Posted by: birdsandsquirrels | October 17, 2009

and the fight begins

I failed my one hour glucose screening test last week. Badly. They like to see the 1 hour glucose levels under 120-140, and mine was 183. My OB had instructed me not to take my metformin that morning, so I’m not surprised that I failed. It was like setting me up to fail. Of course my body is not going to handle that much sugar well without my usual dose of metformin that I have been on for at least 5 years. Without metformin, my body doesn’t use insulin efficiently. Duh!

Before doing the test, I had called the office and argued with several nurses about checking my HbA1C level at the same time. Thank goodness I did that, because it came back beautifully, at 5.5%, which indicates that with the metformin, my blood sugar has indeed been well controlled over the past 2-3 months. However, because I still technically failed the one hour test, they want me to go for the 3 hour glucose tolerance test. Lovely.

At my 30 week appointment on Friday, I had to put on my assertive pants and have the nerve to ask questions about the reasoning behind it. I saw my OB’s partner, because my OB was out of the office again Friday. The partner is not so nice. I had an issue with her two weeks ago, when I brought up a concern to her. I haven’t decided if I am going to blog about it, because it could be a big thing or a little thing for baby Bird, and I guess I need to figure out where to draw the line as far as protecting her privacy goes. But, I can say that it was something that I really wanted checked out by a specialist, and the bitch doctor refused until I made a gigantic stink about it later the next week.

I ended up getting a referral for an ultrasound with the maternal fetal medicine specialists at the hospital, and have an appointment for next week. I was dreading this appointment with the OB on Friday. I hate being confrontational and defensive, but I knew I needed to stand up for myself.

When we were discussing the results of the one hour test, I asked the doctor how many patients she had that have PCOS, struggled with infertility and stayed on metformin throughout their pregnancy, and how did she handle their gestational diabetes screening. She told me that she has only had two patients stay on it, and they both ended up seeing the maternal fetal medicine specialist for unrelated things, and the MFM had them go off it because it could “mask” GD. I asked her to clarify for me the difference between metformin “masking” GD and metformin preventing the development of it. She had no answer for me.

I explained that I understood that it is not standard procedure yet to keep PCOS women on met throughout the entire pregnancy, that I had read the journal articles and discussed it with my RE, that I was aware of the fact that many studies show that it appears to be quite safe and helps prevent gestational diabetes and other complications, but that more studies are needed before recommending that all women stay on it, and that I am comfortable taking that calculated risk. She shrugged and said that she defers to the MFM specialists, and that they will probably tell me to go off the metformin. I guess it’s good to know that I’ll have a bit of a battle on my hands ahead of the appointment, so that I can go in armed with lots of information and copies of journal articles.

I don’t get it. If it’s safe to stay on until 12 weeks to prevent miscarriage, why is it so bad for the rest of pregnancy? The traditional treatment of GD is insulin. My body already makes too much insulin! That excess insulin makes my body overproduce testosterone, which fucked up my ovaries, and I’m sure would not be good for my developing daughter. Metformin helps reduce the insulin my body produces by using smaller amounts of it more effectively. I really hope that the specialist I see is flexible and open minded. If not, I have enough metformin to carry me through the pregnancy if need be.

Some people take what their doctors say as gospel and would not think of questioning them. Clearly I am not one of those people. Doctors are not perfect. They are not gods. Doctors make mistakes. Doctors cannot always be on top of every new study that comes out about every condition. I wish I could have that naive trust in doctors, but if I did, I would not be pregnant right now. I have had to push and push for things, time and time again, with my medical care, and also with family members. It is exhausting.

I really hope that the appointment on Tuesday brings some reassurance and the okay to stay on metformin.

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Responses

  1. I talked with the MFM I’m seeing now about the metformin. Before he ever said anything about it I got defensive and said I had weighed the risks and felt it was best to stay on it. HE COMPLETELY AGREED. He said he has his PCOS patients stay on it! So clearly their are different opinions out there.

    I kept on it for my GTT the other day too. It doesn’t make sense to me to go off it because can be used to treat GD and you were going to stay on it anyhow. Sounds very frustrating.

    I hope the issue with baby bird isn’t bad and everything else goes ok.

  2. I am sending you strength. You are the Mother. It is your baby. It is your choice. If I learned anything taking care of my own Mom, it is that some doctors are great and some suck. You have to be your own advocate. Which is exhausting. I have been off Met the entire pregnancy. I am doing fine so far. But it is only 18 weeks so there is still plenty of time for the glucose to hit the fan.

  3. “mask it”, really? My, that sounds like a load of crap. I hope you give them hell. Best wishes, I think staying on the Metformin for your insulin issues makes sense.

    And yeah, doctors are not always right. So true.

    Hope the issue with baby girl turns out to be nothing.

  4. I’m glad you are standing up for yourself. Dr’s do not know everything and like you I’ve found myself more knowledgable than they are in certain areas. IF does that to us, we research.

    I have mild PCOS and stayed on the Met until 12 weeks and then went off. I have tons left if you need any.

    Good luck!

  5. arg. glad that you at least know to ask questions and not just take everything that they say… also glad to hear that things are okay! 🙂

    xoxo


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