# Has anyone refused insulin for Gestaional diabetes? (long post)



## Caezzybe

After not having diabetes pre-pregnancy, I was diagnosed with gestational diabetes on Tuesday and tried to control by diet, but most of the readings in the two days I have tested blood glucose were higher than the NICE guidelines (over 7.7 mmol/l one hour after meals and over 5.8mmol/l before breakfast):

https://www.nice.org.uk/nicemedia/pdf/CG063Guidance.pdf

Now considering that according to the NHS the normal type 2 diabetic acceptable readings are that "a normal blood glucose level is between 4.0-6.0 mmol/l before meals (preprandial), and less than 10.0 mmol/l two hours after meals (postprandial)":

https://www.nhs.uk/Conditions/Diabetes-type2/Pages/Treatment.aspx

I am under the normal type 2 limits, but over the NICE guidelines.

Also notice that the NICE guidelines say ONE hour after meals and the normal guidelines say TWO hours after meals. This seems grossly unfair and I have not been able to find any reason why the goalposts have been moved, either on the interenet or by asking people. The diabetic nurse couldn't answer the question either and said "but these are national guidelines" (for anyone who has seen the film This is Spinal Tap, she may as well have said "these go up to 11 :( )

I'm not doing anything "wrong" with my diet as I confirmed with the dietician today, so the diabetic nurse/midwife wanted me to go on insulin. I asked if they did tablets and they said no, only insulin. This to me seems very extreme. The nurse got out the insulin pen to show me, I saw the needle and completely freaked out. I burst into uncontrollable sobbing and my eyes glazed over when she asked me if I was going to try it in my stomach or my thigh. When I didn't respond, she offered to inject it into my stomach or thigh. I still wasn't capable of responding, I am terrified of needles and was awake most of Tuesday night in near hysterics worrying about the possibility of this happening. I finally blurted out another request for tablets, asking why I couldn't go on Metformin tablets (which I know is an approved treatment for gestational diabetes). After what seemed like a very long time, she said she would make an appointment for me to see the consultant on Monday and wrote "not keen on trying insulin" in my notes. She couldn't understand why I lost it at the thought of insulin and not glucose testing, but with insulin I can see the needle (the blood sugar lancets are hidden inside a pen so I'm ok with those) and I also don't have to report a blood glucose monitor to the DVLA and car insurance company (nor would I have to report tablets!)

There is no way I could stab that thing in myself and I was relieved to get out of the hospital. I don't know how I drove home as I was that upset and suspect I may have gone through a red light. I got home, burst into tears and hugged the cat for some comfort. My husband is away on business today, so I'm having to deal with this on my own until he gets back tomorrow evening. I have spoken to him on the phone, but it's difficult being alone right now.

After having calmed down a bit, I'm resolved to say a definite no to insulin when I see the consultant, even if it means changing hospital. My friend who lives 20 miles away and who gave birth at a different hospital had tablets, why can't I? When I asked the other day why they didn't do tablets, the diabetes midwife said "the hospital has very good figures". I couldn't give damn about figures, Im not an NHS statistic :(

I'm just worried they will try and section me or something, thinking I'm a nutter (I'm not, the word insulin fills me with dread as it's a last resort treatment and I have a bad needle phobia).

Has anyone else refused (or attempted to refuse) insulin and what happened?

Sorry for the long post, I'm at my wits' end right now :'(


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## sarafused

From your figures you clearly do need to go on some medication to control your sugar levels, Im sure you know the extra sugars are very good for babys growth. I do think your levels after meals have been high, they should be under 7.8ml. Type 2 diabetes is slightly different as its more your body cant produce the insulin, with gestational diabetes its the placenta thats causing the problems. So most of the time its not a permanant change and you should go back to normal after the birth.

You mentioned on your other posts about some meal examples. Yes your diet is healthy and balanced but I can see ways to alter it that may bring your levels down to "normal".

* Porridge- personally Id bin this completely its just carbs, milk has the same effect on blood sugar. Id look for something lower in carbs. Do you like eggs for example?

* Lean bacon, grilled tomato and bread. Here I would say skip the bread and have extra bacon instead, maybe a egg too?

Have you been given any guidelines for the amount of carbs? Im from the UK, but living in Finland. We are given a booklet with a eating guide with suggested measurements for things like pasta, potato etc. I can honestly say the portions for these are so tiny it hardly worth bothering. I can type these up if you think they might help you. I seem to remembe for made up porridge its something like 2dl (200ml which is not a lot). Its also 2dl for something like a pasta bake.

my blood sugar levels an hour after a meal have been 5.somethings. Ive been having half a plate of salad with something like tuna mayo, meatballs, chicken breast. A small slice of heavy rye bread and the odd glass of skimmed milk.

