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Tricky question...

Cocosilk

Well-Known Member
Messages
818
Location
Australia
Type of diabetes
Gestational
Treatment type
Insulin
After reading and watching diet doctor's Jason Fung, it sounds like Metformin and Insulin are helping to control really high BG but long term are no solution for the root of the problem if the the body (in T2) never gets to release the stored sugars.
My question is in the context of being 31 weeks pregnant and having a morning fasting reading of 5.1 - 5.6, usually 5.3 and wondering, if I manage to have daytime before meal readings as low as 4.5 and after meals below 6.7 (if I eat only vegetable carbs and tiny bits of fruit but maybe no grains at all) is this slightly higher fasting level a problem for baby? I really don't have so many weeks to go and may only be asked to take a small dose of Metformin so maybe it's not a big deal, but if the levels are essentially in the normal during the day, does this slightly higher fasting level really matter? I know after baby is out I'll have to watch my fasting level in case it leads to pre-diabetes and eating low carb during breastfeeding might not be an option either, but I'm mostly concerned about baby in utero, effects of Metformin vs effects of that slightly higher fasting level. Would you take Metformin for that if told it was the right thing?
 

Cocosilk, I would urge you not to keep second guessing everything that might or not happen through your pregnancy.

In terms of if you are advised to take Metformin, that choice must be yours. This site has very strict guidelines on this; covered in Rule A11, here:

https://www.diabetes.co.uk/forum/threads/community-ethos-forum-rules.50278/ , but specifically:

"11. Important: Members are generally not Health Care Professionals, and those who are participate on the Forum as Members, not Health Care Professionals. Members are unable to diagnose any condition, or instruct in the alteration of medication, irrespective of personal or professional standing or experience."

Any posts breaching the above will be removed, without warning.

Now is clearly an important time for you and your family, so I urge you to remain close to your medical team, who appear, thus far, to be fairly switched on.

Good luck with it all.
 

Thanks, I should probably have framed it more to ask for experiences of any women who have been pregnant and had BG readings like mine and to know what their doctors wanted them to do, just to hear some other stories and to know if they managed it with diet alone, did everything turn out okay for them VS those who were put on Metformin for their slightly elevated fasting levels.
My medical team seems to have slightly different opinions with my private OB being okay with me to manage it with diet for now, but the diabetes counsellor at the hospital expecting I would be put on Metformin after the week or so of seeing my fasting level still above 5.0. She knows they are normally strict at the hospital.

I'm not wanting to do the wrong thing by baby obviously and I know taking medication that crosses the placenta has risks, but also, untreated Gestational Diabetes is risky if it's not managed appropriately.
I just wanted to hear some other people's thoughts and experiences. I'm not about to ignore my medical team's advice though.

A few days ago I thought maybe I should be asking to be put on Metformin because of the way the diabetes counsellor seemed surprised, and also after reading about a women whose fasting levels were not much over 5.1 and whose baby was hypoglycemic when she gave birth. I mean, there must be a reason they have brought the levels down for pregnant women from 5.5 to 5.0. But I just wondered how the bigger picture of BG levels is if your other levels stay in the normal range with dietary restrictions, does that work to counteract the effect of the slightly elevated fasting level when the numbers are in the 5s, I just wondered. Maybe not even the doctors can answer that question.
 
Have you been «diagnosed» with gestational diabetes?
5.-5.6 are not really of any concern. Pre-diabetic are fasting blood glucose from 6.0 a 6.9 mmol.

If you’re not any meds I don’t see why you should start on metformin, as your levels are not slightly higher the way I see it.

Where I live 5.6 are considered perfectly normal for fasting blood glucose, I would have been more concerned if it were above 6 or near 7 fasting. Or if you had abnormal elevated blood glucose after eating.

I think you shoul relax and not concern yourself too much
 
Hello @Cocosilk I was diagnosed at 23 weeks with gestational and levels were high enough to warrant being put straight onto insulin, all I can say is that if your levels do increase then you will be seeing alot more of your diabetic team and being monitored regularly, if I was told metformin would of helped then yes I would of taken it, it is safe to prescribe in pregnancy and your GP should of put your mind at rest with this.

BTW my levels weren't great in pregnancy unlike yours, however baby was fine if a little large which was typical with how my body reacted during pregnancy, so as @Emile_the_rat has said please relax and enjoy your pregnancy, any concerns should be relayed direct to your team.
 

