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Suggest Treatment For Gestational Diabetes
Question: Dear Sir,
My wife had gestational diabetes detected in 2009 during her first pregnancy. Glucose Tolerance Test was OK after one month of delivering the baby & it was OK again after one year. However, diabetes was detected in July/August'2011 for which she started taking following medicines since August'2011 as advised by the Doctor. Before 2009, her sugar levels were OK.
1. Tablet Janemet 50mg/500mg(Sitagliptin Phosphate 50mg & Metformin Hydrochloride 500mg) twice daily in the morning & at night
2. Capsule Mylogen Forte once daily at night
3. Tablet Tayo 60K(Cholecalciferol 60000 IU) once in a month
4. Tablet Rasilez 150mg(Aliskiren 150mg) once daily in the morning
5. Tablet Novastat TG(Rosuvastatin 10mg & Fenofibrate 160mg) once daily at night
6. Tablet Folvite(Folic acid 5mg) once daily
7. Tablet Neurobion Forte once daily
However, during second pregnancy in 2012, all the above medicines were stopped by the diabetologist. Metformin was started along with other medicines prescribed by the gynaecologist. During last 15 days of pregnancy, insulin was also started due bed rest(Baby was born at 28 weeks).
After delivering the second baby, sugar levels were OK for quite sometime.
During periodic check ups, sugar levels of My wife, XXXXXXX Rani(Age-41 yrs.) were found slightly higher during fasting in March'2014, though HbA1c reports were found almost OK whenever this test was carried out. She started taking following medicines since March'14 after consultation with Dr. U S XXXXXXX Nephrologist.
1. GP1(Glimepiride IP- 1 mg) - one tab. daily before breakfast for last three months(Earlier GP 0.5 since March'2014)
2. Telema 20(Telmisartan IP- 20mg) - one & half tablets daily at night
3. Rosave 10(Rosuvastatine Calcium IP 10mg)- one tablet daily at night
4. Nefrosave Forte(Acytyl Cysteine USP 300mg & Pyridoxamine Dihydrochloride 50mg)- one tablet daily(Stopped from August'2014 after consultation at Apollo Hospital, Chennai)
5. Folic Acid IP 5mg- one tablet daily
6. Neurobion Forte(Vitamin)- one tablet daily
We have consulted the Nephrologist in August'2014 at Apollo Hospital, XXXXXXX for my wife. All the tests reports are attached herewith for your kind reference. The Doctor at Apollo Hospital had advised us to stop the medicine Nefrosave Forte as he said that it was not working & also suggested us to get the biopsy of kidneys done.
Kindly let us know the reason of higher 24 hour urinary protein excretion & advise us whether it is necessary to get the biopsy of kidneys done. Is it a cause of concern & what is the cure?
Please also advise us the next course of action.
Regards,
XXXXXXX XXXXXXX
My wife had gestational diabetes detected in 2009 during her first pregnancy. Glucose Tolerance Test was OK after one month of delivering the baby & it was OK again after one year. However, diabetes was detected in July/August'2011 for which she started taking following medicines since August'2011 as advised by the Doctor. Before 2009, her sugar levels were OK.
1. Tablet Janemet 50mg/500mg(Sitagliptin Phosphate 50mg & Metformin Hydrochloride 500mg) twice daily in the morning & at night
2. Capsule Mylogen Forte once daily at night
3. Tablet Tayo 60K(Cholecalciferol 60000 IU) once in a month
4. Tablet Rasilez 150mg(Aliskiren 150mg) once daily in the morning
5. Tablet Novastat TG(Rosuvastatin 10mg & Fenofibrate 160mg) once daily at night
6. Tablet Folvite(Folic acid 5mg) once daily
7. Tablet Neurobion Forte once daily
However, during second pregnancy in 2012, all the above medicines were stopped by the diabetologist. Metformin was started along with other medicines prescribed by the gynaecologist. During last 15 days of pregnancy, insulin was also started due bed rest(Baby was born at 28 weeks).
After delivering the second baby, sugar levels were OK for quite sometime.
During periodic check ups, sugar levels of My wife, XXXXXXX Rani(Age-41 yrs.) were found slightly higher during fasting in March'2014, though HbA1c reports were found almost OK whenever this test was carried out. She started taking following medicines since March'14 after consultation with Dr. U S XXXXXXX Nephrologist.
