Medication for gestational diabetes… “But I wanted to stay diet controlled”

The words, “I wanted to stay diet controlled” come up in our Facebook support group very often and my answer is always the same; “Not one mother WANTS to be taking medication for gestational diabetes or injecting insulin. But there is only so much you can do with diet and exercise alone.”

medication for gestational diabetes. A mother holding a pill, looking confused, reading the medication leaflet

Feeling a failure

Many women express that they feel like a failure when they need to start medication or insulin to help lower and stabilise blood sugar levels. 

32-36 weeks the hardest time

If you’re a failure then so am I and so are all of us that ended up on medication or insulin! So stop saying you’re a failure – how exactly have you failed?

Just because you need to start medication to help control your blood sugar levels does not mean you’ve failed! If that’s the case, I failed in all 3 of my pregnancies! Yep, a failure at 13 weeks in my second pregnancy and from the word go in my most recent pregnancy, in fact, most of my Facebook admin team would be classed as failures! Please remember that many ladies who are diagnosed may need to go straight onto medication and/or insulin and are not even given a chance to try diet control. Does that make them failures from the word go? NO. Many mothers diagnosed with gestational diabetes will need help with medication to achieve lower levels and that’s OKAY.

Diet-controlled women with gestational are not trying harder, or doing better because they have managed to control the condition by making changes to diet and exercise alone. They simply do not have insulin resistance as bad as some others. Going on metformin or insulin does not mean that you can eat whatever you like. It means you should be able to eat the same diet as a diet-controlled mother.

QUESTION. Would you feel you failed if you needed to take medication for other illnesses and ailments? e.g. antibiotics for an infection that you can’t get rid of on your own? Have you failed if you need to take iron tablets because you need more iron or tablets for high blood pressure? Why is gestational diabetes any different?

Gestational diabetes is not a cold or a headache where you can try to just get on with it, not take the paracetamol and struggle through it. If you need help to lower your blood sugar levels, then unfortunately you need that help – it is for the safety of your growing baby. That doesn’t make you a terrible mother or a failure and it is NOT your fault!

To learn more about medications used to help lower and stabilise blood sugar levels, you can see further info on our Metformin for gestational diabetes page and our Insulin for gestational diabetes page.

Identifying the root cause of not wanting medication for gestational diabetes

From seeing the many posts in our support group around starting medication for gestational diabetes, it is usually very obvious that there are underlying reasons for these battles and concerns.

In order to understand and deal with those issues it’s important to identify what the root cause is so that the true issues can be discussed and hopefully resolved, or at least discussed and concerns eased, making mothers able to make better-informed decisions.

The most common root causes for not wanting to start medication for gestational diabetes are the following:-

  1. Starting medication means that they will be advised to have an induction of labour or changes to birth plans
  2. Concern over starting Metformin as they have heard that the gastric side effects are terrible
  3. Concern over starting Metformin as they have heard that it is not licensed for use in pregnant women
  4. Concern over having to inject insulin using needles
  5. Concern over having hypos if starting insulin
  6. They just have ‘big babies’ and don’t really believe the high blood sugar levels will have a negative impact on the baby or the birth
  7. Blood sugar levels aren’t over the recommended targets
  8. Disbelief in diagnosis or have been told they are borderline

*This is obviously not an exhaustive list as there could be many varying factors in the reasons why each individual has concerns over starting medication for gestational diabetes, but these are the most common reasons we have seen in our support group

1. Medication to manage blood sugar levels means induction of labour?

Without a shadow of a doubt, the number 1 reason we see mothers say they are reluctant to start medication is that it will impact their birth choices. That they have been advised or have heard that they will not be able to have a spontaneous or natural birth if they are taking medication or insulin for gestational diabetes, and it will mean a consultant-led birth at a hospital, being induced at an earlier gestation.

FACT or FICTION?

The truth is that we see many mothers in our Facebook group being advised to have inductions if they are on medication for gestational diabetes, however, we also see lots of ladies left to go into spontaneous labour too.