Ive been recording anything thats given me a slightly higher reading. I had a third of a cheese pizza last night with salad. That gave me a level of 7 which is high for me. So its something Im not going to have very often.

Im sorry if that sounds a bit preachy, but Im thinking if you have a little time before you see the consultant you could try to bring the levels down with altering your diet.

But if it doesnt work do fight for the tablets! Perhaps you could demand a trial on them and if they arent working after a few weeks then go on the insulin? - I can honestly say the needle isnt as bad as you think. My mum is insulin dependant and petrified of needles. She has to see a specialist for blood tests its that bad. But she has learnt to do the injections very easily.

I also had GD in my last pregnancy, it was diet controlled that time as well. The doctor I saw at the hospital did say they prefer not to put mothers on insulin unless its completely necessary.

When you go have you got someone to take with you?


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## costgang

ive got gd again this time, the insulin really isnt so bad, infact i find the testing of the finger hurts more than the insulin pen,and at the end of the day you will be doing it for your baby. i cant do it in my stomach, that one completly freaks me out and for some reason i can only do it in my right leg, ive got to inject 4 times a day now,but youve got to remember its not forever, you will prob be induced at 38 weeks, so yoy only got 10 weeks to go, the best way if found is to pinch my leg then slowly push needle in, the fiorst few times wil be hard and if you want any advice please pm me, goodluck:thumbup:


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## suzib76

i had GD but never needed insulin, however if it was required and the recommended course of treatment i have to say i would not argue against it. the fact that you would have to inform the DVLA and insurance company is irrelevant, your health and that of your baby comes first - these are minor things that just take a quick phone call/form sent off

you cant compare yourself to your freind either, everyone is different and whatever treatment was right for her may not neccessarily be right for you

i would say to see the consultant with a very open mind, dont go in resolved not to go on insulin as if it is going to be the best course of action then you may have to face up to it and accept thats what you need. but, on the other hand, ask the consultant to explain etc why you cant have tabs and if you dont like his reasoning then you could refuse i guess, personally i wouldnt, but its entirely your choice


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## Caezzybe

Thank you all for your replies, particularly the advice from Sarafused which is more or less along the lines of what I was thinking with regard to carbs. I'd like more time to see what's no good as far as carbs go and what's a good reading. The thing with bacon etc. you suggested was the next on my list for Monday at work. I tried one slice of whole grain toast with bits and Marmite this morning to test what would happen, followed by a 10 minute walk (to mimic the amount of time I could get away with being absent from my desk at work) and a large cup of green jasmine tea. My reading was 8.9, still high but lower than previous days (9.9 on Wednesday and 9.5 on Thursday). It does look like breakfast is a problem and bread is now off the menu completely until I see the consultant. Pre-breakfast, my reading was 4.9 today, which is absolutely fine. 

I seem OK with dairy stuff, as this has been a substantial proportion of meals with lower readings (the main part being non-starchy vegetables or salad). I'll try low fat yogurt for breakfast tomorrow, to see what reading I get with that.

Stress could be playing a part in the high blood sugar readings too, but its difficult to stay calm under the circumstances.

WIth regard to my friend who was put on Metformin, I actually went to her first diabetic consultation with her, suspecting it would happen to me. I wasn't prescribed just in her case, the diabetes midwife said that at that hospital they put ALL their gestational diabetes patients on Metoformin that can't control blood sugar with diet and only resort to insulin if that doesn't work. She also said that the guidelines changed recently and that until a couple of years ago, all hospitals put women straight onto insulin if diet didn't work. So it's more the blanket policy of my hospital that I'm challenging.

I can remember the name of the consultant at the other hospital and might try to get her phone number to pass to my consultant. Unfortunately, I'm not in that hospital's catchment area or I would ask to transfer there.

And as a quick recap for anyone reading this, I'm not trying to refuse medication altogether, I'm trying to get the consultant to prescribe Metformin tablets instead of insulin. I think 2 days on diet control before suggesting insulin is a bit extreme!


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## sarafused

I know I wouldnt want to go straight onto the insulin if the tablets would work. I think youre right to stand up for yourself.

Im lucky that we get really heavy rye bread here, so I have that for breakfast everyday. Im going to be over in the UK for 2 weeks in July and I know breakfast is going to be a problem for me there. I can see plenty of bacon being eaten :thumbup:

Ive been following this "diet" for 2 weeks now and Ive lost 5lbs so far so Im not going to complain about that.


