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Metformin Gestational Diabetes Side Effects

Metformin In Gestational Diabetes: An Emerging Contender

Metformin In Gestational Diabetes: An Emerging Contender

Metformin in gestational diabetes: An emerging contender 1Consultant Endocrinologist, Department of Endocrinology, G. D Hospital and Diabetes Institute, Kolkata, West Bengal, India 2Chief Endocrinologist, Department of Endocrinology, Sun Valley Diabetes Hospital, Guwahati, Assam, India 1Consultant Endocrinologist, Department of Endocrinology, G. D Hospital and Diabetes Institute, Kolkata, West Bengal, India 2Chief Endocrinologist, Department of Endocrinology, Sun Valley Diabetes Hospital, Guwahati, Assam, India 3Consultant Gynecologist, Department of Gynecology, G. D Hospital and Diabetes Institute, Kolkata, West Bengal, India Corresponding Author: Dr. Awadhesh Kumar Singh, Flat 1C, 3 Canal Street, Kolkata, West Bengal - 700 014, India. E-mail: [email protected]_hgniskard Author information Copyright and License information Disclaimer Copyright : Indian Journal of Endocrinology and Metabolism This is an open-access article distributed under the terms of the Creative Commons Attribution-Noncommercial-Share Alike 3.0 Unported, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. This article has been cited by other articles in PMC. Gestational diabetes mellitus (GDM) is defined as any degree of glucose intolerance occurring first time during pregnancy. Its prevalence is simultaneously increasing with the global rise of diabesity. GDM commonly develops, when maternal glucose metabolism is unable to compensate for the progressive development of insulin resistance, arising primarily from the consistently rising diabetogenic placental hormones. It classically develops during the second or third trimester. Theoretically, insulin sensitizers should have been the ideal agent in its treatment, given the insulin Continue reading >>

Metformin In Gestational Diabetes Mellitus

Metformin In Gestational Diabetes Mellitus

Metformin in gestational diabetes mellitus Department of Obstetrics & Gynaecology, Maulana Azad Medical College & LNJP Hospital, New Delhi 110 002, India Copyright : 2017 Indian Journal of Medical Research This is an open access article distributed under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike 3.0 License, which allows others to remix, tweak, and build upon the work non-commercially, as long as the author is credited and the new creations are licensed under the identical terms. See the article " Acute encephalitis in India: An unfolding tragedy " onpage584. The primary goal of therapy for gestational diabetes mellitus (GDM) is to achieve euglycaemia and thus decrease adverse perinatal outcomes. The proportion of patients who require pharmacotherapy to achieve this end result is dependent on diagnostic criteria used. However, with current low diagnostic thresholds, the proportion requiring pharmacotherapy is lesser than in the past where insulin has been the gold standard treatment for GDM when dietary and lifestyle measures have failed. Theoretically, insulin sensitizers should have been the ideal agent in the treatment of GDM, but foetal concerns have outweighed practical utility till the recent past. Oral hypoglycaemic agents are cost-effective, patient-friendly, potentially compliance-enhancing and also more physiological, given that insulin resistance is likely to be the main pathogenetic mechanism in GDM 1 . Metformin has been in use since decades for patients of type II DM and also for many years now in insulin-resistant polycystic ovarian syndrome (PCOS) patients 2 . However, its use in pregnancy has been limited. The metformin in gestational (MiG) diabetes trial 3 was a landmark study being one of the largest randomized controlled Continue reading >>

Metformin And Pregnancy: Is This Drug Safe?

Metformin And Pregnancy: Is This Drug Safe?

Whether you're expecting your first child or expanding your family, a safe and healthy pregnancy is crucial. This is why you take precautions before and during pregnancy to keep your unborn child healthy and reduce the risk of birth defects. In every pregnancy, there’s a 3 to 5 percent risk of having a baby with a birth defect, according to the Organization of Teratology Information Specialist (OTIS). Some birth defects can’t be prevented. But you can lower your child’s risk by taking prenatal vitamins, maintaining a healthy weight, and maintaining a healthy lifestyle. Your doctor might recommend that you don’t take certain medications while pregnant. This is because certain medications can cause birth defects. If you're taking the prescription drug metformin, you might have concerns about how the drug will affect your pregnancy and the health of your unborn child. What Is Metformin? Metformin is an oral medication used to treat type 2 diabetes and polycystic ovary syndrome (PCOS). Type 2 diabetes is a condition that increases blood sugar levels. PCOS is an endocrine disorder that occurs in women of reproductive age. It’s important to maintain a healthy blood sugar level while pregnant. This is one way to reduce the risk of birth defects and complications. Although metformin can control blood sugar, you may question whether this drug is safe to take during pregnancy. Before we get into this, let’s discuss how metformin is beneficial prior to pregnancy. Metformin Before Conception If you took metformin before getting pregnant, you might know that this drug can be a godsend — especially if you’ve had difficulty conceiving. Having PCOS makes it harder to become pregnant. This condition can cause missed or irregular periods, and small cysts can grow on your Continue reading >>

