Re: Glyburide
From: Anna Meenan, MD (annam@uic.edu)
Wed Mar 23 15:49:02 2005
Just got a new ACOG Practice Bulletin on pregestational diabetics and
the recommendation for pregestational DM is allow to go to due date if
well-controlled and otherwise healthy with good testing. I would assume
that gestational diabetics could also be allowed to go to due date if
well-controlled. My ACOG bulleting on gestational DM is at the office.
--
Anna Meenan, MD
At Wed, 23 Mar 2005, Lynn D. Montgomery, M.D. wrote:
>
>Glen,
>I use fasting and two hour postprandial values (and occasional Hgb A1C's for
>those I don't believe). The delivery question is a good one and not clearly
>answered as yet. I compromise between a diet controlled and an
>insulin-dependent diabetic and deliver at 38 weeks. I also lean more toward
>an insulin-dependent diabetic with regard to fetal surveillance and do
>weekly BPP's from 34 weeks.
>Lynn
>
>--
>Lynn D. Montgomery, M.D.
>Maternal-Fetal Medicine, OB/GYN
>Rocky Mountain Women's Health
>2835 Fort Missoula Rd., Suite 304
>Missoula, Montana, 59804
>406-549-0978
>fax 406-549-0987
>e-mail: apgar10@montanadsl.net
>
> _____
>
>From: ob-gyn-l@obgyn.net [mailto:ob-gyn-l@obgyn.net] On Behalf Of Elrod
>Darryl G MAJ 48 MDOS/SGOBO
>Sent: Wednesday, March 23, 2005 1:25 PM
>To: Multiple recipients of list OB-GYN-L
>Subject: Re: Glyburide
>
>Lynn,
>
>Do you test them as you would an A2 on insulin? Do you still recommend
>delivery at or about 39 weeks?
>
>Thanks,
>
>Glen
>
> _____
>
>From: ob-gyn-l@obgyn.net [mailto:ob-gyn-l@obgyn.net] On Behalf Of Lynn D.
>Montgomery, M.D.
>Sent: Wednesday, March 23, 2005 5:47 PM
>To: Multiple recipients of list OB-GYN-L
>Subject: Glyburide
>
>I have been using it for several years. The South Africans have been using
>the oral hypoglycemics for many years and have good data on them. In this
>country, Langer, et al, who was in San Antonio and now New York, did great
>work using a placental model and demonstrated its relative safety.
>
>I start out with 5 mg per day and increase to a max of 20 mg per day, then
>if further control is needed, change over to insulin. There is at least one
>paper recently where they added insulin to the Glyburide. I haven't done
>that.
>
>Interesting note on a couple of papers at the Society meeting last month
>that addressed Glyburide therapy was that there seemed to be an increased
>incidence of patients using Glyburide therapy developing preeclampsia late
>in pregnancy. Obviously small studies and difficult to sort through the
>issue that this subset of patients may be at increased risk of developing
>preeclampsia. The standard line fits: This needs to be looked at in a
>larger population.
>
>Lynn
>
>Lynn D. Montgomery, M.D.
>
>Maternal-Fetal Medicine, OB/GYN
>
>Rocky Mountain Women's Health
>
>2835 Fort Missoula Rd., Suite 304
>
>Missoula, Montana, 59804
>
>406-549-0978
>
>fax 406-549-0987
>
>e-mail: apgar10@montanadsl.net
>
