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Lauren

Disagree with the Endo

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Lauren

I'm 14 weeks, and got my hba1c result back last week - 7.4. My OB referred me to an endo and I saw him on Friday. He said ideally he would like to see my hba1c between 8&9, because of the dangers of hypos. He told me that the risk of damage to the baby due to high sugar has been 'blown out of proportion' and only if one's a1c runs at 13 do you start running into trouble.

 

I'm not on a pump and he told me I have the 'dawn phenomenon' as my sugars spike in the morning before I have had breakfast. He completely changed the way I inject. I used to be on 10 units Levemir morning and night, with 6 - 8 units Novorapid with meals. He has taken away the morning Levemir and told me to only have protein shakes for breakfast and lunch and only snack in between if I really have to. He has also told me not to take any supplementary injections unless my sugar is above 15 (270 mg/dl I think).

I woke up on Saturday with a count of 4.7 (84) and that was the last time my sugar has been in range.

 

I have so many issues with this new proposed treatment. Firstly, I don't see how protein shakes could possibly sustain me during pregnancy, especially as I head into my second trimester. How can a protein shake provide enough nutrition for my baby and where do I get fibre, etc from? Also, if I only have one meal containing carbs a day, does this not increase my chances of ketoacidosis if sugar runs high?

 

My second concern is that he's told me not to take additional boluses unless my sugar is very high - so if my sugar runs at 13 (230) I am just supposed to wait until my next meal and hope the insulin I take then is enough to handle the high and the meal? Plus, as soon as my sugar goes above 10 (180) I start feeling ill. I am so tired and emotional as it is at the moment, the last thing I need is for high sugar to add to it. Is this kind of treatment not going to ensure that I have a really big baby? So despite what he said, I have been taking additional boluses when my counts have been higher than 10 over the weekend, I have just been taking smaller doses than usual and no hypos so far.

 

He told me that he's been specialising in diabetes for 8 years (I've been diabetic for 10, so that didn't impress me) and he has never had a case where a baby was born with any defects, he's only had big babies. My personal feeling is that so far he has been lucky. My OB wants my a1c below 7, preferably closer to 6. From all I've read here, 6 and below seems to be a good range to be in. He also said that it's easier to control your sugar during pregnancy. I wanted to ask him whether he's a)diabetic and b)ever been pregnant. So far, trying to control my sugar during pregnancy has been the hardest part in my 10 years with diabetes.

 

I do not feel comfortable with his advice, or his attitude. Needless to say I am going for a second opinion this afternoon. I just needed to rant!

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Cormac_Doyle

The numbers that doc is talking about are insane

 

I would simply tell him that he is an idiot.

 

Go with your OB ... they are the specialist when it comes to babies

 

A1c during pregnancy should be under 6 ...

 

Even running slightly LOW all the time is better than running high.

 

This other doc may not have had any "sick babies", just loads of "big babies", but this means that these babies were all born with elevated insulin resistance. Elevated Insulin Resistance at BIRTH means that they are already half way to being diagnosed with T2 diabetes!!!

 

(plus - according to the wider medical community, you need to check in on the infants at 5, 10 and 15 years before you can say that your treatment caused no harm).

 

You should be working to keep your BGs dow with a basal and bolus insulin.

 

As to the diet ... a low carb diet wont hurt during pregnancy (although the cravings everyone gets might be tough). The protein shake is enough to get you through the morning (most have upwards on 15-20g of sugar in them), although I'd recommend a proper breakfast of eggs instead ... much tastier!

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TeddySue

I've never had a baby... adopted 7 though. I AM diabetic. I just wanted to tell you how sorry I am for the asinine advice that Endo gave you. I DO relate to the obvious scare tactics used by some doctors and Endos. I was a wreck last December with an infection my doctor refused to treat, which upped my BG; and then she forbid me to up my Lantus to gain control of the upped BG. It was the last time I listened to her... moved on to someone who would work with me and not keep telling me I was going to die of a heart attack or low BG. What it did was ruin my last A1c.

You have enough to deal with in birthing a healthy baby AND managing BG without listening to an idiot Endo who obviously is listening to the book-learning they all claim is gospel-truth. NOT!

I think you sound very wise in your observations of D. and how to control it. And controlling it is the answer. Those numbers the Endo wants are insane. Go with what you know.

I wish you the very best.

TS

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mom24grlz

find a new doctor. Wow he sounds like the doctor my SIL had the time she was pg. He also basically told her not to inject insulin while pregnant. She believed him because she was a newly dx type 1 and ended up going into DKA. I've always heard that if you have diabetes and are pregnant they like your A1Cs to be in the 6% or lower range, never 8-9%.

