Glyburide not recommended?

[Bonita]

I am on my 3rd pregnancy with gestational diabetes, though at this point I think I technically have "overt diabetes" as with my 2nd and now my 3rd pregnancy diabetes shows up at/before week 16.

Nonetheless, with my 2nd pregnancy I have what I think is the dawn phenomenon - my blood sugar is fine when I go to bed, but high when I wake up, and fine after eating breakfast. The OB I saw with my 2nd pregnancy put me on a very small dose of Glyburide and that controlled my fasting blood glucose wonderfully. My current OB said that Glyburide is no longer recommended, and has had me try out Metformin instead - I tried Metformin and now Metformin ER with what seems zero result. My current OB also mentioned insulin, which I am not sure when I would give myself insulin as my blood sugars are fine before bed, and are only high upon waking and the second I eat food they seem to come back to normal.

I could not find much information on Glyburide - is there a reason it would no longer be recommended? I just took it with my pregnancy in 2016, and had a very good experience with it.

[Sandra]

Bonita,

"Glyburide is a second generation sulfonylurea agent useful in the treatment of non insulin-dependent (Type II) diabetes mellitus. Experts recommend that insulin be used during pregnancy to maintain blood glucose levels as close to normal as possible. Diabeta has been shown to affect the maturation of the long bones (humerus and femur) in rat pups when given in doses 6250 times the maximum recommended human dose. These effects, which were seen during the period of lactation and not during organogenesis, are a shortening of the bones with effects to various structures of the long bones, especially in humerus and femur.There are no adequate and well-controlled studies in pregnant women. Because animal reproduction studies are not always predictive of human response, Diabeta should be used during pregnancy only if the potential benefit justifies the risk to the fetus. Because recent information suggests that abnormal blood glucose levels during pregnancy are associated with a higher incidence of congenital abnormalities, many experts recommend that insulin be used during pregnancy to maintain blood glucose levels as close to normal as possible. Prolonged severe hypoglycemia (4 to 10 days) has been reported in neonates born to mothers who were receiving a sulfonylurea drug at the time of delivery. This has been reported more frequently with the use of agents with prolonged half-lives. If Dia?eta is used during pregnancy, it should be discontinued at least two weeks before the expected delivery date."(Medications and Mothers' Milk database, Dr Thomas Hale, PhD).

Sandra Lovato R.N.
InfantRisk Center
806-352-2519

[Bonita]

Thank you for this information - my apologies for not understanding 100%, but is Diabeta the insulin, or is that what they are calling Glyburide?

Also, Metformin ER has been deemed safe? I was not able to find any information on it either, just the regular non-ER version.

[Sandra]

Bonita,

Sorry the Diabeta is another name for Glyburide. Metformin Er is ok, categorized the same as regular metformin.

Sandra