Why T1s Can’t Be Grouped in with GDs

I know what you’re thinking… duh, of course not. T1 and Gestational Diabetes shouldn’t really be lumped into the same treatment categories during pregnancy. Hell, since everyone is different, no one should really be grouped together period. But the methods are similar (counting carbs, maintaining a much lower average, etc.) so what’s the problem?

Since I passed my one year bloggerversary, I wanted to reflect on why I started the blog – a means to track my progress as an aspiring T1 mom-to-be in addition to being an athlete. Now, we still don’t have any positive sticks to showcase, which is okay-ish because my A1C could still use some work. (Still – I’d like to see SOME reward for my work at maintaining said A1C.)

The process to become a parent actually started very shortly after my hubby and I got married. While we weren’t planning to have kids that early on in our marriage, I like to prepare for everything really far in advance. I believe my old endo asked me about wanting to explore the possibility, so she wrote the initial referral to high risk OB for me to talk to someone.

A few weeks later I got a call from their receptionist. I explained that I was recently married and wanted more information about becoming pregnant as a T1 Diabetic.

“Are you currently pregnant?” she asked.

“No… I just said I wanted more information,” I replied.

“… Well, we have this class,” and she proceeded to schedule me for the afternoon session a few weeks later.

Class date rolls around and the hubs and I sit down in a small conference room in our HMO’s facility with 4-5 other people. Mostly women, but some brought their significant others/husbands.

First thing I notice – everyone is already pregnant in a variety of stages. (The one next to me was quite obviously pregnant, but I found out later she was 5 months along with triplets!) Then there is me, who is very obviously not pregnant.

Hmmm.

The class is divided into three parts: a presentation by the nutritionist, a presentation by one of the high risk OBs/Peris, and training. (Training?)

The nutritionist is up first. She talks about how pregnant women with diabetes need to think more about their food intake because high blood sugars are bad for the baby, but you still have to eat for two, etc. and so forth. She warned the class that the if you couldn’t control your blood sugars with diet alone, then you would have to go on insulin.

… Dear God, I’m in the wrong class.

So I raise my hand… “I’m already on an insulin pump, so what do I need to know?”

Nutritionist stares at me for a second. “Well, we’ll just have to get you off of that now won’t we?”

WTF?!

It was becoming clearer that I was in a class with gestational diabetics. Ladies that failed their glucose tests and now have to be more careful about what they consume and have never seen a glucose meter in their lives. Fine. I’ll deal, but clearly no one was thinking about that when they booked me in this class. Relax… you’re just here to get information.

Further into the presentation, the more evident it was that this nutritionist didn’t work with T1s very often. We moved on the meal planning and carb counting. We were each asked to total out the amount of carbs with sample menus and cross reference our choices with our allotted amount for that meal so our blood sugars wouldn’t be effected.

The dinner choice? Pizza. <sigh>

Moving on…

Next we get a visit from one of the high risk OBs. Now – my Endo warned me that the high risk department is very, well, dogmatic, in their approach to pregnant diabetics. It’s essentially their way, or the highway, which worried me because I am far from being a textbook PWD. Plus, my A1C was consistently on the higher side (for me) and I knew that wasn’t going to please them.

As expected, the doc had a “I’m not taking any of your shit today” attitude. So much for a supportive team. She went on to talk about the processes involved in getting blood sugar results to the CDEs and nurses, what late term appointments will involve, and the importance of keeping that baby healthy at the expense of your sanity. Naturally, she goes into birth defects and miscarriage rates to a room full of already pregnant and scared ladies. Awesome. Empathy is not her strong suit. Got it.

So I ask the question, “I’m a T1 who eventually wants to be pregnant but I don’t fit your ideal blood sugar range, well, ever. What should I do? Do I need to be off my insulin pump, as the nutritionist told me?” (The thought of going back to MDI was not exciting.)

“Oh no! We like insulin pumps! We can set basals to adjust for everything and we make you get into that range that we want.”

Yeah… I dunno about that.

Somehow my blood sugar readings came up, and I have no idea why? I was asked, “What was your last blood sugar?”

To which I replied, reluctantly, “412.” (Yay inaccurate carb count on labels and bad infusion sets.)

You could see her judging me like my number was 14.0% rather than the 7.0% it was. “Oh – well you can’t get pregnant with those types of numbers.” Trust me… I don’t like them either.

This is stupid. I’m never having kids.

The doc ended her presentation and asked all those still needing training (ha!) to either get the glucose monitor out that they received from the pharmacy or to leave the class and pick one up. The next section will instruct them how to use the meters and record the readings in the provided log sheets. All those with already non-functioning pancreases can leave.

The hubs and I left. Discouraged doesn’t even begin to describe it. I’m pretty sure I had written off the possibility of ever carrying a child to term right then and there. Clearly, no medical staffer wanted to work with me.

I still tried the “diet” just to see if it had any effect. At the very least, my blood sugars could always be better. But, my Endo was too conservative about me altering my ratios and rates, so nothing really changed.

I gave up and started looking into the cost of adoption for family expansion. It seemed the safest for everyone. Except maybe our checkbook.

My decision to never want kids naturally was put to the test in 2010. At the beginning of that year, my hubs was diagnosed with a very early form of cancer. The docs didn’t want to take chances, so they ordered surgery, 12 weeks of chemotherapy and urged us to bank if we ever wanted to consider children in the future.

No pressure or anything. 

Easy – I didn’t want kids naturally anyway. Oh, wait… what if I did? Crap.

Long story short, we banked, proceeded with chemo, and have since moved on, cancer free, with our lives. Sadly, my blood sugar control never really got any better… but, all for good reason.

Fast forward to last year. I discover the DOC, Cheryl Akon’s book on T1 Diabetes and pregnancy, and start doing my own research. I go back to my regular OB and ask for a referral to high risk AGAIN. (Her response to my experience in 2007… yeah, they shouldn’t have put you in that class.) I speak with an actual doctor, one on one, about my case, who also agrees that the class wasn’t a good idea. (Other than to scare me stupid.)

What did I learn from all of this?

Not all Ds are equal and shouldn’t be lumped together as so. If I had known back then what I know now, my hand would have been shooting up every 10 minutes, questioning everything. (Especially the bit about carb counting pizza…)

If you have GD, ask questions about their reasons and be your own advocate. It’s probably scary as hell, but no good will come from sitting silently (like all of my classmates did.)

Here’s to another year… hopefully with some positive results.

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3 thoughts on “Why T1s Can’t Be Grouped in with GDs

  1. theperfectd says:

    If I had seen a high risk OB and the endo I was paired with during my pregnancy, The Kid would not be here. I was not the perfect patient. My numbers were not ideal. Hell, I was 40 and dealing with all sorts of issues.

    There is never “the right time”, “the right blood sugar”, and “the perfect diabetic” (except me…ok, except my blog at least…). There is this… Great support from your medical team, your family, the DOC, and the willingness to do what it takes when the time comes.

    I’m glad your blogging and sharing and someday when we meet, I will tickle the toes of your kid and you can play with The Kid’s curly locks… If you can catch her while she spins, because like you… She loves to dance.

    Keep the faith. You can do this.

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