High-Risk Pregnancy
MrsWhipple
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When did you get put on insulin
MrsWhipple
member
My MFM diabetic nurse called me today and said they are ready to put me on insulin. I thought my numbers were good. My fasting number has been slightly high (supposed to be under 95, but hovers around 100), and my after meal numbers have been good (only a few high numbers here and there). She said I'm already taking the max dose of metformin, and their criteria for putting a patient on insulin is if you have 2 or more high numbers in a week's period. I'm really frustrated because I thought I had it under control with my diet. That and they need me to come in so they can "teach" me how to give myself insulin. How hard can it be? She is going to call my regular ob/gyn and see if there is someone I can see closer to home (the MFM office is quite a drive for me, and I have to miss a day of work), in order to "learn" how to give myself a shot. When did you get put on insulin? What was your doctor's criteria?
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Re: When did you get put on insulin
I was at two different practices with my two pregnancies. Both of them put patients on insulin after seeing a pattern of high numbers and/or if fasting was consistently above the cut off. From what your said about your fasting numbers, you would meet their criteria.
The first, I was diagnosed at 28 weeks and on insulin twice a day at 29 weeks. None of my numbers were under control by diet alone that first week, insulin was very necessary.
The second time, I was diagnosed at 13 weeks and on insulin once a day at 18 weeks, increased to 4 times a day at 22 weeks. I should have been on it sooner but the endo at my practice left the practice quite suddenly about 2 hours before my first appt, so I had to wait until I could get in to a new one. My fastings were high from the start, and my meal numbers crept up fairly quickly after about 15 weeks.
As far as having to learn how to do the insulin, it's fairly simple but better to let them go over it with you and make sure you understand exactly how to draw your dose, when you should take it, and where/how to inject it for the least amount of pain and damage to the tissue.
DD1 Feb 2010
DD2 Sept 2011
I was diet/exercise controlled with my first GD pregnancy.
This time, I was diagnosed at 13 weeks, really struggled to control my numbers and managed to avoid insulin until about 34 weeks. I was put on a bedtime dose, then, it was upped a week later. Then, a week or two later, I started a morning dose, then my night dose got upped again.
As far as learing how to inject the insulin, my "educator" was worthless. It was a stupid waste of time. (If I decide to write a "comment card" to my OBs office, that is one of the things that I will address.) I actually learned more by reading the inserts in the insulin and syringe packages.
I felt like insulin was a really big deal before I started, but now that I am used to it, it's just a little more complicated than checking my blood sugar.
Hm, that's really intersting, OP.. perhaps it's different because you were already taking an oral medication to help control your GD and that wasn't working..
For me, I've been doing it by diet alone for the past 3+ weeks. I just had my appointment with MFM to do a growth scan and evaluate my sugars over these past 3 weeks and determine a path forward. My after meal numbers have been great.. I think I had 5 readings over 3 weeks that were above 120 (and, only out by max of 5 points or so).. all my other after meal numbers stay between 85-110. My morning numbers, however, fluctuate between 95 and 100 quite a lot.. I think I had one or two mornings where I measured 101. Anyway, I was very resistant to do insulin, and when I said to my specialist that I really don't want to do insulin he said they wouldn't even consider putting me on insulin at this point because my numbers are so close. Apparantly there are 2 standards for GD recommendations for fasting numbers.. one is under 105 and another is under 95. He did put me on a super low dose of glyburide (2.5mg before bed) just to see if that would help keep my numbers a little lower, and said the only reason why he's doing that is because my growth scan showed baby measuring quite big (>95%).
It's interesting how different each doctors' approaches can be. I have a coworker who is 5 weeks ahead of me.. she's been on insulin from very early on.. they didn't even give her the option of diet control and attempting to use glyburide (and, I'm assuming metformin or what not is the same kind of thing as glyburide).. and, I know she said she barely failed her 1 hour (only by a handful of points), and only failed 2 out of 4 of the 3hr time points.. I failed my 1hr by 35 points and failed all 4 of my timepoints for the 3hr.. it's just very interesting to see how different the approaches are..
Anyway.. have you played around with different things to try and lower your fasting numbers? For example, I've found that I need to eat a bigger snack at night to keep my numbers lower in the morning.. I usually eat 2 slices of wheat toast (16g carbs) and a tbsp of peanut butter.. and, occasionally if I wake up in the middle of the night hungry, I'll eat a cheese stick.. I started doing that this past week, and 5/7 days I was under the 95 mark. Did the same thing last night, (and, actually cheated and put a bit of jelly on there, too!!), but did take the glyburide for the first time and my morning # was 90.
One of the tricky parts about fasting is if you don't eat enough before, and your glucose drops too low, your body will overcompensate (gluconeogenesis), which means your body will begin breaking down glycogen molecules into glucose to prevent you from going into hypoglycemia. So, when I was really struggling with my fasting numbers (almost always between 97-99), cutting out my night time snack was just making things worse.. after doing some more research into the matter (and, I did talk briefly with my specialist about this), I found more about gluconeogenesis. So, that makes sense why, now that I'm eating bigger snacks at night, things are leveling out.
Anyway.. long story short.. this is how I've been handled so far.. hopefully you're able to get your fasting numbers under control a bit more that way you can avoid insulin!
That is absurd!! You passed your 3hour, but they are still considering you a GD patient? If your numbers are considered normal, I would fight going on insulin. At the end of the day, you need to weigh out the pros and cons.. if your numbers reach a point where you're unable to control them, then yes, insulin may be the answer.. but if you're keeping them within range majority of the time.. I disagree, and don't think insulin is right for you (same thing my specialist just told me..).
Good luck with it all.. how far ahead are you measuring (just curious).. at my last growth scan, I was 31w2d and measured 33w5d. They said baby's estimated weight was 4lbs14oz.. freaked me out a bit, as that's much bigger than I expected, but I was also told it could just be that baby had a growth spurt and will slow down the next few weeks making it likely that when we check again he'll be within normal ranges!