Glyburide called boon for 'brittle' dabetics in pregnancy. (Combined with Insulin).

BIG SKY, MONT. -- Dr. Jodi Schucker finds the use of glyburide in women with gestarional diabetes has made a real difference in her practice.

"I was always taught that you cant use anything like this in pregnancy But now there are wonderful studies showing the drug does not cross the placenta well, it does not last very long, and there's no trace of the medication when you look in the newborn's blood. So I feel very safe in using it. And I think most of my patients like the glyburide better than insulin," she said at an ob.gyn. update sponsored by the Geisinger Health System.

While most patients appreciate having an alternative to self-injected insulin, there are two situations where Dr. Schucker has found glyburide to be indispensable.

One is in the "brittle" diabetic patient. Combining insulin with glyburide in such patients greatly improves their diabetic control. Their problematic and challenging blood glucose peaks and valleys become much less extreme than with the use of insulin alone.

The other situation where glyburide has proved a great boon is in the occasional gestational diabetic patient who needs medication to achieve good metabolic control but whose aversion to taking insulin is so overpowering that she just won't consider the prospect.

"I can tell you that about once a month I get a patient like that," said Dr. Schucker, a perinatologist at Geisinger Medical Center in Danville, Pa.

Studies indicate only 0.2% of glyburide crosses the placenta. The other 99.8% is protein bound. The drug's half-life is 4 hours. Analysis of cord blood samples of newborns whose ...