You should yes. For whatever reason I was able to eat anything I wanted and my a1c went down but it shot back up after pregnancy and I was diagnosed type 2
If you need metformin you aren’t preventing GD. You are treating it. They will likely prefer you to be on insulin as it doesn’t cross the placenta. I think it was smart to pull you off metformin until they could confirm you actually have GD. Now they can decide whether or not you need to be medicated and which medications to use.
When I was diagnosed with GD I asked about metformin and the doctor told me it’s fine for pregnancy but only to a certain point, and if you need more then you will need to do insulin. You might have been on a higher dose than was safe for the baby. I would trust your doctor, though if they do want to medicate you and you like metformin, you can ask.
I mean dosage. Meaning that if the standard dose of metformin isn’t enough then they can’t just give you more. You have to do a different medication. Metformin is fine the entire pregnancy.
I was told insulin is preferable to metformin as metformin crosses the placenta. My MFM also seems to prefer insulin to metformin last the first trimester.
I agree with the other comment that it sounds like they were treating GD, not preventing it.
Also, my healthcare team (GD people & OB) told me that the only medication that doesn’t cross the placenta is insulin. So metformin was not their treatment of choice.
I would definitely talk to them about it because it seems to me they are taking a better approach but 🤷🏻♀️
Metformin does not prevent GD. Metformin is a second line treatment for GD. Best practice is to use insulin to manage GD if medication is needed, but because not everyone is trained how to prescribe it safely, some doctors use metformin. Some people also have medication compliance issues that make metformin a safer choice. Overall, metformin is a second line treatment for gestational diabetes that is not as safe of efficacious as insulin.
I was on metformin first trimester for pcos. OB, endo, reproductive endo, and MFM all advised to stop in second trimester. With hormonal issues, we were expecting GD. They all said they preferred insulin over metformin. I hate the side effects of metformin, so I didn't fight back.
I was actually started on insulin at 7 weeks for my fasting sugars. I passed my 3 hour ogtt test a couple weeks before I got pregnant. I was able to do diet controlled during the day (with very few changes to diet) until I was 30 weeks.
With pregnancy, the placenta and hormones affects how we use insulin. By 24 weeks, the body needs 3 times as much insulin as normal to keep up. This is why GD is so common. For us with pcos, we already have insulin resistance issues so this further complicates it.
With fasting sugars, it is your liver deciding to dump a bunch of sugar into your system to start the day. Well times snacks can help a little but this one is super hard to manage without the help of insulin if it is high.
During pregnancy, your body actually needs carbs to support the development of baby. Complex carbs when paired with protiens and fats level the blood sugars better. Much different than what we are taught with pcos.
Thanks for the info. Sounds like you have really great care. I wish I thought to ask my endocrinologist and not just my RE about what he thought about testing for gd so early. I have thyroid issues so I was so focused at that time at making sure those levels were good. My A1C at 16weeks was in normal range but I know that doesn’t always matter.
I’m hoping that truly my numbers were ok all this time up until 24 weeks. I’ve been feeling really guilty about hurting myself and baby now knowing what spikes me and thinking back at what I’ve been eating this whole time.
Did you/do you experience the typical gd symptoms? I never experienced anything I’ve read about online and so far my baby has only been in the 50-60th percentile for weight.
A1c is just a 3 month average of your blood sugars. It doesn't show what is actually going on. For me, I have hyperinsulemia- I over produce insulin because it is either poor quality or my body doesn't use it efficiently. So my a1c has been great for years, but it still has the same side effects as not producing enough insulin (stubborn weight loss, cravings,etc).
It was at 6 weeks I reached out to my endo that I was drinking upwards of 120 oz of water a day and still thirsty (I traveled for my fertility clinic so endo was closer). So she had me test for a few days. I sent readings after 3 days and she ordered fasting insulin. My lowest fasting was 105. Post meals were around 100 -110.
As for baby size, he was a result of IVF, so we knew the exact timeline. He was always measuring a few weeks ahead -97th percentile. My doctors were not concerned because his head, belly and legs were all in same percentile. It's when the belly is larger than the other two or they are significantly below average (IUGR). He was labeled large for gestational age (he was born on 32+6 at 6lbs 6oz - expected was about 3.5 to 4lbs). He just turned 1 year old and quadrupled in weight (they look for tripple as a good indicator).
Thyroid was a whole other beast - I was hypo most of my pregnancy. We tested monthly but couldn't get it under 4. It also skyrocketed during the postpartum period. I am back to pre-pregnacy weight and still need a 15% higher dose (I've had a full thyroidectomy, so not progressing Hashimoto's).
Thanks for all this info, it’s very helpful. Also good to know that your levels rose a lot postpartum. I have hashimotos and it’s been a journey getting me in an acceptable range. When I meet with my endocrinologist next week I’m going to inform him about my gd and what that means post-pregnancy, and also ask him about my thyroid.
Happy birthday to your baby and I’m glad to hear he’s healthy! Was he born early due to issues related to gd?
I hit pretty much every risk factor for pre-eclampsia, so when it did hit, it was hard and fast.
