GD and midwife quick to offer insulin

[slimyak]

Just had a 29 week diabetes midwife and consultant appointments. I'm currently boarderline GD and have been managing my blood sugar though diet. I've had a few higher (between 5.5 and 6) fasting readings but after meals I'm keeping things under control. The midwife said I should go on insulin as it would be easier and I could book in my 38 week induction asap. Thankfully the consultant said to wait and see what happened with morning readings over the next couple of weeks and check the next growth scan in two weeks too.

I was a bit shocked. I've had GD previously and managed it all through diet and had a natural birth at 40 weeks. Baby growing fine and not too big. Whats the hurry to medicalise this?

I would have thought they would want to try metformin before insulin. I am 34+3 and have been managing on diet alone but my morning fasting reading crept up past 6 so I now take one Metformin at night. The levels are creeping up slowly again and the diabetes nurse has said to keep an eye on it and if it gets consistently higher (currently 5.6-5.8 but if rises to 5.8 - 6.0) then 2 add an extra Metformin at night. Insulin hasn't really been mentioned. Re C-section, I will be having an ELCS but for reasons other than the diabetes. My understanding of it is if baby's growth is the normal range and levels are under control, there is no reason why you couldn't have a normal delivery.

Sorry, I hate text typing - that 2 should read to!!!

Thanks for that, I will keep the metformin in mind for my next appointment. Almost all the food related readings of which I have some level of control have been within the boundaries set, it's those morning ones I can't control that may tip the balance into needing meds.

Apparently it's hospital policy here that if your GD is bad enough for you to need insulin you will automatically be recommended for induction at 38weeks. I will fight a policy decision over a medical reason if necessary.

I think your readings sound ok, and if the baby is right size, then insulin sounds a bit fierce. I'm type 1 and having ridiculous problems with hypos atm, so if you can control with diet and/pr metformin that seems the best way to go.

Re the 38 wk induction - my doc said GD/diabetic babies can put on a LOT of weight in the last two weeks, a silly amount compared to what they gain over the course of the rest of the pg. That's partly why they do the induction.

Thanks for the reasurance disco, hope the hypos sort themselves out or at least your doc can balance your meds. I thought it was a bit fierce too.

Interesting about what your doc said about the last 2 weeks of preg. I was told last time that induction at 38 weeks was recommended to get a large baby out before it would cause birth complications, but more importantly because you are at a much higher risk of early placental breakdown.

When pg with DD1 my consultant saw me at 36 weeks decided at that point an induction wasn't necessary as not a big baby and placenta looked v. healthy. Said they would reassess at 40 weeks if I hadn't delivered by then. I saw no-one else until DD was born at 39+5 weighing a happy 7lb7oz.

Maybe if they're already a 9lber at 38 weeks any growth spurt will make a whopper!

Most large teaching hospitals have a dedicated diabetic midwife. I'd be inclined to speak to her and take her advice more than a general obstetrician. My (limited) understanding is that the morning spikes and dips are indicative of things going haywire in the night, and aggressive control is the way to go in those circumstances.