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Old 12-02-2011
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ObGyn Management of diabetes in pregnancy

A 35-year-old woman with type 2 diabetes comes to your office seeking pregnancy advice. Although she is not currently pregnant and has never been pregnant, she and her spouse are planning to have their first child. She has previously managed her diabetes with diet and exercise. Approximately 4 months ago, however, you started her on metformin, as her fasting blood glucose levels were consistently elevated. Her hemoglobin A1c level at that time was 9%. She has no specific complaints today and her physical examination is unremarkable. A hemoglobin A1c level drawn 1 week before today’s visit is 6.2%. She would like to know which, if any, diabetic medications she can take during her pregnancy. Which of the following is the most appropriate pharmacologic monotherapy for her?

A. Acarbose
B. Glyburide
C. Insulin
D. Metformin
E. No medication, continue diet and exercise
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Old 12-02-2011
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C. Insulin
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Old 12-02-2011
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C. Insulin
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Old 12-03-2011
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cant she continue on metformin atleast for the first trimester?
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Old 12-03-2011
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i m with insulin
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Old 12-03-2011
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C. Insulin
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Old 12-04-2011
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Quote:
Originally Posted by sonu.agarwall View Post
cant she continue on metformin atleast for the first trimester?
in pregnancy, Diet modification and Insulin are treatment.
You dont use other med what we use in non pregnant person...
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Old 12-04-2011
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The correct answer is C. Tight glucose control during pregnancy, particularly the first 10 weeks when organogenesis occurs, is essential to avoid congenital malformations and spontaneous abortion. Insulin is the only treatment proven safe during pregnancy. Insulin should be used in patients with types 1 and 2 diabetes and the appropriate amount necessary to tightly control blood glucose should be determined before pregnancy.
Acarbose (choice A) is theoretically a safe drug, as it acts mainly within the gut lumen, with only a small amount of systemic absorption. Its safety in pregnancy has not been proven, however. Further, it is not very effective at controlling glucose levels when used as monotherapy. Other oral diabetic medications, such as glyburide and metformin (choices B and D), are potentially teratogenic.
Tight diabetes control is essential. Diet and exercise alone (choice E) have previously failed to control this woman’s diabetes, as evidenced by an elevated hemoglobin A1c level. With this in mind, the safest course of action is to treat her diabetes with insulin
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Old 08-14-2012
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Gestational diabetes is Changing hormones and weight gain are part of a healthy pregnancy. But both changes make it hard for your body to keep up with its need for a hormone called insulin .

Signs of Pregnancy
Morning sickness
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