Use Of Metformin In Gestational Diabetes

Use Of Metformin In Gestational Diabetes

Metformin is associated with improved treatment satisfaction and a favorable impact on quality of life (QoL) compared with insulin alone or in combination…. The rise in obesity and the increasing age of mothers have contributed to an increasing incidence of GDM. Depending on the diagnostic criteria used, GDM complicates up to 10% of pregnancies. Treatment conventionally consists of lifestyle measures (diet and physical activity) initially. If target glucose values are not achieved, insulin has traditionally been instituted. Because of the need for constant injections, the risks of hypoglycemia and the potential for weight gain, insulin therapy might be expected to have a negative impact on the QoL for GDM mothers. By contrast, metformin is gaining increasing acceptance as a safe alternative to insulin in the management of GDM. It is associated with improved insulin sensitivity and less maternal weight gain and there is evidence of reduced maternal risk of pre-eclampsia and need for operative delivery. In this study, Latif et al, compare treatment satisfaction and QoL in GDM women receiving metformin alone, insulin alone or a combination of both treatments. One hundred and ninety seven women whose pregnancies had been complicated by GDM were recruited over a 12-month period (2011–2012). Of those, 128 were eligible to be analyzed and 68 patients were treated with metformin alone, 32 with insulin and 28 with the combination of metformin and insulin.Patients had started on insulin as NovoRapid with meals and Insulatard at night if metformin was relatively contra-indicated (renal impairment, history of GI symptoms, inadequate fetal growth on scan) or if this was patient preference. Otherwise, patients were offered metformin initially at a daily dose of 500 mg with meals, Continue reading >>

Metformin In Gestational Diabetes Mellitus

Metformin In Gestational Diabetes Mellitus

Metformin in Gestational Diabetes Mellitus Sara Wilson Reece , PharmD, CDE, BC-ADM, Harish S. Parihar , RPh, PhD, and Christina LoBello Sara Wilson Reece, PharmD, CDE, BC-ADM, is an assistant professor of pharmacy practice; Harish S. Parihar, RPh, PhD, is an assistant professor of pharmaceutical sciences; and Christina LoBello is a doctor of pharmacy candidate in the class of 2015 at the Philadelphia College of Osteopathic Medicine, Georgia Campus, School of Pharmacy, in Suwanee, Ga. Dr. Reece also provides diabetes clinical services for The Longstreet Clinic in Gainesville, Ga. Author information Copyright and License information Disclaimer Copyright 2014 by the American Diabetes Association. Readers may use this article as long as the work is properly cited, the use is educational and not for profit, and the work is not altered. See for details. As currently diagnosed, gestational diabetes mellitus (GDM) affects 59% of all pregnancies in the United States and is growing in prevalence. 1 It is defined as carbohydrate intolerance of variable severity that is first recognized during pregnancy. Although GDM has been recognized for decades, the potential significance of the condition, as well as criteria for screening and diagnosis, remain debatable. 1 Historically, GDM has been treated with lifestyle modifications and insulin, and oral antihyperglycemic agents have been used infrequently because of concerns regarding neonatal hypoglycemia and teratogenicity. Most recent studies suggest that oral hypoglycemic agents, specifically metformin, are safe to use during pregnancy ( Table 1 ). 2 13 Risk for developing GDM has been noted in women who are overweight before pregnancy, have had GDM in a previous pregnancy, or have a family history of diabetes. Poorer outcomes have be Continue reading >>

Efficacy And Safety Of Metformin During Pregnancy In Women With Gestational Diabetes Mellitus Or Polycystic Ovary Syndrome: A Systematic Review.

