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Question:

From Hockley, Essex, England:

When I was eight weeks pregnant, I was diagnosed diabetic, although no one was sure what type because of the pregnancy. I was put on insulin straight away and I injected four times a day. Once I was controlled, I felt wonderful, the best I had felt in years. Once I delivered, however, the doctors stopped all medication and, after four months, diagnosed me as type 2. I am now taking metformin 500 mg three times per day and it hasn't controlled my blood sugars at all. How would I know if I was actually needing insulin instead of oral medication? It is now six months after delivery and I am feeling very fed up not being controlled like I was when pregnant. During my pregnancy, my blood sugars were between 4 and 7 mmol/L [72 and 126 mg/dl] and my A1c was 6.3. My blood pressure is also very high and I am taking atenolol, 50mg per day, to help control this. Is the diabetes contributing to this high level?

Answer:

When you have diabetes that early in your pregnancy, it is likely you had diabetes prior to conception. I would be concerned that you may have an evolving form of type 1 diabetes. The reason for my concern is your inability to be controlled on oral agents. A hemoglobin A1c of 6.3% is not bad, but the highs you are noting suggest the metformin is not enough. There are usual sorts of tests that are done to try to differentiate type 1 from type 2 diabetes. C-peptide levels are low in type 1 diabetes and not type 2. Antibody levels, especially anti-GAD antibody, are high with type 1 diabetes. Please discuss your blood sugars with your physician so that a more aggressive forms of therapy can be pursued. If you really have type 1 diabetes, insulin is the appropriate form of therapy.

High blood pressure is not specifically related to the blood sugar. However, patients with type 2 diabetes may have a constellation of conditions that includes hypertension as part of the group. Others include dyslipidemia, obesity, irregular menses, elevated uric acid levels, etc. You should have a microalbuminuria test as well. If this is positive, you need to discuss with your physician about the use of a medication that projects your kidneys with your diabetes.

JTL

DTQ-20040715170806
Original posting 24 Jul 2004
Posted to Diagnosis and Symptoms

  
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Last Updated: Tuesday April 06, 2010 15:09:58
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