My Endo

This is the message from my endo about my less than “perfect” BUT not terrible blood sugars:-

"we should have a more consistent diet and activity… please take regular meals on a specified time… alot a more rigid diet time and amount so the insulin per day will be stable

target 95 before meals and 120 1-2 hrs afer meals".

Why on earth do I have to have everything at exactly the same time every day? Why do I have to take exactly the same amount of insulin (bous) every day? Why can’t the insulin work for me, instead of me having to adjust my life around this damn insulin. It just doesn’t work for me. Yes, i know I have to have excellent bs control as I’m now an incubator, BUT why this way???

This doctor is supposed to one of the best here in Philippines! Yet he doesn’t seem to have any idea about ‘modern’ diabetes management. He seems to be in the dark ages.

My question to him btw was whether dropping blood sugars at end of first trimester is normal, as I’ve had a very significant drop in insulin requirement recently. Actually I now know it is from here and from reading, but does he?

I really am so FRUSTRATED here! I just don’t know how to manage this or what to do. I WANT a doctor who is up-to-date knowledgeable and will work with me, instead of me now feeling I am so alone in this.

When I saw him last he tried to give me a handout on gestational diabetes. Hello! This is preexisting. God knows what type, because NOONE will test. But it sure as XXX is NOT GD.

I really want to change endo, but am so scared that someone else will be exactly the same… or not be willing to let me continue my current thyroid management… (this endo has been my doctor for about 8 years now, including pre-diabetes…)… I like him personally, but am really questioning his approach…

It’s probably sort of dicey? I think there are some things about “Type G” that may be similar, e.g. the baby sacrificing the mom for itself? I sort of understand his point, as very regular habits will give one more regular data but I agree with you that it’s not very realistic in this day and age and that it should be possible to make adjustments. The other thing is that it may be harder to notice/ document/ prove that changes, like the decreased need for insulin you are perceiving, if the input/ output part of the equations are all over the place? Part of the reason that I like having a pump etc. is that I don’t have to eat all the time, the way I used to with R/NPH. It might be worth it to explore your options and maybe talk to another doctor/ clinic?

It DOES seem like your doctor is concerned about the health and development of the baby, and that’s a good thing. He’s absolutely right that you need extra-tight control, but I don’t know how you might manage more variety of meals and times on shots without taking risks of high or low BGs that might damage the baby. I hope you are on the Oh Baby group – the women there are either experiencing or have experienced pregnancy with diabetes. I just remember a friend, who had a successful diabetic pregnancy saying that she would be happy if she never saw another egg again, because that was all she could tolerate for breakfast during her pregnancy. It’s definitely NOT easy, but the results will be worth it, I would think?

Glad to see you are being proactive about the insulin. My doc put me on 70/30 many years ago when it became apparent after a day or two that NPH at night only wasn’t going to do the job. What a nightmare! Can you at least get Lantus or Levemir instead of NPH? They would at least give you a smoother basal.

I wonder if the treatments in the Philippines are archaic because most people can’t afford any better, if they can afford insulin at all. I wonder whether the rich people have access to the modern conveniences that we have. I’m really hoping for the best for you!

Hmmm. I have no experience of pregnancy, but I guess diabetes could go one way or another - high (to do with hormones) or lower (such as yourself) because the baby growing inside you is taking up more nutrition. I read that the diabetes is pre-existing, but perhaps there is more that you need to do because you are pregnant and things might change during pregnancy!

I know it is frustrating and that doctors do not seem to have any idea of lifestyle etc! My biggest bugbear is that they seem to think that we have time to stop and test and spend loads of time in the kitchen weighing everything out and preparing food at certain times! It IS time consuming, and not everyone has the luxury of time!

Here in the US our high risk obgyn takes over care for patients who have diabetes…they
Have more training with pregnancy and other high risk issues that women
Can have. I see there are high risk obgyn’s in the phillipines but don’t know
If this can be an option for you. Good luck.

PLEASE be VERY careful with being pregnant and hypoglycemia. I can’t STRESS that enough. I had severe hypoglycemia while I was pregnant almost all the way up to 36-37 weeks and even then I only went as high as 140’s. Im glad you are not doing 70/30 in my opinion it is a horrible insulin that gives you no room for adjustments at all. Back in the day that was what I was on while pregnant. Also agree Lantus or Levemir would be if you can get it a much better choice for a basal insulin too. While I haven’t made the switch to a pump YET, I do think it might be a good option to explore, from everything I have been told or have read or heard, it does tend to give people a lot more flexibility and control and they are able to kinda work diabetes around their life instead of the other way around. If you can get it too I would look into the continous glucose monitoring as well, at least definately while pregnant, so you can catch those lows before they become dangerously low. Please find a good OB/Gyn who specializes in high risk pregnancy. While not a long term solution for managing your diabetes, a high risk ob/gyn SHOULD be knowlegable in what insulin does or can do to people while pregnant. Good luck, pregnancy and diabetes can make things a bit more tricky but having a healthy baby will make up for all of it. Oh and one other thing too, it is not all together uncommon after pregnancy for you to become for a short time very sensitive to insulin and your needs may drop dramatically, just something to keep in mind as your body and hormone levels level out after you deliver.