# Can someone help me with these questions / queries...?



## Babysaurus (Oct 30, 2011)

Hi, 
I am 7+3 and, so far, have had one ante natal appointment. I won't drone on, but the consultant is very much of the assuming and not listening variety so our 10 minute (after waiting two hours ) appointment was mainly focused on the, er, _one_ high reading of 14.1 that I had had over the previous week. So, as I suspect future appointments may be similar can any fellow Type 1's (or 2's if it's similar for you) help me with the following queries...? 

1) How do mild (say 2.7mmol) hypo's affect the baby in very early, and also later, pregnancy? 
2) Why do all diabetics seem to be either induced or offered c-secs? I ask this as I was told that my control was so good (this in the previous pregnancy which unfortunately ended in a missed miscarriage) that I would be able to go into labour naturally. 
3) If your blood sugar is too high after eating, over the recommended 7.9mmol, and you correct it straight away is this okay? 

I realise I need to also ask the doc or DSN these things but they currently seem to be too busy with trying to get me on a carb counting course or getting me to 'realise that blood glucose testing is really important' (with a HBa1c of 6.4mmol, and I suspect this last one will be even lower, plus me having fingers like pincushions and a diary full of on-target readings you would suspect they'd realise I already do both these things!)

So, any views or answers would be fab! Thank you!


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## margie (Oct 30, 2011)

I can't help with your queries but I can sympathise - its really annoying when people tell you to do things that you are already doing. 

There are quite a few members who have gone through pregnancy so hopefully they will be able to help with your other questions.


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## Monkey (Oct 30, 2011)

Congratulations! AN appointments were fairly frustrating in my experience too, so sympathy aplenty.
1) How do mild (say 2.7mmol) hypo's affect the baby in very early, and also later, pregnancy? 
I was told the effects of hypos were far less serious than the effects of hypers. Obviously that depends on you remaining conscious etc!
2) Why do all diabetics seem to be either induced or offered c-secs? I ask this as I was told that my control was so good (this in the previous pregnancy which unfortunately ended in a missed miscarriage) that I would be able to go into labour naturally. 
Two reasons - one, the evidence that the placenta begins to fail in T1 diabetic pregnancies sooner than in a non-diabetic pregnancy. I'm fairly sure the evidence says that even if your control is very good, it still won't be as perfect as in a non-diabetic, so the placenta works harder and its lifespan can be shorter.
Second, size. Some (not all - there are several babies here who were normal sizes!) babies of diabetic mums can be big. My son was 10lb 11oz, born at 38+2, and I'd had good control throughout my pregnancy - as good as you can expect, anyway. My consultant did wonder if there was a link with using lantus in pregnancy, but that was entirely her pondering and nothing scientific! 
Saying all of that, I know a couple of people who have refused induction and had a good experience from that.
3) If your blood sugar is too high after eating, over the recommended 7.9mmol, and you correct it straight away is this okay? 
Depends how much higher, in my opinion, and after how long. After an hour, I wouldn't have acted on a 7.9. After 2 hours I might have done - it's a case of trial and error to see what else might be going on, how you're feeling in terms of morning sickness. 

Your hba1c is fab tho - so try not to worry.


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## Babysaurus (Oct 30, 2011)

Thanks for replying you two! I have been reading the pregnancy message boards most of the day and it seems like there a large number of us who get frustrated! 

I tend to get plenty of notice about hypo's, and have had quite a few readings on the lower side of things as I am trying to avoid being higher than 7.9mmol an hour after eating, which is going pretty well so far considering I am having to alter doses quite a bit due to being pregnant. I am doing plenty of tests though regardless just to keep an eye on things and have not had any nasty one's, but it's still great to hear that the effects are far less serious than being high.

I was initially confused re the induction question as I had been told one thing but then read about failing placenta's etc, so maybe I was initially told the wrong thing in the first place. (Hmmm, this does not bode terribly well, does it?!) 

With giving corrective doses, I was thinking if the readings were over 11 an hour after eating (depending on what I was doing - if I was going out with the dog I wouldn't bother) I would have another two units and then test again in an hour. 
My consultant, the one who specialises in not listening, looked in horror when I said I would not give corrective does (unless over 11) if I was about to go out walking or similar as this brings levels down quickly and naturally and instead suggested I get someone else to walk the dog!  I then found myself explaining to him that perhaps being fit is pretty important during pregnancy too, and also pointing out that we were hardly talking about readings in the 20's! To this, he looked at me like I was a wayward child as opposed to a long standing diabetic of 30+ years with excellent HBa1c's and no history of needing hospital treatment of any kind... 

Ooooh, it does make me cross! 

If I can think of anything else I'll be back! Also, if anyone can think of anything else they wish they'd knew or that wasn't explained to them very well at first, I would love to hear it!

Thank you! x


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## HOBIE (Oct 30, 2011)

Cant help but good luck !


