I'm facing a mystery this morning. My period is due to start, and there's no sign of it. Not a hint. Nothing.
Am I pregnant? Well, according to the test I did this morning, NO. (And this was one of those sensitive, 6 days early-type tests.) Nada. One pink line. Not pregnant.
So where is my period? Is my cycle just reverting to it's old random patterns after a few months of stability? I dunno. But I do hate mysteries. :(
Lilypie First Birthday tickers
Wednesday, 21 July 2010
Thursday, 8 July 2010
Happiness and the green-eyed monster
Funny title for a blog post, huh? Well, I seem to be able to accommodate both huge delight for my pregnant friends and a nagging little green eyed monster making me ask 'when will it be my turn?'
I met up with a couple of friends last weekend for coffee (actually, I don't drink coffee, but you know what I mean!) M was one of the friends I spoke about in my last post - who was lucky enough to become pregnant in the first month of trying. She brought along her gorgeous little girl, who is 16 months old, and her new pregnancy bump (yes, she's pregnant again, already 20 weeks and expecting a boy). I'm so thrilled for her, but burst into ridiculous tears when I arrived home, because I want to be a mum so much. The rational part of my brain says we've only had two unsuccessful months trying and that I'm a loon, but the irrational part of my brain seemed to stage a short but effective take-over of my cranium. (Added to this, my other friend L, who waited so long to get pregnant and was expecting any moment last time I posted gave birth to a gorgeous healthy little girl. Again, thrilled... again, just slightly green-eyed!) The other dear friend who came along to our coffee date would love to have had kids, but couldn't. I feel so sad for her, as R would have been a brilliant mum, and her situation makes me feel all the worse for throwing my silly little pity party, so I've pulled myself together.
Being the total geek that I am (with a background in research), I was curious to see what the stats would say about the likelihood of pregnancy each month of trying. I found the following whilst googling around:
http://www.womens-health.co.uk/infertility2.asp
Another site says: 'On average, 20% of all couples trying to get pregnant will not conceive in the first year of trying. According to one study, 25% of couples get pregnant in the first month of trying, while 60% of couples trying to get pregnant do so within six months. On the other hand, 75% of couples get pregnant within nine months while 80% get pregnant within a year. Finally, some 90% of couples get pregnant within eighteen months of trying.' http://www.gettingpregnant.co.uk/howlongwillittake.htm
Rational Brain says 'these numbers look reassuring, calm down and enjoy the trying!' Irrational Brain says: 'blah, blah, blah... bet I'm infertile!' I am a rational woman. Yes I am. But reading this blog you might just question it!! :)
I probably ovulated a couple of days ago, and we've been doing 'the necessary' all week long, so here we go with another two week wait. Whilst I'm waiting I'll be doing my best to blitz my sugars even more, and sticking to caffeine free diet coke in the hope that this might just be third time lucky. And if it isn't, then I'm just going to have to erect some mental barricades so that pesky Irrational Brain can't sneak back in for another take over.
I met up with a couple of friends last weekend for coffee (actually, I don't drink coffee, but you know what I mean!) M was one of the friends I spoke about in my last post - who was lucky enough to become pregnant in the first month of trying. She brought along her gorgeous little girl, who is 16 months old, and her new pregnancy bump (yes, she's pregnant again, already 20 weeks and expecting a boy). I'm so thrilled for her, but burst into ridiculous tears when I arrived home, because I want to be a mum so much. The rational part of my brain says we've only had two unsuccessful months trying and that I'm a loon, but the irrational part of my brain seemed to stage a short but effective take-over of my cranium. (Added to this, my other friend L, who waited so long to get pregnant and was expecting any moment last time I posted gave birth to a gorgeous healthy little girl. Again, thrilled... again, just slightly green-eyed!) The other dear friend who came along to our coffee date would love to have had kids, but couldn't. I feel so sad for her, as R would have been a brilliant mum, and her situation makes me feel all the worse for throwing my silly little pity party, so I've pulled myself together.