According to the current NICE guidelines, induction of labour before 40+6 is not advised unless there are maternal or fetal complications. If you are advised to have an early induction of labour, this is advice and ultimately the choice is yours to make and consent to.

The NICE guidelines recommend offering elective birth by either induction of labour or cesarean section after 40+6. Still, the critical point here is that the guidelines recommend offering this, and ultimately the choice is yours to make and consent to.

Read more about birth choices with gestational diabetes, and see the national guidelines and evidence-based research to help you make informed choices here.

2. Metformin will make me poorly

FACT or FICTION?

Just like with any medication, Metformin may cause side effects. However, not all people suffer side effects from taking Metformin you won’t know until you try.

Metformin can very often cause gastric side effects such as nausea, loose stools (diarrhoea) cramps or stomach upset. Sometimes people can get these side effects when starting the medication, but after a few days, they should stop.  It is also common to experience side effects when a dose is increased.

There are tips to help ease side effects, such as starting on a low dose and slowly increasing and taking the dose in the middle of the meal. If side effects still remain then there is a prolonged release Metformin which many people find better to tolerate. Metformin is also available in liquid form if there are concerns about swallowing tablets.

For those that have or are experiencing sickness with hyperemesis, or conditions such as IBS, or Crohn’s disease, you may want to ask to use insulin instead of Metformin.

3. Metformin is not licensed for use in pregnancy?

FACT or FICTION?

It’s a fact! Metformin is not licensed for use in pregnancy in the UK. This is because no drugs are licensed for use during pregnancy.

It is however safe for use in pregnancy according to many medical research trials. The biggest research trial to date on the use of Metformin for gestational diabetes was the MiG trial and the follow-up MiG TOFU trial.

To read more about Metformin, how it works, FAQs and links to these research publications, you can read more here.

4. Fear of needles

A big fear for many is having to take insulin as they have a fear of needles.

In the UK & ROI, we are fortunate that insulin is no longer in a vial which needs to be drawn up with a hypodermic needle and syringe.

in the UK we no longer use insulin syringes like these where insulin is drawn from a vial

All insulin used here is in the form of flexpens or pre-loaded devices where you dial up the insulin dose as advised and a small needle is screwed onto the end.

The screw-on insulin needles are very small and have protective caps over them which are removed just before use. They come in a range of sizes from 4mm to 8mm long. They really are very small and the pen-style devices make injecting and administering insulin very simple.

Many mothers will understandably still be worried, anxious, upset, and possibly distraught at needing to inject insulin.

The key to this is support, understanding and encouragement. Partners, family and friends can all help with this. That tiny needle may seem like nothing to them but until you have to inject yourself, even more so if you have a fear of needles, it is very hard to understand what it is like to cope with it.

Some find it easier to let their partners or family members inject for them, but for the majority, it is something that they are able to work on and overcome.

We will help you…

The Gestational Diabetes UK Facebook group will always offer as much support and encouragement as possible when it comes to mums taking their first injections. Just pop a post onto the group and lots of ladies will support anyone needing a hand to hold.

Injecting is not painful and hurts much less than finger prick testing. The first is always the worst, but once you’ve overcome that hurdle they get easier each time.

We also have a visual guide and links to videos showing how to inject insulin and FAQs on this page.

5. Fear of having hypos (very low blood sugar levels)

Hypos are where blood sugar levels drop low (below 4.0mmol/L) in insulin-treated patients which can cause symptoms making you feel unwell or unsteady, and in severe cases could mean passing out.

True life-threatening hypos are extremely rare with gestational diabetes.

To prevent hypos in those who are insulin-treated, when starting on insulin, the starting dose is typically very small (usually 2 – 4 units) and then doses are increased in small amounts until reaching a dose which lowers blood sugar levels effectively enough to normalise them.

Note: Not everyone taking insulin will experience a hypo.

