GD - Refusing metformin?

[doremifaso]

Was diagnosed with Gestational Diabetes at 27 weeks and was given 2 weeks to see if I could manage it without meds with lifestyle and dietary changes.
When I went back in for a diabetic review, I got pulled up for a few high readings that were over 7. There were a couple that went to 9 but overall my readings have been great, especially the fasting glucose one.
It was quite hard to figure out what my body could/couldn’t handle within just 2 weeks!
I’ve now been given an extra week to see if I can further improve the readings.
This week I’ve had 2 readings that measured just over 7. Like 7.2 or 7.3 and one was just above 8 and now I am worried that they will put me on metformin since the hospital I’ve been attending is quite strict on GD.
I am anxious about having to take it as I’ve read it crosses the placenta and not enough research has been conducted to show if there are any long term affects to the baby.

Given the readings have only just gone over the mark, do you think I can refuse metformin and ask for another diabetic review in another weeks time, or wait until I’ve had a scan first to see what percentile my baby is at… or would that be a stupid thing to do given the risks to baby if GD is not managed well?

Are the rest of your 2 hours after food readings reading in the bracket?

I had GD and took metformin and insulin. To start with I didn’t have that many readings over 7 but they were there. I also wasn’t eating many carbs to get those readings.
I’d consider 3 points:

• how likely is it that you can keep the strict diet you’ve been doing for the next week. If you’re getting above 7 then you may need to be stricter.
• my blood sugar readings got worse as the pregnancy went on (apparently this is normal) and my insulin dose has to be increased every couple of weeks. So diet might work now but not longer term.
• would you consider insulin? You could propose that instead of metformin.

Honestly sometimes you can do everything in your power to remain diet controlled but your body has other ideas and needs something to help properly maintain your levels.

I appreciate it's worrying and daunting but chances are even after another week of trying your best on the diet the chances are your tolerance will still have changed and you levels are just as likely to be still creeping upwards.

You can ask for another week but try to be open to the fact sometimes medication is the only solution.

I highly recommend the gestationaldiabetes.co.uk website and Facebook group. There's lots of support there and advice on everything GD related.
Helped me through my last GD pregnancy

Oh and if you're not already 9n it get yourself to the gestational diabetes Facebook page pronto. They are the best of the best when it comes to advice, miles better than anything I was told by the NHS professionals.

I tried diet control and it was always just slightly off.

I eventually ended up on 3x metformin. Didn't cross my mind not to take them.

I don’t use Facebook unfortunately! But I had been doing lots of research and know pretty much what I can and cannot eat now.
I’m confident I can keep the numbers down if I just stick with what I know works, but yes there are some days where I’ll have something I’m unsure about and that’s when the higher reading might crop up!
Although something happened the other day where I had a meal for tea and the readings were well under. Then the next day I had the leftovers for my lunch (pretty much exact same portion) and the reading was over! So frustrating.

My hospital advises to test 1 hour after meals so that’s what I’ve been sticking to.
I know I most probably will have to go on the tablets anyway as I’ve still got 10 weeks to go, just didn’t want to go on it so soon!
Also heard that Metformin could upset your tummy so not looking forward to that either but I will have to do what is best for my baby.

I was told that an hour after meals anything under 7.8 was good, should be starting to regulate after the 2 hours if diet controlled alone.
I stuck to this my first pregnancy and they had no concerns with any of the readings.

Metformin works with the insulin you have. I had gestational diabetes twice, first time straight to insulin as my body just went utterly insane caught at the gtt. Sugar levels of over ten for a salad (and only a salad no dressings etc.) Second pregnancy I had Metformin and just a bit of insulin at the end but caught at booking/12 wk bloods. Both I was incredibly controlled but my body just said nope! Simple as. The dishes I had earlier in pregnancy that were fine got worse and worse. Completely normal as your placenta secretes more and more hormones making your insulin less and less effective.

Get rid of the view that you must be mainlining mars bars or something silly, some groups can mark you as a failure when you're anything but! It's like I'm a better mum to be than you because I'm not on tablets/medicine. Mini rant aside. 😉

It can upset your tum, in my trust they give you three days and ease you in slowly, I was fine with this. If I had been affected after those three days it's straight to insulin as they don't want pregnant ladies ill.