Being the total geek that I am (with a background in research), I was curious to see what the stats would say about the likelihood of pregnancy each month of trying. I found the following whilst googling around:
Number of months trying | Overall % of couples | Monthly success rate (%) | Proportion (%) who |
| 0 | 100 | 20 | 86 |
| 6 | 30 | 14 | 77 |
| 12 | 14 | 11 | 69 |
| 24 | 4.3 | 8 | 57 |
| 36 | 1.9 | 6 | 48 |
| 48 | 1 | 5 | 41 |
| 60 | 0.6 | 4 | 36 |
Another site says: 'On average, 20% of all couples trying to get pregnant will not conceive in the first year of trying. According to one study, 25% of couples get pregnant in the first month of trying, while 60% of couples trying to get pregnant do so within six months. On the other hand, 75% of couples get pregnant within nine months while 80% get pregnant within a year. Finally, some 90% of couples get pregnant within eighteen months of trying.' http://www.gettingpregnant.co.uk/howlongwillittake.htm
Rational Brain says 'these numbers look reassuring, calm down and enjoy the trying!' Irrational Brain says: 'blah, blah, blah... bet I'm infertile!' I am a rational woman. Yes I am. But reading this blog you might just question it!! :)
I probably ovulated a couple of days ago, and we've been doing 'the necessary' all week long, so here we go with another two week wait. Whilst I'm waiting I'll be doing my best to blitz my sugars even more, and sticking to caffeine free diet coke in the hope that this might just be third time lucky. And if it isn't, then I'm just going to have to erect some mental barricades so that pesky Irrational Brain can't sneak back in for another take over.
Sunday, 27 June 2010
If at first you don't succeed...
...then try, try again!
And we have been. I know that it's daft to hope that you'll get pregnant in your first month, but it's hard to be rational about this TTC stuff. After all, we women spend large swathes of our twenties and early thirties trying to suppress our fertility, and believing that one 'accident' is all it could take. Then suddenly your world goes topsy turvy and you're actively trying to get pregnant. You sit down with a calendar and try to predict your fertile days. You start thinking about icky things like the consistency of your cervical mucus. Eeeew. You agonise about how much sex to have - every other day? every day? every three days? You wonder about ovulation predictor kits, and taking your basal temperature, and then you convince yourself that you won't worry about that malarkey just yet. You read books about getting pregnant and websites about getting pregnant, and you watch all the pregnancy related TV you can find (including the wonderful One Born Every Minute on Channel 4 in the UK). You realise that you're just a little deranged!
As I've already said, I'm 36, so I'm no spring chicken! Lots of my friends, who are the same sort of age as me or just a little older, have had kids in the last 18 months. I'm happy and excited for them, and jealous as hell! I want to be in that club. Different people have had very different conception experiences. One friend spent almost two years trying to conceive, and worried that she was infertile (she now has a gorgeous 16 month old son and another on the way - the second time was much easier, and number two is due any day). Another conceived the very first month of trying, and yet another on the second month. Oh how I wish to be in that group...
The first month of trying came and went, and along came my period. Grrrr. Oh well, it's only about a 25% chance that month.
The second month also came and went, and along came my period again (just a few days ago). So, we're about to go into month three. If I'm honest, last month wouldn't have been the best month to get pregnant, since I caught a nasty bug which sent my sugars a bit haywire for about 10 days. My meter averages went up from 6.5 mmol/l for the past 7 days to more like 8.5 mmol/l. I'm now back on the downward curve, and have settled at about 7.5. Now, six months ago that would have seemed impossibly good, but things have changed, and whilst these aren't disastrous levels, they did give me pause for thought.
So... onto month three. Here we go again. Back on the stringent diet wagon (after a little lapse when my period came - which just happened to co-incide with a short holiday in Copenhagen and the availability of some very good ice cream!) Back on the counting of days and the having lots of sex (yes, there are compensations to this - S, if you're reading, I love you so much!) , and back to being just slightly bonkers about the whole getting pregnant thing (sorry lovely husband)!
And we have been. I know that it's daft to hope that you'll get pregnant in your first month, but it's hard to be rational about this TTC stuff. After all, we women spend large swathes of our twenties and early thirties trying to suppress our fertility, and believing that one 'accident' is all it could take. Then suddenly your world goes topsy turvy and you're actively trying to get pregnant. You sit down with a calendar and try to predict your fertile days. You start thinking about icky things like the consistency of your cervical mucus. Eeeew. You agonise about how much sex to have - every other day? every day? every three days? You wonder about ovulation predictor kits, and taking your basal temperature, and then you convince yourself that you won't worry about that malarkey just yet. You read books about getting pregnant and websites about getting pregnant, and you watch all the pregnancy related TV you can find (including the wonderful One Born Every Minute on Channel 4 in the UK). You realise that you're just a little deranged!
