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GrnEyes84

Doctors want bs higher

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GrnEyes84

I saw my high risk ob last Tuesday and she is also an endo and she said that she wants my bs no less than 120 and she even said the 140s and 160s are fine as well. Im assuming this is partly because i am ouy od the most critical part of the pregnancy. My other endo I saw before her said they wanted them between 90-100 fasting and 120 2hrs after meals. Is it normal for a doctor to change things like this?

 

I have been having issues with a lot of lows ever since I got pregnant and sometimes really low lows and I think they're concerned about that and that's why they changed things.

 

It's been really hard to keep them above 120 cause of being so insulin sensitive right now! It's frustrating!

 

Sent from my GT-I9300 using Diabetes forums

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jdm

As a T2, I've never had to deal with lows but they are very dangerous. Any of the numbers you mentioned sound far preferable to the chance of a hypo. I think your doctor knows what they are doing.

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Tanikit

How far pregnant are you - weeks 10-14 are notorious for extreme insulin sensitivity and lows - and they can be very bad lows too so that may be why they have changed your target. Hang in there - keep trying to get them up - you probably won't manage all the time, but if you test at 100 treat it as though it were a low and eat something because the chances are they are dropping. If you test at 90 treat it as you would a level of 70 normally and so on. No one expects you to have it perfect to the targets they set - but if you set for 100 and only treat at 70 the chances are you will be at 50 and below before you know it.

 

By the way those lows are dangerous for you - NOT for the baby. I scanned myself at a blood sugar of 2.2 (40) and the baby was quite happy - she's a healthy happy nearly 3 year old now and that pregnancy was SHOCKING with lows (this was an insulin problem and a doctor who had no clue what was going on and neither did I though I tried to read all I could) But if you land up getting hurt because of the lows then the baby can be hurt too so be careful. By 12 weeks all the major organs have been formed so running slightly high should not result in developmental abnormalities - just a slightly bigger baby - once you get to weeks 16 or so you can lower your targets again probably.

 

At least this is how I understand it - other people may have had different advice and different goals and treatment advice - you need to do what is safest and best for you and your baby.

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k_dub

I would not be comfortable with having my BG be that high during my pregnancy.

I saw the same doc once...My A1c going into the appointment was 5.7% (at 8 weeks into the pregnancy) and they kept telling me it was too low. I decided to stop seeing the MFM office at UC and stuck with my regular endo at Barbara Davis and my regular OB.

I just kinda felt like I'm not their typical high risk patient and they were treating me like I'm an idiot. They wanted to do a lot of hand holding with me that I just don't need...

I'm 36 weeks and feel confident in that decision, btw.

 

But...you are in an entirely different risk category than me based on your pre-existing health issues. So you have a lot more to consider and manage...

I am hypo aware and have never had a problem treating lows on my own (have never been unconscious, etc), so their claim that being in normal range was too low or was putting the baby at risk somehow was ridiculous.

I don't doubt that your doc is weighing all of the considerations to determine where your pregnancy is going to be most at risk.

 

What do you think? How are you feeling about the advice?

I would honestly ask them how being in normal range 80-100 or even 80-120 would be "bad" for you or the pregnancy.

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rubidoux

I have mixed feelings about this bc I was *too low* for large chunks of my first pregnancy. I don't mean I was actually having a hypo all the time, but I think I went for weeks at a time sitting right at 70. I had an a1c of 4.2. And I worry, now that he's ten that it wasn't good for him. :( I would think, though, that if you're spending most of your time above 90, baby wouldn't be an issue.

 

If it were me I'd have a hard time shooting for those higher numbers, but maybe 100.

 

Are you living on your own, or is there someone to watch out for you? When I was pg I didn't have a lot of lows but the ones I had were doozies, like the kind you hear about where people get practically delusional and psychotic. I think they were at or before about four months... I don't remember lows being a problem after that.

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Lizzie G

i agree with kelly. i would personally not be comfortable with those targets during (or outside in fact) pregnancy. 160 is far too high to be in your target range (im not saying it never happens but as a target, too high). a good trick to keep post prandial readings down is to over bolus and have a planned snack 1-2 hours after.

 

how much confidence do you have in managing your own insulin regime ie making adjustments, understanding what is going on and so on?

 

obviously your safety must come first but if you are struggling to keep your bg at a decent level without problematic hypos i think the longer term fix is learning how to do this proactively without having to aim high which is 100% possible whether you are on shots or a pump.

 

also remember that your baby does NOT suffer any ill effects from low bg other than if you fell or something.

