Today was my first NST (non-stress test) since I recently hit 32 weeks with my pregnancy. Fortunately, everything continues to go smoothly with the pregnancy and thanks to my low carb diet, my bgs have stayed pretty steady and my A1C has been between 4.9-5.1 throughout.
The NST was at the MFMs office and each time I go, they ask a number of standard questions - if I brought my “logs,” how my post-prandials are doing, etc. I usually leave the appointments really frustrated because they often seem very judgmental and inflexible, despite my great A1C and how well the baby is doing. This time I was more prepared with how I wanted to respond.
I explained to the nurse that I upload my data to a website, which I can pull up for them. When they said they want to see the logs each week so they can recommend adjustments, I explained that I make my own adjustments as needed. When they said they are interested in seeing the 1- and 2-hour post-prandials, I explained that those metrics are only relevant to someone on a high carb diet. I also assertively let the nurse know that I would be happy to discuss and negotiate with the doctor. I also confirmed with them that they mostly see gestational diabetics and few T1Ds (and mentioned that I’ve been living with and managing my diabetes for nearly 30 years).
During the NST itself, I pulled up my CGM data online and looked for my averages over the last week, which I shared with the nurse: 88 overnight, 102 morning, 93 afternoon, and 107 evening.
When the doctor came in, we talked a bit about my strategies and practices for making adjustments. The nurse shared the bg averages with her. There was no mention after that of me bringing in logs or them making decisions about my diabetes.
I’ll probably have to go through this each week, but at least this week, I feel like I was able to demonstrate my competence and walked out feeling good about the experience.
Way to put an exclamation point on that conversation! Those numbers are stellar. Medical professionals need to recognize the competence you acquired over hundreds of thousands of hours of observing your glucose metabolism.
I’m T2 and went through something like this with my pregnancy, too. Luckily for me, my MFM’s office new my endocrinologist, and so I always would just say, “you know, I’m working with Dr. XYZ, who is an expert in her field. I discuss my insulin needs with her.” And they would always drop it.
HOWEVER I did have one nurse who was awful around the NSTs and laid on the guilt trip pretty heavily. My A1C was in the 5’s throughout the pregnancy, and I kind of just told her off. Sounds like you were more polite! Way to go!
Good on you @Pipli! I’ve experienced the judgement of the medics in my time, I once took a sneaky peep in my case notes to read" this patient has the intelligence to control her illness but chooses not to". Lol, if only intelligence were the only thing needed to control diabetes, what about time, education, access to technology, motivation, discipline, not being hypo phobic etc etc etc. Best of luck with your birth and new arrival, such an exciting time.
Oh my! That is totally out of line! Who on earth chooses not to! Maybe they don’t realise that even with our best efforts, following their ‘often terrible’ advice is why some patients cannot achieve their targets.
When i was last sick my doctor told all the other staff “Hands off her diabetes, she manages it extremely well”. He told me diabetes care is up to you. We will only help if you are not able to do it yourself…
I’m very curious to read your updates, @Pipli, since I am also currently pregnant (still closer to mid-point though). It’s particularly encouraging to hear that things have been going smoothly for you!
About this particular interaction, I couldn’t tell what exactly your healthcare providers are judgmental about since it sounds like the things they generally care about – average BGs, HbA1c – you have well under control. What other concerns did they express? Is it something about the baby? Or was it purely procedural (they want the weekly logs)?
If so, are these the same people whom you’ve been seeing from the beginning of the pregnancy? (I ask because I only go to a MFM clinic myself and it was very quickly established that I make my own adjustments and am only planning to call them if I encounter a stretch where my own skills do not lead to the desired results. That hasn’t happened yet, though I am worried about the coming insulin resistance since I hadn’t experienced that pre-pregnancy and it will be a new challenge for me.)
