Hi all, I just found out I'm 8 weeks pregnant. Type 1 for 20 years, age 31. This is a planned pregnancy, my first, and we're very excited. My A1C's have been great pre-pregnancy (in the low 6s) and my latest was 6.2 which both my endo and OB were happy with. Here's my question: my OB is a high risk OB, but they seem happy to let me manage my blood sugars myself because, in their words, I have "really good control and a good handle on things". My endo doesn't seem to really like this, and it seems like she would prefer to have me be more closely monitored by a maternal-fetal medicine group that is centered at a big local hospital (I'm in the U.S, just FYI). They manage a lot of diabetics (both type 1, 2, and gestational) and have a whole group of nurses dedicated to looking over blood sugar logs and making adjustments on a weekly basis. My endo said that she'd be happy to help me manage my blood sugars instead, but it really seems like she's leaning to have me work with this maternal-fetal medicine group instead of my high-risk OB. Any advice or take on this? All of the sudden I'm worried that my OB isn't taking as good care of me as they should (since they're not making me report my blood sugars to them weekly, etc.), although up until this point I have really liked my OB. I'm a little afraid of going with that maternal-fetal medicine group, because I feel like they would micromanage my diabetes care (make me see a dietitian, eat a very strict meal plan, stuff like that) and that I wouldn't have very much of a say in my own care. However, I really just want to do what is best for me and the baby. I know some people's endos manage their blood sugars during pregnancy, and some people have a high risk group like my endo suggested, but I'm not sure which way to go on this one. Any experiences with both or either would be greatly appreciated.
Hi, and congratulations!
I also had my first baby when i was in my early 30s (32) and have had diabetes 20+ yrs. I also recently had my second. I had each at different hospitals so for one I saw a high risk on and my own endo. For the second I used a non high risk ob and and was required to see the diabetes group at the hospital. My a1cs were also very good for both (5s to low 6s which were the best I’ve ever had).
I think your answer really depends on which you prefer. I personally prefer to not be monitored and required to report my numbers weekly, get advice from people that have read more about diabetes but have not lived with diabetes, etc. So I definitely preferred not seeing the hospital group. I did, though, do a lot of reading on my own so I was informed about the huge insulin increases I would need over the duration of the pregnancy and that I would need to decrease it fully, immediately after the baby is born, and I was comfortable making these changes with a support group. So it really just depends on your preference. In my experience, while both options cared about my blood sugars during pregnancy, neither did a good job in explaining how I would be controlled and monitored during labor. It was like the hospital group that I was required to meet with during pregnancy had never even been in the labor room or talked to the nurses who are actually who helps you control your diabetes during labor and afterward.
I found this site to be really helpful for info about control during pregnancy and during labor.
Good luck and congrats again.
Most OBs have very little to do with the BG management of their T1 patients. They aren't specialists in diabetes or insulin therapy. They're specialists in obstetrics (even if "high risk" obstetrics).
Here's how it works for me...
My endocrinologist and I are the ones in charge of my blood sugar and any necessary adjustments. Last pregnancy, I saw her every 2 weeks. This pregnancy, she's letting me meet with her every 3 weeks. I can also fax her my numbers anytime I want a recommendation from her.
My OB always looks at my BG numbers when I visit her, but she doesn't "manage" my diabetes. She leaves that to my endo. She told me to make adjustments a few times during my last pregnancy, and I made the adjustment if I agreed, but there were moments when it was painfully clear that she doesn't understand more than the bare basics about insulin-dependent diabetes.
And then, I also saw a perinatologist (these folks handle high-risk pregnancies) for my ultrasounds and consultations on how my baby was doing. He also did nothing with my blood sugar. He's asked about my A1c before and asked who my endo was. Other than that, he just monitored the baby for any problems and explained things to me.
That's about it.
hey congrats on your pregnancy, I’m 33 weeks pregnant with #2 and 33 years old. I had my first baby in the US and will be having baby in Canada, God willing. In both pregnancies my diabetes was supervised by my endo. In both cases I had an ob who never asked for my readings, I would just tell them how I was doing and report my a1cs. I found my endo very helpful and my ob did her part well. It made more sense to me to have them focus on their area of expertise, especially when my endo already knew me and we had been working together with my diabetes for a while. Congrats on your pregnancy and all the best!
I live in Hungary and my OB was not at all involved in blood sugar management. Actually my OB even has a degree in endocrinology as well, but she and I trusted my endo (who does have a lot of experience working with pregnant women). I think it is really up to you about what you feel comfortable with.