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Lady Imp

Unfortunately, pregnancy biochemistry is VERY VERY VERY unpredictable, especially in a T1 diabetic. There's a chance that your doctor wants to err on the side of caution in order to protect yourself. I do think that 160 is a tad high, but too tight control can lead to serious consequences for your health during pregnancy, especially if you're not comfortable tweaking insulin yourself. You're on MDI and have been having issues with lows, and that's why they've got you the way they got you, and in the end being a touch on the high side is a much better alternative than being low and falling down the stairs or something. Being pregnant on MDI is quite difficult, that's why a lot of doctors suggest people switch to the pump during pregnancy - you can make minuscule tweaks on it that are very difficult to do with a MDI regimen, and make them instantaneously. If you don't like it, just stick with it throughout the pregnancy, most doctors will be all right with you going back to what you were doing before (added bonus: if you were thinking of pump therapy before, it's a **** of a lot easier to get an insurance company to pay for the pump when you're pregnant then it is when you're not).

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k_dub

It just doesn't make sense to have 120+ be the target IF you are able to be stable below 120.

If you have trouble having stable BGs under 120 (prone to erratic lows once you get 120 or lower), then I can understand setting higher targets.

 

Even then, though, why not set goals to stabilize rather than setting goals of high/potentially damaging BGs?

 

I shoot for 80-100. My BG isn't perfect, and I spend plenty of time higher than that - as evidenced by my 6.0% A1c.

I just don't understand the targets she has set for you - why if you could safely be near-normal?

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GrnEyes84

What the doctors told me is that they want them higher cause this is the time when the baby does all the growing. They said they're not worried about me having a big baby but they don't want me having to small of a baby and that's why they want them higher.

 

They're also worried about me getting low and not noticing it since I have had quite a few lows in the 30s and haven't felt them at all! They're just a bit concerned I think!

 

Sent from my GT-I9300 using Diabetes forums

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rubidoux

Is there a chance that you'd have to deliver early if you run into problems with your kidneys or eyes? Do you think they might actually want the baby to gain a little more than it would if your b/s was normal? If so, then that seems like a totally different situation and I think I'd follow their recs.

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Lizzie G

im kind of surprised by what they are saying about the size. it doesnt make sense to me on two levels:

 

1) this would suggest that anyone with normal blood sugars would be at risk of a small baby which isnt the case whether the mother is diabetic or not.

 

2) if the thought is around pre term delivery then the size thing is incorrect anyway; its factors such as lung development that are relevant and the kind of "big" caused by higher blood sugars (excess abdominal fat) is not advantageous & in fact im sure i have heard that for a preemie witj under developed lungs (which is a given at less than 36 weeks) excess weight is not good at all.

 

i would be getting a second opinion on this size justification. at best it sounds flakey at worst poor.

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Lizzie G
Is there a chance that you'd have to deliver early if you run into problems with your kidneys or eyes? Do you think they might actually want the baby to gain a little more than it would if your b/s was normal? If so, then that seems like a totally different situation and I think I'd follow their recs.

 

im sure i have read that extra weight (and blood sugar can only accelerate growth of fat not bones or organs) is actually counter-productive in preemies.

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k_dub

So Grneyes,

 

If I remember your medical history right, I think your conditions put you in Class H of the Modified White's Classifications Scale for Diabetes During Pregnancy. I do believe that the higher on the scale you are (H is second highest risk category), the chances of a small baby are greater. I'm in the B class, and women with diabetes in A1, A2, and B are at higher risk of having big babies.

So I see where they are coming from in terms of their concern for small baby, but it still doesn't explain why they would think being 120+ is better than being 80-100 and stable.

 

It does sound like you have some hypo unawareness, which is concerning, but the best solution for that is trying to maintain near-normal BG over time.

But it's hard for some Type 1s to be near normal and not be crashing.

 

If I were you, I'd be shooting for BG targets that are as close to normal as possible while being able to maintain stable BGs (so as few lows as possible).

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GrnEyes84

I am shooting for a bs of 120. I don't want it to be any higher than that cause I worry about problems with the baby. My goal is to keep it around 120 and no higher than that.

 

I was told I am not aloud to drive anywhere if I am not 120 or higher cause they worry about lows and worry about me dropping way too fast!

 

Sent from my GT-I9300 using Diabetes forums

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GrnEyes84

I will keep everyone updated. Had a lot of lows today when I was at families and eating all day. I think I guess on the carbs and then take too rich insulin. I am on a pump and have been since June so that helps a lot but it's still an issue with the lows!

 

Sent from my GT-I9300 using Diabetes forums

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Tanikit

That sounds like a good goal - and definitely a good thing to do about the driving - you can crash fast when it happens (learn from my mistakes here) - make sure you take something to drink in the car that can push your sugars up higher as well just in case even if you drive starting at higher levels. Try not to guess with the carb counting - rather take your time to work it out properly - its frustrating, but worth doing - if you are really hungry maybe carry around snacks in carb labelled packets or something so that you already know how much insulin to take for them while you are working out for the other food (pregnancy can make you really hungry at times). Hang in there - your pregnancy is moving on and you'll be near the end before you know it.

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