And on a separate note, have you decided on your birth and labor plan choices yet? To what degree do you have a choice? My MFM told me at the very beginning that he recommends induction at 39 weeks as a standard approach because of increased risk for placental issues with T1D mothers. That makes sense in general, but now that I am reading more about this, I asked for a more tailored approach where we take into account my tight control. So far I was only able to get agreement from one of the nurses and not the doctor himself (haven’t seen him personally for a few weeks), but if I manage to keep control the same in the last five months and have no other complications arise in that time, I will definitely object to induction. But I am worried about this and curious how other pregnant T1D moms in good control are approaching the issue. (Or maybe you are interested in all the medical help that can facilitate the birth process, which of course is fine too – as I said, I am more curious about others’ choices than anything else.)
For me they recommended induction at 38 weeks, I had great control and no complications during pregnancy but they said that because I had type one for such a long period of time, 25 years, they felt it was the safest option. I went with their advice as my knowledge was limited and I was being treated in the national maternity hospital (ireland) where they would have a lot of experience with higher risk pregnancies. Induction went well for both my children and it certainly didn’t go on for days as I had feared. Lol, to be honest by 38 weeks I was more than happy to be induced, I’m 5’2" and at at 38 weeks I wasn’t sure if that measurement was referring to my height or my depth! I was extremely uncomfortable and hadn’t slept more than 3 hrs a night since I was 18 weeks pregnant.
The MFM’s concern is mostly procedural. They have a way of doing things with diabetics and they seem fairly inflexible, which is why this was a big win for me. They want written logs to show a specific number of meter checks per day at specific pre- and post-meal times, and they want to make adjustments to my rates. They also had specific opinions about how many carbs diabetics should be eating at each meal. Not to mention insisting on induction at 38 weeks.
I am very much opposed to the MFM making adjustments to my pump settings, which is why I am usually more on the “non-compliant” side in terms of providing them with the meter data. If they had expressed an interest in understanding my management techniques and the thought I put into my diet and management, then I’d be more open to hearing their opinions and suggestions. But they started immediately and have stuck to very rigid and industry-defined standards for “all” diabetics. If I can do better than their industry standards 90% of the time, I feel like they should give me some credit and let me keep doing what I’m doing.
My endo manages the diabetes. Actually, she knows I do adjustments on my own and is fine with that. She reviews what I’ve done and suggests additional tweaks. I see her once a month during the pregnancy.
The MFM does all the ultrasounds and now, one of the NSTs per week. My OB (different office) does all the regular checks, the other NSTs, and they deliver the baby. They’ve been good about leaving me (and the endo) to handle the diabetes.
Regarding labor and delivery, the OB has confirmed that I’ll be able to keep my pump and CGM on and will be able to manage that (barring any emergencies). As I get closer to when they’d be scheduling the induction (two weeks ahead), I’ll ask if they’d consider letting me go to 39 weeks if all continues to go well. I’m not holding my breath with the MFM…they are militant. I figure until I’m much closer and able to show how tight my control is (and pair that with the baby continuing to do well), it’s not worth trying to get them to commit to hypotheticals.
Thanks for the extra context, @Pipli ; I understand now and agree it must be frustrating to be second-guessed that way, but the good news is that since the MFM staff are not your primary healthcare providers, you need to just bear with them for a few weeks only.
I ended up being induced, but it was only because my insulin requirements dropped at 38.5 weeks - which my MFM said was an indication of an “aging” placenta. Otherwise, they would not have induced me (though I don’t think they would let me go past my due date).
How “low carb” is your diet? Are there risks to eating low carb, since baby needs some carbs for development?
I’m a T1, 8 weeks pregnant, and wanting desperately to decrease my a1c (7.3)!)
My low carb is Bernstein low. about 30 g a day, coming mostly from nonstarchy veges. Carbs are not an essential nutrient they are simply molecules of c-h-o. carbohydrates are not needed to maintain blood sugar levels. the body can do that quite well from protein sources and from small amounts of carbs eaten.
Congratulations on your pregnancy! I started out and stayed fairly strict to Dr. Bernstein’s 30 carbs per day. After a few months into my pregnancy, I started to relax it a bit and probably did closer to 60 carbs per day.