I was seeing my endo weekly, which I found excessive in the beginning, but I have to admit that I was really grateful for it. Even though I had a lot of experience with blood sugar management, my endo knew a lot more about how my insulin needs may change in pregnancy. She was able to act preemptively at times (for example ready to make more drastic increases when she saw insulin resistance on it's way etc). So I was thankful to have someone to consult with weekly, but I would NOT have wanted someone taking over management and micro managing my life :)
I'm 27 weeks pregnant with my first and in April will be diabetic for 20 years. I saw my endo first thing when I found out I was pregnant. She didn't require me to see a high risk OB, she thought it would be too hard on me since there are none in my area (I live an hour north of Dallas. I would have had to drive into Dallas to see one), so she said my regular OB would be fine. I didn't have an OB at the time, so I had to find one. I was referred to one by my PCP and I love her. When I went in for the first visit, she asked if I had an endo and when I said yes, she was seriously relived. She said she would leave all of my diabetes care up to her because if it were up to her she would manage it like they did 20 years ago with Regular and NPH insulin, but that she would send me to a maternal fetal medicine group to have my 20 week anatomy sonogram done since they're more trained to spot abnormalities and deal with any defects (which my endo had said they would do, and if the OB did NOT recommend this, to find a new one). When I had that done, baby was perfect and they said she looked 100% like a non-diabetic baby, so they weren't sure if they would be seeing me again. They said people from my doctor usually only get sent back to them if there's a problem and since I had none, they didn't think she would send me back (the MFM was in Plano, so about 45 minutes away from where I live). My endo only saw me every 6 weeks in the beginning since she's also in Plano and didn't want me having to drive so often, but I emailed them with any questions I had and was in constant communication with them. Now she's seeing me every 4 weeks, and maybe more closer to my due date. I go to a Diabetes America, so I only go to one place to see everyone; Endo, educator and lab work. I prefer that, since the educator is the one that I go over my numbers with. She's young like me and I really like her, so we're in constant communication via email. This last time I was there she asked me what I ate in a day and logged it all into her computer and said that I had a very balanced diet so she saw no need for any change there, so I'm assuming if I wasn't getting enough of something she would have given me a diet I needed to follow. She did give me a few lists of good things to eat during pregnancy that shouldn't effect my blood sugar, so that was nice. I'm very well controlled and I've been going there long enough that they trust that I know what I'm doing and will make rational adjustments when I need to (which is about every 3-4 days right now) and that I'm not going to wait until they make a decision, which could take awhile. I've been on this board, and done enough research that I was well aware way in advance of the changes and increases I would face once I finally got pregnant (took us 3 years) so nothing has been a surprise so far.
I would say go with whatever you're most comfortable with. I'm comfortable with how my doctors are handling everything, but I know some people wouldn't be. It works for me and I'm enjoying not having to go to the doctor so often, but I am definitely seeing my OB more than a non-diabetic would. I saw her every 4 weeks from the get-go, and starting Tuesday, I'll be seeing her every week until delivery for non-stress tests and ultrasounds.
Good luck with your decision and congratulations!
When I was pregnant with my daughter, I saw a high-risk OB who did everything--I never saw another OB, my endo, or a diabetes educator for my whole pregnancy. I emailed her my bgs once a week and she helped me adjust things as needed. I really liked her and felt she did her best for me. However, I often wished I had more of a team working with me, especially a good diabetes educator.
One thing that strikes me is the fact that your endo is leaning towards having you work with the MFM group. This may mean that although she feels comfortable taking care of you during pregnancy, she thinks the MFM group may have more experience or just be better able to spend a lot of time with you (especially with the team of nurses, etc).
I wonder if it would be possible for you to have a consultation with the MFM group, just to get a feel for how they do things and to see if you would feel comfortable with them. Also some MFMs work with other OBs on a consultation basis... it's all so complicated and sometimes hard to figure out how each practice does things.
I sympathize with your concerns--for my next pregnancy I'm planning to be managed by an MFM group with a dedicated Diabetes in Pregnancy program run by an NP and a dietitian. I'm kind of afraid of the dietitian part of it and the possibility of micro/mismanagement. However, for what it's worth, I wish I had been more micromanaged and had more attention paid to my diet when I was pregnant before. Even though you know so much, and you know your own body the best, pregnancy is such a crazy time that you may possibly be glad for that kind of support, even if you normally wouldn't want it or need it.
I will also echo the person who mentioned that it may be hard to get answers about what will happen during labor/delivery. If you have questions about that, try to be persistent until you get clear answers. I can tell you from my experience that lying in the triage room having contractions is not the time to find out that you hadn't been told some important things...
Best of luck and let us know what you decide!
I think it really depends on how confident you feel in your endo's ability vs. this high-risk mfm group's ability to help you manage your BGs. Here is my experience: Until recently, I had a very old school endo and a regular OB as my care team with occasional consults from a high risk OB. I was sending weekly BGs in to a nurse practitioner with the mfm group and a team of four high risk OBs (whoever was on call that week, it changed from week to week) would make recommendations. They were not very helpful but part of the reason was that I was not giving them consistent readings (some 2 hours, but not every time). When I expressed dissatisfaction to my regular OB about my BG management, she suggested having my endo manage things instead (and then went ahead and arranged that for me, in retrospect a very bad idea). My endo... is not capable of providing that kind of management. My pregnancy ended at 20 weeks due to cardiac abnormalities and I am now pregnant again and have a very different setup. I have a new endo and diabetes educator team who are having me fax readings between once and twice a week. I am working with a high risk OB who gets regular reports from my endo. If I feel like I need help with carb counting or nutritional planning, my endo will give me that support. I also have a counselor who I'm seeing to help with that aspect.