As I've already said, I'm 36, so I'm no spring chicken! Lots of my friends, who are the same sort of age as me or just a little older, have had kids in the last 18 months. I'm happy and excited for them, and jealous as hell! I want to be in that club. Different people have had very different conception experiences. One friend spent almost two years trying to conceive, and worried that she was infertile (she now has a gorgeous 16 month old son and another on the way - the second time was much easier, and number two is due any day). Another conceived the very first month of trying, and yet another on the second month. Oh how I wish to be in that group...
The first month of trying came and went, and along came my period. Grrrr. Oh well, it's only about a 25% chance that month.
The second month also came and went, and along came my period again (just a few days ago). So, we're about to go into month three. If I'm honest, last month wouldn't have been the best month to get pregnant, since I caught a nasty bug which sent my sugars a bit haywire for about 10 days. My meter averages went up from 6.5 mmol/l for the past 7 days to more like 8.5 mmol/l. I'm now back on the downward curve, and have settled at about 7.5. Now, six months ago that would have seemed impossibly good, but things have changed, and whilst these aren't disastrous levels, they did give me pause for thought.
So... onto month three. Here we go again. Back on the stringent diet wagon (after a little lapse when my period came - which just happened to co-incide with a short holiday in Copenhagen and the availability of some very good ice cream!) Back on the counting of days and the having lots of sex (yes, there are compensations to this - S, if you're reading, I love you so much!) , and back to being just slightly bonkers about the whole getting pregnant thing (sorry lovely husband)!
Fourth appointment (or the Green Light) - 13 May 2010
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
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
Third appointment (or Spectacular Progress!) - 15 April 2010
I had called L, the dietician, in advance of this appointment to get the results of my HbA1C, and had to endure a frustrating wait of a few days whilst she was on holiday. I'd been really hopefully that it would be under 7.0%, and was gutted to find that it was still 7.3.
When I arrived at my appointment Dr Inspiring came bounding in and told me how well I looked, and then gave me the HbA1C result. 'What do you think?' he asked. 'Well...', I said, 'I'm pretty disappointed that it doesn't start with a 6.' Dr I then proceeded to tell me that I was beating myself up for making spectacular progress. He told me that he could see that I'd worked extremely hard, and took a quick look at my log book before proclaiming that my HbA1C should be less than 7.0% within four weeks. As it turns out his enthusiasm is pretty infectious, and his comment totally made my day!
He wondered aloud if I'd thought about switching from Lantus to Levemir, and when I explained that L and I had discussed it last appointment, and that I was keen to try it, he wrote me a prescription for a snazzy new Novopen and one box of 5 cartridges. We agreed that I'd try it and would see how I went. He advised starting the new insulin at a weekend, so that I could have a couple of days to settle in before going back to work. He wasn't sure if 1:1 would be the right conversion ration between insulins, as apparently it varies between people, so he told me to test frequently to start off with. Apparently it can take time for the Lantus to leave your system, so I might need to adjust things after the first few days.
We talked about my very frequent hypos, and he agreed that my strategy of holding back some food from each meal was a good one. Many of his patients eat small packets of carb throughout the day, rather than having three 'big' meals. 'Treat it like a military campaign...' he said, 'maintain the same level of food, but have more meals - small meal, snack, small meal, snack...' He gave me a leaflet about how to treat hypos, and I promised I'd try to stick to its advice, rather than doing my usual 'hoover up all the carbs within reach' approach and then rebounding. Glucose tabs are truly disgusting though, so I've not been as good as I might have. Still, I'm trying.
I asked again about my thyroid results, having had some time to digest them and read up on the internet. Dr I said that it was nothing to worry about at present, but that he'd keep a close eye on my levels.