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## ChubbyCheeks

*I have GD...tried to control it on diet & now im on metroformin twice a day...
But my readings are still wonky!!

Consultant told me i will be going onto insulin anytime soon.
I have to phone up every few days to give them my readings,
which is a pain in the butt!

On the positive...ive heard the inulin is easier to do than the 
finger prick?!
My fingers are sore with it, blood blotches everywhere 

But my answer is no i wont refuse the unsulin i will take it x*


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## Floralaura

Honestly I wouldnt refuse insulin no matter how scared i was of needles..my readings were low, i never had any over 9..no matter what i ate, so i made a few bad choices..it resulted in my LO being huge and poorly at birth. I regret it everyday now..
So yes, if they do give you tablets because they think they will work then good, if not then you would be messing with your babies life by refusing insulin if its the only way to control your levels..


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## Caezzybe

Just to reiterate, I'm not refusing all treatment, I'm only refusing to go on insulin without tablets at least being considered. If I try tablets and they don't work, I know I will have to go on insulin, but for the hospital to deny me even the chance to try Metformin is pretty extreme (and even the midwife at the GP surgery today agreed that it's extreme and said I must stand up for myself) Unfortunately, the title lines in threads don't have much room to say exactly what you mean!! After 2 days on diet control, it sems a bit all or nothing to be talking about insulin straight away. It's not me, it's the hospital policy.


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## costgang

i went on metformin first and itv didnt make that much dif to my figures


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## Rory

Caezzy,

My diet is very strict and has to do with combinations of food at certain times. I have really brought my sugars under control with diet alone.

You should really try this...
NO DAIRY in the Morning! Dairy should never be eaten at breakfast. 
ALWAYS pair carbs (like toast) with Protein!

For me, I have to stay away form any white bread products as well. Keeping a food diary really helps you figure out what your body reacts strongly to. I'm surprised you saw a nutritionist who didn't give you a diet plan. Let me know if you want to know more about mine.


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## angelstardust

The advice for type 2 diabetes is irrelevant. You don't have type 2, you have gestational diabetes. There are a few subtle but important differences in how exactly your body is responding to the glucose and insulin and more importantly, how your baby is responding to the glucose and insulin. 

Your baby will be producing a high amount of insulin to deal with the glucose it's getting right now. Imagine if you are on a very good diet, your body knows food will arrive at certain times and it prepares for it. Now imagine you have suddenly been starved of food and offered measly rations. Your going to feel like crap. And that will happen when your baby is born. 

I should have been put onto insulin 3 weeks before Amber arrived, but due to other complications, it never happened. She spent a week in SCBU on a glucose drip because her body was not adjusting to the lower food source (milk). That was despite me doing everything I could to firstly sort out my blood sugars (I also had high levels of keytones so was in early labour for 4 weeks) but no matter what I ate or didn't eat, my body just wasn't processing the glucose. And then when she was born I breast fed her constantly and gave her formula top ups. 

Fight for the tablets by all means, but if they won't give them to you, you will need insulin. Have a look at the side effects for hypoglycaemia in newborns and every time you need to inject yourself, remember them. I guarantee you, you will manage each and every injection.


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## Imalia

I have type 2 diabetes that was well controlled with diet and metformin before I got pregnant, however by the end of the first trimester it just wasn't controlling them enough and I had to be put on insulin. I was very resistant at first as well, but it honestly isn't as bad as I thought it was going to be. I also felt very cheated by the fact that suddenly the "goal posts" were changed and much tighter.

Whether you have pre existing diabetes or gestational diabetes the fact that your body's need for insulin increases as your pregnancy progresses is the same, and I am now resigned to the fact that I will need more and more insulin as time goes by. My short term insulin has already needed to be doubled in three weeks, although the longer acting insulin has only increased by 1 unit.

I know my diabetic team used scare tactics on me to get me to be a little more compliant with their treatment regieme, but at the end of the day these risks are just not worth avoiding a couple of injections a day.

The risks I was told about:

High birth weight leading to complications of labour and c-section
Neonatal hypoglycemia
Jaundice
Breathing problems at birth
Higher risk of premature labour and still birth
Maternal high blood pressure and odema
Urinary tract infections
Build up of ketones in the blood
Diabetic retinopathy
Possible damage to kidneys

I know those are worst case scenarios, but to me it just wasn't worth taking the chance.

