Gestational diabetes - should I try extra hard to avoid Metformin?

[MumtoF]

I am 33+2 and am self monitoring. Failed GTT last pregnancy but managed with diet but was very strict. Basically have got to the point where I need to avoid bread to keep my post meal numbers below 7. They have told me not to starve myself and I don't feel particulary hungry and I reckon I could get through the next 2 weeks (can stop testing at 35 weeks) with vast majority of my numbers in range.

If I don't I will need to go on Metformin, test until the end of pregnancy and possibly transfer my care to a different hospital. DS had no sugar problems at birth, was not big (although I think I have a poorly functioning placenta) so am assuming this baby will be fine and would like to avoid all the fuss if not necessary, but at the same time don't want to put the baby at risk.

BTW, my hospital tests before and 2 hours after meals for 3 days a week. I have read guidelines are now 1 hr after meals with a 7.8 rather than 7 cut off? Is this a problem.

Last time had a C-section at 39+2 as didn't want an induction and will do the same this time. My consultant was suggesting an induction this time but not sure inductions after a c-section are a good idea plus don't really mind having a section again.

What do they do differently after 35 weeks if you are on Metformin and what changes pre and post birth?

Don't think about it like that as in if I can just get through this and then I am home and dry.

If you are struggling with your sugars, don't hide it or cut out foods without talking to your mw, if you need metformin so be it. I am currently on this and am 33+2.

I had mild gdd before and it was a shock to find it hard this time, I was diet controlled before and this time it's worse.

Infact my GDD in my last diet was so mild it was missed and ds was born very ill.

So I have had it officially 3 times but 4 in reality. Been a breeze really using diet, however this time something is not right. Its best they have an accurate score and idea so they can monitor you accordingly IMO.

I was testing 2x a day it's now 4x and metformin worked for a week.......but my sugars are rising again so have to have another scan see cons next week.

GDD tend to get worse as the pregnancy progresses and the placenta becomes more important, don't try and under play things thinking "oh it may just go away" ifyswim?

Thanks - yes, I know what you mean, I shouldn't try to cheat! know it gets worse....Last time I pretty much cut out bread as really didn't want to go on insulin and metformin was not an option at that time. I don't plan to cut out carbs completely e.g. porridge for breakfast is less than 5 after 2 hours. Pasta & rice are OK. I will obviously stick to my current diet even when not testing for the last four+ weeks. Am just reluctant to take Metformin if it won't have much effect and might make me feel a bit ill.

It seems everyone's tests are different - mine are 6 times a day, 3 times a week. Also feel concerned that the hospital are too lenient - I need to keep my numbers to below 7 after 2 hours whereas NICE guidelines are now 7.8 after 1 hour. In some ways it might be easier to stop 'officially' testing at 35 weeks then carry on myself doing 1hr after meals and if I get any problems contact the diabetes team.

If it is not controlled what problems does it cause the baby? Apart from size (I am not worried about this..)

Hi MumtoF :)

I tried to avoid Metformin as there seems to be conflicting info about its use in pregnancy. When I was diagnosed with type 2 diabetes a couple of years ago I was very much borderline (fasting glucose test results were 7.1 with the diabetes diagnosis threshold being 7 (don't know if this varies from hospital to hospital) and I've always controlled it with diet and regular self-testing. I had no presenting symptoms - just found through routine obs for my other condition.

When we got pregnant the obstetrician linked to the endocrinology antenatal people at my hospital was determined I would take metformin or insulin and with all my other meds I didn't particularly want to, especially as my dietary control was very good and I was always within the safe range.

However, last week my glucose levels started rising and were at low 8s an hour after eating - I'm not overweight and have a good diet - so I started taking metformin 500mg a day and consulted my GP who is happy with that. for the first few days I felt pretty icky but it seems to have levelled out again now and I feel good. My levels are better, if perhaps now a little low - my GP tells me to snack in between meals, actually making it harder to monitor! Haven't had a reading above 8 since starting metformin, have had a couple below 4 though.

I have to say my antenatal diabetes team are not keen on dietary control and self monitoring so my determination to do this has caused issues between me and my obstetrician but I still believe I've done the right thing, and the various other consultants working with me have been great.

Other risks besides size are birth defects, however I would have thought any risks like this would have been identified already as you are 33 weeks. Good luck :)

Thanks Dancing Cat - I don't understand why I am told to test 2 hours afterwards - strange!

I test before meals and before bed, not after, guidelines are 7.8 1hr after and 5.8 before.

The problems I had with my last DS, was he was born small, due to placenta and, serious breathing issues and fluid on the lungs, he needed a vent for a while.

He is A ok now but that's the only GDD "free" pregnancy I had, I wasn't free of it, it was so mild it was not picked up with random testing so wasn't properly controlled or monitored until it was too late.

If it's not controlled it can cause, a failing placenta, which can happen very suddenly, breathing problems, fluid on the lungs and blood sugar crashes and excess insulin production in the baby. These are all things they know to look out for, and it's more accurate if they have a longer window to see what your body has been up to.

My other 2 who were GDD babies were fine, but I was monitored throughout, this time though god knows what is going on it's all over the place!

But dont worry as long as it's all under control then risks are minimal but that is why they may deliver early if metformin and insulin fail to stabalise sugars as it's important.

I think that different diabetes clinics have different guidance as to levels - mine says under 5 before meals, under 8 1 hour after. It is however important to test AFTER meals as well as before in order to tell how your body is managing sugars. I can't understand why I'm advised to test one hour after eating during pregnancy, when I was advised to test two hours after when not pregnant (I don't have gestational diabetes, I am type 2 diabetic). The important thing is ensuring that your blood sugars stay within the safe / recommended range - the problem is that this range seems to vary! Early delivery is due to size or other problems with the baby rather than simply poor tolerance in the mother.
Good luck everyone :)

I never have before meal problems - wake up at 4.4 and generally that before all meals. I am going to try not to cheat over the next few days and see what happens - chicken pie tonight!!!!!