 

BTW Congratulations on your pregnancy. I hope everything goes well and you have a happy healthy baby.

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jbmacomber

So glad you are having second opinion. How can having damaging levels of BG be good for you or your baby? Hope all goes well and you get a "real" doctor.

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ant hill

Hello Lauren :D, Congrats!!! :D

I like the OB idea and keep the BG's level and look at long and slow carbs if possible. With the high's I would factor in with more bolus with the meal so the bolus covers the high & meal.

How often you test? if low of course treat it Gently!!! NO FAST CARBS!!!! Sipp on a OJ if it's very low.

The idea is not shocking the newborn wherever possible. ;):) You may be of tougher stuff, Not the newborn. :) Oh be happy. :T:cool:

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Lauren

My second opinion Endo made me feel a lot more comfortable. She said my 7.4 a1c is great. She said to go back to the treatment I was on before, and to start checking at 2:00 am to see if I really do have the 'dawn phenomenon' or if my morning spikes are due to hypos during the night. From there we will make adjustments as necessary. She also said she saw another patient on Friday who had been to the same Endo I went to and who was also not happy with his idea of treatment. The only thing she told me to stop doing was taking supplementary injections in between meals, and rather correct for highs with meals. This should stop the frequent hypos I have been having, as I tend to over-correct for highs. She's going to refer me to a dietician who is going to start me on carb counting, which I have not had as part of my treatment before. She also said that the protein shakes are definitely not a good idea during pregnancy, as it is likely to make me lose weight and could also have a detrimental effect on my baby's growth, not to mention that I need good carbs for energy.

 

So basically she confirmed what I was thinking and suggested a healthy way forward, which will be the best for both me and baby!

 

Thanks for everybody's support and comments, much appreciated!

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Kathryn10

Oh I am so glad you got a second opinion! Pregnant women's blood sugars naturally run lower than someone who is not pregnant, so it would be better to be a little low than in the high 200's!!

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Lauren

Further update: at 2:00 this morning my sugar was 4.2 (about 75), at 6:00 am it was 5.1 (92) and two hours after breakfast 7.9 (140), back on my old treatment. I will see how the rest of this week goes, but judging by today, my morning spikes could very well be stress reactions to hypos during the night and not the 'dawn phenomon' at all.

I already feel better!

 

Question to the moms: At what point in your pregnancy did you start requiring more insulin? I am now 14 weeks and still require less than pre-pregnancy...

 

Thank

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-Lee-B

Yikes! Glad you found a new/better endo! This one reminds me of the one I had about 20 years ago. For years we didn't have an endo at all in our city, one would visit us 2x a year from Toronto. Finally we got one, everyone was excited. I went and he looked at my record book (at this point I was on multiple injections of fast insulin and pretty much had snacks and bolused as I needed - similar to a pump). Well he got annoyed and told me I did it all wrong. I was to take my insulin at breakfast to cover all snacks I would have for next 4 hours. Then take one shot at lunch to cover next four hours of snacks. I was on humalog, which works for the most part in less than 2 hours. I explained that his was would kill me and he insisted it wouldn't that I was doing it all wrong (even though it was working).

 

I left and never returned. He had no clue about the progress we had made in diabetes treatment and was insistant I do things the way they did 15 years prior when I was diagnosed.

 

Sometimes you have to go with your gut and find someone knew and ignore medical advice when it goes against what you already know. Your baby will be way better off with this new endo you found!

 

As for insulin increases, it varies greatly by person. My team said that week 28 is the main one for most people. I was much closer to week 20. I went from suing way less to a sudden climb, many have a calm period inbetween. Don't stress over meeting the norm for these milestones...just make the changes your body is requiring as they are required!!

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lilyrose24

Hello! I'm glad you found a new doctor! That advice seems crazy to me! I have been Type 1 for 16 years and I had my first baby 12 days ago! My A1c was 7.8% when I first got pregnant, but I got it down to 5.8% for the remainder of my pregnancy. My son is completely healthy. I'm glad you used your best judgement and got another opinion. You know what's best for your body and your baby. Ultimately it's your decision. If you think something isn't right, don't do it! :)

 

As far as insulin requirements, mine increased starting around week 12 or 13 little by little but it didn't get bad until I hit the third trimester. It seems like the day I hit 28 weeks my insulin requirements went up dramatically. Toward the end though I had the opposite problem and couldn't keep my sugars UP. I was having tons of hypos and the dr thought it would be best for me to deliver at 37 weeks. It's different for every person! Good luck with your pregnancy, I'm sure you will do great! :)

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