Brief Answer:
Metformin can be continued with close monitoring of blood sugar levels.

Detailed Answer:
Hi,

Thanks for your question.
Noted your concern.

There are different types of artificial sweeteners many of them can be used in pregnancy in moderate amount.

Metformin can be continued in pregnancy depending upon blood sugar levels.
In pregnancy tight blood sugar control is required to avoid complications in both mother and baby.

Considering her fasting and post-prandial blood sugar levels there may be need for increasing the dose of Metformin with close monitoring of blood sugar levels.
Recommended blood sugar levels in pregnancy are premeal, bedtime, and
overnight blood glucose 60–99 mg/dl, peak postprandial glucose 100–129 mg/dl, and HbA1C 6.0.
Though these targets need to be individualized in each patient depending upon current blood sugar levels, medications and hypoglycemia risk.

If even with increasing the dose of metformin blood sugar levels are not within target range then insulin is the only option. Insulin gives rapid and reliable blood sugar control.

I may suggest to consult near by diabetologist or endocrinologist as physical examination, one to one counselling and with frequent follow ups are important.

Hope this helps.

Regards,
Dr. Abhay Mali.
Diabetologist.

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Brief Answer:
May suggest to increase dose of Metformin with blood sugar monitoring.

Detailed Answer:
HbA1c of 6.4 denote good blood sugar control.
I may suggest to increase dose of metfromin to 1500mg per day in divided doses over a period of 7 to 10 days.
With monitoring blood sugar level with glucometer at home.
I may suggest to monitor-
- Fasting
- 2 hours after breakfast.
- 2 hours after Lunch.
- 2 hours after dinner.
May suggest to give trial of increased dose of metformin for a period of 2 to 3 weeks.
If blood sugar levels are not within limits Insulin should be considered.

Obviously Final decision should be taken by her treating diabetologist.

Hope this helps.

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