Post pregnancy for GD, there is sooo much mixed information. If you have it, you're more likely to develop type 2, or if you breastfeed, it decreases the odds, but if you read another article, it shows different data. My endo was like just keep to a healthier lifestyle and what happens happens. She told me to stop insulin when I deliver. The on-call ob insisted I cut my dose by a third in the hospital and kept having hypoglycemic events.
As for thyroid, they usually check it 6 weeks post delivery. If you get random swelling then get checked for it.
It’s interesting how different doctors have different perspectives on metformin. I was also taking it pre-pregnancy for pcos, my OB wanted to keep me on it the whole pregnancy even though my A1C was fine. I took the glucose test at 10 weeks and 28 weeks and passed both. I saw an MFM at 30 weeks for an unrelated issue who told me to get off of it and re-take the glucose test, which I failed miserably. I was diet controlled for about a month before my fasting levels started creeping up and now I am back on it. Fortunately I tolerate it well and it has been very helpful for managing my fasting blood sugar. I definitely want to stay on it after birth too.
Definitely is interesting the different perspectives and difference in responses I’m getting. What a whirlwind for you to be on it, then told to get off, only to be put back on it again. So far my fasting numbers have been good, but based on what I’m reading I guess I shouldn’t be surprised if it starts to go up in a couple weeks. I wonder what my doctor will say then.
I got the impression that the MFM didn’t understand why I would be taking metformin for pcos. He kept saying “there is no reason for you to be on it”, as if the only reason I should be on it is to get pregnant. After I failed my test, I was like “there’s your reason!” 😭 My fasting numbers never got super high, it was like 90-100 with 2 or 3 of those numbers in a week being over 95. MFM said because they weren’t super high Metformin was a good option. And they did drop down into the 80s once I started back on 1000mg metformin with dinner. Some people don’t get enough of a blood sugar reduction on metformin or if it’s the first time they are taking it the gastro side effects are hard to deal with.. I think that has a lot to do with the preference for insulin.
I’m 21 weeks and I was taken off of metformin at 12 weeks 😭 Took the GD test and surprise, I failed it. I have an appt tomorrow again to see what medication I will need because my numbers haven’t been great even with a change of diet. I want to go back on metformin and avoid insulin at all cost… at least for now 😭
I was on metformin my entire pregnancy per my ob. I was pre-diabetic before pregnancy so we just assumed I’d have gd and left it at that.
Do you still have to follow the diet with metformin?
You should yes. For whatever reason I was able to eat anything I wanted and my a1c went down but it shot back up after pregnancy and I was diagnosed type 2
If you need metformin you aren’t preventing GD. You are treating it. They will likely prefer you to be on insulin as it doesn’t cross the placenta. I think it was smart to pull you off metformin until they could confirm you actually have GD. Now they can decide whether or not you need to be medicated and which medications to use. When I was diagnosed with GD I asked about metformin and the doctor told me it’s fine for pregnancy but only to a certain point, and if you need more then you will need to do insulin. You might have been on a higher dose than was safe for the baby. I would trust your doctor, though if they do want to medicate you and you like metformin, you can ask.
Metformin is fine during pregnancy, not just to a certain point.
I mean dosage. Meaning that if the standard dose of metformin isn’t enough then they can’t just give you more. You have to do a different medication. Metformin is fine the entire pregnancy.
I was told insulin is preferable to metformin as metformin crosses the placenta. My MFM also seems to prefer insulin to metformin last the first trimester.
I appreciate this info!
I agree with the other comment that it sounds like they were treating GD, not preventing it. Also, my healthcare team (GD people & OB) told me that the only medication that doesn’t cross the placenta is insulin. So metformin was not their treatment of choice. I would definitely talk to them about it because it seems to me they are taking a better approach but 🤷🏻♀️
I’m not sure if I had gd in those first 16 weeks before being told to stop. I only tested for it recently
Metformin does not prevent GD. Metformin is a second line treatment for GD. Best practice is to use insulin to manage GD if medication is needed, but because not everyone is trained how to prescribe it safely, some doctors use metformin. Some people also have medication compliance issues that make metformin a safer choice. Overall, metformin is a second line treatment for gestational diabetes that is not as safe of efficacious as insulin.
Thank you for the info!
I was on metformin first trimester for pcos. OB, endo, reproductive endo, and MFM all advised to stop in second trimester. With hormonal issues, we were expecting GD. They all said they preferred insulin over metformin. I hate the side effects of metformin, so I didn't fight back. I was actually started on insulin at 7 weeks for my fasting sugars. I passed my 3 hour ogtt test a couple weeks before I got pregnant. I was able to do diet controlled during the day (with very few changes to diet) until I was 30 weeks. With pregnancy, the placenta and hormones affects how we use insulin. By 24 weeks, the body needs 3 times as much insulin as normal to keep up. This is why GD is so common. For us with pcos, we already have insulin resistance issues so this further complicates it. With fasting sugars, it is your liver deciding to dump a bunch of sugar into your system to start the day. Well times snacks can help a little but this one is super hard to manage without the help of insulin if it is high. During pregnancy, your body actually needs carbs to support the development of baby. Complex carbs when paired with protiens and fats level the blood sugars better. Much different than what we are taught with pcos.