If I were you, if you are happy with the management options your endo is offering I would stay with them. If it were me, I would be curious as to why your endo wants you to go with the mfm group - do they have more expertise? better support staff? options that your endo thinks would benefit you? If there's a compelling reason that your endo can articulate, maybe it's worth going with this mfm group. If not, then why switch? Just my $.02.
Congrats on your pregnancy! Here's hoping for a quiet nine months :)
Hi, I am a type 1 for about 18 years now. I had my first (and last lol) baby two years ago. When I got pregnant I was not in good control at all. My A1C was around 11 (YIKES)... I immediately strapped down and by the end of the pregnancy got it down to a 6.8. While I was pregnant, I worked with my Endo to manage my diabetes. I saw her once EVERY two weeks for my entire pregnancy and we communicated every week. I sent her my numbers at the end of every week and we just managed it like that. My OBs had very little to do with my diabetes at all. The High Risk OB pretty much let me handle that with my Endo. I guess it is what ever you feel comfy with. I was familiar with my Endo. She is a specialist in diabetes manaement, I felt confident with her so it was a good plan for me. I don't think I would have felt good about the OBs taking main control of my diabetes managment during my pregnancy. Overall, they just worked together to get me through, communicating when they had to and it wasnt much at all.
Thank you all so much for your replies. This has helped me a lot. I am so much more comfortable having my endo manage my blood sugars, and as of now she seems willing to do it for now. We've been in contact via emails and such, and they've been downloading my pump & CGM once a week so far and helping me adjust as needed, and it seems to be working out just fine. I go in for an actual appointment with her next week, so I'll be able to more accurately assess why she was pushing the maternal-fetal medicine group then, I think. All of your responses have helped so much! Thanks!
Im currently 6 months pregnant and I work with my endo, educator and obstetrician
I also have a very supportive GP.
I am a pumper with a CGM (Medtronic) which has been a big help but would have loved Dexcom for the no time lag but $$$ pressures stopping that
I went to an obstetrician with experience in diabetes and I see him basically every 4 weeks up until 22 weeks and more frequently after that. My blood pressure has started to rise so thats why the more frequent visits now
I visit my endo monthly, do a blood glucose review twice weekly (via email/phone) and that seems to have worked well so far. Im at the stage where my resistance is steadily on the increase which is horrible but she assures me we are doing well.
Micromanagement of diabetes in pregnancy is unfortunately an unavoidable side effect but as you say you want what is best for you and bub so dont fight it.
I went from a completely low carb diet to a diet with carbs at every meal. Firstly because I was sick as dog in the first 17 weeks and then carbs were the only settler.
I am exhausted, dying to have a ham sandwich and many other complaints I could bore you with but my HBA1C yesterday was 5.0 & baby is thriving
Congratulations!! My advice would be to trust your own instincts. You have a long road ahead of you and you must trust the people you're working with. I too got pregnant with my first at 31 (he's now four months old) and I've been T1 for 18yrs. I was super anxious about my blood sugars for all 38.5 weeks. Throughout the pregnancy I saw my endo, a high risk ob, a maternal-fetal specialist, and a nutritionist (twice). My ob was not with a large group because I didn't want to be just another number in their system. My endo took care of the diabetes side of things, the ob took care of the baby, and the maternal-fetal specialist made sure everything was okay with the baby as far as the diabetes went (i.e. lots of ultrasounds). This was all fine until insulin resistance started to set in at about 20 weeks. My numbers and insulin needs started changing rapidly and it was really hard to get in touch with my endo in a timely manner. I was fairly new to pumping at the time too so I felt really hesitant to make adjustments on my own. This quickly changed when my endo didn't return my call after a few days with high numbers. I bit the bullet and started making my own adjustments. I spent the rest of the pregnancy making my own adjustments and checking in with my endo every 2-3 weeks. With all that said I guess what I'm getting at is I had to learn to trust myself because I didn't trust my endo. I would have gone crazy with a group of people micro-managing my life because I was doing that myself. When we all arrived at the hospital for delivery day(s) I knew exactly how to manage my own blood sugar & insulin (my husband knew how to operate my glucometer and pump in case I couldn't) in many cases better then the hospital staff. It's your body and your baby, and you know what's best. Trust yourself and good luck!! ps. this group helped me through some really tough weeks. There are some amazingly strong, intelligent, and loving women on here,
Just wanted to give you all an update. I went in for an actual appointment with my endo, and it went really really well. She said they were happy to manage my blood sugars during pregnancy unless things started to go badly, and then they'd have me go to the maternal-fetal medicine group. They seemed really happy with how I was managing things, and are going to be having me upload my pump/meter to them twice a week and adjusting things as needed. It ended up being really positive, and I'm really happy with how it all is working out. Thanks so much for all your advice! My A1C is currently 5.6, btw! Crazy! And the baby is doing well, we've had an ultrasound and have heard the heart beat a couple of different times now, and are very excited! Thanks again for all your thoughts and advice!
Awesome! Hope it continues to go smoothly for you. Thanks for the update.
And way to go on the A1c!!
Awesome!!! Congrats on the A1c!!