Frustrated with OB

#1

I’m feeling a little frustrated after my first pre-natal appointment. I’m T2 and 9 weeks pregnant with my second child. I was originally diagnosed with diabetes at 13 weeks with my first that never went away. I’m diet-controlled and have been able to maintain an A1C around 5.2. We moved since my daughter was born so I have all new doctors this time. I will admit I went into the appointment not feeling super confident in them because when I called to set up the appointment the nurse told me I would need to take the 1 hour GTT, which I had no intention of taking. I already have the problem that doctors are always skeptical that I am T2 because I am thin, eat healthy, am active and have never had elevated fasting numbers. Yet multiple Endos have told me I have diabetes because of my post-prandial numbers, and I am negative for T1 auto-antibodies and MODY 1-5.

So yeah, the Nurse Practioner tried to get me to do a 1 hour GTT, which I refused, to which she replies, “So you want us to just treat you as a diabetic?” Yes, because I am? My diagnosis is in my chart which you have access to, and I have a blood sugar log for the past several months showing that there is a 0% chance I will pass a GTT and my blood sugar numbers since I’ve been pregnant. She also informed me that I will be considered higher risk and induced at 38 weeks if I go on insulin, but not if I take oral medications or stay diet-controlled. I was hoping to start insulin (which I also took during my last pregnancy) to give me a little more flexiblilty in my diet instead of having to go keto. I already have IBS so I don’t want to try Metformin. I tried keto last time and felt terrible on it, but I can maintain good blood sugar control that way. I’m annoyed that my diabetes is considered “worse” if I opt for a certain treatment. Why does choosing oral meds over insulin mean my diabetes is better controlled and therefore I get fewer interventions?:angry:

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#2

Great for you for sticking up for yourself - we are members of a select group

#3

So what does this mean - no insulin or required inducement?

#4

Sort of. If I take insulin they will watch me more closely, schedule the induction earlier and be more quick to jump to other interventions like a C-section, because they think that insulin=worse blood sugars=more risks. I don’t see how choosing to use insulin over oral meds or a keto diet changes my diabetes as long as I maintain tight control with the chosen method.

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#5

I’m sorry ur OB team seems to be uninformed on many fronts!!! This must be maddening!! Seems like ur being punished for using insulin to help u keep ur bg’s more in range. Is there any way of talking with the DR/NP/Midwife directly and discuss ur concerns and treatment plan?? I can’t imagine the stress of dealing with the team as it is will be good for ur BG’s either.

Hang in there!! I’ll be thinking good positive thoughts and sending them ur way!! And congrats on ur new impending arrival!!

#6

Shoot, I’d find a different practice if at ALL possible. They sound like idiots.
They need to work with you to find a solution that works FOR YOU, not just makes their job easier. You never know what kind of foods you might want or need to eat to get through the first trimester (or second…or third…) and from what I hear, every pregnancy is different, so what may have worked before, might not now - meaning changing up the plan later down the road. They need to be able to be flexible and treat you as an individual patient! Not just slap a label on you “DIABETIC” and be done with it. Sorry, I get very worked up! :smiley:

Also induction at 38 weeks is not always necessary anymore…it just depends on how things are going.

#7

How do you find a doctor that doesn’t think induction at 38 or 39 weeks is a requirement no matter how everything is going?

#8

Usually if they lean a bit more towards evidenced-based practice they’ll be more open to allowing baby to come when he’s ready. There should be a lot of hints to this during your visits.
I can understand why some docs don’t want to take the “risks” of letting patients go past 38 or 39 weeks but honestly, inductions come with plenty of risks too - one could argue they come with a LOT more risks. Those risks just shift a bit out of their laps & onto mom & baby…

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#9

Did you call up several offices and ask them about it? So far I am 2 for 2 on offices that are on the side of required induction no matter what. And the last one was a major research hospital so you would think they would be into evidence-based practices. They were the ones that also had a strict carb minimum of 175g/day too though, so maybe not.

#10

Oh dear lord, that’s ridiculously high! Holy crap!
No, we have two ob practices here and I left the one last fall to switch to one that was a bit further away, but located at the hospital I wanted to deliver at. That was back when we were still trying to get pregnant. I talked to the midwife (at the not-great ob) who did my pap and when she just smiled and said to come back after we’d been trying a year and called my MTHFR mutation “MTHFDR” and after I had a long frustrating conversation with a nurse there who couldn’t understand why I wanted more “advanced” testing done before we had been trying a year…I said forget it and booked a fertility consultation with a doctor at the other ob practice.

Anyways, long story short, I didn’t call them, but I read their entire website, all the doc & midwife bios, etc. You can kind of read between the lines by where they’ve each done their residency & those kinds of things too.

I didn’t have much other choice unless I wanted to drive into downtown Atlanta for EVERY prenatal visit - I already drive there for my endo, so I know its a pain, but I only had to see them every 4-6 weeks. So I may have lucked out with this ob practice.

I know its hard. It took me a while to find a good endo. And the game plan may have changed - this kid is measuring big, and while my endo has been pleased with my sugars, the mfm says to get them down lower. So we’ll see what the endo says when I see him Tuesday.

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