Dear Henci,

I was just diagnosed with GD for the second time. What worries me is that the acceptable morning fasting glucose levels have been lowered for pregnant women from <95 to <90. Towards the end of my first pregnancy I had fasting glucose levels in the high 90's and never received insulin. This time I was told that if I get 94 twice, they take immediate action with insulin. Based on my experience with my first pregnancy, I know that won't be necessary for me. I had a normal sized baby with normal blood sugar levels at 41 weeks and I had none of the complications associated with GD.

Even though my dietician says that insulin is very safe and that you never become dependant on it, I'm still very hesitant about taking it (or any other medication) while I'm pregnant if I don't really need it. But in order to stay in their new guidelines, I have been looking into more natural options to lower blood sugar. I read a lot of great stuff about Chromium. Do you know of any women with GD that have taken it? If so, has it helped with their morning blood levels? Also, do you know the acceptable dosage for a pregnant woman? I read that it was 4 to 8 mcg's per kilo of body weight. I just don't know if that is correct.

I also read that accupuncture is very helpful for a lot of problems associated with pregnancy like morning sickness and turning a breech baby. Do you know if an accupunturist can help lower blood sugar levels?

Thank you for reading my very long question. I would appreciate any guidance you can give me.

Agnes
By: Agnes

The key thing here is getting the information you need to make an informed decision, keeping in mind that "informed decision" can mean "informed refusal" as well as "informed consent."

Let me begin by sending you off this site to my own website, where you can link to two articles I have written on gestational diabetes. Scroll down and under "Pregnancy Issues," you will find "Gestational Diabetes" and "Gestational Diabetes: A Practical Approach." Those articles should give you some helpful background on the issues of GD as well as some options to consider and questions to ask.

As for the informed decision part, here's a couple of good sources on this issue: The Rights of Childbearing Women and Making Informed Decisions.

Regarding your question on using alternative therapies, I have no expertise in this area. I would advise using the same approach to making an informed decision in this area as I would for the use (or non use) of conventional therapies. As a purely personal opinion, though, if it turned out that acupuncture was a possibility--and keeping in mind that I don't know that it is--I don't see that it could have any adverse effects other than the cost of the treatments if it is actually ineffective. The same cannot be said of something you take internally.

-- Henci By: Henci Goer

Agnes,
You may begin by asking questions about the evidence on which blood glucose guidelines are based and whether their recommended targets have been shown to result in clinically significant outcomes. For instance, a lower rate of macrosomic (large) infants may not be clinically significant whereas differences in rates of birth injury would be.

The American College of Obstetrics and Gynecology most recently updated their clinical guidelines for gestational diabetes in 2001 and state that "When medical nutritional therapy has not resulted in fasting glucose levels less than 95 mg/dL or 1-hour postprandial values less than 130–140 mg/dL or 2-hour postprandial values less than 120 mg/dL, insulin should be considered." They admit that this recommendation is based on "limited or inconsistent scientific evidence".

The National Institutes of Health publish a booklet about gestational diabetes (published in 2004) in which they recommend a target fasting glucose below 105.

Clearly there is not consensus around the target levels and as you mention they have changed over time. I'm not aware of new studies that offer better evidence for target glucose levels but it is possible that these exist. However, as Henci mentioned, it is your right (and responsibility!) to make an informed decision about your care. The MCA materials are a great framework from which to start.

Best of luck!

Amy Romano, MSN, CNM
Editor, Lamaze Institute for Normal Birth By: Amy Romano

Dear Henci and Amy,

Thank you so much for your advice. The articles you referred me to were very helpful and informative. You have really helped me stop stressing about this.

I recently called my diabetes clinic from two years ago to see what the fasting glucose levels were for women with GD. They are still using 60-95. Where I live now they are using 60-90. So they are giving insulin to women in one state for the same numbers that are acceptable in another state. I didn't know that the guidelines are so different from state to state.

It's very hard to go against what the doctor recommends because you think they have experience and know so much more than you. But in this case I realize they are still just guessing. I just have to do all the research I can and make the right decision based on my experience.

My fasting levels are in the 80's now every morning probably because I stopped stressing so much. But if this ever becomes an issue again, I am so much better prepared to talk to the doctors about it thanks to you. Thank you so much for responding to my questions. You are the only ones who did.

Agnes By: Agnes

"My fasting levels are in the 80's now every morning probably because I stopped stressing so much. But if this ever becomes an issue again, I am so much better prepared to talk to the doctors about it thanks to you."

This comment reminded me of the paradox of designating women as "high risk" for relatively minor and clinically unimportant deviations from average. The tests and treatments that follow and the anxiety they cause can cause more problems than they cure, sometimes the very same complications the care provider is trying to avert. As your experience illustrates, stress activates the adrenal system, and one result of that is high blood glucose levels.

-- Henci
By: Henci Goer