Dr Inspiring and the D.O.C.

So, in my last post I talked about my diagnosis and our plans for pregnancy, and said a little bit about my diabetes over the last 15 years. In those years I've been looked after by three different hospital clinics, and one GP surgery, and despite the fact that I've sometimes seen excellent and very committed doctors, I don't feel I've always had the best possible care. I certainly haven't always had the best possible control, and I'm not denying my own responsibility for that too.

As I said before, I have a pretty full on job, I travel a lot, and I sometimes travel to out of the way places. I can start work pretty early on the days I'm up in London for meetings; I can end up eating lunch in the late afternoon, because that's how the day pans out; and I can come home late in the evening without having eaten. My life is hectic. Travelling in Africa or Latin America can also add interesting complications to the mix! However, that's how my life is, and I'm not ever going to be one of those people who can live a nice ordered stable life where I eat exactly the same thing every day, at regular times, although I do my best.

When I was first diagnosed I was put on multiple daily injections of Actrapid and Insulatard, so I had far more flexibility than diabetics like my Grandfather, who was on one injection of Bovine Lente a day. Carb counting and exchanges were considered passe, and newly diagnosed diabetics were told to eat a healthy diet with carbs at every meal (the more complex, the better). Insulin could be adjusted, but the doctors didn't share any hard and fast rules - it was a matter of trial and error, and tweaking to see what worked. Today's DAFNE courses were still a thing of the future, and I was sent on my way. I saw the diabetes clinic in Exeter every six months, and when I moved to Oxford University to do my doctorate I swapped over to the OCDEM in Oxford, where I was seen every 9 months or so. Some of the doctors I met there were fabulous - one, who came from South Africa, took extra time to talk me through the standards of diabetes care there, so that when I went to do my research, living in South Africa for months on end, I'd know what to expect. Another doctor gave me excellent advice on losing weight, and challenged me to try - when I came back to see him nine months later I was about three stone lighter! But, other doctors weren't so great, and it was rare to see the same person twice, as new doctors would rotate through the clinic learning their trade.

For years, I struggled with my morning blood sugars. Throughout the day my sugars would be spot on, but first thing in the morning they were always too high. Every doctor who I saw had a theory, or an idea to try, and I tried them all. I switched from Insulatard to glargine (Lantus) on the basis that it had a flatter profile and less of a peak. Slight improvement, but the problem persisted. I tweaked doses upwards (in case I was having too little insulin) and downwards (as I was told that maybe I was having night time hypos followed by a big rebound). Still no luck. I split my doses of Lantus to see if that would help. I also started Novorapid during this period. And I kept testing and checking my blood sugars day in and day out (4 times or more), and seeing numbers that I didn't like. My HbA1C was sometimes great, and sometimes dodgy, but I kept on keeping on, and I complied with everything that was suggested to the best of my ability (although at times my diet slipped badly). The last couple of doctors I saw at the Oxford clinic were both 'bad' doctors. I'm sure that they knew their stuff (from the textbooks at least), but for bedside manner and empathy they each scored zero. I was made to feel that if I just followed the advice things would be fine. Why was I so fat? Did I know I'd made myself insulin resistant? 'It's a simple equation really: food + insulin + exercise = blood glucose'. Well, most type 1 diabetics know different. Sure, in general that's not a bad equation, but what about stress hormones, infection, tiredness, the GI of your food, the type of carbs, the combination of food you're eating and how that all interacts? What about the effects of fat? of protein? And so on and so on. I've always found that the doctors who 'get' this are the ones I like best. The people who know that diabetes management is not just science, it's art too. One of my very early consultants was like that, but he was a T1, so he knew about diabetes in a way that the textbooks just can't teach you.

So then, how do we get to the title of this blog post 'Dr Inspiring'? Well, I moved to Bristol, and moved GP surgeries in the process. My new GP is interested in diabetes, and he's excellent. He makes time to listen. He also knows when to refer you on. When I announced that I was thinking about a pregnancy, and showed how serious I was by losing two and a half stone, he leapt into action. I had tests for my rubella status and my folate levels, and was put onto high dose folic acid. And then, I was referred to the Pre-Pregnancy Clinic for Diabetics at my local hospital where I met Dr Inspiring.

Dr Inspiring doesn't judge. He listens, and he understands that life isn't as straightforward as the textbooks would tell you. He has really high standards for diabetic woment contemplating a pregnancy, but he's your biggest supporter in working towards achieving them. He has a great team around him too. I feel like I won the lottery when I was referred to this clinic. I've taken control of my diabetes back. I've worked incredibly hard... and I feel like my hard work has been recognised, and I'm grateful.

The last few months also saw my introduction to the D.O.C. (Diabetes Online Community, for the uninitiated), and the scores of blogs that I now read on a daily basis have also been incredibly inspiring. As I said in my last post, I've found out that I'm not the only one, and I've seen that others share my struggles. I've read blogs where I could have written the very same thing, and had dozens of 'me too' moments. And I've learned so much in the process.

Dr Inspiring and the D.O.C. have taught me more useful stuff in the last five months than I learned in the last 15 years, and whilst I'm happy about this, I feel a little let down by what went before.

My next few posts are going to be about my first few appointments at the Pre-Pregnancy clinic, to bring my blog bang up to date.