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Will Insulin Affect My Baby

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Gestational Diabetes

What is gestational diabetes? Gestational diabetes is a type of diabetes that develops only during pregnancy. Diabetes means your blood glucose, also called blood sugar, is too high. Your body uses glucose for energy. Too much glucose in your blood is not good for you or your baby. Gestational diabetes is usually diagnosed during late pregnancy. If you are diagnosed with diabetes earlier in your pregnancy, you may have had diabetes before you became pregnant. Treating gestational diabetes can help both you and your baby stay healthy. You can protect your baby and yourself by taking action right away to control your blood glucose levels. If you have gestational diabetes, a health care team will likely be part of your care. In addition to your obstetrician-gynecologist, or OB/GYN—the doctor who will deliver your baby—your team might include a doctor who treats diabetes, a diabetes educator, and a dietitian to help you plan meals. What causes gestational diabetes? Gestational diabetes happens when your body can't make enough insulin during pregnancy. Insulin is a hormone made in your pancreas, an organ located behind your stomach. Insulin helps your body use glucose for energy and Continue reading >>

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  1. Caezzybe

    After not having diabetes pre-pregnancy, I was diagnosed with gestational diabetes on Tuesday and tried to control by diet, but most of the readings in the two days I have tested blood glucose were higher than the NICE guidelines (over 7.7 mmol/l one hour after meals and over 5.8mmol/l before breakfast):
    http://www.nice.org.uk/nicemedia/pdf/CG063Guidance.pdf
    Now considering that according to the NHS the normal type 2 diabetic acceptable readings are that "a normal blood glucose level is between 4.0-6.0 mmol/l before meals (preprandial), and less than 10.0 mmol/l two hours after meals (postprandial)":
    http://www.nhs.uk/Conditions/Diabetes-type2/Pages/Treatment.aspx
    I am under the normal type 2 limits, but over the NICE guidelines.
    Also notice that the NICE guidelines say ONE hour after meals and the normal guidelines say TWO hours after meals. This seems grossly unfair and I have not been able to find any reason why the goalposts have been moved, either on the interenet or by asking people. The diabetic nurse couldn't answer the question either and said "but these are national guidelines" (for anyone who has seen the film This is Spinal Tap, she may as well have said "these go up to 11 )
    I'm not doing anything "wrong" with my diet as I confirmed with the dietician today, so the diabetic nurse/midwife wanted me to go on insulin. I asked if they did tablets and they said no, only insulin. This to me seems very extreme. The nurse got out the insulin pen to show me, I saw the needle and completely freaked out. I burst into uncontrollable sobbing and my eyes glazed over when she asked me if I was going to try it in my stomach or my thigh. When I didn't respond, she offered to inject it into my stomach or thigh. I still wasn't capable of responding, I am terrified of needles and was awake most of Tuesday night in near hysterics worrying about the possibility of this happening. I finally blurted out another request for tablets, asking why I couldn't go on Metformin tablets (which I know is an approved treatment for gestational diabetes). After what seemed like a very long time, she said she would make an appointment for me to see the consultant on Monday and wrote "not keen on trying insulin" in my notes. She couldn't understand why I lost it at the thought of insulin and not glucose testing, but with insulin I can see the needle (the blood sugar lancets are hidden inside a pen so I'm ok with those) and I also don't have to report a blood glucose monitor to the DVLA and car insurance company (nor would I have to report tablets!)
    There is no way I could stab that thing in myself and I was relieved to get out of the hospital. I don't know how I drove home as I was that upset and suspect I may have gone through a red light. I got home, burst into tears and hugged the cat for some comfort. My husband is away on business today, so I'm having to deal with this on my own until he gets back tomorrow evening. I have spoken to him on the phone, but it's difficult being alone right now.
    After having calmed down a bit, I'm resolved to say a definite no to insulin when I see the consultant, even if it means changing hospital. My friend who lives 20 miles away and who gave birth at a different hospital had tablets, why can't I? When I asked the other day why they didn't do tablets, the diabetes midwife said "the hospital has very good figures". I couldn't give damn about figures, Im not an NHS statistic
    I'm just worried they will try and section me or something, thinking I'm a nutter (I'm not, the word insulin fills me with dread as it's a last resort treatment and I have a bad needle phobia).
    Has anyone else refused (or attempted to refuse) insulin and what happened?
    Sorry for the long post, I'm at my wits' end right now :'(

