"Your A1c is 6.4 & the Doctor is VERY Concerned About That."

Diabetes and Pregnancy Trying to Get Pregnant
1

Ugh.

That's what the nurse practitioner from my OB's office said in a call this morning. "Your A1c is 6.4 & the Doctor is VERY Concerned About That."

As I've mentioned in a recent post, she wants my A1c under 6 (which it was for nearly all of my last pregnancy).

Even better? The NP said, "Are you on a diabetic diet?" So I explained that I'm on intensive insulin therapy via pump, because when I hear "diabetic diet," it's usually in the context of a T2 or pre-D controlling their BG via a strict diet. She interrupted me and said, "I know that, but she's worried about your glucose levels and wants you to go for a nutritional consult."

Nutritional consult? Really? She thinks I must not know how to eat well for my blood sugar, when she's seen me have such great control before? I may not always make the best choices, but I find the suggested need for a "nutritional consult" slightly insulting. This, from the woman who told me to eat peanut butter to bring up a bad low blood sugar. (Yeah. Really.)

But luckily, she was calling partly to confirm who my endo is, so they can recommend she order this consult for me. My endo knows I know my stuff. I faxed her a note about the situation and said that if there's some sort of pregnancy-specific training her CDEs could offer, great, but I didn't want to end up sitting though Whole-Grains 101.

Oh, and they also think I should start seeing the prenatalogist sooner rather than later. I did the research after you ladies assured me that there have been many healthy babies born to women with quite varied A1c scores on this site, and it's not until 7 and up that "risks to the fetus" are seen at higher rates than women without diabetes.

I like my OB, except she stresses me the hell out over my BG! Yes, I want to get my A1c down before we get to the point where the baby can start gaining weight too fast. But yikes... I'd have expected a response like this for a much higher A1c!

Thanks, I just needed to vent. :)

2

Wow, talk about stress! I think your OB needs to talk with your Endo to get some accurate info. The nurse might also be to blame since healthy concern from your OB could have turned into 'Very concerned" in the mind of the nurse.

I've had two pregnancies and two healthy baby girls- one in the USA, the other most recent in Argentina. In the USA, my OB was freakish about A1C and I hovered between 6.0 and 6.3 for that pregnancy. With a first pregnancy, I was stressed and didn't know any better.

With my second, I was much more relaxed and my A1C levels were between 5.8 and 6.0. Both my OB and Endo were thrilled that it was under 7.0 and said it was PERFECT.

A 6.4 is really good. Could it be better, sure, but it is NOTHING to be very concerned about. You know your stuff, your Endo knows that you know your stuff. That's good, but apparently not enough for your OB.

Question: Is it worth the stress from this OB (or is it stress from the nurse?)? You said that you like her but is that enough??

Good luck and let us know how it goes!

3

Ugh is right! That was what I hated most about being pregnant- the ignorance! I had a NP tell me to make sure I took sugar tablets with me in case I had a low blood sugar... I was like, really? I've had this disease 20 years, and I'm on week 34 of this pregnancy, but now you want to make sure I can take care of my lows? It's the worst. Just know that it is okay to be assertive- hell, its the best time to be even aggressive- you're pregnant- its the best excuse to be a b**** ever! Hang in there. I think we have to work on being our best advocates- even if it means to tell someone thank you for caring, but I've got this taken care of... :)

4

Thanks for the responses!

Lisa: Regarding whether she’s “worth it,” she was my OB for my last pregnancy and I think she’s very good and worth it. Most of the time, the stress factor was minimal. Of course, my numbers were where she wanted them then! I do think she tries to insert herself into my D-management more than is her business, but she backed off anytime I hinted that she needed to. (I think she’s used to getting to “manage” her patients’ gestational D.) It’s possible she may be worse about it this time if I don’t get my numbers as low as she’d like, but I’m already starting to arm myself with statistics and planning a polite way to say, “Kindly eff off and take it up with my endo if you would like to request SHE work with me on a below-6 A1c.” :stuck_out_tongue:

Megan: Wow. I probably couldn’t have resisted saying something like, “OMG, I’ve never though of that in all my 20 years of managing my diabetes! Wow!!!” :stuck_out_tongue:

5

So, I have a fun update to this. :)

Yesterday afternoon, I got a message from my endo's receptionist that said we'd talk about it in more detail at my appointment next week, "but she wants you to know she's with you on this. She knows you know what to do."

Then yesterday around 6:30 pm, I got a personal phone call from my OB herself. She backpedaled on her recommendation, saying, "I remembered that you're an insulin dependent diabetic, but I just completely forgot that Dr. Kennedy takes care of you! Of course you don't need to see a dietitian!" (I'd also faxed my blood sugar averages to her to show that they've been coming consistently down and are now around 115, and she said she's very pleased with that.)

So, sounds to me like my endo had a conversation with my OB! :)

6

I have no idea why high risk OB are handling T1 diabetic like we are idiots. I've done 1 pregnancy in Canada where I was sent to a high risk clinic where I saw a nurse, an endo, an OB, and a nutritionist on a biweekly basis until my last trimester and then I saw them weekly.
My last pregnancy I did here in the US and I got kicked out of Maternal Fetal Medicine for being non compliant. Apparently making my own pump adjustment after 17 yrs of diabetes is frown upon. I had the head of the department call me to lecture me at 7am. I called several endos who refused to take me on as a patient because I was pregnant (don't know why they went to school?). I got lucky, finally found an endo, met with the high risk OB once, and my regular OB consulted with her when she had a concern but she was the one who delivered me. You are your best advocate, tell her that stressing you out with her unfounded concerns is stressing you out and is going to spike your sugars...lol.

7

That totally flabbergasts me! Remembering my last pregnancy, I sometimes had to make my own adjustments once every couple of DAYS. They expected you to just ignore your own clear needs until they could give you an in-person nod?

I thought that too, BTW, that I should tell her the stress she's giving me spikes my BG. ;) Haha. She'd probably stare at me like she doesn't know what I'm talking about, though! Like she did when I once explained that a certain high blood sugar had been "most likely a delayed glucagon reaction since I was low before dinner." It was like I could hear all of the rusty gears creaking as she blinked at me and tried oh so hard to remember what she'd learned about glucagon in medical school!!!

8

great job handling this situation. I think a lot of OB's unfortunately see the worst in their patients with diabetes. My perinatologist is always telling me how most of his patients on the pump are constantly seeing BG numbers in the 200-300's. It stinks for us who have good control when we have to really sell ourselves to our doctors.

Good luck!!