Any experience of getting off the GD train before birth? UK/NHS

You won’t be put back into the low risk category because having gestational diabetes has several risks for baby when not managed. It is frustrating when you are managing it and are still classed as thigh risk but the extra monitoring etc is there for a reason. I had GD with my daughter (now 13mo) and as my pregnancy progressed my blood sugars got harder to manage so I wouldn’t stop testing them either as knowing when you need to make changes again either with your diet or meds is important to minimise the risk to baby. One of those risks is babies growth but that’s not the only risk. Why are they pushing you to have insulin are you not managing to keep your numbers in range? With my daughter I was fully diet controlled and so was given the all clear to give birth on the midwifery unit and have a water birth etc with no early induction necessary but then from 36 weeks I had recurrent reduced movements so when offered an induction at that point I jumped at the chance because nobody

Could tell me why I was struggling with her movements so much and my induction was actually a really positive experience in the end despite not being what I originally wanted. I’m currently 26 weeks with baby number 2. I had my first GTT 10 Weeks ago and numbers were fine so having my second GTT on Thursday. I’m so glad they’re checking as I want to be able to make any necessary changes for me and baby again like I did last time. Also hoping as with last time I’m able to remain diet controlled if it does come back positive but won’t know for a few days!

Have you also been speaking with a consultant, or just a diabetes midwife? I found the consultants easier to speak with - and one agreed with my view about not starting meds last week whereas the midwife didn’t. Something that has been really bugging me with this is that I feel I’m being directed down a particular path rather than discussing options - as everyone and their baby is an individual situation. And GD doesn’t always equate high risk, there’s the higher chance of risks though. With that, personally I’ve decided to keep up with the blood testing even though some days I just want to chuck it in the bin and be done with it. My baby is measuring around the 50th centile on scans and all looking good; however, it’s not my diet and exercise that’s the issue - it’s the fasting numbers, which hormones are responsible for and will just do what they do, that are creeping up. So I may have to start on meds after all - despite my resistance and trying various things to keep them down.

But also, that’s my personal experience with it all - causing me massive anxiety and stress (which is probably worse than the GD on my baby). I’ve also been told that my risk score (can’t remember the actual name!) is still only a 1. Frustratingly, some of these things vary trust to trust too. But if you’re controlling your numbers well, baby is looking happy and healthy in scans and no issues re. reduced movements, inductions aren’t needed and the NICE guidelines are 40w+6. Currently, my community midwives are even supporting me with having a homebirth (may change still as I’m only 33weeks and lots can change still) or going to the local MLU. Have you been able to speak with those midwives in your area, or someone about what your ideal birth would look like? Or do a tour or anything? I’ve genuinely found that just viewing and familiarising myself with the different wards have made me feel a bit better about it all (I’m someone who likes to have about 5 backups in any situation).

@Kate I’m having a similar experience, they wanted me to take overnight insulin because of the fasting numbers. The whole thing is causing so much stress which I know isn’t good for the baby. I stopped testing for a week and almost did throw it in the bin. But I had one appointment with the consultant and we found her to be much more supportive and encouraging of my choices compared to the midwife which I wasn’t expecting! That’s awesome they’re still supporting you for homebirth. My midwife said they wouldn’t want me to do homebirth and also said they don’t offer tours of the MLU or labour ward. I would love to do a homebirth but we’re currently living with my parents and I don’t think they’d be comfortable with it. So it doesn’t seem fair to talk to the home birth team if we know it’s not an option. I don’t mind going to the MLU/hospital, I just don’t want to be pressured into an induction on the grounds of something that nobody can provide me the evidence of.

@Nicole thanks for getting back and that’s nice to hear you had a positive induction experience. I want to stay managing it with diet if possible, did you find anything that worked for keeping the fasting numbers low? That seems to be my issue. The rest seem fine when I’m eating properly and doing a bit of movement. I’m struggling though because I don’t feel like eating 3 meals a day. It’s getting uncomfortable and I’d rather just eat small portions as and when I’m hungry. I have a bit of an issue with food anyway so the testing is not helping with that. Not to mention that it feels horrible to go from being told you’re having a low risk healthy pregnancy to all of a sudden feely guilty every day like I’m suddenly putting my baby at risk even though every appointment before I was told I’m doing everything right.

I'm a type 1 but refused induction/sections etc and gave birth naturally at 41 weeks. However, I was extremely tight with my levels and my hba1c was 4.2. I will say that insulin doesn't cross the placenta so that may encourage you a bit. The main fear is baby having a hypoglycaemic seizure at birth, this doesn't happen if you're able to keep blood sugars in the 4 zone. Hope this helps.

