Has anyone refused insulin for gestational diabetes?

[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 **** 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 :'(

 

[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.

 

[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.

 

[Caezzybe]

Thank you both for your replies. I was aware of the change in the NICE regulations and that's why I am hoping that the consultant will allow me to go on Metformin tablets rather than insulin. I already have a copy of the NICE document printed out and I will go over the relevant section in highlighter pen and present it to the consultant on Monday. What I am not going to do is just sit back at my forthcoming appointment on Monday and say "ok, I'll do whatever you ask". I see insulin as very much a last resort and if one hospital 20 miles away are happy to prescribe Metformin as the treatment of choice, why are the diabetic clinic team so reluctant to even discuss it at my hospital?

I'm also trying harder with the diet over the weekend, I now know from my 2 days' glucose testing experience that (all) bread, porridge and fruit send my sugar high, so I'll avoid them from now on and if I have to go for a half hour walk after every meal to boost my metabolism, I will do. I can get by on salad, dairy and minimal amounts of potato if I have to, just no insulin please! I got a 7.7 reading an hour after my evening meal tonight after salad, ham, 150g of potato and cottage cheese, I just need to find something to have for breakfast that isn't carb heavy.

It's really ironic that I feel far more energetic lately after having stopped working shifts and this is the best I've felt in a long time

 

[HLW]

I have a bad needle phobia

I thought there was no way I could inject insulin, I hate needles. I've had to stop them taking blood for blood tests a couple of times, because I couldn't cope with it. When they showed me the insulin pen I though I could never inject myself, that night when it was time for the first injection I just sat there looking at the pen trying not to cry. I eventually plucked up the courage and decided to inject it into a buttock, where I couldn't see the needle. It didn't hurt at all, and was nowhere near as bad as I expected. Next time was much easier, and now it's no problem at all. I suspect blood tests will still be a problem though

If seeing the needle is a problem (it was for me), there are needles available that come with a cover so you don't see the needles - NovoFine Autocover are one type, I'm sure there are others.

re: reporting it to the DVLA + insurance, when I spoke to the insurance company they said it didn't affect the cost or anything, if my GP said it was OK to drive, you just have to notify them. The DVLA replaced the licence with a 3 year one but they don't stop you driving, both were really easy to do, just a phone call to the insurance and a phone call and simple for for the DVLA, so nothing to worry about, really!

 

[Caezzybe]

Just a quick update, I saw the consultant yesterday who said I was doing fine on diet (all my bloods have been 4 point something or 5 point something over the weekend) and to keep up the good work, no mention of insulin at all! I'm so glad I just didn't sit back and do as I was told now, especially as I found it so suspicious in the first place that the diabetic nurse only gave me 2 days to try diet control before getting the insulin pen out.

I've upped my exercise to 50-60 min per day and cut out carbs at breakfast to avoid a blood sugar spike (the consultant was OK with this), having some carbs at lunch and evening meal.

I've found out I can't eat any sort of bread or porridge without my sugar being 8-9 after meals, so I just avoid them in favour of potatoes (about 200g max per meal).

Happy is not the word for it at the moment, I think some medical professionals are too quick to reach for the most extreme option!

 

[Miki243]

I’m in the same situation as you are at the moment. What was the outcome in your situation?

 

[EllieM]

I’m in the same situation as you are at the moment. What was the outcome in your situation?

Hi @Miki243 and welcome to the forums. @Caezzybe hasn't been on the forums since June 2010 so you might do better to start a new thread on this subject.

I wish you the best for your pregnancy journey

 

[Liz Mc]

Hi, in terms of breakfast try high fat Greek yoghurt with a few berries, nuts and seeds or eggs but have advocado instead of toast. Both work for me regarding not pushing up blood sugar. Soup is good for lunch but check the carbs, chicken and veg is usually ok. Basmati rice doesn’t push up my blood sugar neither do new potatoes but mash and baked do. Good luck

 

[ert]

I am a type 1 diabetic who injects 8 to 10 times a day. I did not believe I could inject when I was first diagnosed. In the end, I did not have a choice as I had to choose to inject to live. My sister and colleague both had gestational diabetes. They were simply placed on a single injection of long acting insulin at night which worked well. The needles are 4 mm and very short and thin, meaning you hardly notice them. If you need insulin, follow the medical advice and take insulin. The finger pricks hurt more than the injections. Injections will be nothing compared to child birth. Sending you hugs.

 

[zerocarbisbest]

I would try eating essential proteins and fats, and lots of vegetables. The more sugar u eat the more damage is done, carbs = sugar.

good names to search info are:

Dr Robert Lustig

Dr Pradip Jamnadas

Dr Paul Mason I think his name is, xD

Take care.

 

[lorib64]

They missed gestational diabetes in me. I had a GTT that was normal, but had an 11 lb baby (c section) he aspirated meuconium and was in nicu for a week, his glucose was okay. You can get another opinion and maybe get an oral medication, but please find someone who you trust and follow the advice.