Slightly frustrated with Dr.

[Jingles]

I just got back from my OB, who is taking the lead in my care at the moment, and I'm just blown away with how little some doctors know about diabetes and what can affect it. And she deals with many women that have high blood pressure and diabetes while being pregnant.

I take Novalog insulin before lunch and dinner and NPH insulin before bed. I also take Procardia in the morning before breakfast for my blood pressure.

Doc's been concerned with my blood pressure as it is always high in the office (she's finally believing me about having white coat syndrome). So, she added a fluid pill. I'm allergic to sulfa drugs, so this was kind of a gamble. I noticed that my after breakfast BS were going up and up after just a few days on this new drug.

I eat the same thing for breakfast 99% of the time (low carb shake with just 2 ECC's). So when my BS's are in the low 100's everyday and all of a sudden they are 120, 130 and 145 :eek: , something is going on besides being pregnant.

I did research. Found out that this drug CAN raise BS's, and can push someone who is not diabetic (but on their way to IR) over the line (which both my OB and Internist agree upon). But my OB stresses that it can't make a diabetic have worse BS's. Just doesn't seem very logical to me. If a drug can push someone over the line, then why can't it make a diabetic worse? All I know is that thankfully I started itching and the internist took me off that drug and my breakfast numbers have steadily come back down to the low 100's again (on the drug for a week, been off a week).

I also got chewed out for my meal times not being on a strict schedule. My fasting BS's are refusing to come down to below 90 even though she keeps raising my bedtime NPH insulin. I remember when I first started LC and taking diabetic meds (oral then), I had the same problem. It took a while, but my body finally decided to cooperate. Perhaps someone can refresh me on that (something about my liver making sugar?)

However, when I eat lunch and dinner depends on my family and our activities that day (household of teens and pre-teens). Many times lunch might come about 3 hours after breakfast and dinner 6+ hours after lunch. The doc told me that Novalog has to be taken at the same time everyday and so many hours apart for it to work. HUH? Is this true? I take the shot, eat and 2 hours later test. It's supposed to be fast acting and only lasts about 4 hours. Anybody have any insight on this?

Don't get me wrong, by BS's are relatively good (last A1C was 5.4). We're dealing with bumping my numbers down by just a few numbers (like from 90's to below 90's on fasting and from 120's after meals - usually, once in a while 130's - down to below 120). I'm as frustrated as my dr with this weekly tweaking of my meds and not seeing any improvement.

[Omlette]

Are you currently preg? I'm thinking, yes.

I was preg last year, and my ob referred me to an ednocrinoligist specializing in diabetes. I was on novalog 3 times per day and then nph at bed. My amounts of nph were crazy. I was taking 80-90 units before the preg was over. It still did not get the morning numbers below 114.

My endo never said anything about eating at the same time or with the same amount of time between meals. The novalog just has to be taken right before you eat.

I think you are thinking of the Dawn Effect. Your body starts releasing/producing sugar to prepare for the day causing the a.m. numbers to rise.

Also, the further into my preg, the more insulin I took. It didn't matter what I ate. My endo just kept saying that the closer to the end of preg, the more insulin resistant or diabetic a person becomes. The hormones are just crazy at that time.

I would request to see a specialist.

[gitfiddle]

Perhaps someone can refresh me on that (something about my liver making sugar?)
Jingles, I don't take insulin, so I'm no help there, but the liver will make glucose (glucogenesis) if your own blood sugar drops too low while you're sleeping. It's commonly called the Dawn Effect. There's a very good article on it at Jenny's website www.bloodsugar101.com (http://www.bloodsugar101.com).

When I was having some concern about my own blood sugar, I found that an early dinner and no evening snacking improved my fasting morning blood sugars a lot.

I think it can sometimes take a couple of weeks for lifestyle or diet changes to show up.

[Belfrybat]

Jingles--I find that very few doctors know diddlysquat about diabetes. If I followed my doctor's advice, I'd be running much higher numbers than I do at present. I basically lie to her at times because I don't want to get into an argument. "Yes, I am eating healthy and watching fat and carbs" substitutes for her asking if I'm following the ADA diet, etc.

