My fourth visit to the Pre-Pregnancy Clinic had me walking on air. My HbA1C, taken on 5 May, was 6.6%, and Dr Inspiring's response really made me smile: 'Not to be crude, but what are you waiting for?!'
Okay, if you want to split hairs, it wasn't below 6.5%, but YAY! Go me! As Dr I observed, 'you've really turned things around'. We had a long talk about why this is, and I was very open about how I've not always had the best treatment, and how I feel that the approach of this clinic is so amazing. I've had continuity since I started seeing Dr I, and I've had a huge supporter. He also feels that this approach is the way forward, and is therefore frustrated that the NHS is moving more and more to GP-centred treatment for diabetics and limiting funding for the kind of hospital based clinics where he works. It seems to me that this is madness. My GP is brilliant, and has an active interest in diabetes, but he's not an expert, and can't be on the cutting edge of every specialism. I hope that the NHS at least continues to support the kind of Pre-Pregnancy Diabetes clinic that I've been so lucky to find - anything else would just be wrong. Oh, and if it were possible to clone Dr Inspiring and have one of him in every city, that would be good too :)
I also took the opportunity to talk to Dr I at this appointment about some discoveries I'd made on the internet which I'd found incredibly helpful. He didn't know about the vibrant D-blogging and D-advocacy communities, so hopefully I've opened his eyes to something new too. I'd found quite a lot of information which suggests that a basal:bolus ration of 50:50 is a good starting point, and that a basal rate of higher than 50% can work well since it cuts down on post meal spiking. People with strong Dawn Phenomenon may find that 60% works even better.* My proportions weren't in line with this - I was taking about 40-45% of my insulin as background (or basal) dose, and I'd experimented between appointments with shifting this closer to the magic 50-60%. My control was improving, and my spikes (and hypos) were evening out. What did Dr I think of all of this? He was happy for me to tinker, and to find what works for me, and didn't play the 'God' card. Wow. A doctor who understands, really understands, that diabetes is a combination of art and science, and that diabetics can learn from one another. This man is a national treasure!
My other big question at this appointment was about maternal vitamins. I was keen to start taking a supplement, to make sure I was getting all my requirements. I already eat a good and varied diet, so this was more of a 'belt and braces' approach than a necessity, but I was keen nonetheless. However, I was already on high dose folic acid (for diabetics) and the maternal multivitamin I wanted to take also contained folate (at the non-diabetic pregnant lady dose). I'd done some Googling, and it seemed to me that what I didn't absorb would be excreted in my urine, but I wanted to double check that I couldn't overdose. Dr I confirmed this, so I was able to start the maternal vitamins on top of the high dose folic acid.
I asked what would happen next, given that I've reached my target HbA1C. Dr Inspiring explained that I'd have planned appointments every eight weeks until I get pregnant. If I have any problems in between appointments I can call him for advice. If we 'hit the jackpot' I should call him straight away, so that we can get onto the proper pregnancy treadmill of medical appointments. My next appointment will see a repeat HbA1C, to make sure that things are still on course, and a full blood panel including the thyroid tests. With that news, I got a big hug and off I went. My next appointment was set for 8 July.
Notes:
*For the interested, some links: http://www.andorrapediatrics.com/ap_folders/hand-outs/knowledge/insulin_pump_initiation.htm; http://www.diabetesnet.com/diabetes_control_tips/basal_bolus.php#axzz0s556dqml
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