Posted by: birdsandsquirrels | January 2, 2012

ugh, not again

I am so pissed. I had my first “official” OB appointment on Friday and things were going great (heard the heartbeat on the doppler) until my doctor said she wants me off metformin. It totally took me by surprise because I discussed this in depth with her when I was pregnant with Birdie, that I felt strongly about wanting to stay on it, and at that time she was fine with it. She wants me to go off it and do a one hour glucose tolerance test this coming week and see what’s going on without the metformin. I was so surprised that I just nodded and tried to process what she was saying. She said that if I do get gestational diabetes, there are better medications for me to be on (mentioning glyburide).

I was totally unprepared to have to fight about this, so I just didn’t say anything. And then I came home and became more and more angry. What the fuck? I do not want to go off metformin. I truly believe that it is what kept me from getting gestational diabetes and kept Birdie to a reasonable 8lbs 3 oz.

The way she tried to sell it was by saying that there are now better medicines. Well there isn’t! There is nothing new. Glyburide is an oral medication much like metformin except that it functions totally differently. Metformin is an insulin sensitizer. It decreases the amount of glucose your liver puts out and at the same time it makes it easier for your muscle cells to use insulin and glucose more efficiently. Glyburide causes your body to pump out MORE insulin. I have insulin resistance, so my body already has too much insulin – I don’t need more! They have the same effect – to lower the blood sugar, but they work totally differently and glyburide causes more side effects, like hypoglycemia and increased weight gain (because of the higher insulin). Who knows if my pancreas could handle having to pump out more insulin. I think it would make me more likely to develop diabetes!

The studies I have read have both had the same concerns about metformin and glyburide, that they cross the placenta, and while both seem to not cause any problems for the fetus, long term studies have not been done, so they are not recommended for everyone at this point. There are a number of studies that have been done regarding with with PCOS staying on metformin during pregnancy, finding that metformin can prevent gestational diabetes, does not cause preeclampsia, and that the babies do not get too large due to high blood sugar.

When we got referred to the maternal fetal medicine specialist for an unrelated matter, he was a total asshole and said he wanted me off metformin. I ended up talking with another doctor in the practice who was more open minded and said that I could stay on it if I wanted. I was fine, Birdie was fine, and Birdie appears to be perfectly healthy. At her 2 year appointment, she was 95th percentile for height and 75th for weight. I told her last time that I was aware that more studies are needed to confirm that it is perfectly safe during pregnancy, but that I was willing to take that calculated risk. It is known that babies born to mothers with gestational diabetes are at a much higher risk to develop diabetes themselves later in life, so perhaps if I can keep from getting GD, it will help Birdie.

I get my metformin prescription from my primary care doctor, so it is theoretically possible for me to continue taking it against my ob’s wishes. Or I could go in talk with her and fight for it. I am considering putting together a printout of studies about metformin and writing up a note about my reasons for wanting to stay on it and dropping it off at her office. I figure it would give her a chance to read the studies and have a chance to think about my reasons rather than just trying to argue it out in a phone call or at my next appointment (4 weeks away).  I hate conflict, and I really don’t want to fight about this. I really don’t want to find another doctor. In general I like her. I have been so pissed about this all weekend though, and it makes me mad that I have to even go through this argument again.

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Responses

  1. I do think met prevents GD. Based on the completely unscientific fact that you and Amanda stayed on it and did not get it and I went off it and DID get it. Though I did not this time. I am currently begging everyone to let me back on it when the baby is born because I gained almost THIRTY pounds in the 13 months I nursed Peter. And as soon as I went back on met, the weight started coming off. But why do I have to even get that fat? Why can’t the baby get to nurse without me blowing up like a pufferfish? It is a shitty place to be in when you are trying to decide what is best for all.

  2. Freakin A. It’s impossible for every dr to be informed on every subject out there, but I hate it when they aren’t up on the research and make recommendations counter to the evidence.

    Follow your gut on this one.

  3. arg. it sucks that you have to go through this again! i think it’s worth trying to have a conversation with your ob again about it. or may switch obs?

  4. now that you’ve had time to process i think you should call your doctor and get in again to discuss your feeling with him/her. maybe it’s not that big of a deal to them and they will say you can stay on it if going off of it really freaks you out. i would feel the same way, having been through infertility i would want to do everything as closely to my pregnancy with louise since it resulted in a healthy baby.

  5. I’d probably keep taking it. I took it through the better part of my pregnancy with K. What is your OB going to do, fire you as a patient if you stay on it? At the most, I’d go off it 2 days or so ahead of the glucose test, and then go right back on it. If you’re not getting the prescription from her, she doesn’t really have control. We have no control over patients who don’t fill prescriptions or use their CPAP machine or do physio. They’re noone’s favourite patients, but they don’t get kicked to the curb. They’re just taking a calculated risk with their health. Personally, I don’t think staying on the metformin is much of a risk, and I’d just stay on it, take along my research to the next appointment, and have done with it.

  6. […] | Paid Su.. The best technique to Tell If You’ve got Dietary Insufficiency &laquo.. ugh, not again « birds and squirrels Getting The Most Effect Diet Supplement | Youngsters with Diabetic troubles : Contributes to, […]

  7. I’d fight to stay on it too. I was lucky that my OB let me continue with it, and to take my 1hr glucose while on Met. I barely passed my GTT while on it, I know I would have failed if I’d stopped taking it. Sorry she’s not on board with your wishes so far 😦 I hope you can stay on it.

    Thanks for sharing your experience on my blog btw, it’s good to hear from someone else who went through something similar!

  8. Hey, thanks for your comment. So nice to hear someone has been reading for so long!

  9. I just found your blog and we have a LOT in common. I took Met for the first 12 weeks with both pregnancies. I’m really concerned about GD this time around.


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