Efficacy And Safety Of Metformin During Pregnancy In Women With Gestational Diabetes Mellitus Or Polycystic Ovary Syndrome: A Systematic Review.

Abstract BACKGROUND: Metformin is an effective oral anti-hyperglycemic agent that is widely used to manage diabetes mellitus type 2 in the general population and more recently, in pregnancy. However, as metformin crosses the placenta, its use during pregnancy raises concerns regarding potential adverse effects on the mother and fetus. OBJECTIVE: (i) To provide background for the use of metformin during pregnancy through a narrative review and (ii) to critically appraise the published evidence on the efficacy and safety of using metformin during pregnancy through a systematic review. RESULTS: Metformin appears to be effective and safe for the treatment of gestational diabetes mellitus (GDM), particularly for overweight or obese women. However, patients with multiple risk factors for insulin resistance may not meet their treatment goals with metformin alone and may require supplementary insulin. Evidence suggests that there are potential advantages for the use of metformin over insulin in GDM with respect to maternal weight gain and neonatal outcomes. Furthermore, patients are more accepting of metformin than insulin. The use of metformin throughout pregnancy in women with polycystic ovary syndrome reduces the rates of early pregnancy loss and preterm labor and protects against fetal growth restriction. There have been no demonstrable teratogenic effects, intra-uterine deaths or developmental delays with the use of metformin. CONCLUSIONS: The publications reviewed in this paper support the efficacy and safety of metformin during pregnancy with respect to immediate pregnancy outcomes. Because there are no guidelines for the continuous use of metformin in pregnancy, the duration of treatment is based on clinical judgment and experience on a case-by-case basis. © 2013. Continue reading >>

Metformin For Gestational Diabetes: As Safe And As Effective As Insulin?

Metformin For Gestational Diabetes: As Safe And As Effective As Insulin?

Metformin for gestational diabetes: As safe and as effective as insulin? Rowan JA, Hague WM, Gao W, Battin MR, Moore MP, for the MiG Trial Investigators. Metformin versus insulin for the treatment of gestational diabetes. N Engl J Med. 2008;358:20032015. Professor and Chairman, Department of Obstetrics and Gynecology, Penn State University College of Medicine, and Obstetrician-Gynecologist-in-Chief, Milton S. Hershey Medical Center, Hershey, Pa. Dr. Repke serves on the OBG Management Board of Editors. Compared with insulin, metformin did not increase the risk of perinatal complications and was preferred by most women YES. In this open-label randomized trial comparing metformin, with or without supplemental insulin, with insulin alone, metformin did not increase the risk of perinatal complications and was preferred by a majority of women. Rowan and colleagues add to the data on the potential benefits of oral hypoglycemic agents, compared with insulin, in managing gestational diabetes. The presumption was that dietary treatment alone would not result in adequate glycemic control. In the study, women assigned to metformin were given a starting dosage of 500 mg once or twice daily, which was then increased to a maximum daily dosage of 2,500 mg. According to the authors, women assigned to insulin were prescribed the drug according to usual practice, although that practice was never defined. In addition, if adequate glycemic control was not achieved in the metformin group, insulin was added. Overall, 363 of the women who received metformin completed the study, with 195 receiving metformin alone and 168 ultimately receiving metformin plus insulin. In the other arm, 370 of the women assigned to insulin completed the study. Maternal baseline characteristics were the same for bo Continue reading >>

Could Metformin Manage Gestational Diabetes Mellitus Instead Of Insulin?

Could Metformin Manage Gestational Diabetes Mellitus Instead Of Insulin?

Copyright © 2016 Hend S. Saleh et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Abstract Gestational diabetes mellitus (GDM) complicates a significant number of pregnancies. Blood glucose control improves perinatal outcomes. Medical nutrition therapy is the foundation in management. Aim of This Study. To evaluate efficacy of metformin in comparison to insulin for managing GDM. Methods. In prospective randomized comparative study, 150 antenatal women whose pregnancies had been complicated by GDM and did not respond to diet alone were recruited from antenatal clinics at Obstetrics Department in Zagazig University Hospitals from November 2012 to December 2014. They were divided randomly into two groups, 75 patients in each, and were subjected to either insulin or metformin medication. Outcomes were comparing the effects of both medications on maternal glycemic control, antenatal complications, and neonatal outcome. Results. No significant difference in controlling high blood sugar in GDM with the use of metformin or insulin (, 0.15). Maternal complications in both groups had no significant difference and fetal outcomes were as well similar except the fact that the hypoglycemia occurred more in insulin group with value 0.01. Conclusion. Glycaemic control in GDM can be achieved by using metformin orally without increasing risk of maternal hypoglycemia with satisfying neonatal outcome. 1. Introduction Gestational diabetes mellitus (GDM) is a condition with any level of glucose intolerance which began or was detected for first time during pregnancy despite type of management; it may also relate to situatio Continue reading >>

