Re: Metformin, early pregnancy and glucose screening
From: Braun, R. Daniel (rbraun@iupui.edu)
Thu Oct 7 13:46:15 2004
The 50 gm test is a screen for NORMAL patients. Patients with prior 4500
gm babies, weight >220 pounds(100 Kilos), parents with DM, or hx of
prior GDM have already failed a screen and need the GOLD test (3 hour
GTT)
Dan
R. Daniel Braun, MD
"If everyone likes you, you're doing something wrong."
Kinky Friedman
I believe a self-righteous liberal or conservative with a cause is more
dangerous than a Hell's Angel with an attitude.
Andy Rooney
-----Original Message-----
From: ob-gyn-l@obgyn.net [mailto:ob-gyn-l@obgyn.net] On Behalf Of Garry
E. Siegel, M.D.
Sent: Thursday, October 07, 2004 1:30 PM
To: Multiple recipients of list OB-GYN-L
Subject: Re: Metformin, early pregnancy and glucose screening
We also do the 50 gm. test for those who were prior gestational
diabetics who did not have interval screening, FWIW.
Garry
At Wed, 6 Oct 2004, Charlie Chambers wrote:
>
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>The association with pregnancy loss and anomalies is with Type 1
>diabetics, not gestational diabetics. Fasting glucose has been
>suggested to be the preferred test for Type 1 diabetics. Hopefully, the
>patient has had an interval screen, but all too often, I see the
>patient and she hasn't had any diabetes screening after a prior
>pregnancy with gestational diabetes.
>***********************************************************************
>*
>*
>***********************************************************************
*
>
>--
>Charlie Chambers
>Hood River, OR
>cchamber@alumni.rice.edu
>
>"No matter where you go...
> there you are."
>Dr. Buckaroo Banzai
>***********************************************************************
>*
>On Oct 6, 2004, at 8:47 PM, Steve & Eryl Raymond wrote:
>***********************************************************************
*
>
>> Can't agree with this at all. One of the effects of glucose
>> intolerance is to increase first trimester pregnancy loss, and
>> another is increased fetal abnormality; so not doing your test until
>> 28 weeks means you are missing any chance of changing these. Since
>> when did a fasting rule out a pre-existing diabetic?? Steve
>>
>> Charlie Chambers wrote:
>>
>>> To me, it doesn't make much sense to do the 50 gm test prior to 28
>>> weeks for reasons already outlined. if I was going to test early in
>>> pregnancy, I would do a fasting to rule out a pre-existing diabetic.
>>>
>>> On Oct 6, 2004, at 8:09 AM, Richard Chudacoff, MD wrote:
>>>
>>>> Do you re-screen at 28 weeks when the HPL is increased if the first
>>>> test is negative?
>>>>
>>>> Richard Chudacoff, MD
>>>>
>>>> -----Original Message-----
>>>> From: ob-gyn-l@obgyn.net [mailto:ob-gyn-l@obgyn.net] On Behalf Of
>>>> Garry E. Siegel, M.D.
>>>> Sent: Tuesday, October 05, 2004 7:44 PM
>>>> To: Multiple recipients of list OB-GYN-L
>>>> Subject: Re: Metformin, early pregnancy and glucose screening
>>>>
>>>> 50 grams glucose randomly followed by a serum glucose in an hour,
>>>> just like 24 to 28 weeks.
>>>>
>>>> I have no literature other than what I thought was the propensity
>>>> to be more likely to be diabetic during pregnancy if a mature
>>>> gravida. Thus,
>>>> we are screening early and late on those 35 or more.
>>>>
>>>> Garry
>>>>
>>>> At Tue, 5 Oct 2004, Braun, R. Daniel wrote:
>>>>
>>>>> What screen do you do at the initial visit? What literature do
>>>>> you have to validate that screen?
>>>>>
>>>>> Dan
>>>>>
>>>>> R. Daniel Braun, MD
>>>>>
>>>>> "If everyone likes you, you're doing something wrong."
>>>>>
>>>>> Kinky Friedman
>>>>>
>>>>> I believe a self-righteous liberal or conservative with a cause is
>>>>> more dangerous than a Hell's Angel with an attitude.
>>>>>
>>>>> Andy Rooney
>>>>>
>>>>> -----Original Message-----
>>>>> From: ob-gyn-l@obgyn.net [mailto:ob-gyn-l@obgyn.net] On Behalf Of
>>>>> Garry E. Siegel, M.D.
>>>>> Sent: Tuesday, October 05, 2004 9:35 AM
>>>>> To: Multiple recipients of list OB-GYN-L
>>>>> Subject: OB: Metformin, early pregnancy and glucose screening
>>>>>
>>>>> 37 YO P1001 at 9 weeks, on metformin for insulin resistance. She
>>>>> is not overtly diabetic, and has a viable pregnancy. The
>>>>> referring REI has suggested that she stay on Metformin until 12
>>>>> weeks.
>>>>>
>>>>> Normally, we screen for gestational diabetes at the initial visit
>>>>> for 35 or mores, or if insulin resistant.
>>>>>
>>>>> Does anyone have any thoughts/information/reference as to whether
>>>>> she should delay her glucose screen until AFTER she stops
>>>>> Metformin, or not?
>>>>>
>>>>> The MFM and I both are using obstetric horse sense to say wait
>>>>> until after 12 weeks.
>>>>>
>>>>> Garry
>>>>>
>>>>> --
>>>>> Garry E. Siegel, M.D.
>>>>> Private Practice
>>>>> Roswell, GA
>>>>>
>>>> --
>>>> Garry E. Siegel, M.D.
>>>> Private Practice
>>>> Roswell, GA
>>>>
>>> ********************************************************************
>>> **
>>> ** ****
>>>
**********************************************************************
>>> Charlie Chambers
>>> Hood River, OR USA
--
>>> cchamber@alumni.rice.edu
>>>
>>> "...not because I regard fishing as being so terribly important but
>>> because I suspect that so many of the other concerns of men are
>>> equally unimportant-and not nearly so much fun."
>>> John Voelker
>>>
**********************************************************************
>>> ** *****
>>>
**********************************************************************
>>>
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><fontfamily><param>Lucida Grande</param>The association with pregnancy
>loss and anomalies is with Type 1 diabetics, not gestational diabetics.
>Fasting glucose has been suggested to be the preferred test for Type 1
>diabetics. Hopefully, the patient has had an interval screen, but all
>too often, I see the patient and she hasn't had any diabetes screening
>after a prior pregnancy with gestational diabetes. </fontfamily>
>
><fontfamily><param>Helvetica</param>***********************************
>**************************************
>
><fontfamily><param>Helvetica</param>***********************************
>**************************************
>Charlie Chambers
>
>Hood River, OR
>
>cchamber@alumni.rice.edu
>
>"No matter where you go...
>
> there you are."
>
>Dr. Buckaroo Banzai
>
>***********************************************************************
>*</fontfamily>
>
>***********************************************************************
>*</fontfamily>
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>
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>
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>
>Roswell</fontfamily>, <fontfamily><param>Lucida Grande</param>GA
>
></fontfamily></excerpt>************************************************
>************************
>****
></fontfamily></excerpt>************************************************
************************
>
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>
><fontfamily><param>Lucida Grande</param>John</fontfamily>
><fontfamily><param>Lucida Grande</param>Voelker
>
></fontfamily>**********************************************************
>**************
>*****
></fontfamily>**********************************************************
**************
>
></excerpt>
>
></excerpt>
>--Apple-Mail-1-703103583--
>
--
Garry E. Siegel, M.D.
Private Practice
Roswell, GA
