. Thiyagarajan. T
Diabetology
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Patient's Query
Hello doctor,
I am 30-years-old, and I had gestational diabetes during pregnancy. My fasting blood sugar has always been normal. However, after eating a meal, the levels were outside the normal ranges. So, I just ate minimal carbohydrates. The baby was born ten days before the due date with a weight of 6.8 lbs. My height is 5.5 feet, and my weight before pregnancy was around 119 lbs; I reached 141 lbs during pregnancy. Now I am around 114 lbs. I returned to this level within seven months. After delivery, whenever I monitored my blood sugar levels after meals, they kept being out of range. After 45 days of delivery, I did a glucose tolerance test, and the results were as follows:
Is it possible that the hormones are still not balanced after delivery, and more time is needed? I did not understand the reason for gestational diabetes to be still present.
Kindly help.
Hi,
Welcome to icliniq.com.
You seem to be doing a great job with diet and keeping your weight down. But, unfortunately, your glucose appears to rise after meals. The GTT (glucose tolerance test) done 45 days after delivery shows high glucose values after two hours of a meal. I think you have impaired glucose tolerance and may have diabetes. I cannot make a diagnosis of diabetes as your fasting glucose was normal on the GTT. Hormones responsible for gestational glucose rise will reduce immediately after delivery. Some hormonal changes may still be there, but the influence on glucose control should not be significant. Breastfeeding will help bring the glucose down and should not raise it. Gestational diabetes is a risk factor for developing diabetes in the future. Do you have a family history of diabetes?
Regards.
Patient's Query
Hello doctor,
Thanks for the reply.
I do not have a family history of diabetes. If I do not include carbohydrates in the meal, my glucose levels are normal. HbA1c tested before five months was 4.9 %, but as far as I am aware, it might be low due to the low carbohydrate diet that I am following. Are there any other tests I can do to get a final diagnosis?
Thanks.
Hi,
Welcome back to icliniq.com.
The HbA1c may have been lower due to changes in red blood cell mass. The low carbohydrate diet could have also influenced it. The rise in insulin levels and glucose during GTT shows that you have impaired glucose tolerance (IGT). IGT and diabetes fall in the same spectrum at different positions. So, whether you have a diagnosis of diabetes or IGT, it has the same management implications. There are no other reasons for the rise in blood glucose after two hours of meals except that your body or pancreas cannot lower it. I recommend repeating HbA1c (hemoglobin A1c), FBG (fasting blood sugar), and PPBG (postprandial blood sugar). You could start Metformin 500 mg once daily in the morning.
Regards.
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