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## elliebug (Oct 30, 2011)

after some trial and error i found that if i corrected anything under 10 i just had a mega hypo as after 4 hours i was in target without another correction if that makes sense?? i've really struggled with the post meal readings i suspect its cos i've not changed my diet properly but as i have felt so sick i've just eaten whatever i wanted!! my hba1c at 6 weeks was 6.6 my lowest ever, hopefully they will repeat it next week so i can see how im doing. i've tried not to stress too much as long as im under 10! also cos of my job running at 4-6 is really hard cos its so close to hypo and i cant always stop for a biscuit when i need to!  anyway, will be quiet now, sounds like your doing really well, way better than me so maybe ignore me and carry on with what you were doing


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## Babysaurus (Oct 30, 2011)

Ellie, it sounds like you're doing okay too - don't be too hard on yourself! I am finding that being pregnant adds a whole new dimension to things. 
I normally don't worry if it is 10ish after food, especially as I am pretty active so it doesn't stay high for long but now am a bit more neurotic about it, so can empathise with you completely. 

Does everyone have to have an Hbc1c blood test every visit...? (Ugh)


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## Robster65 (Oct 30, 2011)

Similarly I can't help with your queries but I have found every consultant who isn't a diabetic specialist thinks they are and that we, the patient, are stupid and have spent the past 30 odd years slowly dying until they came along to save us.

Not one has ever raised an eyebrow and seemed remotely interested in learning anything. They know it all. End of.

Best of luck with what's to come. I'm sure the next 20 years will fly by until you get your free time back again.

Rob


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## elliebug (Oct 30, 2011)

they have taken blood every visit so far....


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## Babysaurus (Oct 30, 2011)

Rob, you put it perfectly! (Apart from the 20 years till I next have free time bit...!) 

Ellie - urgh! I did suspect as much but hoped I was wrong!


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## Monkey (Oct 30, 2011)

I don't think I had blood taken every time, but had a hba1c every month, certainly. 

The one thing I'd say is to be well prepared for every appointment. If there are things you want to know or want explaining, then ask. I found that some of the consultants I saw seemed very used to just talking at patients and were surprised if I questionned something or wanted to know more, but once they realised I was an intelligent women, were more than happy to explain.

Good luck!


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## Smit (Oct 30, 2011)

Hi Babysaurus

I was at my 12 week appointment on Tuesday, my diabetic consultant looked at all my readings and said I was been way too controlling lol. I have to lay off the correcting and worrying about post 1 hour readings and run a little higher for 2 weeks. I was getting in a right pickle if I was 8 or above after 1 hour, I would then correct only to have a massive hypo an hour or so later. So I have been told to test 2 hours after and if above 10 then correct, as I have a tendency to hypo 3+ hours after eating. He is going to review my figures in 2 weeks time and see where we go. 

I have also to have supper at night, 20grams of carbs and take no insulin for it as hypoing all night long. This so far is working, I was sure i'd wake up with blood in the 20's but waking to reading of 4-6.

My insulin was increasing from 4 weeks till 11, but we have put that down to a chest infection as my levels have dropped again. 

I understand what you mean when you say you've been diabetic for years, I told my consultant I had been diabetic for 26 years and know very well how to monitor it. I also told him when he was humming over a reading of 21 for ages trying to find a reason for it, that these things just sometimes happen. I was only human and can't always get carb ratios right. So I think we are now both singing from the same sheet.

Smit 12+2 woooooooooooooooooooooooooooooo!!!!


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## Babysaurus (Oct 30, 2011)

Smit, did he say you were too controlling due to the hypo's or for another reason...?


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## Babysaurus (Oct 30, 2011)

Monkey, I am get to get to the point where the consultant stops talking AT me and listens a bit more but hopefully I will get there eventually. I did see the same consultant a few times in June / July (unfortunately I had a missed miscarriage spotted at the 12 week scan) and he was similar then. It is like he has so many patients to get through that he likes to 'tell' you what to do and then get you on your way. I have decided, and call me awkward if you want to (!), to ask him _why_ he has come to the conclusions he comes to (eg when he tells me that I 'really ought to take blood sugar readings' ask him why he thinks I don't in the first place, when he talks about my (non existant) 'persistently high readings' and 'bad diet' I will ask him why he has assumed both these things (bearing in mind my Hba1c of 6.4 and the fact I am of normal weight and also very fit - I told him I do triathlons which may or may not have sunk in.) Hopefully this may get him to come round to realise that he simply assumes, tells and doesn't listen. 

Sorry for the ranting everyone...


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## Babysaurus (Oct 30, 2011)

Sorry, meant to say 'I am _yet to get to the point_...


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## Northerner (Oct 30, 2011)

Babysaurus said:


> Sorry, meant to say 'I am _yet to get to the point_...



You can go back and edit your own posts if you want - click on the 'Edit' button in the bottom right corner of the post


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## Babysaurus (Oct 30, 2011)

Oooh yes, so you can! Thanks Northerner!


