My second appointment at the Pre-Pregnancy clinic was with L, the dietician who works with Dr Inspiring. In all honesty, I was initially a bit disappointed that I wasn't going to see Dr I again this time, but L was brilliant - and talked about much more than I'd usually expect from a dietician.
We started with a look at my injection sites and my wonky tummy. As I undid my jeans (which were held together with a safety pin) L laughed and suggested it might be time to buy some new ones, given my recent weight loss. I didn't like to say that these were the new jeans I'd bought, and that they were already too big too! I've always tried to be diligent about switching my injection sites, moving from side to side, but have been a habitual tummy injector (my legs bruise up, and I don't find the absorption as good). L took one look and told me what I already knew - 'you have hyperlipotrophy'. She gave me some great advice about using my sides and hips whilst waiting for the lumps to dissipate (which they will, if I leave those sites fallow for long enough). She also suggested using my buttocks for my Lantus dose, as this will give me slower and more even absorption.*
We talked a bit about the different insulins available, and L suggested taking my Novorapid between 10 and 20 minutes before a meal. Although I was told that it could be taken with, or even after food, L told me that most people still find that there's something of a delay before their insulin starts acting, and therefore taking your insulin around a quarter of an hour before a meal can make a difference and even out the post meal spikes a little. For me it's like going back to the old days of Actrapid - I don't always manage to get my timings right, but with a little planning it's fine. L also suggested thinking about changing my Lantus to Levemir, which is made by Novo Nordisk, the same manufacturer as Novorapid. Apparently Lantus has been associated in some studies with a slight increased risk of breast cancer, and some women who have a family history of breast cancer have been switched over to Levemir. Levemir is also considered, by some doctors at least, to be more flexible and work better for some people. It has to be taken in two doses, 12 hours apart, but since my Lantus is already on a split dose that would be no hardship! We also talked just a little about the benefits of going on a pump, although L said that the clinic had yet to switch someone over who was pregnant. It's an interesting thought, and I've wondered in the past about the possibility of an insulin pump (and especially about the wonders of the CGM - continuous glucose monitor - which is very attractive to me indeed), but I'm not won over. I can't help worrying about what would happen if the pump malfunctioned - at least when you're doing your own injections you dial up your own dose and feel the pen click as the dose goes in. Maybe I'm just too much of a control freak. Also, I have a horrible allergy to the glue in sticking plasters, and infusion sites and CGM sensors probably involve too much glue for my poor sensitive skin! :(
We also talked a little about my continuing attempts to lose weight. With my new tighter control I was having a lot of hyps - two or three every day, in fact. I could manage to keep my post-meal spikes down to 8-9 mmol/l, but this would mean going low a couple of hours later. I'd worked out a good plan to solve this, which was to hold back a small portion of each meal to eat three hours later, when the inevitable hypo struck, but I was also having fast acting carbs (often a couple of sweets) to fix the hypos I didn't catch early enough, and the extra calories from this meant that my weight loss had stalled (even though I was still only on about 1,500 calories a day). L suggested that maybe my metabolism had got used to the 1,200-1,500 calories from my diet and needed to be shocked. Exercise would increase my muscle mass, and hopefully shock my metabolism back into a place where I'd lose weight.**
Finally, I got the results of my blood tests taken at the previous appointment. My HbA1C was 8.1%. Far from the target level of 6.5%, but going in the right direction (it was 8.8% last time I had it done, in November 2009). I knew more or less what the result was going to be, as I'd had an HbA1C done at my GP surgery on 5 February, and it had been 7.9%. I was also given my thyroid function results, which were a little borderline. Apparently I have antibodies which indicate a risk for an underactive thyroid (which is another auto-immune condition often found in conjunction with type 1 diabetes). L wanted to check what Dr Inspiring thought about this result, and a couple of minutes later he popped his head around the door. He said that it was possible that a pregnancy would tip me into hypothyroidism, but that for the moment I'm okay. They'll monitor me closely, so I shouldn't worry too much - it's not unusual for T1 women. Although I'm not keen to have yet another thrilling medical condition to juggle I'm pretty sanguine - I'd much rather know, and I'm being taken good care of, so it could be a whole lot worse. And anyway, it hasn't happened yet, and might never happen, so I'll just 'keep on keeping on!'
I left my appointment with instructions to have another HbA1C in two weeks. The blood could be taken at my GPs, meaning that I didn't have to go back to the hospital to have the test, and I could call L 48 hours later for the results. My next appointment with Dr I would be on 15 April, giving me another four weeks to hammer that HbA1C.
****
I've talked about my struggles with my diabetes in a previous post, but this appointment was when lots fell into place for me. As I wrote in my earlier post, I'd been experiencing high sugars in the morning for about ten years, all told, and every doctor who I saw had a different explanation. L was the first diabetes professional, in all that time, to suggest that I might be experiencing the 'Dawn Phenomenon', where hormones are released whilst you sleep (somewhere around 4am) which cause your body to release stores of glucose from the pancreas. Knowing that I wasn't alone, and that what I have has a name, made a huge difference. I was able to read blog posts and diabetes advocacy sites which had suggestions for how to defeat the dawn phenomenon, and my new understanding has improved things for me. I'm not saying that the problem's gone away, but I've found ways of tackling it. If I wake in the night I'll check my sugars and give myself a small correction dose if I'm running high. I always test and then take my background insulin first thing when I wake up, even if I'm not planning to eat. At the weekend this means that my sugars are likely to stay more stable, before eating a late breakfast. During the week I also take my novorapid as soon as I wake. This means that it has a chance to kick in and start working whilst I'm poddling around the house getting ready to go to work. By the time I have breakfast a hour later my insulin is at peak action, and I'm less likely to spike after my breakfast. I now know, thanks to other d-bloggers, that the Dawn Phenomenon tends to make diabetics less insulin sensitive in the morning, so I'm more apt to take a bigger bolus for my small breakfast than I would otherwise be.
As I've discovered, the Dawn Phenomenon is a known feature of T1. So I feel short-changed that it's taken so long for someone to name it for me, and hence help me to tame it. I only wish that I'd found this clinic, and the D.O.C. a few years earlier, so I wouldn't have felt that I was to blame for my morning highs, and I wouldn't have felt so alone.
****
Notes:
* I've taken her advice and this works brilliantly (although I do have to contort myself somewhat to reach my bum, and my lovely hubby S has been known to have a good laugh watching this!)
** I left the hospital intending to try this, but to be honest, with all the hypos, every time I sat on my exercise bike I could only do 10 minutes before conking out and having to eat something, which seemed somewhat counter-productive. Grrrr. So, exercise would be good and is still on my to-do list, but I've so far failed in my endeavours.
No comments:
Post a Comment