Wednesday, December 15, 2010

Doctor vs. Doctor

Okay, this is something that I could have gone into on my most recent rant but I was getting ramble-y already and, it really is a separate issue. I'm not sure if this is a common problem in diabetic pregnancies but it's been pretty frustrating for me so I thought I'd put it out there and see what others' experiences were. . .

Over the past few months as the doctors appointments have really ramped up, I've been getting more and more frustrated with all these crazy doctors! Individually, I actually really like all the MDs that I see. But all together, they seem to be one of my biggest hurdles right now. Mostly emotionally. For instance, it doesn't help certain bloodsugar-related matters that my Endo is freaking out over every single low blood sugar. And, of course, I'm super worried about the highs. But I feel like I have to go super slow with any adjustments I make for fear of being lectured again about over-doing it. ("You don't want to have a seizure, do you? You know, that wouldn't be good for the baby either, would it?") And it seems like going so slow just means my numbers stay out-of-whack for longer.

Meanwhile, my OB and perinatologist freak out anytime my fasting sugars are over 95. Even a morning blood-sugar of 105 draws sideways glances from them. Seriously? My Endo says that the OB's just don't get diabetes and aren't realistic but my OB's say that pregnancy is a totally different animal that just can't follow the same rules. No one can agree and in the mean time, it seems like no one cares what I think. Which is especially frustrating because not only have I been diabetic for 20 years but I'm medical and work in the NICU and deal with pregnant ladies and babies all the time. I kinda know what I'm talking about here and wish everyone would stop patronizing me and just listen! Add to it that I have to hear these opinions multiple times a week because that's how often I'm seeing random doctors, and I feel like my head is going to explode.

On a brighter note, the tweaks to my carb ratio made a huge difference in my sugars. The week of bad sugars that I was talking about in my recent rant happened a while ago and things have definitely made a turn for the better since then. Also, my Endo said something to me that (::gasp::) actually helped. He explained that as pregnancy progresses, gastric emptying time increases. Meaning that as I get further along, the food I eat doesn't exit my stomach and actually start getting absorbed until more and more time has elapsed. This really helps explain why I'm not spiking until 2-3 hours after I eat. It was so annoying to see my blood sugars stay pretty steady initially after a meal and actually think that I'd actually managed to bolus correctly . . . until 3 hours later, when I'd randomly spike into the 250s. He also suggested since I'm having to go up so much on my car ratio that maybe I should try grazing throughout the day rather than eating 3 larger meals.

I'm not really a fan of grazing because I feel like I end up eating a lot more. At a meal, I plan out what I eat, sit down, eat it and when it's gone, I'm done. But if I have to graze and eat more often, I feel like I lose the regimen and the willpower and overeat. But I'm trying it anyway. The plan is no more than 30-35 carbs at a time, with lots of protein (hard for me because I'm more of a fruit and veggie girl than a meat-eater) and eating every 3-ish hours. So far, combining these two things (grazing and taking the slower gastric emptying time into account) with increasing my carb ratio has proved very helpful in reigning in my numbers!!! I haven't seen anything in the 200s in several days!! :-D And even the 170s and 180s have only cropped up a couple of times.

Anyway, I know that each doctor has me and the baby in mind but my Endo's tend to put a lot of focus on me and my OB's/perinatologists put way more focus on the baby. I tend to be somewhere in the middle but, truthfully, lean more toward my OBs way of thinking. Mostly because I've been lucky enough (::knocking on wood::) that I haven't ever had lows that were scary. No passing out. No inability to think straight. I've always been with it enough to eat and check my sugar if I need to. And no issues with hypoglycemia unawareness. So I'm not really afraid of lows. I'd rather just air on the lower side and protect the little girl rather than air on the higher end of the spectrum.

But that's just me. And I really do get both sides of the argument.

I spoke with my Endo's nurse today because I'm still waiting on the labs from my last appointment. My fructosamine 207) and my microalbumin (7) look great (YAY!) but still no word on the A1C. Anyway, I told her a little bit about the tug-of-war that I feel like I'm in the middle of and she said that this was very common in their Type 1 pregnant patients. She said that most OB's just don't understand that there is a difference between Type 1's and Type 2's/Gestational diabetics. I get that and I tend to agree. Mostly I was just glad to hear that this is something other patients had to deal with and not just me.

Anyone else out there having this issue? Just curious.

1 comment:

  1. Oh doctors!!! :D

    I had those problems initially. My OB was telling me to only check my blood sugar AFTER meals, that's the numbers he wanted so those are the only ones I needed to test for (he said as much). Well, Mr.OB - how do you suggest I get those idea post-food numbers without first checking before hand to know how much insulin to give myself?

    My Endo was sweet, but she was also concerned with the lows and not as concerned with the highs. I had gotten to where waking up at 72 in the mornings was normal and no big deal. My big spikes were 180-ish late afternoon/evening and I just decided to not care.

    I wound up with my best a1c ever at a 5.4 at the end of my pregnancy - despite the unending resistance (I was up to 140ish units a day!).

    My daughter was 9 pounds and I had TONS of amniotic fluid, so to say I was uncomfortable was a bit of an understatement. But, my Husbands family hasn't had a baby under 8.5 pounds in their history in 50 years, so I was kinda doomed to begin with. Oh well. She's healthy, I'm healthy, life worked out.

    A friend explained to me that diabetics already have a higher-than-normal blood sugar range to be expected, even when pregnant. So even with the "best control" for a diabetic, it's still higher than a non-diabetic. So, chances are already in the baby's favor to be slightly larger, if it is going to be larger than "normal." Of course, you work in the medical field and with babies so you also know that "normal" is any range from 5 pounds to 10 pounds for any "normal" non-D mother! It just so happens that when a D-Mom has a baby, the baby's size is always blamed on diabetes.

    Just gotta sit back and ignore it all. :D You're doing your best. The random lows and highs aren't that bad. I snacked most of my pregnancy because I love to snack more than eat meals. As you get bigger (baby gets bigger) it's easier to eat in smaller portions too.

    Despite my OB's ignorance in how to actually handle Type 1 diabetes, he actually dealt a lot with diabetic moms, and was completely willing to let me go to 40 weeks before considering a c-section or induction. I was being monitored 4+ times a week so nothing was going to go wrong without someone knowing and able to do something about it. :)

    You know your body, and now your baby, best. You know if you can handle the lows. I have never passed out and *always* wake up when I'm low (at this point) so I was comfortable with 75 being a normal morning and before meal number - even if my Endo didn't like it. Heehee.