It is safe to be low carb during pregnancy. I did a lot of research before starting LCHF and specifically looked for pregnant T1Ds following the diet. There is someone on YouTube (Type1Mama) who did during her pregnancy and she posted a few videos specifically about that. There’s also a Facebook group - “Grit Pregnancies” - of diabetics following low carb during their pregnancies.
I was told by some of my doctors (MFM, OBs, a CDE) that my baby would be at risk if I didn’t eat more carbs. Luckily my endo was well-informed and another CDE was, too, so I trusted their perspective and knowledge and guidance during my pregnancy - when it related to my diabetes and diet.
Do you have a CGM? That’s the best tool during pregnancy to help reduce your A1C.
Just wondering- do you eat any fruit, bread, rice, pasta? Is your diet mainly vegetables?
To be honest, I don’t know if I could survive on only vegetables!
I don’t eat any grains, any starchy vegetables, any fruit, any sugar (unless I am correcting a low).
I do bake low carb breads and make low carb pancakes (based on almond flour, psyllium husk, coconut flour). I eat mainly vegetables and meat. I do eat higher fat and higher protein. I eat some nuts and seeds. I eat cheese.
Here is what I ate yesterday:-
Breakfast: coffee with a good dash of cream, low carb bread (2 slices) with vegemite.
Lunch: Pork rib and vegetable soup. The vegetables were cabbage and mixed Asian greens.
Dinner: steak fried with garlic, zucchini pasta (zucchini spiralised and cooked in butter, and cream), green beans. 1 small piece of dark chocolate.
I often eat eggs for breakfast, avocado, with sardines. I eat lots of salads with dressings. I eat seeds and nuts such as sunflower seeds, pumpkin seeds, when I want a snack.
Hope this helps. My insulin requirements have already jumped from about 20 - 25 units a day up to 50+ units a day and I am only about 6 weeks pregnant. If I was eating carbs my insulin requirements would be even higher and I would surely be chasing highs and lows all day; as it is things are already challenging and I need to keep things on as even a keel as possible (and I work full time and look after my other 2 daughters, so I have to also keep things simple).
Thank you for the details. It sounds like you are doing so well with diabetes management.
It becomes a whole new ballgame when you know your children are depending on you to be around for many more years. It makes every sacrifice worth it.
That being said, I doubt I would be able to cook and eat like you, because of the lack of availability/ the high cost of things like coconut flour, almond flour etc. in Japan.
But I’m inspired to do my best with what I have.
Thanks for
Your encouragement.
Please check if you can order items to Japan from I-herb.com.
I know they ship to most places in the world. But you would also need to check on import requirements etc.
I am able to get items delivered shipping charge free to Hong Kong (a colleague or I bring them by hand to Philippines after this). Philippines is not easy to get things sent to.
I’m not so low-carb now while on maternity leave (but plan to go back on it when I go back to work in a few weeks), but when I was my diet was very similar to what has been mentioned above (…minus the vegemite). After a while, I did introduce some fruits and starchy vegetables to my diet, but only through trial and error and once I figured out which ones worked ok. So, for instance, I could eat fruits that were still firm, like bananas with a tinge of green on their peels, or tart green apples. Ripe fruits did NOT do me any favors. This worked for me because I prefer fruit before it gets ripe. Sweet potatoes worked for me in small quantities and I also added some quinoa and some beans, to vary up the diet a little bit. All in moderation but it helped to give me some variety. I did find low carb tortillas that tasted pretty good, which were bought in bulk, and now live in my deep freezer.
I would suspect that there are small communities of LCHF devotees in different countries that have sourced local resources. Have you done any research to see? Slightly different, but I’ve seen plenty of online conversations of LCHF+vegetarian, LCHF+pregnancy, LCHF+diabetes, LCHF+diabetes+pregnancy, etc. Perhaps LCHF+Japan would result in some interesting findings?
