Frustrating doctors disagreeing

ketomommy

I was on metformin for my PCOS to control insulin levels to prevent diabetes.  I was not on it for fertility.  My OB pulled me off of it at week 11.  My metabolic specialist is upset and wants me to go back on it.  I want to do the best thing for myself and the baby.  I'm not sure who to listen to.  

nopegoat

I'd probably lean towards my OB on this one as they are a bit more knowledgeable on meds and pregnancy.

I am not very knowledgeable on PCOS but I have heard from many that a lot of the PCOS symptoms are repressed by pregnancy 

Your OB can also send you for a glucose tolerance test to check how your body is handling sugar right now and can send you to an endocrinologist for a better medicine right now if needed to help with insulin levels. 

nopegoat

Did you ask your OB exactly why they took you off it as far as negative side effect goes? 

ketomommy

I just got an email back from the OB saying that there are no studies that say metformin is safe after the first trimester.  The metabolic doctor is saying there are studies.  I asked her to email them to me.

frenchbaby18

@ketomommy I would definitely get a second opinion (well, third...) and see if it is in line with the OB or the endocrinologist. 

I work in the medical field and am constantly surprised by how many doctors aren’t up to date on the most recent guidelines. Spontaneously, I think your OB is right to stop the meds but would have you follow your blood sugar as if you had GD before and after all meals and start treatment only if symptoms present + have you follow the GD diet even if your levels are normal. 

Hopefully you can find someone who can fully explain the risk:benefit of continuing the metformin (potentially your GP? Or is your hospital has a doctor specialized in GD?) 

ketomommy

@frenchbaby18 I follow a keto diet when not pregnant and a low carb diet while pregnant.  I'm already on the the GD diet.

frenchbaby18

@ketomommy I would have thought it was still good to test your blood sugar around meals just for 100% confidence your pre-diabetes hasn’t progressed during pregnancy, but I’m sure your OB or other provider will give you much better answer knowing your full medical history!! 

I’m surprised they haven’t ordered an early glucose tolerance test as @nopegoat mentioned. 

In any case, I would definitely look for a third medical opinion! It’s definitey possible in your specific situation that the risks of metformin are outweighed by the benefits and your OB isn’t a specialist in diabetes management! Or your other doctor isn’t up to date on GD management practices and is recommending something that is not in the best interest for you and baby! Impossible for anyone to know without your full history. I hope you find the right specialist who gives you confidence you are making the right decision!

frenchbaby18

https://www.healthline.com/health/pregnancy/metformin-is-it-safe#takeaway

(Simple explanation but definitely helps understand why if it is for PCOS and not pre-existing T2D it may still be a good idea to take to prevent progressing to GD)

ketomommy

@frenchbaby18 I never had pre-diabetes.  I was on metformin because I wasn't losing weight after following a strict 1200 kcal/20 net carb a day diet last spring.  The docs figured it might be due to the PCOS and ordered metformin.  It worked.  I lost 30lbs in two months and got pregnant.

abnelsen22

My OB said she was happy to have me continue metformin while pregnant. 

babyginjuly

@Ketomommy, you had said "I was on metformin for my PCOS to control insulin levels to prevent diabetes. " I think this is why many of us are concerned if you're pre-diabetic. If I was in your situation, I'd mainly stick to listening to your OB and monitor your glucose levels. The reason you list that Metformin was prescribed to you in the first place is, " I was on metformin because I wasn't losing weight after following a strict 1200 kcal/20 net carb a day diet last spring." I don't think at this current state, your weight loss should be of concern. I'd really think about the side effects of the medication itself on your body and baby before anything else. I'd also get a third opinion from a medical professional.

ketomommy

@babyginjuly I guess I didn't explain it well.  I am not looking for weight loss right now.  PCOS often leads to diabetes.  The theory back in April was that the PCOS was causing my insulin levels to rise and my body couldn't break down the food properly.  I'd like to prevent GD and/or needing insulin if I have GD.  

nopegoat

I wouldn't want to take meds unless I absolutely needed them during my pregnancy. I'd let your OB test you for GD and go from there.

ETA There's no preventing/cure for GD only managing it. If you do have GD and the meds you are on masks high glucose levels more complications can occur. GD pregnancies needs more monitoring besides just sugar/carb control. There's extra growth ultrasounds, NST's, and monitoring for the baby once born.