I agree with Carol -- cut out or greatly diminish supper and snacks and your morning numbers should improve. I switched to the principle of "eat breakfast like a king (queen), lunch like a prince(ss) and supper like a pauper". I have a moderate Dawn Phenomena response, and I've gone from an average morning bgs. of 100-110 down to 85-90 in about three weeks without increasing meds. I take Metformin 2x daily and 10 units of Lantus at night. I've also found a night dose of soluble fiber helps with morning bgs. (I use Fiber-Psyll, but Metamusil is more widely available). Just work up to it slowly if you go that route.

As to timing of meals -- Dr. Bernstein says if you are low carbing and taking a rapid acting insulin, timing is not all that important. Most rapid acting insulins only last 3 hours. He recommends 5 hours between meals because it takes that long to completely digest your food. But you have to live with what is reality for you. I wouldn't recommend any closer than 3 hours since it is hard to determine what insulin dose you will need if the previous injection is still viable.

To check if you have having Dawn Phenomena, test your bs at 2-3 am., then again after you wake. The liver dumps glucose just before you wake, and that will show whether DP is a problem for you.

[Jingles]

Are you currently preg? I'm thinking, yes.

Yes, I am pregnant. It was quite a surprise actually! I found out about 5 weeks ago and I'm now at week 25. I've been diabetic for a year and a half (about a year before the pregnacy). I was taking Avandamet (2/500) twice a day, sort of low carbing (somewhere around August 07 I just fell off the wagon, but still kept one foot on), and gained back about half of what I had lost.

I actually got back on PP this past March when my work ran a contest and 60 of us went on a weight loss program (we each did our own thing) and I lost 11 pounds in 8 weeks. I wasn't doing strict PP because I just couldn't keep down a lot. It was morning sickness, but I didn't know. When you're 45 and have never been pregnant, the idea of being pregnant just doesn't enter your mind!

My regular OB did refer me to an endo. He's the one that switched me to insulin. However, he just gives me the guidelines for my OB to follow. My OB is much more strict on my BS's than the endo and she's the one that I check in with weekly. I'm up to 6 units of novalog before lunch and dinner and 20 units of nph before bed (just started this level 2 days ago). My tests yesterday were 80, 100, 80 and 108 (very 1st time that all 4 tests were below - or even low). I was worried about taking the nph last night due to the low after dinner test, but I was having some heartburn so a small glass of milk helped me out.

My endo has warned me that I'm going to end up taking more before the baby comes. I'm still having problems with giving myself the shots, so I'm trying hard to keep the carbs down as much as I can in the hopes of keeping the meds low. At least I can hope! :D

When I was having some concern about my own blood sugar, I found that an early dinner and no evening snacking improved my fasting morning blood sugars a lot.

I did make that adjustment this past week, well about the earlier dinner at least. My biggest complaint about this pregnancy (so far) is that I get hungry! Starving almost! Right after I eat, but I'm full. It's crazy I know, but it's true. I'm supposed to eat 3 small meals plus 3 snacks and not go more than 3 hours between eating something. I've added back some carbs during meals and that seems to be helping the hunger. I try hard not to have anything before bed (but I'm "supposed" to), and it doesn't seem to have any effect at all. At least not so far. I'm going to stick to eating earlier though and time will tell.

I find that very few doctors know diddlysquat about diabetes. If I followed my doctor's advice, I'd be running much higher numbers than I do at present.

I agree with that! I told my OB that I was going to eat at Olive Garden one night (a birthday celebration) and was probably going to have the t-bone (shared with hubby) and veggies instead of the potatoes. She about came unglued and told me to have a pasta dish with veggies. :eek: That made me wonder what in the world her other pregnant, diabetic patients were taking for meds!