Metformin For Gestational Diabetes - What It Is And How It Works

Metformin For Gestational Diabetes - What It Is And How It Works

In the UK it is common to use Metformin for gestational diabetes where dietary and lifestyle changes are not enough to lower and stabilise blood sugar levels. It is widely used to help lower fasting blood sugar levels as well as post meal levels. Metformin is an oral medication in tablet form. It is used in diabetics to help the body use insulin better by increasing how well the insulin works. In pregnancy it can be used in women who have diabetes before becoming pregnant (Type 2 diabetes) and in women who develop diabetes during pregnancy (gestational diabetes). Metformin is also used for other conditions too, commonly used in those that have PCOS (polycystic ovarian syndrome). Metformin is a slow release medication. Here are the most commonly asked Q&A on Metformin for gestational diabetes from our Facebook support group Why do I need to take Metformin? For many ladies with gestational or type 2 diabetes, if lower blood sugar levels cannot be reached through diet and exercise then medication will be required to assist. If blood sugar levels remain high, then the diabetes is not controlled and can cause major complications with the pregnancy and baby. Some consultants will prescribe Metformin on diagnosis of gestational diabetes on the basis of your GTT results. Others will let you try diet control first and when blood glucose levels rise out of target range, or close to the target range, they may prescribe Metformin as a way to help lower and control your levels. NICE guidelines regarding the timing and use of Metformin for gestational diabetes 1.2.19 Offer a trial of changes in diet and exercise to women with gestational diabetes who have a fasting plasma glucose level below 7 mmol/litre at diagnosis. [new 2015] 1.2.20 Offer metformin[4] to women with gestational dia Continue reading >>

Women With Gestational Diabetes May Do Best With Metformin And Glyburide Combo

Women With Gestational Diabetes May Do Best With Metformin And Glyburide Combo

A study recently published it the American Diabetes Association’s Diabetes Care journal found that the combination of metformin and glyburide lead to fewer women with gestational diabetes needing insulin after pregnancy when compared to taking just one of the drugs. Researchers sought to find out how effective and safe metformin was compared to glyburide and how well the two worked in a combined treatment for gestational diabetes. Metformin is the first-line treatment for type 2 diabetes which helps increase insulin sensitivity and stops some of the liver’s secretion of glucose. Glyburide is a sulfonylurea which helps to stimulate the increase of insulin in the body. Gestational diabetes is when blood sugar levels rise during pregnancy. Gestational diabetes often leads to type 2 diabetes within the following decade. Researchers conducted a prospective randomized controlled study where they randomly assigned women with gestational diabetes at 13-33 weeks gestation and whose blood sugar levels were inadequately managed by diet to take either metformin or glyburide. If any of the women didn’t have optimal blood sugars, they took the combination of the two drugs. In the case of adverse effects, the women took a different drug and if both didn’t work, then insulin was provided. The researchers looked for the rate of treatment failure and blood sugar management after the first medication was given by checking mean daily blood sugar charts. So Which Medication Worked Best? Glyburide was started in 53 patients. The drug failed in 18 patients due to low blood sugar in 6 patients and a lack of blood sugar control in 12 patients. Metformin was started in 51 patients and failed in 15 patients due to gastrointestinal side effects in one patient a lack of glycemic control in Continue reading >>

Effects Of Diet And Metformin On Placental Morphology In Gestational Diabetes Mellitus

Effects Of Diet And Metformin On Placental Morphology In Gestational Diabetes Mellitus