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## Northerner (Oct 30, 2011)

Babysaurus said:


> Oooh yes, so you can! Thanks Northerner!



We're much better than Facebook, you know


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## Babysaurus (Oct 30, 2011)

Ha! I was actually thinking of the Mumsnet way of posting!


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## HappyHelen (Oct 30, 2011)

Hi Babysaurus

Your story sounds exactly like mine - in fact I wonder if we are at the same hospital?

I have been type 1 for 31 years and have always had great hba1c's and have never been hospitalised. All of a sudden when you fall pregnant, they assume that your knowledge of diabetes goes out of the window.

For a long time I refused to complete their diary as I record my results in my own spreadsheet which apparently they couldn't understand. What they didn't accept was that I am the one living with this day to day and if it worked for me, and I was getting good results, that should be good enough.

Anyway, I am always one for an easy life so I now complete their diary and my own and at each appointment I see 6 different people who spend their time circling the one or two high readings I might have. As Smit says sometimes results will be high but as long as they are not consistently high or for long periods, personally I think this is fine ( and when I say high they are not above 11).

At the last appointment the consultant said that i was getting obsessed with testing and should not test as much as i do. However the obstetrician disagreed and said i should continue as there is a very high correlation between those who test regularly and those who get great hba1c's. The way i see it is that it is only for 9 months and why wouldnt you try and give your baby the best start you can. So I have continued to manage things in my own way and my hba1c's have gone from 6.5 to 6.0 to 5.6 and the last one was 5.4.

The meal I struggle most with is breakfast and can end up with results of 8 or 9 some days and in those cases I will correct to stop it staying that high until lunch. My insulin needs have quadrupled for breakfast and more than doubled for lunch and dinner (this happened gradually throughout the pregnancy but still seems odd to do so much insulin for the same food I was eating pre pregnancy eg for a slice of toast I used to do 8 novorapid and now do 32!!). Levemir has also increased drastically so don't be too scared by this.

Your story really struck a nerve with me as it is so similar to my experience. The good news for me is that I am now 29 weeks pregnant and so not too long to go now. 

I hope your pregnancy continues to go well.


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## Babysaurus (Oct 30, 2011)

Helen, I could have written your post! Thank you for your long and detailed reply. I am being seen at Calderdale Royal Infirmary - where are you...? 

I have been increasingly reassured, weirdly, to hear from other people who seem to have the same experiences with regards to their ante natal appointments. Its nice to know I am not the only one! 

I too tend to have high bursts,_ if_ I get one, in the morning so am extra careful over the amount of Humalog I have. I'd rather have a couple of units extra to be on the safe side, and this seems to be working really well so far. 

I too fill in the diary they gave me, but I also explained that the readings for the time slots given (before meals, an hour post meal) isn't neccessarily a true reflection as I may test quite a lot, and correct if needs be, in between.

The last time I was pg and went to see them I also gave the consultant a list of what I ate, what I injected / what I would have previously injected (so they could see how I was altering my doses) and readings in between. He didn't even look at it, instead he put it immediately to the side and said 'that's too much' and said 'if you have so many problems with your blood sugar, you have to see the dietician'. 

I too am going to continue to monitor things in my own way as it seems to be going very well so far, but also 'play along' with them to keep them 'on side', as it were.


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## HappyHelen (Oct 30, 2011)

I am at Basildon hospital but they sound exactly the same!

I also test outside of the normal pre / post meal times they tell you to do - sometimes I have 7 hours between lunch and dinner and for me that is too long go without testing. This is not something I plan to continue after I have the baby (unless I grow another 5 fingers on each hand!). I correct when I feel I need to and having had diabetes for as long as I have, I am comfortable with this. I cannot deny that it is different in pregnancy (mainly in that I have to do soooo much more insulin) but I have coped ok so far. 

 I know that the hospital provide great care and for those newly diagnosed or those with gestational diabetes, they are invaluable. However I do think they should assess those who have had it for years and offer advice as appropriate. 

Anyway, rant over but it is nice to know I am not alone. Good luck with your appointments!


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## Smit (Oct 30, 2011)

Yes it was due to hypo's. Most hypos are because I'm correcting 2 hours after I eat. So to stop unless I feel I'm too high and we'll see how things are in 2 weeks. x


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## Babysaurus (Oct 30, 2011)

Helen, I think you may have hit the nail on the head. I am guessing that the bulk of patients are newly diagnosed GD's or Type 2's which may, and I hope I don't offend anyone with this, be less likely to know what they are doing than those of us who have had it almost all our lives. Maybe this explains the 'telling' and not listening. Glad to know you have coped okay with it. 

Smit, I'll keep reading your posts to see how you are getting on. Am not even seven weeks yet so it's early days for me (and also not even sure if this one is sticking yet, so am trying not to get too carried away...)


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