I will survive this OB for the 3 months I have left with her running the show and then will gladly see the endo. He's awesome! The 1st time I saw him I had just come from the diatitian. When I told him that I normally follow a LC plan, but she told me to cut my fats (as well as LC - but her idea of LC is 180 carbs a day :rolleyes:), he thought for a moment and said "no, choose LC over low fat". :D He is very hopeful that I'll be able to go back to oral meds after the baby is born and eventually be able to cut them out totally. Now that's refreshing!

Thanks for the comments and support guys. It gets a little frustrating when I know I'm doing all I can to have a healthy baby and my BS's are just wild. It also doesn't help when the doc that has the most control over my care at the moment doesn't "get" what I'm trying to do LC-wise.

[gitfiddle]

Jingles, sounds like your endo is a thoughtful, intelligent person who is thinking outside of the cookie-cutter. I have found that it takes a while to bring about changes in my own BS, so with your hormones galloping around, you might have to try different things.

Keep us posted!

[Omlette]

Jingle -

If you breastfeed, you will still need to take insulin if your sugars are still running high. There are no approved oral meds for preg/breastfeeding.

Just from my experience - I was on a sliding scale for all 3 meals. So, I would take my bs before eating, and take the novalog according to what my bs was at the time. I think by later in preg, I was taking 8-10 units before eating. Plus, 70 - 90 (90 later in preg) of NPH before bed. Your OB doesn't realize that pasta is made of carbs which makes sugar rise.

BTW, Congratulations on the Preg!

My OB told me that since diet and insulin was not changing my bs that I needed to see the endo for the remainder of my preg regarding my bs. I have big babies, so the ob was worried about the size of my baby. She weighed 9.3 lbs. My son weighed 9.8, but I was not diabetic with him.

I'm glad that your endo was in agreement with LC over LF.

[Omlette]

One more thing I wanted to point out, when I started taking insulin, I was hungry all the time. There was no controlling the hunger. My weight gain during my preg had been pretty stable and on the lower side until I started insulin. Fortunately, the main things I wanted to eat were advocados and tomatos, but I was starving all the time.

I said something to the endo, and he said that was very common.

[Jingles]

Had another visit with the OB today. She actually said she was happy with my BS's! :eek: To me, my BS's are a little on the low side (sometimes 80's and 90's after a meal), but she was happy. I only had 4 tests out of the whole week that were elevated. Considering I was at a music convention and not really eating on plan (I tried, but some of the food offerings were just awful!), she thought I did well (120's and one 134).

Then she informed me of the results of my 24 hour urine tests. She said I had a protein level of 162 when a level of 150 or lower is normal. She didn't seem too worried, but said she'd do another test soon. Doing some research, I found that elevated protein could be due to diabetes or high blood pressure. My BS's have been good and my BP's are in the normal range (except at the drs office :rolleyes:). I did have a bit of swelling in my ankles and feeling like I was going to have a UTI the day of the test. I wonder if that could have contributed? I've always had a major challenge getting those 8+ glasses of water in every day. Maybe that was it as well.

Baby is doing fine. My last ultrasound was at week 24 and 4 days and she measured that exactly! :nod: My biggest concern is that being a diabetic will make her grow too large and then have problems keeping her own BS's normal after being born.

Another concern is more of comfort. You know, finding plus sized maternity clothing that doesn't cost an arm and a leg is challenging!! I know I can't be the only plus sized pregnant woman around! Maybe I'm just weird, but I like looking like I'm pregnant (instead of just "fat"). And I think I'm having my 1st hemorrhiod! OMG!!! Ok, off topic, I know. :D

[Ammy]

I was joking the other day, that if I ever had been pregnant at my largest size (320lbs, size 30) I would have bought a shirt that said, "Yes, I am Pregnant" :lol::lol::lol:

[gitfiddle]

I could have used one at the time, Amy. :nod:

Jingles, your BS sounds wonderful. Normal and nice. Now tell me what kind of a music convention you went to! :cool:

[Jingles]

Amy - I've been looking for that shirt! Or even the one that has the arrow pointing down that says "Baby". :D

Git - The convention was a band director convention. I teach beginner band at a public school and just finished my 18th year. I've taught all the way up to high school, but I enjoy the "babies" most. I "might" get to teach a 7th grade class this year and that would be awesome as I miss teaching 7th and 8th graders. My district is trying to build a new campus in a couple of years and hopefully that will be 6, 7, and 8th grade and I'll have my "ideal" teaching situation again.