Effects of Diet and Metformin on placental morphology in Gestational Diabetes Mellitus Rabia Arshad ,1 Muhammad Adnan Kanpurwala ,2 Nasim Karim ,3 and Jahan Ara Hassan 4 1Dr. Rabia Arshad, MBBS, M. Phil. Assistant Professor and Head of Pharmacology Department, Altamash Institute of Dental Medicine, 2-R Sunset Boulevard, DHA, Karachi, Pakistan 2Dr. Muhammad Adnan Kanpurwala, MBBS, M. Phil. Associate Professor, Physiology Department, Karachi Institute of Medical Sciences, Karachi, Pakistan Find articles by Muhammad Adnan Kanpurwala 3Dr. Nasim Karim, MBBS, M. Phil, Ph D, Post Doc. Professor and Head of Pharmacology Department, Bahria University Medical and Dental College, Karachi, Pakistan 4Dr. Jahan Ara Hasan, MBBS, FCPS, MCPS. Associate Professor, Gynecology and Obstetrics Department, Dow University of Health Sciences, Karachi, Pakistan 1Dr. Rabia Arshad, MBBS, M. Phil. Assistant Professor and Head of Pharmacology Department, Altamash Institute of Dental Medicine, 2-R Sunset Boulevard, DHA, Karachi, Pakistan 2Dr. Muhammad Adnan Kanpurwala, MBBS, M. Phil. Associate Professor, Physiology Department, Karachi Institute of Medical Sciences, Karachi, Pakistan 3Dr. Nasim Karim, MBBS, M. Phil, Ph D, Post Doc. Professor and Head of Pharmacology Department, Bahria University Medical and Dental College, Karachi, Pakistan 4Dr. Jahan Ara Hasan, MBBS, FCPS, MCPS. Associate Professor, Gynecology and Obstetrics Department, Dow University of Health Sciences, Karachi, Pakistan Correspondence: Dr. Rabia Arshad, House No. D-184, Navy Housing Scheme, Zamzama, Clifton, Karachi, Pakistan. E-mail: [email protected] Received 2016 Jun 23; Revised 2016 Jul 25; Revised 2016 Dec 2; Accepted 2016 Dec 5. Copyright : Pakistan Journal of Medical Sciences This is an Open Access article distributed under Continue reading >>

Articles Effect Of Metformin On Maternal And Fetal Outcomes In Obese Pregnant Women (empowar): A Randomised, Double-blind, Placebo-controlled Trial

Articles Effect Of Metformin On Maternal And Fetal Outcomes In Obese Pregnant Women (empowar): A Randomised, Double-blind, Placebo-controlled Trial

Summary Maternal obesity is associated with increased birthweight, and obesity and premature mortality in adult offspring. The mechanism by which maternal obesity leads to these outcomes is not well understood, but maternal hyperglycaemia and insulin resistance are both implicated. We aimed to establish whether the insulin sensitising drug metformin improves maternal and fetal outcomes in obese pregnant women without diabetes. We did this randomised, double-blind, placebo-controlled trial in antenatal clinics at 15 National Health Service hospitals in the UK. Pregnant women (aged ≥16 years) between 12 and 16 weeks' gestation who had a BMI of 30 kg/m2 or more and normal glucose tolerance were randomly assigned (1:1), via a web-based computer-generated block randomisation procedure (block size of two to four), to receive oral metformin 500 mg (increasing to a maximum of 2500 mg) or matched placebo daily from between 12 and 16 weeks' gestation until delivery of the baby. Randomisation was stratified by study site and BMI band (30–39 vs ≥40 kg/m2). Participants, caregivers, and study personnel were masked to treatment assignment. The primary outcome was Z score corresponding to the gestational age, parity, and sex-standardised birthweight percentile of liveborn babies delivered at 24 weeks or more of gestation. We did analysis by modified intention to treat. This trial is registered, ISRCTN number 51279843. Between Feb 3, 2011, and Jan 16, 2014, inclusive, we randomly assigned 449 women to either placebo (n=223) or metformin (n=226), of whom 434 (97%) were included in the final modified intention-to-treat analysis. Mean birthweight at delivery was 3463 g (SD 660) in the placebo group and 3462 g (548) in the metformin group. The estimated effect size of metformin on th Continue reading >>

Is It Safe To Use Metformin During Pregnancy?

Is It Safe To Use Metformin During Pregnancy?

