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Has anyone refused insulin for gestational diabetes?
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<blockquote data-quote="cugila" data-source="post: 140337" data-attributes="member: 15325"><p>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.</p><p></p><p>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.</p><p></p><p><a href="http://www.nice.org.uk/nicemedia/live/11946/41320/41320.pdf" target="_blank">http://www.nice.org.uk/nicemedia/live/1 ... /41320.pdf</a></p><p></p><p>You will see on Page 73 of 252, Section 2:49 this:</p><p></p><p>Recommendations for the safety of medications for diabetes before and during</p><p>pregnancy</p><p><strong>Women with diabetes may be advised to use metformin as an adjunct or alternative to insulin</strong></p><p><strong>in the preconception period and during pregnancy, when the likely benefits from improved</strong></p><p><strong>glycaemic control outweigh the potential for harm.</strong> All other oral hypoglycaemic agents should</p><p>be discontinued before pregnancy and insulin substituted.</p><p>Healthcare professionals should be aware that data from clinical trials and other sources do</p><p>not suggest that the rapid-acting insulin analogues (aspart and lispro) adversely affect the</p><p>pregnancy or the health of the fetus or newborn baby.</p><p>Women with insulin-treated diabetes who are planning to become pregnant should be</p><p>informed that there is insufficient evidence about the use of long-acting insulin analogues</p><p>during pregnancy. Therefore isophane insulin (also known as NPH insulin) remains the first</p><p>choice for long-acting insulin during pregnancy.</p><p></p><p>There is also this I found as well:</p><p> 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 (<a href="http://www.nice.org.uk/CG063fullguideline" target="_blank">http://www.nice.org.uk/CG063fullguideline</a>). 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. <strong>Informed consent on the use of metformin in these situations should be obtained and documented.</strong></p><p></p><p>I think you will agree that the use of Metformin has certain risks and that these should be considered.</p><p></p><p>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.</p><p></p><p>All I can say is medical advice is for a reason. I have to say that I think you should follow that advice.</p><p>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.</p><p></p><p>Ken.</p></blockquote><p></p>
[QUOTE="cugila, post: 140337, member: 15325"] 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. [url=http://www.nice.org.uk/nicemedia/live/11946/41320/41320.pdf]http://www.nice.org.uk/nicemedia/live/1 ... /41320.pdf[/url] You will see on Page 73 of 252, Section 2:49 this: Recommendations for the safety of medications for diabetes before and during pregnancy [b]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.[/b] 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 ([url=http://www.nice.org.uk/CG063fullguideline]http://www.nice.org.uk/CG063fullguideline[/url]). 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. [b]Informed consent on the use of metformin in these situations should be obtained and documented.[/b] 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. [/QUOTE]
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