20 weeks + pregnant, previous T2 diagnosis & pressure to go on insulin

M

Minsi

New Member
Relationship to Diabetes
Type 2
Pronouns
She/Her
Hello there; I am 20+ weeks pregnant. 20 week scan shows no concerns with baby. I was found to have high HBA1C in June 2022 after two major abdominal surgeries, post surgery sepsis & ileus with triggered Crohns! Despite this being on my records and being classified as a diabetic by the NHS I received no support or advice from a diabetes midwife or anyone else around how to manage my blood sugars in pregnancy. My HBA1C tested 3 weeks ago has come down to 46. I am on metaformin 1000 mg with dinner. I asked to be given a Libre device when I saw my consultant 2.5 weeks ago and she referred me to the obstetric medicine team who from the word go started talking about insulin. I asked for dietician support to help me plan meals since I have Crohns and IBS: the dietician called me a week after I’d been using the Libre. During this call I discovered the Libre device targets were not properly which means I was mistakenly thinking my time in range was better than it was. The dietician was really unhelpful/ she was not interested in having any conversation about what I was eating and did not share any information about the changes I needed to make because my fasting levels were high. She spent the entire time repeatedly telling me that I need to go to the hospital right away to collect insulin. On my insistence she sent me some standard advice that is given for diabetes which didn’t tell me anything I didn’t know.
I am really upset by the lack of proactive, personalised care from maternity services even through I was promised I’d get “better care”. I don’t feel the metformin dose has been optimised and all options explored. I am now having to pay for a very expensive private gestational diabetes dietician to help me manage my sugars better. My worry is that when I asked the consultant if they will take me off insulin after the baby is born; he said “ we shall see” and when I voiced my fears to the NhS dietician that I fear I will be left on insulin and never taken off, she agreed. We all know that the NhS throws women to the dogs in the postpartum period and Gps are very reluctant to off any partum/ postpartum advice and support. Mine said they want to have nothing to do with the pregnancy because it’s high risk! I feel very let down.

Has anyone who was on metaformin before getting pregnant and in early pregnancy taken insulin and been succesfully taken off it after giving birth ? I am due to have an elective caesarean at 37/38 weeks. I see endocrinology- it’s a new person every time and they are only interested in my thyroid levels. So no hope there either
 
I'm sorry you haven't had the support you feel you should have but non the less your HbA1C at 46mmol/mol is what would be considered within range for somebody who is diagnosed as Type 2 though I appreciate that the target during pregnancy may be lower as the safety of yourself and the baby is paramount.
Some people do get gestational diabetes and would then sometimes go on insulin as being the safer option than other Type 2 medications.
Is there anything you can do to help with some dietary changes, low carb is an approach that many do find successful and is suitable if only on metformin. This link may help you with some ideas if your nurse thinks that would help. https://lowcarbfreshwell.com/
When you say your fasting readings are high, what are you seeing as many find that fasting readings can be higher than other daytime readings. Some strategic testing of your meals may help you identify meals foods which are too high carb for you to tolerate with your current medication regime. Seeing what you are before eating and what you are 2 hours after where an increase of no more than 2-3mmol/l would be OK.
It is important to stay well nourished so meals based on meat, fish, cheese, eggs with veg and salads and fruit like berries though maybe some of those may not suit because of your IBS and Crohn's.
You may get some reassurance by talking your situation through with the DUK help line team tomorrow, the number is at the top.
Care obviously varies in different parts of the country as many have said they have had good support, postcode lottery yet again.
Anyway congratulations and welcome to the forum.
 
I’m trying to think of people with Type 2 who have been in the same situation, @merrymunky springs to mind, I think she was definitely on insulin for some parts of her pregnancies. See her thread here, I’m sure she had other threads, if you search using the magnifying glass box at the top right of the screen.
forum.diabetes.org.uk

Wasn’t expecting to be posting this news again…surprise pregnancy!

Hello, Not entirely sure how this has happened (apart from the obvious!) I discovered on Tuesday that we are expecting another little baby. Those of you who know me and my history know why this is utterly terrifying at the moment. With Eris I had lost loads of weight, my levels were in the non...
forum.diabetes.org.uk forum.diabetes.org.uk
 
Welcome @Minsi and congratulations on your pregnancy. Sorry you’re not getting good support. As far as getting the initial input from a pregnancy DSN, you usually have to contact them yourself and inform them you’re TTC, so you can get the high dose folic acid, and then inform them again when you get pregnant. I hope that helps in that you haven’t been ignored, just not triggered the team input.

I’m Type 1 so can’t do without insulin, but there were Type 2s at my pregnancy clinic and it seemed common for them to have to use insulin in the later stages of pregnancy as a temporary measure. They then went back to their normal meds/diet. This is because the pregnancy hormones later in pregnancy trigger massive insulin resistance. That disappears almost immediately after you give birth. My friend had Gestational Diabetes, went on insulin in pregnancy, came off it and isn’t taking any meds at all now. Obviously it depends on the individual, but going onto insulin in pregnancy doesn’t mean you’ll have to stay on it after giving birth. I hope that’s some reassurance 🙂

Also, don’t be afraid of insulin. It can be a fantastic tool and could hopefully bring down your fasting sugars, make control easier, and allow you to eat a wider range of foods that suit your Crohn’s. It’s a friend not a foe 🙂
 
I also meant to reassure you that it’s normal for the GP not to be involved. Pregnancy with diabetes is a hospital clinic thing. My GP had zero input and I wouldn’t have expected him to be involved. I did see a local non-diabetes midwife in between clinic checks but she just did the normal pregnancy things and nothing to do with the diabetes. As you say, that’s because pregnancies with diabetes are classed as high risk and need specialist input.

How are you doing with the very strict pregnancy blood sugar targets apart from the fasting one @Minsi ?
 
Inka said:
I also meant to reassure you that it’s normal for the GP not to be involved. Pregnancy with diabetes is a hospital clinic thing. My GP had zero input and I wouldn’t have expected him to be involved. I did see a local non-diabetes midwife in between clinic checks but she just did the normal pregnancy things and nothing to do with the diabetes. As you say, that’s because pregnancies with diabetes are classed as high risk and need specialist input.
Click to expand...
Yes this, my first appointment was with my gp very early on maybe 4-5 weeks, he did a pregnancy test to confirm and then booked me in with the hospital and I never interacted with my local surgery again.
I had the local midwife checks but again nothing on diabetes and it was about the rest of it really.
Sorry you are having a though time I can’t add to what other have said other than to say congratulations and try to keep calm, take small steps.
 
This is going back to 1988 so May not be right now. I had GD picked up at the end of the first pregnancy, half way through the second, diet treated, and almost immediately in 88. I was given test strips and a meter as big as a brick! I “think” I was given meds, but it’s a long time ago I can’t remember what I was given! I was then put onto insulin. I stayed on it for the remainder of the pregnancy (planned C section as I also had placenta previa. Within 48 hrs BG were down to normal, non diabetic levels so I stopped the insulin. I then went on to develop T2 about 3 years later, requested insulin instead of meds as I know my control would be better.. still there nearly 40 years later.
 
You must log in or register to reply here.
Back
Top