@Charlie thank you for this and it’s encouraging to hear you gave birth naturally! When you say about keeping sugars in the 4 zone do you mean always testing between 4-5? Or is that something else?

I just want to say that I have managed my GD with diet and nightly insulin only. Insulin is produced naturally in the body so all I am doing is topping up what my body needs to keep my glucose levels overnight at bay and make sure baby isnt overworked with that glucose. I’m also not on a high dosage compared to most and my numbers are perfect. I’ve had barely any problems. My main advise for overnight has been Greek yogurt with dark chocolate and nuts for my snack which I have at the latest time possible and don’t leave my morning test any more than 9 hours after that yogurt so I set an alarm. Eating little and often throughout the day is absolutely fine. Just make sure you take your test an hour after something you’ve eaten that you class as a main. My main meal for example tonight was a chicken breast and some veg, that was all and I classed that as my main. Then just before bed I’ll have my yogurt around 9.30pm

@Kathryn your hba1c to be in the 4's so your levels to be 4's more than 5's is recommended. And the week or so before you give birth needs to be really tight if you want to avoid hypoglycaemia for the baby. If your levels are coming up higher I'd recommend the insulin to avoid this. Also, under the human rights act they can't tell you where you can give birth, that's completely up to you! //birthrights.org.uk/ has lots of info

So in my personal life I wouldn’t deny anything that is needed - untreated GD can lead to still birth after a certain point and after having a still birth a little over a year ago I would never deny anything that would increase my still birth chances but to each their own- but to your question no I do not think you’ll be moved to low risk because your GD has been diet controlled GD can still cause issues for your baby afterbirth , baby’s sugar could drop drastically after being born it’s not just while pregnant that it makes you high risk but postpartum for you and baby

I had gd with my last baby (born Nov) I was diet controlled and as long as I stayed that way consultant was happy for me to have baby in midwife led unit. Although my gd remained diet controlled I had reduced movement at 38+3 and movements didn’t return to normal so I did end up having an induction. This time though I had the balloon and no drugs. Kick started labor and I had baby with just gas and air with only one midwife in the room, lights low music playing etc. (very different experience to my previous baby who I also had induction with but didn’t have gd in that pregnancy) I found my gd midwife and consultant team were very open for discussion about treatment options and offered me metformin as I had 3 high readings but all explained with what I had eaten and I still didn’t know my tolerance. So I declined it and they were fine with it

With regards to fasting numbers mine hovered around the threshold and I found late snack - protein yoghurt/ Greek yoghurt/ dark chocolate/ babybel/ cheese, made a difference. Also going for a walk after dinner and drinking loads of water after eating. The order you eat food can help sugar spikes. Have a look at the glucose goddess on instagram or podcast on the diary of a ceo.

@Rachel interesting! What time do you normally eat dinner? I feel like I always eat dinner late so that might make it worse. If I get a high score for dinner it seems counter intuitive to eat something else before bed? But I had yoghurt for breakfast this morning and a very good score so going to buy loads more yoghurt lol!

@Desaray yeah babies' hypoglycaemia after birth is what I'm referring to

My sister had undiagnosed (until the very end) GD. She was aiming for a home birth, spent labour for 5 weeks, he baby grew too big (just under 11lbs) and he was stuck. She eventually insisted on a csection at 42 weeks. Truthfully shes lucky they didnt die. My sister had no risk factors for GD. I had to have insulin with my 1st baby & induced at 38 weeks. Everything was fine. Ive even had 2 non GD babies since. GD is caused by the placenta. Nothing you did or didnt do caused it - but you still need to treat it so it doesnt go out of control. Also - they cant force you to be induced, keeping your GD under control will significantly increase your chances of a sucessful spontaneous labour xx

I was also diagnosed with GD and was diet controlled but eventually was put on metformin because of my fasting numbers. I was a bit worried about starting it at first, however how I see it at the end of the day is, it’s for baby not for me, I don’t want to be selfish and not take it because I’m being stubborn or whatever and all the sugar is going to baby. The further along your pregnancy progresses, the harder it is to control the GD. Have you tried asking for metformin instead of insulin? I’ve been having reduced movements and they’ve said it could be because of the GD even though my readings have all been on the green side. Point I’m making is, think about baby in this situation. Even if you go on meds or insulin, it’ll only be for a short period of time and once that placenta is out, you can go back to your normal self. It’s hard, but you got this!