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Gestational Diabetes Mellitus

What is gestational diabetes?

Pregnancy is a physiological state that predisposes women to diabetes mellitus. During pregnancy, insulin requirements of women changes and there is usually an asymptomatic transitory impairment of regulation of glucose levels in the body. Women who are pregnant have increased insulin resistance and can develop gestational diabetes which may resolve after pregnancy or can develop to diabetes mellitus post-delivery. In addition, women who have had previously undiagnosed prediabetes can develop diabetes mellitus during pregnancy.

  • Increased thirst
  • Blurry vision
  • Generalized fatigue.
  • Tingling and/or numbness in any part of the body especially in the extremities- hands and feet
  • Increased urine output especially at night
  • Weight loss – may or may not be present.

Dr Thomas will do a comprehensive medical evaluation including eliciting a detailed personal and family history and do the appropriate blood tests and any other relevant investigations to diagnose diabetes mellitus and screen you for any complications of diabetes mellitus.  Typically, a diagnosis of diabetes is made if your fasting blood glucose levels is more than 126 mg/dl or a random blood glucose is greater than or equal to 200 mg/dl or Hemoglobin A1c is 6.5% or higher.

The management of gestational mellitus is multi-disciplinary.  Dr Reena Thomas will confirm the diagnosis of diabetes, discuss the pathophysiology of diabetes, monitoring of blood glucose levels and the rationale for optimal treatment of diabetes mellitus with oral medications – Glyburide or Metformin and or insulin therapy. All medications that are contraindicated in pregnancy including GLP-1 agonists, Angiotensin receptor blockers and statins will be stopped.

She will refer you to appropriate providers like a registered dietician, and other specialists that may need to be involved depending on the complications of diabetes mellitus.

Blood glucose monitoring is important for optimal management of diabetes mellitus. Dr Thomas will advise you on the option of monitoring that is appropriate for you.

Self-monitoring of blood glucose levels

Using glucometer (SBGM). Ideally, blood glucose levels should be checked at least 4 times a day – before meals and before bed.

Continuous glucose monitoring

This uses a device to automatically estimate your blood glucose levels at any time of the day. This method helps to review your 24-hour glucose levels and helps you understand the impact of food, exercise, and other activities of daily living on your blood glucose levels. There are different types of sensors in the marketplace.

Dr Thomas will give you an individualized treatment plan focusing on healthy eating, physical activity, and a tailored medication plan.

The different treatment options are:

  • Medical Nutrition Therapy – this includes Healthy eating and lifestyle habits
  • Oral medications: Metformin, SGLT2 inhibitors – Canagliflozin, Dapagliflozin and Empagliflozin, DPP-4 inhibitors – Saxagliptin, Sitagliptin, Alogliptin, Thiazolidinediones – eg. Pioglitazone, Sulfonylureas
  • Injectables include GLP-1 agonists therapy – Semaglutide, Liraglutide , Dulaglutide, dual GLP-1 and GIP-1 receptor agonist- Tirzepatide and insulin therapy.

The above treatments have different modes of action, benefits, and side effects. Not all the above medications are suitable for every individual.

Dr Thomas will discuss the rationale of the different treatment options and offer you a personalized treatment plan. Every effort will be made to support your goal of optimal control of your diabetes mellitus to prevent both short- and long-term complications of diabetes mellitus.

At a Glance

Dr. Reena Thomas, MD

  • Dual American board-certified endocrinologist
  • Author of numerous academic and clinic research
  • Learn more