Confused (and a little pissed off by) gestational diabetes. Any experts?

[weebigmamma]

My blood sugar has been fine since the start of the pregnancy but because the baby was measuring big for dates a couple of weeks ago they sent me for a glucose tolerance test. It came back saying that I had GD so last week, at 35 weeks, I had my first appointment. I went back today and they were pleased with my blood levels- all week long they have been consistently well within the range. But the baby is still measuring too big so they've said they're going to put me on insulin anyway. It's this that I don't understand. Would insulin not lower my blood sugar? If that happened it would often be too low. And could it not be the case that I'm simply having a big baby?! He is about 7lb now they think and I have 3 weeks to go because I'm having a section at 39 weeks. The insulin would start next week. What difference would 2 weeks of insulin make? I feel quite confused and fed up. Would love somebody to explain all this to me.

hmmm this is a complete guess, but I wonder if starting you on insulin now might help prevent low sugars in the baby after birth. If mum has higher sugar antenatally the baby has to produce more insulin to keep its levels normal. Then when it's born, the sugar supply from mum is suddenly cut off, but there is a lag in turning off baby's insulin production resulting in excess insulin and low sugars in the baby. To re phrase I'm fairly sure maternal diabetes increases likely hood of low sugar in babies, I'm just not sure if insulin prevents this. Sure someone will correct me soon.

But I don't have high blood sugar levels. They're completely normal. The only thing they seem concerned about is the size of the baby.

Hey OP I agree this doesn't make any sense. I would definitely be asking more questions before taking the insulin.... Ur thinking seems perfectly logical so they need to explain clearly what their thinking is. I would also be asking for their evidence base. It's such a pain going to endless appts and clinics but I would definitely go back if I were you.

I'm not an expert but have been doing a lot of reading since I was (wrongly, I believe) diagnosed with GD a few weeks ago.

From what you say it makes no sense at all to put you on insulin - usually they would let you diet control unless you had at least two readings over target then start metformin. Insullin would be the next option if you still had trouble controlling your sugars. In some areas women whose sugars are diet controlled are discharged from consultant care at 36 weeks!

Weight estimates don't appear to be very accurate. How is the baby measuring? Mine, at 34 weeks, is above the 90th centile for abdominal circumference but my sugars have been easily controlled with little or no change to diet so they have conceded it could well be a naturally big baby.

What were your fasting and 2-hour GTT results?

Im not an expert btw...but I did have diet controlled GD last preg and now pregnant again and self monitoring. Usually find closer scrutiny of hospital policies is bit dispiriting as not always based on that much decent research! At the end of the day you must be the expert in your own pregnancy. As soon as I say I had GD at appts health professionals like clamining my baby boy was big...he was 8lbs 1oz bang smack on 50th percentile so infact he couldnt have been more average if he tried!!!

Postmanpat are you getting on ok? I remember you from another thread... Are they still seeing you at the diabetic clinic?

OP my hospital also treat women with diet controlled GD as low risk like above post says. Their official policy is to treat you as any other low risk woman although they didn't act quite like that in practice but that is the way it goes once you are labelled I found!!

sisterofcaleb thanks for asking I'm ok thanks, still being seen at the diabetic clinic though my sugars have been fine. They want to induce me between 39 and 40 weeks because that's policy, regardless of whether I'm actually having to restrict my diet to achieve sugars within target it seems!

Am still only 34 weeks so things could change. It's taken any enjoyment out of this pg though.

Do they treat you as having GD from the off in a subsequent pregnancy then? Will you still have the GTT at some point?

I'm glad u can still enjoy the white bread!! Hmmm I would find it all very annoying I have to say as your diagnosis is a bit baffling to me! However I wish I could go with the flow a bit more and trust medical professionals (being one doesn't help)...so I definitely don't wish my attitude upon you!

I am self monitoring and declining referral for further tests at the moment. Can't see the point of having an ogtt as if I fail (I think I would) I would just be asked to monitor my blood sugars which I am already doing. If I can't keep under target with diet consistently I will go to the clinic. About to enter the battlefield for a home birth in the next couple weeks!!

Most important to me is I know I have kept my blood sugars normal, and therefore my baby as safe as possible. I hope you can take comfort in that too.

It is so confusing! I have GD; this is my second time. I have been diet controlling since 18 weeks. I have had weeks with 4 readings above target, but others with none and I was discharged from the diabetes clinic last week at 34 weeks, but need to keep monitoring till birth. I successfully argued against medication earlier on when they wanted to put me on it and now am glad I did. They are not going to induce me early, but will be induced at term. I am not sure this helps, but sounds to me like they are being overly cautious. At my growth scan at 34 weeks my baby was measuring 5lb10, which they didn't seem bothered about.

I think I will ask them about how they think giving me insulin for 2 weeks will halt the baby's growth, and also why that's important. I'm having a section anyway so that's not a risk they need to bear in mind. I'm obviously concerned about baby's health but I have to drive 30 miles to the hospital every week and it's hard enough doing that at the minute- now I'm thinking are they going to put me on insulin so that I'm doing that drive with low blood sugar levels? I don't think that seems wise.

PostmanPat: baby is measuring 90th Centile 2 weeks further on than he should (so about 7lbs now, gaining 1lb a week and I have 3 weeks to go).