Also, not all will experience hypo-type symptoms when levels are low. Some people may test their blood sugar levels for monitoring purposes (ie. for fasting or post-meal levels) and may see low or what’s classed as hypo levels, yet will not experience any of the typical hypo symptoms. So it is not a given that you will feel unwell and certainly not a case that a hypo will cause you to pass out.

Those who are using Metformin cannot have true, life-threatening hypos. Metformin works by making your body use its own insulin more effectively so it cannot lower your blood sugar levels below what is safe. Hypo-type symptoms during the use of Metformin are known as false hypos. To learn more about false hypos, please read more here.

Our advice is to be aware of what to do in the event of a hypo and have a hypo kit ready to hand in many places so that you are prepared if you do need to treat one. To read about hypos and how to treat them, then please take a look at this page.

6. “I just have big babies”

Being diagnosed with gestational diabetes means that the mother is not able to control their blood sugar levels as well as they normally would. Having high blood sugar levels means excess glucose is being passed through to the baby and the baby has to increase their insulin production to process the sugar. As insulin is a growth hormone, this can cause excessive growth (in particular, excessive abdominal circumference) but along with excessive growth, may come other complications too. To see the complications linked to gestational diabetes, please take a look here.

Over the years we have seen many mothers say that they have had previous big babies, yet on the baby where they have been diagnosed, monitored and controlled blood sugar levels they have gone on to have much smaller babies in comparison. Obviously, depending on the genetics of the parents, some ladies may just have bigger babies, but where GD-diagnosed babies have been much smaller, have they had previously undiagnosed gestational diabetes in previous pregnancies?

7. Blood sugar levels are under the recommended targets

Capillary blood glucose tests are only a guide as to what is going on and they are not 100% accurate. There may be other reasons that you are advised to start medication, one of which is excessive fetal growth on growth scans.

If you are unsure why medication is required when your levels are showing below the recommended targets then you should discuss this with your consultant and diabetes team.

8. “But I don’t have it that bad”

Many mothers will be diagnosed as positive for gestational diabetes with borderline results. Some may be told by their diabetes team that as they are borderline that they will be able to control their blood sugar levels by diet alone and so it can come as a bit of a shock when they then may struggle to control the condition and are advised to start medication for gestational diabetes. Unfortunately, this is not uncommon and we have found that the result of the GTT does not necessarily pave the way forward for the rest of the pregnancy.

To read some experiences of those that have been diagnosed as borderline, please take a look at this page.

Gestational diabetes is a progressive condition

Gestational diabetes is progressive which means it worsens as the pregnancy goes on. Typically the hardest time we see ladies struggle is between 32 – 36 weeks (although it should be understood that not everyone will see an increase in insulin resistance at this time). It is therefore very common for mothers to require a little bit of help with medication for gestational diabetes if diet and exercise are no longer keeping blood sugar levels and baby’s growth in line.

To read about how gestational diabetes progresses and what causes this increase in insulin resistance, then please see this page.

increasing insulin resistance in pregnancy

Ketones

If you have got to the point of having to severely cut or restrict all starchy carbs in order to achieve under-target levels then it can lead to ketosis which in turn can cause problems with oxygen delivery to the baby.

High levels of ketones are something that should be avoided in pregnancy and so medication for gestational diabetes may be required to help strike a balance between being able to eat enough carbs and keeping blood sugar levels lowered too. To read more about ketones, please see this page.

ketones ketosis and ketoacidosis

The relief

It can take a while to get doses right, so please don’t expect an immediate fix, but so many mothers experience a great sense of relief when they finally come to terms with taking medication and start seeing their blood sugar levels drop lower and start to stabilise. Many have struggled desperately trying to eat and the medication means that they can start to eat a bit better again.

The amount of mums that post they wished they hadn’t put so much pressure on themselves around trying to control with diet and exercise alone as they were so worried about starting meds is phenomenal. It can make a huge difference in helping control and manage gestational diabetes.

Not everyone will need medication for gestational diabetes, but there should be no shame in taking it IF you do need it