As for TTC, Dr I suggested that we could start trying in May. I left with an appointment for 13 May, and was given a blood test request form so that I could have an HbA1C the week before my appointment. I also left with a book recommendation, having admitted reading the NICE Guidelines from cover to cover. I've promised myself that once we get pregnant I'll treat myself to the following medical tome: Managing Pre-Existing Diabetes Mellitus in Pregnancy by J.L. Kitzmiller et al (American Diabetes Association). Stupid, I know, but I don't want to order it until I see a positive test, just in case I jinx myself. I am a rational person, honest, but this TTC stuff can fry your brain just a little!
When I arrived at my appointment Dr Inspiring came bounding in and told me how well I looked, and then gave me the HbA1C result. 'What do you think?' he asked. 'Well...', I said, 'I'm pretty disappointed that it doesn't start with a 6.' Dr I then proceeded to tell me that I was beating myself up for making spectacular progress. He told me that he could see that I'd worked extremely hard, and took a quick look at my log book before proclaiming that my HbA1C should be less than 7.0% within four weeks. As it turns out his enthusiasm is pretty infectious, and his comment totally made my day!
He wondered aloud if I'd thought about switching from Lantus to Levemir, and when I explained that L and I had discussed it last appointment, and that I was keen to try it, he wrote me a prescription for a snazzy new Novopen and one box of 5 cartridges. We agreed that I'd try it and would see how I went. He advised starting the new insulin at a weekend, so that I could have a couple of days to settle in before going back to work. He wasn't sure if 1:1 would be the right conversion ration between insulins, as apparently it varies between people, so he told me to test frequently to start off with. Apparently it can take time for the Lantus to leave your system, so I might need to adjust things after the first few days.
We talked about my very frequent hypos, and he agreed that my strategy of holding back some food from each meal was a good one. Many of his patients eat small packets of carb throughout the day, rather than having three 'big' meals. 'Treat it like a military campaign...' he said, 'maintain the same level of food, but have more meals - small meal, snack, small meal, snack...' He gave me a leaflet about how to treat hypos, and I promised I'd try to stick to its advice, rather than doing my usual 'hoover up all the carbs within reach' approach and then rebounding. Glucose tabs are truly disgusting though, so I've not been as good as I might have. Still, I'm trying.
I asked again about my thyroid results, having had some time to digest them and read up on the internet. Dr I said that it was nothing to worry about at present, but that he'd keep a close eye on my levels.
As for TTC, Dr I suggested that we could start trying in May. I left with an appointment for 13 May, and was given a blood test request form so that I could have an HbA1C the week before my appointment. I also left with a book recommendation, having admitted reading the NICE Guidelines from cover to cover. I've promised myself that once we get pregnant I'll treat myself to the following medical tome: Managing Pre-Existing Diabetes Mellitus in Pregnancy by J.L. Kitzmiller et al (American Diabetes Association). Stupid, I know, but I don't want to order it until I see a positive test, just in case I jinx myself. I am a rational person, honest, but this TTC stuff can fry your brain just a little!
A short aside about periods!
I stopped taking my Cerazette on 6 February and waited patiently for my period. Actually, that's not true. I stopped taking my Cerazette and waited impatiently! I had assumed that once I wasn't taking the pill my periods would re-establish pretty quickly, but instead I had to endure a month of breast tenderness and abdominal pain, culminating in serious pain in the middle of the night on 28 February - it felt like it might have been an ovary, but what would I know?!
My first period finally (mercifully) arrived on 5 March, and I've never been so glad of it! Since then I've actually been pretty regular, which is unusual for me, as when I was younger my cycle ranged from 18 days to about 53 days.
First period: 5 March
29 day cycle
Second period: 3 April
28 day cycle
Third period: 1 May
28 day cycle
Fourth period: 29 May
26 day cycle
Fifth period: 24 June
My first period finally (mercifully) arrived on 5 March, and I've never been so glad of it! Since then I've actually been pretty regular, which is unusual for me, as when I was younger my cycle ranged from 18 days to about 53 days.
First period: 5 March
29 day cycle
Second period: 3 April
28 day cycle
Third period: 1 May
28 day cycle
Fourth period: 29 May
26 day cycle
Fifth period: 24 June
Second Appointment (or meeting the dietician) - 11 March 2010
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.
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.
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