GTT:
Fasting: 6.6
2 hrs: 5.9

Every reading has been within range since then and the vast majority are on the low side of the range.

BTW I don't understand what those results mean- was I way out of range for the fasting test?

In a normal person a fasting test should be less than 6 and a 2 hour test after the sugar drink less than 7.8.

In pregnancy, the sugars should run slightly lower, so a fasting of less that 5.5 and a 2hr result still less than 7.8.

So by that reckoning your fasting glucose was too high and indicated gd. Was there glucose in ur urine at any stage?

No, never. They only made me do the test because the baby was measuring too big.

You're in pretty much the same situation as me (my GTT results were 5.3 for fasting and two hours, so I failed as the cut-off for fasting was 5.1). I was referred as my bump measured 32 weeks at 28 weeks. Since then my sugars have been fine with my usual diet.

It is confusing isn't it. I really can't see why they would put you on insulin when your blood sugar isn't too high. The NHS page states you may be put on medication if you can't control your blood sugar through diet and exercise.

You have to ask them to explain this at your next appointment. Are you sure they didn't just say they would put you on insulin for the last couple of weeks if you couldn't maintain normal levels?

I'm in a similar situation, I was diagnosed with GD due to a slightly raised fasting levels, I've been checking my levels 7 times a day now for a week and even when I had a huge lunch with a lot of sugar they have been just fine - my fasting levels have been spot on, as well.

Yet hospital policy says I will be induced on my EDD, despite my baby being on the 50th percentile with a proportionally slightly low abdomen.

Weebigmama, do I remember rightly that you're in NI (I'm at the Ulster)? My fasting level was 5.4 and I was told the cut-off at my hospital is 5, your 2 hour result is just fine.

To be perfectly honest, in your situation I would refuse insulin, just like I would refuse insulin if they for some reason decided to prescribe it to me.

I emailed them and here's the reply I got this morning:

'Because of the size of the baby they feel occasionally that there is still a need for insulin, especially if carbohydrates in your diet can easier be increased. The Doctor will need to look at your blood glucose and if they are at the top end of the target we may be able to improve blood glucose level with insulin.

The risk of low blood glucose will be increased with insulin, but this will not harm you baby. The insulin is worked out with your food and the plan would be to reduce risk of low blood glucose levels.
We can discuss this when a decision is made about insulin.'

Sooooooo, even though my blood sugar is fine they're going to put me on insulin anyway because of the baby's size, but they'll up my carbs to make sure that my blood sugar stays normal. Makes perfect sense....

Does insulin have magic baby-shrinking properties?!

(My levels are not 'at the top end of the target' by the way. They're pretty much in the middle.)

I think that because it's your fasting levels which are the problem that diet control is not going to make too much difference. What have your pre-breakfast levels been like? Basically they are saying that your background sugar levels are high even though your body responds properly to sugar when you eat it.
They will probably give you long acting insulin to be injected at bedtime. This will keep your sugars down over night and stop your morning levels being too high. The body releases glucose over night from the liver(?) even though you aren't eating and I expect it is this level they are trying to bring down.
I wonder if it isn't actually the baby's weight they are worried about but the fact that it is an indicator that the baby is getting too much sugar. If the baby gets too much sugar just before birth it produced a lot of insulin to convert it. Then once it is born it is used to producing loads of insulin, but is no longer getting so much sugar so it can end up hypoglycemic.

I think the reason their advice doesn't match up with the nhs page is because you have impaired fasting glycemia whereas people with gd normally have impaired glucose tolerance.
I'm not a medical professional but I saw a lot of specialists in my ladt pregnancy because my gd was also atypical.

I would say they are still worried about your morning glucose levels, which are harder to manage - have you tried eating a small amount of carbs before bed? A small banana works for me and my fasting sugars have all been below 5.0 now.

Like Tarka says, the slow-acting insulin would hopefully sort your fasting sugars, though if they are well within the target range now it should be ok?!

I know some people also find that their blood sugar levels get better after 36 weeks as the hormones seem to drop off at that point.

My fasting levels have been as follows. First blood test of the day over the past week:

5.1, 4.3, 4.7, 4.9, 4.7, 3.9, 4.8, 4.5

I should probably mention to them that I eat during the night when I'm up as well so the 'fast' is never more than a few hours.

Tarka: everything they have said about insulin has been 'because the baby is big'. They haven't even mentioned the baby's blood sugar levels. I'd be much more concerned about that than him being big. Why don't they just tell you what they mean? Argh!

How do they know the baby is big? My first baby measured at the top of the chart for fundal height and a scan at 34 weeks indicated a big baby. They prepared me to expect a 8/9lbs+ baby though reassured me I wouldn't grow a baby too big to deliver. In labour we were all awaiting a big baby and I was terrified he would get stuck so pushed really, really hard.

Tiny little 6lb11oz baby shot out to everyone's surprise! He was sixth centile for weight and I noticed on my current maternity notes (2nd baby) that my first is recorded as SGA (Small for Gestational Age) - he was full term when he was born.

At 35 weeks, the bump is measuring top of the chart again but I have no idea if this time it will be a big baby or or I'll have another tiddler. It seems to me that their growth estimates are not particularly reliable!

They said ds was going to be small but no gd he was 9lb 7 had gd with dd she was 8know but I was on insulin from 28wks