Gestational Diabetes Chatter #6

[belfie]

hi blackorchid, welcome to the thread sorry to hear you've got GD. In regards to your question about metformin I'm sorry I don't know much about metformin use at all - I think you know more than I do! I've only ever used insulin with my GD (this PG and last PG). I'd suggest it might be worth posting a general question in the medical section (i.e. the section this thread is in) and seeing if someone else can shed some light?

I do remember hearing of some others in here a while ago using metformin, but certainly it doesn't seem to be part of the standard treatment in Aus. From my experience I also think there's great variation in how GD IS treated in Aus which I'm sure doesn't help. GL with getting some answers.

hi everyone else, hope you're all going well. AFM visit to endo today exactly as expected, insulin upped to 14 units and for every reading over 7.5, I'm to add another 2 units on... with a review in 2 weeks. So i'm kinda pleased cos I was getting sick of going in there every week lol. Even the endo commented oh you're only 32 weeks, that's going slow which cracked me up. I know I need more insulin tho cos a simple chicken salad sandwich which SHOULD be fine (and was a week or so ago) still sent me too high today. Interestingly I'm tracking about 2 weeks ahead of my last PG in terms of insulin dose, so I imagine I will get to a higher dose before bubba arrives. Oh and they gave me more insulin today, woo hoo.

[~mamaspice~]

Hi Blackorchid, sorry but I have no info on the use of metformin either. Although on the Diabetes australia website there is a story about a mum who had GD who was on tablets to control it (so I'm assuming metformin?) so it must be done for sure.

Hi belfie, Bummer about the higher BSL's good to hear you only need to see the endo fortnightly though. I had a 7.5 last night but I know why. I tried my luck with a jacket potato. I haven't had one for a couple of months and boy was it Yummy. I also had it with crumbed veal so the potato along with the crumbs on the veal would not have done my BSL any favours

Just want to add a quick question for those who are medically managed (ie: on insulin) what gestation does your health care provider feel happy with you going to? Are they keen to let you go over or do they want bub delivered early? The hospital aren't too keen for me to go past 40 weeks. Especially because of combining the GDM with a possible VBAC. In fact the Ob said in a perfect world they'd like to see me go into spontaneous labour before 39 weeks with a bub measuring under 4 kg.

Just curious to know that everyone elses care provider thinks about when you GD bub will be better off out than in IYKWIM?

[sloane]

hi mamaspice, i'm no longer PG but i still pop into this thread every so often to see how the ladies with GD are going

my dr offered me an induction at 38 weeks but i refused. i held out to 40 weeks but had once or twice weekly monitoring (which i had from about 35 weeks i think? can't remember now!). i think if i was to have GD again, i would feel more confident in pushing for 40+ weeks (assuming no other medical concerns) because in hindisght, my DS wasn't ready to make his entrance just yet & the induction put him under what i think was unnecessary stress (i ended up with an assisted delivery as his heartrate dropped when it came to the pushing stage). he was 3.99kg so a big boy, but not huge.

[belfie]

Just want to add a quick question for those who are medically managed (ie: on insulin) what gestation does your health care provider feel happy with you going to? Are they keen to let you go over or do they want bub delivered early? The hospital aren't too keen for me to go past 40 weeks. Especially because of combining the GDM with a possible VBAC. In fact the Ob said in a perfect world they'd like to see me go into spontaneous labour before 39 weeks with a bub measuring under 4 kg.

Just curious to know that everyone elses care provider thinks about when you GD bub will be better off out than in IYKWIM?

