Monday, 16 January 2012

The magic numbers

When I found out I was pregnant one of the first things I had to adapt to was new blood glucose targets. Extreme tight blood glucose targets. What felt like unachievable blood glucose targets.

These targets were one of the first things that my Diabetes Specialist Nurse told me when I contacted her to tell her I was pregnant. In the UK (and it may vary between hospitals and care teams) the current recommendations for pregnancy are:

3.5 mmol/l to 5.5 mmol/l before meals

No higher than 7.8 mmol/l 1 hour after meals

For me these new targets were a shock to the system. My initial thought (and slight anger) was why I hadn't I been advised to practice these tight targets in preparation for when I did fall pregnant? I would recommend this to anyone trying for a baby at the moment, fair enough when you do fall pregnant your hormones might mean your blood sugars are all over the place but even if you just practiced for a week it might be some help when it does happen for real.

In the first few weeks every high reading I saw on my blood monitor set my mind into thinking about what I was doing to the little creation growing inside of me. And to the outsider I think they thought I was over worrying but then being told so much about the complications of pregnancy when you have diabetes - miscarriages, deformities - who can really blame me? I am sure I wasn't the first and I won't be the last.

Now at 16 weeks I am definitely more relaxed, I think it was ever since I had my 12 week scan and I was reassured that everything was developing well. But I still struggle in particular with THE 7.8, the special, elusive number!

I was speaking to a colleague/friend the other day who is currently going through IVF and has type 1 diabetes, her first question was 'how do you get your blood not to go above 7.8??!' It's a good question and I am sure some people manage this easier than others - no carb, low carb, low GI. For me the latter was the only option, when I suffered awful nausea in the first few months I just had to eat anything I fancied. I was endlessly recommended porridge and toast and every now and again I could manage it but most of the time I wanted the higher GI enemies – cereal!

Luckily being on a pump (I'm on Animas) has meant that I can really adapt my carb to insulin ratios and my basal rates and try to prevent the post meal spikes. In my case my blood glucose does come down, past the 7.8 and lower but this happens two hours after, not one hour! And when it does come down I then have to eat about 20g of carbs without insulin to keep on going till my next meal without a hypo. And there are some days when it is bang on target or below, some days I stress. There is debate about whether this is okay to be on target two hours later, in fact I had a lengthy discussion with my Consultant about it today. There are plenty of arguments for it being okay, especially if your hba1c is in target. In fact he told me that even if you don’t have diabetes your blood glucose can be above 7.8 an hour after eating, it is normal, phew!

It takes time and effort (as is often the case with diabetes) to try and achieve these tighter targets and if you're a bit out one day then it's about trying to figure out why then moving onto the next day with a fresh start in mind. And maybe you can't even figure it out sometimes these things just happen! I never thought I would be able to get as good control as I have now but I have, we just have to try and get there a little bit quicker when we have a baby inside us as time isn't on our side. But hey imagine how easy this will all seem when we aren't pregnant? It will be a breeze. Diabetes and breeze? Perhaps not!

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