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by Calvagna M

Medications for Gestational Diabetes

The information provided here is meant to give you a general idea about each of the medicines listed below. Only the most general side effects are included, so ask your doctor if you need to take any special precautions. Use each of these medicines as recommended by your doctor, or according to the instructions provided. If you have further questions about usage or side effects, contact your doctor.
Your doctor will try to control your gestational diabetes with diet and exercise. If that is not successful, you may need to take insulin or other medicines to control your blood sugar levels.

Insulin Injections

Insulin is a hormone produced in the pancreas. Insulin’s main job is to lower blood sugar levels by facilitating the transfer of glucose from the blood to tissue cells. Gestational diabetes occurs when hormones produced during pregnancy block the effects of insulin. This blocking effect creates a condition known as insulin resistance. If diet alone does not control the blood sugar level, insulin is usually prescribed.
There are many different types of insulin that can be prescribed. Some work faster but for shorter periods of time, and others stay in the system all day. Your doctor will choose which type of insulin is correct for you to use.
Treatment aims to keep blood sugar levels within a normal range. The optimum goal for a woman with gestational diabetes is a blood sugar level of:
  • 95 milligrams per deciliter (mg/dL) [5.3 mmol/L] or less at fasting
  • 140 mg/dL (7.8 mmol/L) or less one hour after a meal
  • 120 mg/dL (6.7 mmol/L) or less two hours after a meal
One important part of taking care of your condition is to monitor your blood sugar levels throughout the day. If you need insulin, your doctor will work with you to calculate the right amount needed to keep blood sugar levels within a healthy range for you. This amount may increase as your pregnancy advances. Also, the dose of insulin may need to be adjusted during times of emotional or physical stress (such as, having an infection, exercising a lot).
The main risk of taking insulin is that it can cause your blood sugar to go too low. This can be very dangerous. If you are taking insulin, it is important to notice any strange feelings, such as confusion, sweating, or anxiety . If you have any feelings like this, you should check your blood sugar level. If it is low, it can be increased quickly with by eating or drinking something that has plenty of sugar, like juice or regular cola.

Oral Medicines

Oral medicines are not currently approved by the Food and Drug Administration (FDA) for gestational diabetes, your doctor may recommend that you take oral medicines to help control your blood sugar levels. These oral medicines work in different ways depending on which type of drug they are. Some examples of medicines that may be prescribed to control your blood sugar levels include:
  • Metformin (such as, Fortamet, Glucophage)—works in the liver to lower the production of glucose and makes your body more sensitive to insulin
  • Glyburide (such as, DiaBeta, Glynase, PresTab)—stimulates the body to make more insulin and helps the cells use the insulin better
Side effects of these medications include:
  • Low blood sugar symptoms:
    • Shakiness
    • Hunger
    • Irritability
    • Dizziness
    • Fast heartbeat
    • Headache
  • Nausea and vomiting
  • Stomach pain (metformin)
  • Diarrhea (metformin)
  • Loss of appetite (metformin)
  • Abnormal taste (metformin)

Special Considerations

Whenever you are taking a prescription medication, take the following precautions:
  • Take your medication as directed. Do not change the amount or the schedule.
  • Do not stop taking them without talking to your doctor.
  • Do not share them.
  • Know what the results and side effects. Report them to your doctor.
  • Some drugs can be dangerous when mixed. Talk to a doctor or pharmacist if you are taking more than one drug. This includes over the counter medication and herb or dietary supplements.
  • Plan ahead for refills so you do not run out.

When to Contact Your Doctor

Call your doctor right away or call 911 if you have a serious complication to the medication, such as:
  • Seizures or convulsions
  • Unconsciousness
  • Recurrent or extreme low blood sugar

References

The American College of Obstetricians and Gynecologists. Diabetes and pregnancy. The American College of Obstetricians and Gynecologists website. Available at: http://www.diabetes.org. Accessed July 2010.
American Diabetes Association website. Available at: http://www.diabetes.org.
American Diabetes Association. Standards of medical care in diabetes 2010. Diabetes Care. 2010;33 Suppl 1:S11-61.
Gestational diabetes. The American College of Obstetricians and Gynecologists Practice Bulletin. No. 30. Sept. 2001.
Gestational diabetes mellitus. JAMA. 2001;286:2516-2518.
Gutzin S, Kozder E, et al. Safety of oral hypoglycemic agents in the first trimester of pregnancy: a meta-analysis. Can J Pharm. 2003;10(4):179-183.
Landon MB, Spong CY, et al. for MFMU Network: A multicenter, randomized trial of treatment for mild gestational diabetes. N Engl J Med. 2009;361:1339-1348.
Lexi-PALS. Glyburide. EBSCO Health Library, Lexi-PALS website. Available at: http://www.ebscohost.com/healthLibrary. Updated November 17, 2011. Accessed April 1, 2011.
Lexi-PALS. Metformin. EBSCO Health Library, Lexi-PALS website. Available at: http://www.ebscohost.com/healthLibrary. Updated February 17, 2011. Accessed April 1, 2011.
National Institute of Child Health & Human Development website. Available at: http://www.nichd.nih.gov.
Perkins JM, Dunn JP, et al. Perspectives in gestational diabetes mellitus: a review of screening, diagnosis, and treatment. Clin Diabetes. 2007;25:57-62.
Schroeder K. Medications for type 2 diabetes. EBSCO Health Library website. Available at: http://www.ebscohost.com/healthLibrary. September 9, 2010. Updated April 1, 2011.
Seiji TL, Brown AJ, et al. Gestational diabetes mellitus. Clinical Diabetes. 2005; 23:17-24.
Standards of Medical Care in Diabetes 2006 III. Detection and diagnosis of gestational diabetes mellitus. Diabetes Care. 2006;29:S7
Turok DK, Ratcliffe SD, et al. Management of gestational diabetes mellitus. Am Fam Physician. 2003;68:1767-1772.
4/1/2011 DynaMed's Systematic Literature Surveillance http://www.ebscohost.com/dynamed/what.php. Dhulkotia JS, Ola B, et al. Oral hypoglycemic agents vs insulin in management of gestational diabetes: a systematic review and meta-analysis. Am J Obstet Gynecol. 2010;203(5):457.e1-9.

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