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Will Taking Diabetic And Thyroid Pills Hamper The Growth Of My Fetus ?
Question: hi, im 33 years old female ,weight 70 kg, height 154cms, last year in may i was diagonised with hypothyroidism , just five months back it was revealed i had prediabetes as i was trying to conceive from last year i opted for healthy life style i realised within one month i conceived. my concern is im having fasting blood sugar level 0f 110, random 172,and 131 sugar level after every meal, my doctor has put me on glyciphage 500 mg thrice half after every meal, for thyroid thyronorm 100 once and novorapid insulin 4 ml thrice with every meal and im on weekly testing pattern, i feel everytime there is raise in sugar level with 10-20 points of sugar level and my doctor increase insulin from 4ml to 8ml, is it really working what will be my health if i continue this medication is there adverse affect on my growing baby can you guide me ,
Hi,
Thanks for your query.
What you have is known as pre gestational diabetes - that is you have developed diabetes before onset of pregnancy at a relatively young age. The main problem with this is that the high glucose value might affect your growing baby; specifically it may cause your baby to grow too big making delivery difficult. It may also result in jaundice or low glucose in baby after delivery. So achieving a near normal glucose is essential for you at this time.
The treatments given to you by your doctor are appropriate.
We usually target glucose of below 90 fasting and below 140mg/dl 1 hr post meal. You should ideally test every day and be in frequent touch with your endocrinologist or diabetologist.
These regimens may seem too aggressive when you compare yourself with non pregnant patients -but you have to understand that this line of treatment is being done keeping your baby in mind. It will be more relaxed after the delivery - perhaps only tablets or at the most one or two shots of insulin.
Regarding your concern regarding adverse effect I want to reassure you
1) The baby will only benefit from treatment
2) Your glucose control will also be better after delivery if you take appropriate treatment now
3) There is a small risk of hypoglycaemia - low glucose causing giddiness and sweating. This is because we are giving insulin frequently and also increasing the doses rapidly. So frequent monitoring is advised.
If you recognise symptoms early you can take carbohydrates (sugar). Yet the chances of you getting very low glucose and losing consciousness are negligible.
Coming to the thyroid replacement you need to have the Thyroid Stimulating Hormone (TSH) below 3 at all times. This might warrant taking a slightly higher dose than your pre pregnancy dose. You need to check your TSH and decide what to do after consulting your endocrinologist.
Thyroid supplement won’t cause any side effects if the TSH levels are maintained appropriately.
I hope the information was useful. Let me know if you need information.
Regards
Dr. Anantharaman
Thanks for your query.
What you have is known as pre gestational diabetes - that is you have developed diabetes before onset of pregnancy at a relatively young age. The main problem with this is that the high glucose value might affect your growing baby; specifically it may cause your baby to grow too big making delivery difficult. It may also result in jaundice or low glucose in baby after delivery. So achieving a near normal glucose is essential for you at this time.
The treatments given to you by your doctor are appropriate.
We usually target glucose of below 90 fasting and below 140mg/dl 1 hr post meal. You should ideally test every day and be in frequent touch with your endocrinologist or diabetologist.
These regimens may seem too aggressive when you compare yourself with non pregnant patients -but you have to understand that this line of treatment is being done keeping your baby in mind. It will be more relaxed after the delivery - perhaps only tablets or at the most one or two shots of insulin.
Regarding your concern regarding adverse effect I want to reassure you
1) The baby will only benefit from treatment
2) Your glucose control will also be better after delivery if you take appropriate treatment now
3) There is a small risk of hypoglycaemia - low glucose causing giddiness and sweating. This is because we are giving insulin frequently and also increasing the doses rapidly. So frequent monitoring is advised.
If you recognise symptoms early you can take carbohydrates (sugar). Yet the chances of you getting very low glucose and losing consciousness are negligible.
Coming to the thyroid replacement you need to have the Thyroid Stimulating Hormone (TSH) below 3 at all times. This might warrant taking a slightly higher dose than your pre pregnancy dose. You need to check your TSH and decide what to do after consulting your endocrinologist.
Thyroid supplement won’t cause any side effects if the TSH levels are maintained appropriately.
I hope the information was useful. Let me know if you need information.
Regards
Dr. Anantharaman
Above answer was peer-reviewed by :
Dr. Prasad
thanks for your valuable advice sir!
I know it is for my well being , but please do guide on diet restriction how much it is required?for thyroid my tsh level are under 3 level but t4 was 18 my doc said it is normal in pregnancy, as im about to complete 5 months in next week.
as discussed i had mention about embryo reduction from twins to singleton in 12 week of my pregnancy i want to know whether this reduction and my diabetes can affect remaining child will he be normal .
Im gone through double marker test and result were alright but will my diabetes can cause any abnormalities beside large baby in my pregnancy, as it is common in gdm that it disappear after birth does it also apply with pre gdm cases?what is highest level of increase blood sugar in pre gdm cases like mine.
thanks your support again.
I know it is for my well being , but please do guide on diet restriction how much it is required?for thyroid my tsh level are under 3 level but t4 was 18 my doc said it is normal in pregnancy, as im about to complete 5 months in next week.
as discussed i had mention about embryo reduction from twins to singleton in 12 week of my pregnancy i want to know whether this reduction and my diabetes can affect remaining child will he be normal .
Im gone through double marker test and result were alright but will my diabetes can cause any abnormalities beside large baby in my pregnancy, as it is common in gdm that it disappear after birth does it also apply with pre gdm cases?what is highest level of increase blood sugar in pre gdm cases like mine.
thanks your support again.
Hi,
Your TSH IS FINE you can continue the same thyroid supplementation.
Pre gestational diabetes is associated with a higher degree of fetal malformation 3-5percent when compared to 1-2percent in normal pregnancies. However, you have to note that 95 percent of the time the baby will be normal.
There are tests during pregnancy to look for these. As far as reduction in the risk to embryo is concerned, it depends on the method used. You can follow the advice of your obstetrician regarding these tests.
Your diabetes is unlikely to disappear after delivery unlike GDM. Your diabetes started much earlier and you have to note that diabetes is a progressive disease it is unlikely to improve on its own- though you can control it well.
It will be best if you take the advice of a registered nutritionist, as a GDM DIET is an intricate one you might need to see the nutritionist two to three times with your glucose reports for it to be more effective.
I hope this helps you. Do write back for further clarifications.
Regards
ANANTHARAMAN
Your TSH IS FINE you can continue the same thyroid supplementation.
Pre gestational diabetes is associated with a higher degree of fetal malformation 3-5percent when compared to 1-2percent in normal pregnancies. However, you have to note that 95 percent of the time the baby will be normal.
There are tests during pregnancy to look for these. As far as reduction in the risk to embryo is concerned, it depends on the method used. You can follow the advice of your obstetrician regarding these tests.
Your diabetes is unlikely to disappear after delivery unlike GDM. Your diabetes started much earlier and you have to note that diabetes is a progressive disease it is unlikely to improve on its own- though you can control it well.
It will be best if you take the advice of a registered nutritionist, as a GDM DIET is an intricate one you might need to see the nutritionist two to three times with your glucose reports for it to be more effective.
I hope this helps you. Do write back for further clarifications.
Regards
ANANTHARAMAN
Above answer was peer-reviewed by :
Dr. Shanthi.E
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