Insulin refusal during gestational diabetes is possible, but it may have detrimental impacts on both mother and baby.
Gestational diabetes (GD) is a condition that affects some pregnant women, causing high blood sugar levels due to the body's changes during pregnancy. In managing GD, healthcare professionals may prescribe two common medications: metformin and insulin.
Metformin is an oral medication that improves insulin sensitivity, lowers glucose production in the liver, and helps manage blood sugar. It is often considered a first-line alternative to insulin, especially in cases where insulin use and frequent blood sugar monitoring might be difficult or costly. Metformin may also reduce the required insulin dose if used in combination with insulin, and is associated with higher maternal satisfaction and quality of life.
Insulin is an injectable medication that helps the body move sugar from the blood into other body tissues. It is typically more effective at lowering blood sugar levels than other medications. The dose of insulin a doctor prescribes for GD may vary based on the person's weight and gestational week.
It is crucial to always follow the exact dosage a doctor prescribes. In the first trimester, a person's total daily insulin requirement may be 0.7 units per kilogram of weight per day, while in the second trimester it may increase to 0.8 units per kilogram, and in the third trimester it may reach 0.9-1.0 units per kilogram.
In certain instances, a healthcare professional may recommend the use of a glucose meter to monitor a person's glucose level. Regular physical activity can also enhance insulin sensitivity, thereby lowering blood sugar. Pregnancy-safe activities include brisk walking, swimming, prenatal yoga, and stationary cycling.
If a person cannot take metformin or experiences side effects, a doctor may suggest insulin instead. However, potential side effects of insulin on the fetus can include lower birth weight and a higher risk of admission to a neonatal intensive care unit or special care baby unit.
It is important to discuss treatment decisions with a healthcare team, who can provide personalized recommendations based on individual circumstances. Aside from medication, other ways to manage GD include balanced, nutritious meal plans, regular physical exercise, and regular monitoring of blood glucose. A person should collaborate with a dietician to create an eating plan that suits them and prioritizes well-balanced foods.
Insulin remains the standard of care for severe hyperglycemia or when oral agents do not achieve adequate glucose control. Therefore, metformin is the primary non-insulin medication recommended for managing gestational diabetes when insulin is not used alone, with sulfonylureas as a possible option but less favored due to safety concerns. Other oral or injectable diabetes medications are generally avoided during pregnancy.
In conclusion, managing gestational diabetes requires a combination of lifestyle changes, medication, and regular monitoring. Always consult with a healthcare professional for personalized recommendations and guidance.
