Diabetes and pregnancy
I was bored tonight and was cruising all the different pregnancy boards when I came across a high risk pregnancy board which made me start to think. It seemed that people were either being taken off the Metformin with no substitute (usually PCOSers and not diabetics) or people were switched to insulin.
So, I did a google search and EVERYTHING I read said that oral medications should not be used in pregnancy, insulin should always be the substitute. The scary thing is that all of these articles (on mostly reputable medical sites) talked about the biggest risk of damage to the fetus is in the first trimester...which is quickly coming to an end to me.
Anyway, so my OB had said that she wanted to switch me to a drug and since I had no idea how to spell it, it took a long time to find it, but I have now. It is called glyburide. There was like ONE study that said that it seemed to be safe in pregnancy, but at the end of the summary (I didn't find the actual study..just summaries of it on a couple sites), it almost always had an editorial comment that insulin is best unless in a strictly controlled study in which the participant is well aware of possible consequences.
So, what do I do? I don't WANT to deal with insulin, it is not my first choice for sure. However, it sure sounds to me like it is a safer choice. Should I lobby for it at my follow-up with the OB next Friday which is when she planned to switch me from the Metformin?
So, I did a google search and EVERYTHING I read said that oral medications should not be used in pregnancy, insulin should always be the substitute. The scary thing is that all of these articles (on mostly reputable medical sites) talked about the biggest risk of damage to the fetus is in the first trimester...which is quickly coming to an end to me.
Anyway, so my OB had said that she wanted to switch me to a drug and since I had no idea how to spell it, it took a long time to find it, but I have now. It is called glyburide. There was like ONE study that said that it seemed to be safe in pregnancy, but at the end of the summary (I didn't find the actual study..just summaries of it on a couple sites), it almost always had an editorial comment that insulin is best unless in a strictly controlled study in which the participant is well aware of possible consequences.
So, what do I do? I don't WANT to deal with insulin, it is not my first choice for sure. However, it sure sounds to me like it is a safer choice. Should I lobby for it at my follow-up with the OB next Friday which is when she planned to switch me from the Metformin?
posted by Katrina | 8/22/2005 07:32:00 PM
5 Comments:
Hey Katrina. Are you Type 1 or Type 2 Diabetic? My mother works with children with diabetes in a doctors office and was asking me. My aunt had gestational diabetes and was on insulin. At that time (about 18 years ago) they didn't have as much info. If you go the insulin route ask them about possibly having an insulin pump. It is much easier to deal with and you don't have to worry about shots and such. It sounds like you have it relatively well under control as it is right now but if they want to do the insulin route ask about that.
Jen, I am type 2. I have heard about the insulin pumps with some distant relatives grandsons who have diabetes (type 1). Can you use it for both? I actually don't think insulin is nearly as scary as it was when I was young and my grandfather gave himself these needles...now it is just a pen like the follistim or gonal-f pens if you have done any injectable cycles. LOL
Hi Kat, it is always a difficult choice. Nancy was gestational and her brother is a brittle diabetic and uses the pump. With our two kids being 2 year apart theories and thoughts with the same OBGYN had changed so things are always in flux. The best you can do is study current facts, work with your doctor and take some type of action. I think as long as you do something you will be fine since I have known many people who used various methods with great results. It is taking no action that causes problems. We did not use a pump, but my brother-in-law has one and loves it. He has a permanent port so I don't know the options for temp pump use.
Why don't you talk to your OB about it and find out the reasoning for using the oral meds vs. insulin. I do know alot of women who were taking Metformin for PCOS and who stayed on it throughout their pregnancies, so I guess there must be a school of thought that it's okay to take during pregnancy.
Yeah, I was wondering whether they would use an insulin pump temporarily...it actually sounds a bit scary to me..LOL.
I am definitely going to talk to the perinatalogist and the OB about it and see.
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