1. GP1(Glimepiride IP- 1 mg) - one tab. daily before breakfast for last three months(Earlier GP 0.5 since March'2014)
2. Telema 20(Telmisartan IP- 20mg) - one & half tablets daily at night
3. Rosave 10(Rosuvastatine Calcium IP 10mg)- one tablet daily at night
4. Nefrosave Forte(Acytyl Cysteine USP 300mg & Pyridoxamine Dihydrochloride 50mg)- one tablet daily(Stopped from August'2014 after consultation at Apollo Hospital, Chennai)
5. Folic Acid IP 5mg- one tablet daily
6. Neurobion Forte(Vitamin)- one tablet daily
We have consulted the Nephrologist in August'2014 at Apollo Hospital, XXXXXXX for my wife. All the tests reports are attached herewith for your kind reference. The Doctor at Apollo Hospital had advised us to stop the medicine Nefrosave Forte as he said that it was not working & also suggested us to get the biopsy of kidneys done.
Kindly let us know the reason of higher 24 hour urinary protein excretion & advise us whether it is necessary to get the biopsy of kidneys done. Is it a cause of concern & what is the cure?
Please also advise us the next course of action.
Regards,
XXXXXXX XXXXXXX
Brief Answer:
yes
Detailed Answer:
Gestational diabetes is a risk factor for the development of diabetes later in life, especially those with the family history of diabetes. Though metformin is good, Insulin is required during pregnancy. I feel that she was treated well.
patients with diabetes are at risk for kidney injury any time in their life time. However it requires to pass some duration before manifesting as protein in urine ( called proteinuria) which is the earliest marker of kidney injury. Any amount of protein above 1 gm is considered significant. diabetes with proteinuria is routinely suspected to be due to diabetes not due to any other cause which we se in non diabetic people. However, we need to suspect diabetes as " not the cause of proteinuria" in certain conditions like
1. very short duration of diabetes
2. rapid increase in proteinuria
3. blood in urine
4. very high proteinuria
5. rapid rise in creatinine
6. any systemic disease other than diabetes
. We need to suspect other reasons of proteinuria and do a biopsy
Biopsy is safe and simple and not associated with any major complications. she can safely undergo biopsy . You didn't mention about 24 hrs urine protein in urine as I could see only routine urine showing 2 + protein only.
yes
Detailed Answer:
Gestational diabetes is a risk factor for the development of diabetes later in life, especially those with the family history of diabetes. Though metformin is good, Insulin is required during pregnancy. I feel that she was treated well.
patients with diabetes are at risk for kidney injury any time in their life time. However it requires to pass some duration before manifesting as protein in urine ( called proteinuria) which is the earliest marker of kidney injury. Any amount of protein above 1 gm is considered significant. diabetes with proteinuria is routinely suspected to be due to diabetes not due to any other cause which we se in non diabetic people. However, we need to suspect diabetes as " not the cause of proteinuria" in certain conditions like
1. very short duration of diabetes
2. rapid increase in proteinuria
3. blood in urine
4. very high proteinuria
5. rapid rise in creatinine
6. any systemic disease other than diabetes
. We need to suspect other reasons of proteinuria and do a biopsy
Biopsy is safe and simple and not associated with any major complications. she can safely undergo biopsy . You didn't mention about 24 hrs urine protein in urine as I could see only routine urine showing 2 + protein only.
Above answer was peer-reviewed by :
Dr. Prasad
Hi, I have provided some attachments. Please review them.
Dear Sir,
Because of space constraints at www.healthcaremagic.com, all the reports of my wife, XXXXXXX XXXXXXX could not be uploaded.
Hence, I have sent all the reports of my wife including 24 hrs urine protein reports as asked by you through Email attachments to YYYY@YYYY .
I,therefore, request you to kindly go through all the reports attached with the Email & advise accordingly. Let us also know the approximate cost of the biopsy procedure & whether it is done under local anaesthesia?
XXXXXXX XXXXXXX
Dear Sir,
Because of space constraints at www.healthcaremagic.com, all the reports of my wife, XXXXXXX XXXXXXX could not be uploaded.
Hence, I have sent all the reports of my wife including 24 hrs urine protein reports as asked by you through Email attachments to YYYY@YYYY .
I,therefore, request you to kindly go through all the reports attached with the Email & advise accordingly. Let us also know the approximate cost of the biopsy procedure & whether it is done under local anaesthesia?
