Anyway, back to my appointment. After talking about my diabetes history for a few minutes, and hearing about the 35 lbs I've lost since last October, Dr Inspiring laid it on the line. He wants to see very tight control in his ladies, and I'm to aim for an HbA1C of 6.5. I don't think I've seen numbers like that in a decade. To achieve this incredible feat he gave me some targets for pre-meal sugars (3.5-5.5 mmol/l) and post-meal sugars (3.5-8.0). I didn't even think an 8.0 post meal was possible! To do this I may well need to increase and/or tweak my insulin doses.
Dr Inspiring gave me a new monitoring log book, and told me to keep detailed records of my sugars. His view is that it's not enough to keep your records on your glucose meter - writing them down allows you to see patterns much more clearly, and makes you take greater notice of what is going on. He then scribbled his mobile number in the front of the log book, and the number of his nutritionist colleague, and told me to phone at any time for advice. This is way beyond the 'normal service' in my experience (and was borne out a couple of weeks later when I went to my GP's practice to have blood taken and was told by a new trainee GP in the practice that Dr Inspiring is a bit of a legend!)
We talked a little bit about my weight loss, and whether I needed to lose more before beginning to try. At the time my weight was 14st7lb. Dr Inspiring told me that whilst any more weight loss would be great, and would certainly help in fertility terms, he didn't see a strong need for more weight loss. 'I'm not so worried about your weight - let's focus on your control'. We agreed that I'd carry on with my diet, and aim to lose more weight, but not at the expense of my overall control. Dr I was pleased to hear about the eating habits that my lovely hubby and I try to maintain, and encouraged me to keep focusing on good eating choices - minimising processed food. Following my confession that Diet Coke is one of my biggest vices he also suggested that I try (and this one's going to be really hard) to cut down, since it's an appetite stimulant (and made of icky chemicals!) We agreed that I would continue to try to lose weight slowly whilst trying to conceive, and even once I'm pregnant we should aim to minimise my weight gain.
We talked a little bit about trade-offs between weight loss and the decline in fertility that comes with age, and Dr I was very pragmatic. We agreed that the aim should be for S and I to have two kids before I'm 40, and since that's 'do-able but tight' we shouldn't wait and wait to get to the perfect BMI before starting to try, and in the meantime lose some of my fertile years. Good sense indeed. It seems to me that it's all about the risks, and minimising them, whilst recognising that it's impossible to eliminate any risk completely.
We also talked about the next steps fertility-wise, and Dr I suggested that I stop taking the contraceptive pill (Cerazette) and use barrier methods until S and I are ready to start trying. This would allow my system to settle down and my periods to restart (after many years of pill use - first Marvelon, with the associated withdrawal bleeds, and then Cerazette, with practically no bleeding at all - just a slight smear once every three months or so). Stopping the pill could also have a beneficial effect on my weight.
Dr I was pleased that I was already taking folic acid, but upped my dose from the standard non-diabetic 400mcg to the 5mg dose recommended for diabetic women, and told me to get my GP to put this on my repeat prescription. I was warned that it can take time to conceive, and it could be 9 months, or even a year of trying before we get lucky, but the clinic will be there with me all the way, offering support in keeping my diabetes well controlled. I observed that 'of course, I could be infertile' (a fear that I think we all have, even in the absence of any evidence) and Dr I smiled 'well, we even do fertility assistance if that does happen, and of course you're already in the system!' This clinic is amazing!!
At the end of my appointment Dr I introduced me to one of the Obstetricians on the team, who was lovely (and does lots of work on reproductive health in developing countries - something we bonded over). She also talked me through her expectations regarding HbA1C, saying that Dr I is extra keen on very tight control, and that the obstetricians he works with have slightly less stringent expectations, as follows:
- HbA1C over 10% - don't get pregnant
- HbA1C less than 8% - okay
- Aim for HbA1C of 7%
She also told me a little more about the risks of complications associated with a high HbA1C. Heart complications manifest themselves in about 1-2% of babies born to non-diabetic mothers, which is the same as diabetic mothers with an HbA1C of 7% or less. If the HbA1C is over 8%, this rises to 3-4%, and with an HbA1C of over 10% one in five babies will have heart complications. Scary stuff.
Other complications include big babies - especially if blood glucose is high during pregnancy (and this one is a bit terrifying since my lovely husband was a 10lb baby, and my paternal grandfather was something over 14lbs, with a withered arm to show for it). Eeek. Small babies can also result from diabetes, although this is far less common. She finished up with some better news though - reminding me that this diabetes/obstetrics collaboration sees a lot of diabetic ladies, both T1 and T2, and they usually have really good results.
The last stop was for blood tests (for my HbA1C and thyroid function) and a urine sample. The nurse who took my blood was also a fan of Dr Inspiring, confiding that she is also a diabetic and that Dr Inspiring is her consultant and he saw her through a successful pregnancy! By this stage I was on a total high - never have I felt so supported by a diabetes clinic, and it's a HUUUUUGE motivation to achieve. I left the clinic with a plan, a spring in my step, a head full of determination, and an appointment to come back in five weeks' time.
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