Jacquie Nutt queried:

<While it's great to have a mother so committed to turning things around, I
also have a concern about her blood sugars.  Is the sudden feeding and
possible increase in supply going to play havoc with her blood sugars and
metformin needs?>

I can't answer your question about the baby, but this one I can weigh in on. If this mother is only on metformin, it shouldn't be a concern. 

It is now recognised that close monitoring of blood sugars in diabetes is only necessary in situations where there is a risk of *low* blood sugar due to the medication; typically, when the patient is on insulin. Although some of the oral medications do carry some risk of low blood sugar (to a lesser degree than insulin) metformin is not one of those, and I would not have fears that this patient might be going dangerously hypoglycaemic.

As for changes in the other direction - well, obviously I wouldn't expect the extra feeding to cause an unduly high blood sugar anyway, but, even if it did, that isn't an emergency situation unless it's reaching ridiculously high levels, which, again, I would have no fears of in this situation. (In Type 1 diabetes high blood sugars can be an early sign of a developing ketoacidosis, which is a much more urgent situation but doesn't develop in Type 2. This is often misunderstood and leads to people getting very worried about high blood *sugars* when in fact the worry is whether *ketoacidosis* is going to develop. Ketoacidosis is caused by lack of insulin; it develops alongside high blood sugar but isn't caused by it. Type 2 diabetics still make some insulin and hence ketoacidosis isn't a worry.)

Of course, Type 2 diabetics still need sugar monitoring; it just doesn't have to be on the same kind of acute day-to-day basis (unless they take insulin as part of their treatment). Monitoring is done by a different type of blood test that indicates general glucose control over approximately the previous 3 months, thus this is done three months after a change in the medication regime, or on a regular annual basis if the medication regime is unchanged).

Sorry, got a bit carried away due to being quite interested in the subject (as you can tell from my career choice, I find illnesses and pathophysiology very interesting!) The tl; dr version is that, no, you don't have to be concerned about the mother's blood glucose.

Best wishes,

Dr Sarah Vaughan, MBChB MRCGP
GMC no. 4193096

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