XXXXXXX XXXXXXX
Brief Answer:
Two ways to deal with it
Detailed Answer:
Hi again and I have gone through your reports.
I have seen the 24 hrs protein report. Its just above 1 gm.
Its of two types. You can wait and take treatment while watching proteinuria. Or otherwise you can under go renal Biopsy and see whether there are any changes wowrth. I personally feel that her biopsy report would be an early diabetic nephropathy.
I also feel that you can wait while continuing therapy with ACE inhibitor or ARB group of drug.
Two ways to deal with it
Detailed Answer:
Hi again and I have gone through your reports.
I have seen the 24 hrs protein report. Its just above 1 gm.
Its of two types. You can wait and take treatment while watching proteinuria. Or otherwise you can under go renal Biopsy and see whether there are any changes wowrth. I personally feel that her biopsy report would be an early diabetic nephropathy.
I also feel that you can wait while continuing therapy with ACE inhibitor or ARB group of drug.
Above answer was peer-reviewed by :
Dr. Vaishalee Punj
Dear Sir,
Thanks for your kind reply.
As informed earlier, my wife is taking following medicines at present as advised by the Doctor.
1. GP1(Glimepiride IP- 1 mg) - one tab. daily before breakfast for last three months(Earlier GP 0.5 since March'2014)
2. Telema 20(Telmisartan IP- 20mg) - one & half tablets daily at night
3. Rosave 10(Rosuvastatine Calcium IP 10mg)- one tablet daily at night
4. Nefrosave Forte(Acytyl Cysteine USP 300mg & Pyridoxamine Dihydrochloride 50mg)- one tablet daily(Stopped from August'2014 after consultation at Apollo Hospital, Chennai)
5. Folic Acid IP 5mg- one tablet daily
6. Neurobion Forte(Vitamin)- one tablet daily
Kindly let us know whether any other medicines are to be taken as you said to continue therapy with ACE inhibitor or ARB group of drug.
You feel that this may be a case of an early diabetic nephropathy. If so, can't it be treated completely? Kindly let us know Sir.
Let us also know the approximate cost of the biopsy procedure & whether it is done under local anaesthesia?
Thanks & regards,
XXXXXXX XXXXXXX
Thanks for your kind reply.
As informed earlier, my wife is taking following medicines at present as advised by the Doctor.
1. GP1(Glimepiride IP- 1 mg) - one tab. daily before breakfast for last three months(Earlier GP 0.5 since March'2014)
2. Telema 20(Telmisartan IP- 20mg) - one & half tablets daily at night
3. Rosave 10(Rosuvastatine Calcium IP 10mg)- one tablet daily at night
4. Nefrosave Forte(Acytyl Cysteine USP 300mg & Pyridoxamine Dihydrochloride 50mg)- one tablet daily(Stopped from August'2014 after consultation at Apollo Hospital, Chennai)
5. Folic Acid IP 5mg- one tablet daily
6. Neurobion Forte(Vitamin)- one tablet daily
Kindly let us know whether any other medicines are to be taken as you said to continue therapy with ACE inhibitor or ARB group of drug.
You feel that this may be a case of an early diabetic nephropathy. If so, can't it be treated completely? Kindly let us know Sir.
Let us also know the approximate cost of the biopsy procedure & whether it is done under local anaesthesia?
Thanks & regards,
XXXXXXX XXXXXXX
Brief Answer:
aound ten thousand
Detailed Answer:\
Hi,
ACE inhibitor or ARB can be given to any hypertensive more do for the people with diabetes and especially with dome proreinuria. you'd doctor must have written that or probably would write soon
renal biopsy us a simple bed side procedure and will be done under local anaesthesia. it has no major complications and is safe. the cost varies from hospital to hospital and a ideally shouldn't bust more than 10000/.
Regards
aound ten thousand
Detailed Answer:\
Hi,
ACE inhibitor or ARB can be given to any hypertensive more do for the people with diabetes and especially with dome proreinuria. you'd doctor must have written that or probably would write soon
renal biopsy us a simple bed side procedure and will be done under local anaesthesia. it has no major complications and is safe. the cost varies from hospital to hospital and a ideally shouldn't bust more than 10000/.
Regards
Note: For further queries related to kidney problems and comprehensive renal care, talk to a Nephrologist. Click here to Book a Consultation.
Above answer was peer-reviewed by :
Dr. Raju A.T
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