Another thing that hasn't affected me personally, but my sister went through due to gestational diabetes that she was trying to control though diet alone, was she had her heart set on breasfeeding. But when her son was born, he was too tired to feed right away and the neonatal hypoglycemia meant the doctors weren't happy to wait and so started giving him bottles of formula and she was never able to properly establish breastfeeding after that.


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## tickledpink3

Also I haven't seen it mentioned here yet, but are you on a low impact exercise regimen such as walking? That helps me burn up alot of the excess glucose too. Just my two cents. And to be honest, I wouldnt want to do the insulin either. I'm squeamish like that. I hate the finger pricks but think it could always be worse. Good luck to you and hope they find an alternative for you.


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## angelstardust

I meant to mention the feeding issues too. I breast fed Amber for 8 weeks and she lost weight due to her being too sleepy to feed. We had to start combination feeding which was a great success, but she didn't gain weight till 14 weeks when we were fully formula feeding. A sleepy baby sounds easy, but it's worrying. 

The biggest risk to baby that I was told about is brain damage. Too little glucose to the brain means that cells die. Since I have one child with brain damage already, it was the biggest scare.


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## Caezzybe

Thank you all for your replies. Ironically, I've managed fine on diet control over the weekend and my blood glucose has been well within the required limits, between 5 and 6. I've increased my exercise and am now walking for about an hour a day. This wasn't mentioned to me at my last appointment. I think it's pretty dire that I was only given 2 days to attempt control by diet before insulin was virtually thrust upon me and that exercise was not mentioned.

I have an appointment with the consultant tomorrow and have lots of paperwork printed out saying that the NICE recommendations say that oral hypoglycaemic therapy is acceptable and that trials have proved good results little different to insulin control. So if he says that I can't carry on with diet control I will show him the paperwork. If he doesn't like it I also have my BUPA certificate in the folder and I will contact them to see if I can get someone a bit more sympathetic in private medicine. None of my hospital leaflets mention tablets, it's just their policy not to give them while neighbouring hospitals do as their treatment of choice (and I also have documentation to prove it). I wont be told what to do just because it's their policy to not offer all avaliable recommended treatment!

More to follow after my appointment!


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## sarafused

Well done with the diet control! :thumbup:

Good luck with the appointment!


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## kirmal12

Without trying to scare you i would go with anything your consultant tells you after all he/she is the expert!. There maybe reasons why you can't go on the tablets, when i was diagnosed i was told either manage it with diet or onto insulin straight away because the tablets (if they work at all ) take a couple of weeks to work and i just didn't have the time to play with. I managed to keep it under control with diet but i wouldn't think twice of using insulin. I was diagnosed late (34 weeks) so my poor LO was growing rapidly up till then.

I was induced at 38 weeks, it took 4 days to go 1 cm dilated and after 12 horrific hours in labour i finally had a emergency c section. My LO was born with really low levels (0.5) and nearly ended up in ICU but luckily he got better really quickly after having formula. He was was born at 8lb8 i dread to think how big he would have been if i had gone to 40 weeks. Through my experience i will not be having any more kids because i could not go through all that again ever!!


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## Caezzybe

Well what a nice surprise! My consultant took one look at my blood glucose diary today (all blood readings were well within limits since that horror appointment last week) and said "I see you've been managing diet control really well, keep up the good work". No insulin, no tablets just healthy diet and exercise! I am so glad I didn't just accept what I was told by the nurse last week without questioning it, especially as the advice I was given was only 2 days after being diagnosed without them giving diet adjustments a real chance. 

My advice to anyone who finds themselves in the same situation is to ask to see the consultant before you agree to anything if you're not sure. If you're not happy about something, ask to see someone who can do something.

The consultant is happy with me cutting carbs at breakfast (e.g. bacon, mushrooms, tomatoes) to avoid a sugar spike in the morning, I explained that I wanted to build it up slowly so that my sugar levels stayed consistent throughout the day by having a Muller light yogurt as a snack mid morning and then lunch with carbs, protein and lots of vegetables at mid day.

So today, I'm happy and things have worked out far better than I could have imagined :) I also found out that my HBA1C blood test from last week confirmed that the diabetes is also a very recent thing in the pregnancy and that I definitely wasn't diabetic before :)


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## tickledpink3

Great to hear that all is working out for you


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## sarafused

Fab news! :thumbup: :hugs:

Ive found laying of the carbs gives me low figures, though I havent really got any before to compare with. Im not missing them at all, though if I really fancy something I have a small bit. Ive got 7.5lbs off so far so Im not going to complain about that. :happydance:


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## Caezzybe

sarafused said:


> Fab news! :thumbup: :hugs:
> 
> Ive found laying of the carbs gives me low figures, though I havent really got any before to compare with. Im not missing them at all, though if I really fancy something I have a small bit. Ive got 7.5lbs off so far so Im not going to complain about that. :happydance:

My blood glucose readings are all still well within limits and much the same as last week, fingers crossed that this continues :) I'm glad your readings are also low :)

I think in my case the extra exercise is helping too!