Aah good question. I had that convo with my obs a fortnight ago (once I was on insulin. He was flagging induction at 38.5 weeks for me. I teased him and said you let me go to 39 last time. We both agreed that induction increases the risk of instrumentation (which I need to avoid at all costs) but he said the risk of birthing a bigger baby post 40 weeks (plus placenta maturation risk) is the flip side of the coin. In my case there are also some additional reasons (vaginal prolapse and pelvic floor nerve damage) for wanting a smaller bub... so his logic is second bub, could be bigger + insulin, so I think he'll never want to let me past 40 weeks at the absolute most. Plus he's optomistic that having laboured before I've got a better chance of either a) earlier labour on my own and b) much less induction activity (so to speak!) - if I could get started prior or with just gels/water breaking that would be much better than the drip. Further to that, we're also waiting on a placenta check (marginal placenta praevia) in a few week's time, plus I think HOW much insulin might influence as well (I'm tracking to be on more than last time)... so there's a few variables yet to be fully considered. FYI X's birth was induced at 38+6 (sitting around with gels for a few days) then he was born at 39+1, 3.4kg (7lb 7oz) and his APGAR's were great, no trouble breathing and his BSL's were ok (but on the low end). If we get around that size/gestation I'm not against it... but obviously am hoping for a instrumentation-free vag birth!

Incidentally I also talked to my endo about this, and he did seem less pro-induction, but agreed loosely with the 40 week thing... I got the impression that he didn't think placenta maturation was nearly such a big issue. So saying, he made the caveat that he's not an obs so doesn't have all the other elements in consideration - he's purely thinking about the insulin/placenta component.

Your hossie/obs sounds to have a very similiar perspective. Are you going to be trying all the natural induction methods? I did most, but not all last time. I'll be trying ALL (assuming that placenta moves) this time.

[Trac73]

Hi Ladies

Seachange - Congrats on the birth of your son Thomas, enjoy every moment with him.

BlackOrchid - Welcome and i am looking forward to getting to know you, there is alot of woman in here that have a bucket of knowledge, make sure ask plenty of questions to get your head around GD.

MammaSpice - my last bub was induced at 38+4 days and he was born at 38+5 days and he was insulin, so i think this one will be the same being induced at around that 38week mark, i know that they don't like you to go far over 40 weeks because of the placenta at our hospital but if you are insulin and bub is large (heading towards over 9 pd) they will induce. We will have a scan at 34 weeks to see the progress but i am seriously thining 38 weeks is where i will make it.

Belfie - sorry to hear that they have increased your insulin, so what amount of insulin are you up to now? Hope you are well

AFM - they have increased my night insulin by another 8 units making me have 24units at night and 16 units in the morning. My fasting levels just will not stable, and my day BSL's are seriously all over the place one minute they are 4.4 the next 7.1 so completely confused. Have a feeling that the insulin will just keep getting more and more like it did last time. Other than that health wise i am feeling pretty good. Having a few troubles at work and counting the days until i go on maternity leave and annual leave. I am 30 weeks today so time sure is ticking by fast and guess what i have done nothing, no sorting out clothes, no cradle set up. It is so funny that when we had our son it probably was slowly getting sorted by now funny what happens when it is 3rd child lol

Take Care Everyone and i look forward to Chatting Soon

[belfie]

Trac - do you think your insulin dose is heading up quicker this time? And also, is over 7.0 your trigger? I'm told to just stay under 7.5. I'm only on 14 units (morning only) but copped another 9.1 for dinner tonight and no way should it have been that high (brekkie & lunch were great)... so it's up to 16 units tomorrow for me. Glad you're feeling mostly ok and hopefully mat leave comes around nice & quick!

I had a check-up today and suddenly my measurements are 4 weeks ahead even though they were spot on a fortnight ago. I'm hoping it was just measurement error. On the bright side, she's head down and still definitely a girl (I was getting a bit paranoid!).

[~mamaspice~]

Hi Girls!

Thanks for your imput on when your Ob's/hospital want bubs to be born.

The Ob I saw at the hospital today re-iterated the 39-40 week limit for me. I also have to have CTG monitoring at each weekly visit from now on. The midwife today said I couldn't have gotten a better CTG reading Also have to have another scan to check bubs size, but fundal measurement wise I am measuring 38 weeks ATM.

Wow Belfie, a sudden jump like that doesn't seem quite right to me. I think there has been an error in there somewhere. Try not to worry and wait and see what it is next week.
Still on 6 units of insulin at night

[blackorchid]

Thanks everyone for the warm welcome! I look forward to learning more about your GD experiences as time goes by