I have been diagnosed with Gestational Diabetes with a fasting level of 5.1 in Australia... Now at home when I measure 2 weeks after the test, I'm getting more 5.3 on average. My other numbers on the GTT were okay, if on the higher end: 9.7 for 1hr (they want less than 10), and 7.4 for 2 hour (they want less than 8.5) on the test, but now that I am testing at home and experimenting with some of the carby foods I had been eating, I can see how my 2 hour post meals are can be a bit higher than the 6.7 target they want from pregnant women (in Australia where they are following newer guidelines - I think the change was less than 2 years ago - now my morning fasting should stay under 5.1 and my 2 hour post meals should not go past 6.7). For example, I had an 8.0 two hour post Vita Brits with a bit of honey. (At 1hr it was 9.0.) What numbers do they use to diagnose your post meal levels where you are?)
I know I'm not terribly diabetic and if it's just about the pregnancy hormones, I may be lucky and be less insulin resistant after the birth, but as far as my medical team are concerned, I am being watched now having been diagnosed and I know my OB uses Metformin routinely. He just wasn't too worried about my numbers last week when I was getting the odd 4.9 at fasting. It's just this week they are all over 5.1 - more often 5.3, sometimes 5.4, once 5.6. But I probably am focusing on these numbers more than I need to. I just know that the diabetes counsellor at the hospital, if she was the one making the decision, would have me on Metformin already and would be telling me to eat more carbs again I think. I've cut down a lot to keep under the 6.7 filling up more on vegetables and meats/fish/dairy instead of eating any grain based carbs. I did have half a slice of sourdough rye bread that my husband makes and 1/2 cup of Cannelli beans and a 1/4 apple in a salad in another meal today and both of those small amounts of carbs were perfectly fine. But I can't just relax about eating because if I eat what I want, the way I was before, I'm pretty sure not only would my fasting be past the 5.1, but all of my post meal readings would be past 6.7, so every time I eat, I have to rein myself in if I don't want to end up on Metformin. I'm sure some would happily take the medication and be able to eat bread in larger quantities. It's very tempting if it's only for 7 weeks or so. Except if the side effects end up being nasty.
 

I'll try, thanks.
 

Well that does sound quiet different from where I live.

Well none of the readings you mention here are diabetic or of concern (regard to Norwegian health care system), so I don’t see why you should need metformin to be able to eat larger quantities.

To be honest, I think setting you on metformin would be rather dangerous or unhealthy. Metformin are used to force larger insulin secration, and lower blood glucose. Your blood sugar are normal, so using metformin will either cause hypos or keep your blood sugar at the edga of a hypo, and that is not very pleasant.

The reference values for pre-diabetic or diabetic are the following:

Fasting:
4.0-5.9 - normal
6.0-6.9 - pre-diabetic
7.0 or higher - diabetic.

2 hour post meal (ogtt):
less than 7.8 mmol - normal
7.9-11.1 - pre diabetic
11.2 or higher - diabetic.

For ogtt 30min, 60 min or 90 min everything below 11.2 are considered normal, you had 9.0 mmol, so perfectly health since it went below 7.8 after 2 hour.

My question is more how your GP could have diagnosed you with gestational diabetes when not one of your values were pre-diabetic (or maybe there is some regional differences).

My concern are that metformin or other drugs for lowering blood glucose can cause severe hypos or unpleasant low blood sugar when you already have a healthy and normal blood sugar.

So my guess are that the side effect can be nasty if you start on metformin or larger doses of metformin. As long as you’ve never had fasting blood glucose over 7 mmol or random reading (at any given time) over 11.2 mmol it should not be given prescription for drugs to lower blood glucose. At least that’s what I’ve been told

In comparison, my highest post meal have been 20.6 mmol, and 7.5 fasting. So I won’t say 6.7 mmol after eating are a reason to rein yourself to not end up on metformin.
 

Emile - Metformin doesn't force increased insulin secretion.

Firstly, it increases the sensitivity of muscle cells to insulin. This enables these cells to remove sugar from the blood more effectively. Secondly, it reduces the amount of sugar produced by cells in the liver. Finally, it delays the absorption of sugar from the intestines into the bloodstream after eating so that there is less of a spike in blood sugar levels after meals.

Source: https://www.netdoctor.co.uk/medicines/diabetic/a26612/metformin-uses-and-action/

Finally, it is unusual for individuals taking Metformin to experience hypos, and even less so for any such hypo to be medically concerning. The link I posted there contains useful information.

It is unimportant whether the OP would be diagnosed in any other country. She has been diagnosed in her own country, where clearly different parameters are in play.
 

