# Type 1 Diabetes - No Pre conception support



## PS27 (Mar 2, 2021)

Hi, I have been diabetic for almost 30 years my current Hba1c is 76mmol (it is the best it has ever been) I want to try for a baby however I have not been able to get any pre conception support, currently the hospitals are under a lot of "Covid" pressure and are unable to give me an appointment with a specialist. This makes me really nervous as i don't want to try and be of any risk to the baby without any specialist support. any advice or suggestions please?


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## mellie1806 (Mar 2, 2021)

When i was looking at IVF, my DN wanted my Hba1c as low as possible, almost down to a unimaginable number (I recall it being low 50's). I got to just above that figure. It can be done, but it is hard, and you need to sustain amazing BG figures throughout pregnancy. Good luck, and I hope you get to speak to someone at the hospital soon.

Mel


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## Cherrelle DUK (Mar 2, 2021)

Hi PS27,  

Sorry to hear that you're not able to get support around getting pregnant, it's a bit of a challenge at the moment. Have you tried you GP or nurse? They are often a bit more accessible and can give you some initial advice then offer specialist support once you're pregnant.

We've got some interesting info on getting pregnant when living with diabetes that you may find useful https://www.diabetes.org.uk/guide-to-diabetes/life-with-diabetes/pregnancy


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## PS27 (Mar 2, 2021)

Cherrelle DUK said:


> Hi PS27,
> 
> Sorry to hear that you're not able to get support around getting pregnant, it's a bit of a challenge at the moment. Have you tried you GP or nurse? They are often a bit more accessible and can give you some initial advice then offer specialist support once you're pregnant.
> 
> We've got some interesting info on getting pregnant when living with diabetes that you may find useful https://www.diabetes.org.uk/guide-to-diabetes/life-with-diabetes/pregnancy


Thank you for your reply. My GP has referred me however it can take months before I get an appointment. I have left several messages for my diabetes nurse but had no luck.


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## Inka (Mar 2, 2021)

PS27 said:


> Hi, I have been diabetic for almost 30 years my current Hba1c is 76mmol (it is the best it has ever been) I want to try for a baby however I have not been able to get any pre conception support, currently the hospitals are under a lot of "Covid" pressure and are unable to give me an appointment with a specialist. This makes me really nervous as i don't want to try and be of any risk to the baby without any specialist support. any advice or suggestions please?



The pre-conception support mainly helps people get their HbA1C down and ensures they take the special dose of folic acid.

You could start trying to get your HbA1C down further by yourself. That would save time for when you can eventually see the team. Certainly you’d get suggestions here of how to do that


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## Leadinglights (Mar 2, 2021)

PS27 said:


> Thank you for your reply. My GP has referred me however it can take months before I get an appointment. I have left several messages for my diabetes nurse but had no luck.


You really want to be in a good position with your blood glucose control before becoming pregnant and your level does seem quite high. As you might have to wait a while for the 'professional' advice I'm sure you can find lots of good suggestions here to help you get your situation under better control. You will want to have a good healthy diet during your pregnancy anyway so maybe look at some measures now to improve things.


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## trophywench (Mar 2, 2021)

A few questions before suggesting some practical things - cos there ARE things we can do for ourselves to reduce our BG.

1.  What insulin regime are you currently using?  (ie pump or MDI)
2.  What actual insulin(s)
3.  How do you test your BG (ie meter or Libre or both)
4.  How many times a day on average do you test?


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## PS27 (Mar 2, 2021)

trophywench said:


> A few questions before suggesting some practical things - cos there ARE things we can do for ourselves to reduce our BG.
> 
> 1.  What insulin regime are you currently using?  (ie pump or MDI)
> 2.  What actual insulin(s)
> ...


Hi there,

1. MDI
2. Novorapid and Glargine
3. Libre sensor1
4. 6-8 times a day 

thanks


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## Inka (Mar 2, 2021)

You say you’ve improved your HbA1C already so you’ve made a good start. It has to be under 48 for pregnancy. I found the best things were to check basal was right first, then look at meal-time ratios, then at stopping spikes after meals. Every high has to be dealt with really, just as you would in pregnancy.

Are there any particular times you’re struggling with highs?


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## trophywench (Mar 2, 2021)

Have you actually done a basal test, and how are you handling meal spikes?  You are only aiming to see an increase of a very small amount, so working out how you can iron out the increases - and making this sustainable before you catch, will make it easier for the next 9 months, cos BG control is definitely more difficult when you are pregnant.


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## PS27 (Mar 3, 2021)

Inka said:


> You say you’ve improved your HbA1C already so you’ve made a good start. It has to be under 48 for pregnancy. I found the best things were to check basal was right first, then look at meal-time ratios, then at stopping spikes after meals. Every high has to be dealt with really, just as you would in pregnancy.
> 
> Are there any particular times you’re struggling with highs?


I mainly spike after breakfast and lunch, during the night and pre and post dinner my BG is usually around 6. I am carb counting and often try and weigh my meals too


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## Inka (Mar 3, 2021)

PS27 said:


> I mainly spike after breakfast and lunch, during the night and pre and post dinner my BG is usually around 6. I am carb counting and often try and weigh my meals too



I’m sure all that can be improved   Think of it as a project that will stretch over a fair number of weeks.

The first step is to check your basal is the right amount by doing a basal test:

https://www.diabetes-support.org.uk/info/?page_id=120

Can I ask - do you take your basal once or twice a day? Twice a day gives more flexibility, as you can have more/less at night, as needed. You can take Lantus twice a day, or you could consider if changing to Levemir would help you. What kind of time are you spiking during the night?

Once you have your basal ok, then you can look at limiting your post-breakfast and post-lunch spikes. I found moving my breakfast bolus earlier stopped my spike. I have to have my bolus 30 mins in advance for breakfast, which is around twice as far in advance as the other meals. I also have to have more insulin per carb for breakfast.

Do you have different mealtime ratios for different meals (by that I mean breakfast, lunch, etc)?

It’s great that you’re carb counting. Yes, I weigh some foods too eg cereal and pasta. It helps a lot.


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## Bobbiete (May 8, 2021)

Are you using an insulin pump? If not then I would strongly recommend this...it’s a life changer in terms of BG control.


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## SB2015 (May 8, 2021)

Hi @PS27 

As @Inka says you could look on this as a project.  You will need to reduce your HbA1c before getting pregnant.  You have already got it lower than before, so think about what strategies you have used.  Read around on here and fire away with any questions.  There is plenty of experience to draw on.

On MDI you could try changing the timing of your Bolus, so that the insulin has got going by the time the glucose hits your blood system.  People find that the timing varies, so perhaps start with a bolus 15 mins before you eat and then gradually adapt this based on your Libre graphs. Another things that can reduce spikes is to reduce the size of meals.  Set a lower target for the amount of carbs you eat at those spikes meals, by switching to lower carb options or reducing portion sizes.  

At a recent conference (Connect One Uk) someone stated that pregnant women can get a pump.  It would be well worth asking. This can make life a lot more flexible, as you will be able to make micro adjustments to basal insulin hour by hour, and turn it up or down to match what you are doing.  This takes a bit of work, and plenty of basal testing to get it to match your needs, but it sounds like you are willing to work on this to achieve your aims.


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