Hope my experiences help

I did this. I needed time to wrap my head around things so after 7 days I went back for review and the odd high number meant diabetic nurse prescribed metformin, I said I would give it another week with understanding the diet better before I started taking... never took it in the end and managed to stay diet controlled throughout.

Obviously if I had got to grips with the diet and was still having high numbers then I would've taken the metformin, but I knew it was just a matter of getting used to it and I was right.

The GDUK website meals and guidance was a godsend and I credit it completely with staying diet controlled.

Your hospital being strict about GD is good. It's a dangerous condition. If you don't want Metformin go straight to insulin. It's not a hassle and it also does give you a little more flexibility in what you can eat and tolerate. I stayed "diet controlled" by starving myself and eating pretty much no carbs, I became quite ill because of it. Insulin was a lifesaver and I maintained good control throughout and baby was born with good sugars.

Hi @doremifaso there is a thread @CherLW started here on GD support, there are a few of us there trying to manage it with our diet if you'd like to join. i also had a 2/3 high readings over two weeks so far but generally below threshold. your trust is stricter than mine though - my threshold is

thanks! I’ll look into it

Can I ask... how is GD diet controlled?
I am 15 weeks with twins and am thinking I should be starting to think about this now...as a preventative measure hopefully.
GD seems quite common with twins so I certainly don't want to encourage it through poor diet choices.
What should I be avoiding?

@Ladder789 it doesn’t really work like that - following the diet won’t prevent you getting it and having just delivered my second gd baby 9 days ago I followed the diet strictly for 7 months - you do not want to follow it without a confirmed diagnosis - it’s bloody hard!
@doremifaso I was on two metformin to bring my fasting numbers down and it was fine, no tummy issues whatsoever. Every high reading means excess glucose is being passed onto the baby so for me it was a no brainer. She is a happy healthy baby who was born without any gd related issues

You control your numbers by eating minimal unrefined carbs, no sugar, nothing processed, no white carbs, very limited fruit even and certain foods need to be paired to be tolerated I.e. if I wanted an apple I’d have to pair with cheese or nuts. Very tedious and for me restrictive but I got there in the end and my baby is worth every missed takeaway/ice cream /cake this year!

Yes to food pairing, for me it means I'm mostly eating veg, nuts, nut butters, beans, eggs, dairy, and can only tolerate small amounts of wholemeal seeded bread, wholemeal pasta, roasted butternut squash etc if paired with one of the aforementioned. Even a veg soup unpaired with nuts seeds beans or cheese pushes me over the sugar limit. It feels very restrictive and I've still got a few weeks to go 😒

One tip that does help is exercise immediately after eating - go for a 30 min walk, power walk on the spot, dance whatever. Helps prevent a sugar spike, and keep levels more balanced

Just an update as I have had my baby now!
I managed to control my blood sugars through diet & exercise alone - woohoo!
It was hard… towards the end I was literally just eating one slice of wholemeal toast with cheese & jalapeños and plenty of salad for my breakfast every day since I got sick of eggs.
For other meals the choices were very limited and sometimes I would just have what I fancied but just less of it and walk it off.
I snacked mainly on Cashewnuts and pistachios, hummus on Ryvita (Dark Rye) and fruit. Portion sizes were cut down and I lost weight but seemed fitter for it.

My last scan predicted my baby to be around the 7lb14 mark but she was 6lb 11oz.

I had a pretty smooth delivery too compared to my first born. I had to be induced since they don’t recommend you go over your due date if you have GD. They gave me a pessary and it took around 6 hours to kick start the contractions and from there it took less than an hour for her to come into the world.
We had to stay in hospital for at least 24 hours before getting discharged since they had to check her blood sugars were fine which they were.

@doremifaso thanks for the update! That's so lovely you had a healthy baby and managed okay on the protocol.

It's feeling like a slog now for me, especially when out for work lunches and dinners and there's often very little I can eat on the menu. Breakfasts and dinners at home I've kind of got a handle on, but def missing treat food

Aw don’t worry, you will get there!
I would say just try not to obsess over the numbers too much and think too far ahead about the outcome (like I did) creating unnecessary worry/stress.

Actually one of the diabetic consultants told me it was fine to have the odd treat, like if it was someone’s birthday or something and you wanted a bit of cake. Just keep it small portions and drink plenty of water with it.

Eating out will remain tricky but if it’s not often and you can pick out parts of the food that isn’t very good for you then that should help a bit.
Good luck!

Jees, it is very strict then...