  2. Jen&Khaleb

    My sister and sister in-law both had gestational diabetes. One had insulin and one didn't. The point is that even though you don't feel bad you will put your baby at risk by not following advice given by your health professionals. Can you imagine how a baby would feel being fed a nice sweet diet and then being born and having that taken away? Can you imagine giving birth to a 14 pound baby (Ouch)?
    You might be worried about having a few injections but think how many your baby will need in a special care nursery if you don't take care of things now.
    Get some more information about gestational diabetes before you make a decision that may not be best for you or your baby. Your blood sugar levels may be marginal now but as your hormones change so will those figures.
    Being pregnant can make you a little irrational so try to listen and not be too upset that everything isn't going perfectly. You will also find that the insulin needles are very small and quite painless. Even though it is my son who is diabetic I have used the needles on myself to see what it's like. It isn't like a vaccination or blood test at all.
    I hope all goes well with your pregnancy and all this hassel will be well worthwhile when it is all over.

  3. cugila

    I can understand your concerns and I sympathise with you, however the guidelines are different because of the differing circumstances which apply when you are pregnant. The levels they want you to adhere to are different for the safety of the baby and yourself.
    I have trawled through the full guidelines which have been updated since the link that you posted which is from March 2008. They were updated in July 2008 and in March 2009 this document was published.
    http://www.nice.org.uk/nicemedia/live/1 ... /41320.pdf
    You will see on Page 73 of 252, Section 2:49 this:
    Recommendations for the safety of medications for diabetes before and during
    pregnancy
    Women with diabetes may be advised to use metformin as an adjunct or alternative to insulin
    in the preconception period and during pregnancy, when the likely benefits from improved
    glycaemic control outweigh the potential for harm. All other oral hypoglycaemic agents should
    be discontinued before pregnancy and insulin substituted.
    Healthcare professionals should be aware that data from clinical trials and other sources do
    not suggest that the rapid-acting insulin analogues (aspart and lispro) adversely affect the
    pregnancy or the health of the fetus or newborn baby.
    Women with insulin-treated diabetes who are planning to become pregnant should be
    informed that there is insufficient evidence about the use of long-acting insulin analogues
    during pregnancy. Therefore isophane insulin (also known as NPH insulin) remains the first
    choice for long-acting insulin during pregnancy.
    There is also this I found as well:
    Metformin is used in UK clinical practice in the management of diabetes in pregnancy and lactation. There is strong evidence for its effectiveness and safety, which is presented in the full version of the guideline (http://www.nice.org.uk/CG063fullguideline). This evidence is not currently reflected in the SPC (July 2008). The SPC advises that when a patient plans to become pregnant and during pregnancy, diabetes should not be treated with metformin but insulin should be used to maintain blood glucose levels. Informed consent on the use of metformin in these situations should be obtained and documented.
    I think you will agree that the use of Metformin has certain risks and that these should be considered.
    In the circumstances I think you need to make an appointment at the earliest opportunity and discuss the concerns you have fully with a Consultant, not just the Nurse. Your obvious fear of needles etc has to be taken into consideration and your wishes as well. However the safety of the baby in all this also has to be considered. A difficult decision that I wouldn't wish on anybody.
    All I can say is medical advice is for a reason. I have to say that I think you should follow that advice.
    Just seen Jen's post and have to say I agree with her as well. I too wish you and your baby well, hope everything goes well.
    Ken.

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