What happens after gestational diabetes?

I met a woman a few weeks ago in the hospital. The cardiologists asked me to see her to help manage her diabetes, which on first glance did not appear so bad: her blood sugars were okay, not too high, even though she was not taking any medication. When I spoke to her, she said she was “diet controlled”, but 27 years ago, when she was pregnant, she did have diabetes while pregnant. During that time, she was treated with insulin.{{more}}

I asked what happened after your delivery of your child? She said, “Oh, my sugars were fine, I think. I never checked them anymore and my doctor never did anything.”

I looked back through her lab tests and about four years ago, I found that she had a hemoglobin A1C (that lab test that tells you how your blood sugars are doing over the long term) that was quite high, but she insisted that she never took any medications after her pregnancy, over 20 years ago. I asked her about the four years back when her sugars look like they WERE high, and she said no, she just decided to manage it with diet only.

Here was the kicker: When I looked closely at all her lab studies now that she was in the hospital for the heart problem, I noticed something very bad. She now looked to have kidney disease, whereas a few years ago she did not. The kidney specialists were called in to see her and yes, they agreed she indeed was now at stage three kidney disease, and they suspected it was from years of untreated diabetes. How could this have happened? This woman now had blood sugars that looked okay; how could she have kidney disease from diabetes?

Unfortunately, this is not that uncommon. The massive mistake was not paying close attention after she delivered her child those many years ago. Based on the fact that her blood sugars were high up until four years ago, she most likely developed type 2 diabetes, unrelated to her pregnancy, or continued having high blood sugars afterwards, for many years. Her “diet control” had not managed her diabetes at all, but instead left it to ravage her body, including her heart and kidneys, which were now failing. At 52 years of age. How sad is that?

Don’t let this happen to you!!!! Remember: if you are diagnosed with diabetes when you are pregnant, you have a 50 per cent chance of developing Type 2 diabetes throughout the rest of your lifetime!!!! The mistake here, was taking her eye off this disease once she delivered and most likely her doctor made the same mistake. This woman should have had her blood checked every year, given her risk for developing diabetes in future, especially given that she was ALSO obese AND had a strong family history of diabetes. Perhaps they could have caught and treated her diabetes sooner.

So, how come her sugars were okay now? Interestingly, that often happens with diabetes: once you develop kidney failure, often your sugars get better and you need less medication. But what a high price to pay. This woman’s body was destroyed from years of untreated sugars. She has heart failure and will likely need dialysis soon. Don’t let this happen to you. IF you are diagnosed with diabetes while pregnant, be sure to have regular blood tests every year, to make sure this disease has not returned in the form of Type 1 diabetes. It is up to you to be vigilant. Talk to your doctor about it.

Until next week, stay safe and healthy Vincies!

Anita Ramsetty, MD endodocs@endocrinehelp.com
Medical Director Endocrine Care Group
www.endocrinehelp.com
Tel: 843-798-4227