A few nights ago, I started thinking about it, as I sat up in bed eating Fig Newtons and a Twix bar because my blood sugars were at 47 and dropping. I started thinking about this battle that I see on forums about Type 1 diabetes and pregnancy regarding women saying that their MFMs are wanting them to go back to injections, mixing NPH and R, because that’s what THEY know how to handle. Or hearing that MFMs are coming down hard on mamas-to-be because their sugars are out of range and they’re hurting their baby.
At first, I was like, “What in the hell are they talking about? Why would they do that? Why would they make someone regress in treatment, after we’ve come such a long way in the technology that helps make diabetes more manageable and livable?”
Well, as I was chewing, I remembered the discussion I had with my doctor. In his hand, he had a summary of my CGMS readings. If you actually looked at them, like my endocrinologist does, you’d see the fact that they are pretty stable when you’re looking at as an overall average. I told him that my endo was super happy with my numbers and that he said I was in perfect range. Before my defense, the MFM said I was out of control and my numbers were all over the place. I had to remind him that what he was looking at, those averages in his hand, included 24/7 worth of data, not just 5 or 6 data points that he and the residents were looking at and taking into account.
This, in turn, reminded me of a time when I saw an endocrinologist in my early 20s, she explained finger pricks like this: Consider a 1000 piece puzzle. If you’re only testing with a finger prick 5-7 times a day, you’re missing 900+ pieces to what your whole day is actually looking like. And then it hit me…
MFMs are not looking at the whole picture. They’re looking at those 5-7 data points out of a day, ignoring the fact that the rest of the day, your blood sugars may be damn near perfect. This may not be any fault of their own, but how they’re taught OR the fact that most of the high-risk mamas in their offices are injection dependent, have gestational diabetes or possibly type 2. Many others may NOT EVEN HAVE DIABETES.
I realized this because he was still adamant about me having my sugars below 100 first thing in the morning. However, thanks to my CGM I was able to see a trend: I was spiking at 2 a.m. for no apparent reason. I was able to make adjustments because of that. I even showed him.
I also don’t just take a shot and forget about it. I have a pump that’s literally working like a pancreas, giving me insulin every few minutes over the course of an hour so that should I need an increase or decrease, it’s easier to manage and stop. They don’t understand that unlike a shot, I can test and see how my blood sugars react when I alter the amount of insulin I’m administering.
Since we do have this updated technology that may be out of their reach, they want us to stick to what they know for their management, but not necessarily better management. I also think that it’s pertinent that if they decide to treat type 1 patients, that they learn and keep up with treatments and ways to manage.
Since the last time I saw my MFM, I took myself off of auto mode and have been keeping decent track of my sugars, still trying to stay as tight as possible and not freaking out about the fact that like any other human, my sugars will go up after I eat, to a number that I don’t necessarily like. I went to see my endocrinologist last week and I got my A1c down to a 5.7, which is down from a 6.1 where I was before.
The day after, I saw my MFM and told him. He didn’t ask about all the numbers like last time and when I told him my A1c, he actually told me it was good.
One of the best pieces of advice I ever got from my friends who have 3 children was: BE YOUR OWN ADVOCATE. I know my body, as do many type 1 mamas, and don’t need the added stress of being told that we’re doing something wrong. This is why I decided to keep my endo and let him explain things to me when I had questions.
Overall, it seems that some MFMs (I’m not going to generalize and say all, even though the stories tell you something different) don’t want take the time to understand what it is that we go through. It’s easier for them to not change anything because their way of doing things hasn’t been wrong. It it ain’t broke, don’t fix it, right? Hmmm….