By now I should be used to ignorance, even from medical professionals. But this encounter today really took the cake.
I was at the hospital getting my 28th week scan. I was particularly anxious about the measurements of baby’s tummy because at my last scan, it came out at the 80th percentile and that was flagged up as something to watch. They don’t want it any higher than the 90th percentile.
One of the many reasons why diabetic pregnancies are high risk is that high blood sugars can make the baby abnormally big. But other than the abdominal measurement, all of my baby’s other measurements were solidly average (around the 50th percentile) and utterly normal. My A1C at conception was 5.6% and my latest A1C was 4.9%.
So the 80th percentile tummy from the 23 week scan came as a surprise to everybody.
So today at the 28th week scan, when the tummy measurements were taken, I asked for more information, saying I was worried because it had been a little high the last time.
Sonographer : 'Oh yes, that’s because you’re diabetic.'
Me : 'But all the other measurements were completely normal, 50th percentile. And my HBA1C is 4.9%'
Sonographer : ‘Oh, so your diabetes is really not very well controlled is it?’
Unbelievable! I would not have known what to say either. Congrats on your A1C - that’s a lot of hard work! Hope you and baby are healthy all the way to delivery (and beyond!)
it does get old doesn’t it. Usually US techs are not allowed to comment directly to the patient on what they see anyway. Next time just ask your doctor to be present for the procedure (assuming it is done in their office). Good job on your A1C!! Sounds like you are doing great and baby too
Congratulations on the great A1c. Maybe the sonographer has “dyslexic hearing” and was reasonably commenting on your 9.4 A1c. Don’t let them get you down!
Wow… well first of all that sonographer is obviously ignorant regarding diabetic patients… ugh, even though it’s quite irritating to meet people like that, you know that you’re on the right track and congrats on your A1c!!
Comprehensive Diagnostic Medical Sonography programs vary in length from one to four years depending on the degree or certificate awarded. Prerequisites also vary among programs from high school diploma or GED to specific qualifications in a related allied health profession.
Although certainly frustrating that he/she would say that, I personally would not hold them to the same standards that I would other medical professionals that require a minimum of a Bachelors degree. My perspective is if they don’t know about it they shouldn’t say anything about it.
Well, it’s in one ear and out the other time. The 4.9% is fantastic!
And, obviously, if you’re concerned about the baby’s belly size, you need to make it a priority to talk to your doc about it. It could be something and it could be nothing – us ordinary folks (and the sonographer is one of us) really don’t have a clue. And some babies born to totally non-diabetic mothers are simply large.
When I was 5 months pregnant, I was told by the OB-GYN that my pelvis was too small, and that I would have to have a Caesarian. I cried for hours. Then I went to a different doctor. When it came time to deliver, I did it vaginally, and my son’s head was 90th percentile. All that worry for nothing!
So hang in there until you have a chance to talk to the doc. Don’t worry until you have a reason to!! (I know, easier said than done!) Hoping for the best!!!
I commend you on a great A1c. But I also have to provide you with the context of why the Sonographer may have shocked you. For many T1s, they are given routine guidance on diet and control that leads them to fairly large blood sugar swings, enough that any A1c less than 6% presents some serious risk of lows. When a T1 becomes pregnant, the guidelines are “psycho.” You are told to achieve unbelievably tight control, but you are not given the tools to achieve it. For some women, the way to bring your control (A1c) to target is to run low and risk many harmful lows. If you got an A1c of 4.9% by routinely running your blood sugar low (30-60 mg/dl) and banking those lows, then you would not be well controlled. This may be why your Sonographer made the comment.
However, this is not what you are doing and you have every right to correct such a misinterpretation. Keep up the good work.
OK Gotta say this…If I came in at that as an A1C my dr would faint. Now just goes to show u that some ppl even in the medical feild don’t know too much about D. Congrads on ur A1C!!
finding the right rapid-acting insulin for me (10 minutes action on Apidra rather than 2 hours on Novo-slow)
being lucky enough to stay stable overnight or at most drop 1 mm/ol (18 mg/dl)
I got this down to 4.9 by adding the following:
having to meet 1-hour post meal target of being under 7.8 (140). The only way to do this is to shoot a little extra before the meal, and then keep testing to catch hypos before they hit. If PP+1 is under 7.8, then there will be a hypo at PP+2 and another hypo at PP+3. In order not to have a hypo at PP+4/PP+5 (i.e. to be back at 80-100), then PP+1 would always be at an unacceptably high level, as high as 250, and certainly always over the target of 140. So basically, it is an extreme sport called surfing the crest of hypos and trying not to drown. So far so good. It does mean obsessively writing everything down and remembering the insulin action curve. And stopping a hypo before it happens by correcting even if I’m in the 5s (90-110), depending on where I’m standing on that curve. I also do corrections of 5g rather than 10g as I find the law of small numbers really helps. I actually have fewer bad hypos now on this routine.
Eating small meals. I find this works even with pizza! I once took 2 days to finish a medium thin-crust pizza. I ate it like a mouse. One slice every two hours, and I bolused for 20g of carbs each time. I got a really sweet flatline this way (or as flat as you can get for pizza!). Lowest BG was 3.8 (68) and highest was 7.5 (135)
As far as possible, eating dinner early so that BG stabilizes before bed. Man, I feel like a dweeb having dinner at 5pm but that does mean all insulin is out of the way by 10pm.
And yes, this means a buttload of insulin. I’ve heard so much about how insulin causes weight gain. But you get a slightly different perspective on it when pregnancy hormones mean you have to take 2 units of insulin the moment you get out of bed, just to drink a cup of hot water. I decided I would just use what I need, and not stress about the quantity. At the same time, I was being nagged by my diabetes team to eat more carbs. I was doing 50-100 before, and most days now do 100-150 plus up to 50 for hypos as needed. Plus virtually my only pregnancy symptom was an overnight doubling of insulin needs. All this means I take about three times as much quick-acting insulin compared to pre-pregnancy. Total weight gain in first trimester was a whopping 500 grams. After 28 weeks, total weight gain is just under 4kg/about 8 pounds. Practically all of that is baby-related and utterly normal.
It is exhausting and stressful but hopefully in a few months time, when I am covered in baby puke, I will look back and think it was all worth it!!!
Awesome A1C Lila. Just goes to show what can be done with an understanding of the principals involved as well as the willingness to try different tweeks until the desired results are achieved.
In fairness to medical professionals, in general they don’t run into people like you and many others on tuD, who set ambitious targets and then experiment until they can meet them.
I would have said something extremely…um, unladylike, to the doctor. Or at least a sarcastic ‘Wow, I can tell you’ve spent a lot of time studying diabetes’…
Even with an A1C of 5.9 my son was 6 lbs 12 ozs at 34 weeks and 1 day. All his ultrasounds he measured 2 to 3 weeks ahead of where he was supposed to be. My endocrinologist said its normal for diabetes even with well controlled diabetes to have large babies. What I don’t understand is why my OB said that Type 1 diabetes tend to have smaller babies?
Yeah, I wonder about that, too! How big was your son when he was born? There is certainly a normal variation in size among full-term babies born to non-diabetic mothers. I think it’s more or less between 5 and 9 lb. with average being between 6 and 8. If a diabetic mom can have a full-term baby in that range, she has done super!!
it does get old doesn’t it. Usually US techs are not allowed to comment directly to the patient on what they see anyway. Next time just ask your doctor to be present for the procedure (assuming it is done in their office). Good job on your A1C!! Sounds like you are doing great and baby too 