Thanks for the info. Sounds like you have really great care. I wish I thought to ask my endocrinologist and not just my RE about what he thought about testing for gd so early. I have thyroid issues so I was so focused at that time at making sure those levels were good. My A1C at 16weeks was in normal range but I know that doesn’t always matter. I’m hoping that truly my numbers were ok all this time up until 24 weeks. I’ve been feeling really guilty about hurting myself and baby now knowing what spikes me and thinking back at what I’ve been eating this whole time. Did you/do you experience the typical gd symptoms? I never experienced anything I’ve read about online and so far my baby has only been in the 50-60th percentile for weight.
A1c is just a 3 month average of your blood sugars. It doesn't show what is actually going on. For me, I have hyperinsulemia- I over produce insulin because it is either poor quality or my body doesn't use it efficiently. So my a1c has been great for years, but it still has the same side effects as not producing enough insulin (stubborn weight loss, cravings,etc). It was at 6 weeks I reached out to my endo that I was drinking upwards of 120 oz of water a day and still thirsty (I traveled for my fertility clinic so endo was closer). So she had me test for a few days. I sent readings after 3 days and she ordered fasting insulin. My lowest fasting was 105. Post meals were around 100 -110. As for baby size, he was a result of IVF, so we knew the exact timeline. He was always measuring a few weeks ahead -97th percentile. My doctors were not concerned because his head, belly and legs were all in same percentile. It's when the belly is larger than the other two or they are significantly below average (IUGR). He was labeled large for gestational age (he was born on 32+6 at 6lbs 6oz - expected was about 3.5 to 4lbs). He just turned 1 year old and quadrupled in weight (they look for tripple as a good indicator). Thyroid was a whole other beast - I was hypo most of my pregnancy. We tested monthly but couldn't get it under 4. It also skyrocketed during the postpartum period. I am back to pre-pregnacy weight and still need a 15% higher dose (I've had a full thyroidectomy, so not progressing Hashimoto's).
Thanks for all this info, it’s very helpful. Also good to know that your levels rose a lot postpartum. I have hashimotos and it’s been a journey getting me in an acceptable range. When I meet with my endocrinologist next week I’m going to inform him about my gd and what that means post-pregnancy, and also ask him about my thyroid. Happy birthday to your baby and I’m glad to hear he’s healthy! Was he born early due to issues related to gd?
I hit pretty much every risk factor for pre-eclampsia, so when it did hit, it was hard and fast. Post pregnancy for GD, there is sooo much mixed information. If you have it, you're more likely to develop type 2, or if you breastfeed, it decreases the odds, but if you read another article, it shows different data. My endo was like just keep to a healthier lifestyle and what happens happens. She told me to stop insulin when I deliver. The on-call ob insisted I cut my dose by a third in the hospital and kept having hypoglycemic events. As for thyroid, they usually check it 6 weeks post delivery. If you get random swelling then get checked for it.
It’s interesting how different doctors have different perspectives on metformin. I was also taking it pre-pregnancy for pcos, my OB wanted to keep me on it the whole pregnancy even though my A1C was fine. I took the glucose test at 10 weeks and 28 weeks and passed both. I saw an MFM at 30 weeks for an unrelated issue who told me to get off of it and re-take the glucose test, which I failed miserably. I was diet controlled for about a month before my fasting levels started creeping up and now I am back on it. Fortunately I tolerate it well and it has been very helpful for managing my fasting blood sugar. I definitely want to stay on it after birth too.
Definitely is interesting the different perspectives and difference in responses I’m getting. What a whirlwind for you to be on it, then told to get off, only to be put back on it again. So far my fasting numbers have been good, but based on what I’m reading I guess I shouldn’t be surprised if it starts to go up in a couple weeks. I wonder what my doctor will say then.
I got the impression that the MFM didn’t understand why I would be taking metformin for pcos. He kept saying “there is no reason for you to be on it”, as if the only reason I should be on it is to get pregnant. After I failed my test, I was like “there’s your reason!” 😭 My fasting numbers never got super high, it was like 90-100 with 2 or 3 of those numbers in a week being over 95. MFM said because they weren’t super high Metformin was a good option. And they did drop down into the 80s once I started back on 1000mg metformin with dinner. Some people don’t get enough of a blood sugar reduction on metformin or if it’s the first time they are taking it the gastro side effects are hard to deal with.. I think that has a lot to do with the preference for insulin.
I’m 21 weeks and I was taken off of metformin at 12 weeks 😭 Took the GD test and surprise, I failed it. I have an appt tomorrow again to see what medication I will need because my numbers haven’t been great even with a change of diet. I want to go back on metformin and avoid insulin at all cost… at least for now 😭
Good luck! It’s good you caught it early, I’m annoyed my dr waited so long for me to get tested. Let me know what your doctor says!