Hi Emile, as far as I know, metformin does not force a larger insulin secretion, it stops the liver producing as much glucose as it would otherwise do.
 

It is a bit strict here by the sounds. And I was also concerned that if I can get my BG down as low as 4.5 before my next meal, then I probably would end up with a hypo if I was on medication. I would be forced to consume the larger amounts of carbs that I had been previously eating I guess. I do wonder if I have been under eating this pat week though, or maybe I was always just over eating - easy to do when pregnant. But I was snacking all the time before. Naughty snacks too. So now I am eating like an angel in comparison.
It is interesting how different the guidelines are in different countries. I guess, even if I wouldn't have been diagnosed if I were in your part of the world, it might still be a good kick up the bum that I need to get on track and not end up with a surprise diagnosis of T2 down the track. It seems that creeps up on people sometimes, whereas having practically normal BG levels flagged is at least making me pay attention now and hopefully I can save myself in the future.

As far as the rest of this pregnancy goes, I guess I'll have to wait and see what my OB thinks. He might be happy for me to just continue with the low carb way of eating.

Thanks for showing me yours numbers as a comparison!
This is info about the new diagnostic criteria in Australia.
https://www.ranzcog.edu.au/RANZCOG_SITE/media/RANZCOG-MEDIA/Women's Health/Statement and guidelines/Clinical-Obstetrics/Diagnosis-of-GDM-(C-Obs-7)-review-July-2017.pdf?ext=.pdf
Except they got the "less than or equal to" symbol wrong... ha ha
 

The parameters for diabetes are similar in Australia as in Norway.

Source: http://www.health.gov.au/internet/main/publishing.nsf/Content/chronic-diabetes

So OP are not diabetic by Australian parameters. It say fasting of 7.0 mmol or above, any reading over 11.2 or HbA1c of 6.5%.

Yes I misunderstood metformin, I do not take metformin but insulin myself, so I stated just what I’ve heard. Sorry for being wrong there. Thanks for correcting me there

But still, treathing someone with normal blood sugar values as diabetic are wrong. I know the parameters for pre-diabetes are different from each country (as pre-diabetes aren’t a disease but a precursor or warning of developement of a possible disease).
But the parameters for diagnosing someone as diabetic are similar wherever you live.

I say this because I want to calm OP, since I think she shouldn’t worry too much as her blood sugar actually are pretty good
 

Emile - the OP has been diagnosed with gestational diabetes, for which parameters differ. The OP is being treated by a specialist medical team, in her country's of residence.

You may find the following informative. https://www.racgp.org.au/afp/2013/august/gestational-diabetes-mellitus/
 

I did read up on what Metformin does. I knew the basic that it suppresses the liver from releasing glycogen. It does sound like a smart drug for managing things in the short term, like in a situation where you are pregnant. It's good to know that it may not necessary lead to hypos.
In the long term, would it be better for the liver to have a chance to release stored up sugars? Does it work like that? If you have a lot of sugar in your liver, (stored as fat? = fatty liver?) that is you suppress the liver from releasing the sugar, it's really only a patch to prevent high blood sugar, but if you want to correct the situation, somehow the liver must release some of the sugar?
 

Cocsilk, my take on Metformin, from and observational and with a bit of reading under my belt, is that it just oils the body blood glucose cogs a bit, allowing the body to work a bit more effectively. As a medication is is quite gentle, although for those who have the initial gastric disturbances gentle is probably not a word they would use!

Many, many T2s on this forum are prescribed Metformin at or near diagnosis, and many of those folks come off it some time later. Our livers release the stored up sugars. Metformin doesn't stop it; it just adjusts it a bit.

Whilst there are undoubtedly exceptions to every rule, Metformin isn't in my view a permanent drug. It temporarily alters the body's way of dealing with sugar. Metformin can be prescribed for conditions other than diabetes, such as PCOS and straightforward insulin resistance. It's not uncommonly prescribed to T1s for IR, but of course, their insulin therapy my continude alongside it.

Please wait and see what your Team's reaction is at your next appointment.
 

I ended up calling my OB this morning when my morning fasting reading hit 5.5. It's been over a week of 5.3 - 5.4. In my first week, I had a couple of 4.9s, but I only get that now between meals if I've eaten almost no carbs.
Anyway, I thought Metformin might be a good idea since I read it can also help with preeclampsia prevention (I had preeclampsia right at the end of my first pregnancy), but my OB decided it's straight to insulin injections for me, at least one before bedtime as a start. So that's the verdict here so far.
 
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