Metformin is a commonly used drug for managing type 2 diabetes. It is considered an effective treatment option for many people with diabetes, but is it safe for pregnant women? Metformin is a drug that helps to lower blood sugar. It is considered one of the best first line treatments for type 2 diabetes. A review posted to Diabetology & Metabolic Syndrome notes that metformin helps to lower blood sugar levels, strengthens the endocrine system, improves insulin resistance, and reduces fat distribution in the body. Before taking any drugs, including metformin, a pregnant woman has to be absolutely sure that the drugs will not affect her or her baby. Effects of metformin use during and after pregnancy Some people are concerned about using metformin during and after pregnancy because it crosses the placenta. This means that when a pregnant woman takes metformin, so does her baby. However, the results of the few studies that have been carried out so far into the effects of taking metformin during pregnancy have been positive. A 2014 review posted to Human Reproduction Update found that the drug did not cause birth defects, complications, or diseases. The researchers did note, however, that larger studies should be carried out to make this evidence more conclusive. Metformin and gestational diabetes A separate review posted to Human Reproduction Update noted that women who took metformin to treat gestational diabetes (diabetes during pregnancy) gained less weight than women who took insulin. A 2-year follow-up study found that babies born to the women treated with metformin had less fat around their organs, which could make them less prone to insulin resistance later in life. This could mean that children who are exposed to metformin at a young age could gain long-term benefi Continue reading >>

Metformin Therapy During Pregnancy

Metformin Therapy During Pregnancy

Type 2 diabetes and gestational diabetes mellitus (GDM) are closely related disorders characterized by increased insulin resistance. Metformin, a biguanide compound, exerts its clinical effect by both reducing hepatic glucose output and by increasing insulin sensitivity. This results in a decreased glucose level without an associated high risk of either hypoglycemia or weight gain. These characteristics have established metformin as an ideal first-line treatment for people with type 2 diabetes and, hypothetically, a particularly attractive drug for use in pregnancy. However, metformin is known to cross the placenta (1,2), and its use in pregnancy has been limited by concerns regarding potential adverse effects on both the mother and the fetus. Historically, some of the earliest reports of the use of metformin during pregnancy have come from South Africa, where it has been used since the late 1970s for women with both type 2 diabetes and GDM (3–6). While perinatal mortality for these women was still higher than that seen in the general obstetric population, it was nonetheless lower than in women who had gone untreated and similar to those who were changed to insulin. No “headline” adverse events or side effects were reported. Confidence regarding the use of metformin in pregnancy has been reinforced by the results of several observational studies and randomized trials over the past decade. Two meta-analyses of observational studies—one of women using metformin and/or sulphonylureas and one of women using metformin alone during the first trimester—did not show an increase in congenital malformations or neonatal deaths (7,8). While increased perinatal mortality and pre-eclampsia was noted in one study of 50 women with type 2 diabetes using metformin, these result Continue reading >>

Metformin For Gestational Diabetes

Metformin For Gestational Diabetes

Since the first trimester I've been having to monitor my glucose level as my OBGYN noticed from the beginning I was 'borderline' for gestational diabetes,therefore taking the glucose test is not on my schedule as I have been monitoring my glucose level since the beginning. The thing is- I am confident that if I were to take the 1 hr/3hr test that everyone takes- that I would pass. Due to recent elevated levels(fasting 95-100), metformin is suggested. I honestly don't think it's medically necessary for me to take it but at the same time, I know gest. diab. Can cause issues with delivery,ect. Has anyone taken Metformjn before during pregnancy and have any insight ?TIA! To be honest I'd ask for a referral to an endocrinologist. Your OB should not be managing any sort of diabetes care unless they have completed a fellowship in maternal fetal medicine. But to be honest only endocrinologist should be the ones managing blood sugars. OBs and PCPs should ask for an opinion from an endo in my opinion. If your fasting levels are high, you have GD, it may not be as bad as some but it's not normal to have a high fasting. I have GD and even my fasting levels are fine unless I eat a bunch of sugar before bed. You can try eating more protein as you bed time snack and make sure you do eat a bed time snack but if that doesn't help then you need medication. Having elevated fasting levels every day is not healthy. It can lead to early labor or even still birth. My friend had to do insulin shots to help her fasting she didn't have any issues with it. I honestly wish I could just take medication. I have pcos and was put on metformin to regulate, everything.. Actually how I got pregnant, I was on 1500 mg a day I will let you know the first day you will feel extremely hung over and dead lol a Continue reading >>

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