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## jennie-jack

i just got insulin yesterday after metformin for 3 months and it isnt as bad as i thought it would be my bloods were over 10 with the metformin.


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## BLONDIE35

Caezzybe said:


> Thank you all for your replies, particularly the advice from Sarafused which is more or less along the lines of what I was thinking with regard to carbs. I'd like more time to see what's no good as far as carbs go and what's a good reading. The thing with bacon etc. you suggested was the next on my list for Monday at work. I tried one slice of whole grain toast with bits and Marmite this morning to test what would happen, followed by a 10 minute walk (to mimic the amount of time I could get away with being absent from my desk at work) and a large cup of green jasmine tea. My reading was 8.9, still high but lower than previous days (9.9 on Wednesday and 9.5 on Thursday). It does look like breakfast is a problem and bread is now off the menu completely until I see the consultant. Pre-breakfast, my reading was 4.9 today, which is absolutely fine.
> 
> I seem OK with dairy stuff, as this has been a substantial proportion of meals with lower readings (the main part being non-starchy vegetables or salad). I'll try low fat yogurt for breakfast tomorrow, to see what reading I get with that.
> 
> Stress could be playing a part in the high blood sugar readings too, but its difficult to stay calm under the circumstances.
> 
> WIth regard to my friend who was put on Metformin, I actually went to her first diabetic consultation with her, suspecting it would happen to me. I wasn't prescribed just in her case, the diabetes midwife said that at that hospital they put ALL their gestational diabetes patients on Metoformin that can't control blood sugar with diet and only resort to insulin if that doesn't work. She also said that the guidelines changed recently and that until a couple of years ago, all hospitals put women straight onto insulin if diet didn't work. So it's more the blanket policy of my hospital that I'm challenging.
> 
> I can remember the name of the consultant at the other hospital and might try to get her phone number to pass to my consultant. Unfortunately, I'm not in that hospital's catchment area or I would ask to transfer there.
> 
> And as a quick recap for anyone reading this, I'm not trying to refuse medication altogether, I'm trying to get the consultant to prescribe Metformin tablets instead of insulin. I think 2 days on diet control before suggesting insulin is a bit extreme!

Hi just to say that if the other hospital's policy suits you better then you can transfer to another hospital even if it's not in your catchment area. NHS Choices has opened this up so you can refer to any hospital that you want to go to. It's your choice.


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## cantthink

I do not know much about GD, but I am in totally the same situation with a drug called clexane. You also inject it. 

I am worried that taking any drug while pregnant is not a good thing.. but I also understand that the med profession are also using these drugs to avoid other complications. My worry is that sometimes adding drugs may make bring other complications...... 
It is such a difficult one. No one wants a 'complicated' pregnancy. I am coming to terms with mine. 

Hope you decide what is best for you


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## Caezzybe

Thanks ladies for the last 2 replies. Just as a quick update, fortunately my blood sugar levels have stayed really good with diet control alone; I just had to kick back against the hospital's insistence on me eating carbs at breakfast, which was the only time I was having a problem as insulin resistance is at its greates in the morning. I'm certainly happier having egg, bacon, mushrooms and tomato for breakfast than eating toast and injecting insulin! I've also been told that I may be left to go right up to my due date before induction as my blood sugars are so well controlled :) I found that no drugs at all was the best option for me, but if I hadn't managed to control it yes I would have gone on insulin for the sake of the baby.


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## katsina

PROUD OF YOU! You have done all within your power to control something that is extremely hard to do and you have been successful! I was diabetic prior to pregnancy and sugars have been a total pain in the but, and major stresser, from week two on. I was told that insulin does not pass through the placenta like my medication does. It is much more painful to prick my finger several times per day than to inject 3x. 
Your story is helpful because finding a food regime while pregnant can only offer good outcomes and stress alone can throw the healthiest of us out of whack. I too have found that carbs in the AM are horrible for my levels. It changes for each of us, so taking a few days and challenging your diet is worth it. All of us are here to do right by our babies and our bodies!
Blesings and LOVE!
:dust:


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