The Fourth M of Gestational Diabetes - Medication
You have gestational diabetes. You have started monitoring your glucoses, you are paying attention to what and when you eat, you are walking every day. You are doing everything right, but your blood sugars are elevated. What’s happening?
!It can be frustrating to see glucoses go up in pregnancy despite your efforts.
But the fact is that glucoses tend to rise as pregnancy progresses. Your sugars may not be controlled on a diabetic diet. Or they may be well controlled on a diet for weeks or months, only to rise as you get closer to delivery.
About 10% of women with gestational diabetes will not be successful with diet alone.
This doesn't mean you are doing anything wrong. Your body may just need a little extra help.
Oral medications for gestational diabetes
Until recently, women who needed help with glucose control had to take insulin, because the oral medications that were available were not safe for use in pregnancy. Nowadays, there are a couple of options for oral medications, although they are still somewhat controversial in pregnancy.
These are the medications that have been studied and appear to be safe for moms and fetuses.
Metformin: This oral medication lowers blood glucose by decreasing the amount of glucose that the liver releases, increasing your sensitivity to insulin, and helping your cells to use insulin better. However, as many as 30% of women on metformin will go on to require insulin before the end of the pregnancy. Metformin is usually given once or twice daily; the dose range in 500-2000 mg daily.
Glyburide: Glyburide is another oral medication. It works by helping your body produce more insulin. It has been studied quite a bit in pregnant patients in the last 10 years or so, and appears to be safe and effective. About 10-20% of patients taking glyburide will require insulin during pregnancy. It is usually given once or twice daily before meals. The dose range varies from 1.25-20 mg daily.
Insulin: If your glucoses are high enough that oral medication is not an option for you, your provider may start insulin. There are a variety of long-acting and short-acting insulins. Your regimen will be developed based on your individual needs. People are sometimes apprehensive about taking insulin. Maybe it’s the idea of giving themselves injections. But it’s easier than you think.
Important tips for medication and gestational diabetes
Some tips to remember when taking medication for diabetes.
You may be placed on more than one medication. Insulin plus an oral medication sometimes reduces the need for higher doses of insulin.
When you begin taking medication for diabetes, it will be more important than ever to eat on a regular schedule. If you take medication and don’t eat, your blood sugar may drop too low, and you will feel terrible.
After you deliver your baby, your glucoses usually improve very quickly. Don’t be afraid that once you start medication in pregnancy, you will be dependent on it for life. More often than not, people go home from the hospital on no medication.
In conclusion
Even though you may be doing everything right, your blood sugars may still be elevated. There's no need to worry. Investigate these medications and decide with your doctor which route is best for you.
This is the second to last post in a month-long series I've been doing about how to manage gestational diabetes. Next week, we wrap up the series with The Fifth M of Gestational Diabetes - Monitoring. Be sure to subscribe to not miss the last post. When you join my private email list you'll get your free copy of my free guide!