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Question:

From East Brunswick, New Brunswick, USA:

I am 35 years old, I have had insulin-treated gestational diabetes during both of my pregnancies, and for the first time I have started birth control (the patch), not realizing that one of the listed side effects is "reduced tolerance to carbohydrates". Two week ago, I had a complete physical exam during which my fasting glucose was 125 mg/dl [6.9 mmol/L]. My internist said I have borderline diabetes and requested a second test be taken next month. I tested myself yesterday because I have been experiencing headaches for the last two days, and my blood sugars were 158 mg/dl [8.8 mmol/L] at 8:00 am, 250 mg/dl [13.9 mmol/L] after lunch, and 136 mg/dl [mmol/L] three hours after dinner, not very good. My husband suggested that the patch could be causing my body to develop diabetes. We think this is the case because birth control causes the body to think its pregnant so you don't get pregnant.

I telephoned my OB-Gyn who told me to continue using the patch but to contact my endocrinologist. I telephoned him, and of course he said the OB-Gyn should know if it affects my sugar. So, as you can see, no one will help me. I have stopped using the patch in the meantime, in hope that it's the hormones in the patch causing me to have diabetes.I am watching my diet basically by avoiding carbs.

Answer:

You are negotiating the pitfalls of multiple physicians. In general, having gestational diabetes is a very big risk for developing diabetes later in life. It is true that pregnancy is associated with a high estrogen and progesterone state, but it is also associated with the production of growth factors from the placenta that specifically antagonize insulin's effects.

Diabetes is defined as a fasting blood sugar greater than 126 mg/dl [7 mmol/L] on two different occasions so you were very close. At the very least, you have prediabetes, and recent data from the Diabetes Prevention Program (DPP) and others suggest that interventions, including diet/exercise and/or Glucophage [metformin], may have benefit in preventing or delaying the onset of type 2 diabetes. At the worst, you may have early diabetes. Borderline diabetes is a terrible term and one I discourage because it makes it seem okay for now but questionable for the future when, in fact, you may have diabetes. More testing is needed here. You could go ahead and have a 75 gram oral glucose tolerance test which could allow diagnosis based on the one test. You could also have more fasting glucose levels taken. Please note the fasting glucose cutoff is for glucose levels measured in a clinical laboratory and not from home glucose meters.

As far as the estrogen goes, it does cause insulin resistance. Depending where you are, it may be enough to push you over the edge if your underlying problem is bad enough.

My recommendation, more testing. The birth control issue is important, but there is no one correct answer. If you stop the patch, at least you can be studied in your baseline condition.

JTL

DTQ-20030121193049
Original posting 4 Feb 2003
Posted to Research: Causes and Prevention

  
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Last Updated: Tuesday April 06, 2010 15:09:42
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