This year I took all my kids for the 1st time (my step-daughter (17) and our 3 adopted kids (10, 12 and 13)). They didn't like the classes, but loved the jazz concert and the exhibits. They were surprised by all the free stuff the venders had - pizza, cookies and other fundraiser things as well as candy, luggage tages .. you name it. My son plays percussion and he saw some HUGE drums and about fell over! :D As a bonus, we stayed at my Dad's and my sister and her husband visited, as well as my brother. Nice little family reunion. My Dad is retired Navy, so we also went out to one of the bases and watched the jet pilots in training (my boys were so impressed). It was a great 4 days.

On another note: my dad is diabetic and I was able to impart some PP wisdom (example: bananas aren't as good for you as he thinks and he'll eat 3 or 4 a day). Both him and his new wife were interested in why I eat the way I do. They're not ready to do PP, but at least were looking at the carb counts of foods instead of just the sugar. I'll have to send them some Dreamsfield pasta since they couldn't find any where they live (you'd think a big city like San Antonio, TX would have some place that sells it). Hmmmm .... almost lunch time ... pasta sounds great!

[Ammy]

Hey, thought I'd do a quick search...and look what I came up with!!!

http://www.cafepress.com/tshirtsgiftsmug/2990914
http://images.cafepress.com/product/133224662v5_240x240_Front.jpg
(http://javascript<b></b>:getColorAndViewLarger('color_133224662','/cp/moredetails.aspx?showBleed=false&ProductNo=133224662','height=610,width=650,scrollb ars=1'))
http://www.cafepress.com/content/global/img/spacer.gifTrust Me I'm Pregnant Women's Plus Size Scoop Neck

They go to 5x...size 32-34!!!
and different colors!!

Not the best price for a t-shirt, but...

[gitfiddle]

Oh, Amy, that is so CUTE! :nod:

Jingles, is "beginner band" fifth grade? Do you play an instrument? My brother, my sister and my son were all brass players, but I went for strings when I was well out of school. The grandson looks like a drummer at four.

[Belfrybat]

I'll have to send them some Dreamsfield pasta since they couldn't find any where they live (you'd think a big city like San Antonio, TX would have some place that sells it). Hmmmm .... almost lunch time ... pasta sounds great!

It's been a while since I was in San Antonio, but I've seen Dreamfields at HEB or Central Market (can't remember which since they are owned by the same company). Also, did you try Sun Harvest?

[Jingles]

is "beginner band" fifth grade? Do you play an instrument? My brother, my sister and my son were all brass players, but I went for strings when I was well out of school. The grandson looks like a drummer at four.

Our beginner band is 6th grade. I'm a percussionist, but I can play well enough on all the brass and woodwind instruments to out play my beginners on them. I really like the brass instruments more than woodwinds though, and French Horn is my favorite. I wish my university had taught strings better (we only had 1 sememster on violin), but since I don't teach in a school with orchestra, I would have forgotten all of it by now. Grandpa had a bluegrass band and I would listen for hours when his group practiced.

It's been a while since I was in San Antonio, but I've seen Dreamfields at HEB or Central Market (can't remember which since they are owned by the same company). Also, did you try Sun Harvest?

I'll have to ask them if they looked at HEB, but they did check at Central Market and Sun Harvest. I really would have thought one of those places would have carried it. We don't have and HEB where I live and I've only found it at Kroger. Strange that we don't have and HEB and they don't have a Kroger.

Amy - Well look at that! The things you can find online! I just might have to spend the money. Thanks for the info!

[Ammy]

I liked this one best!!

http://zodiac-tshirts.com/images/150maternitymaternitywhite.jpg
Cute Maternity T-Shirts

[BlancE]

Jingles, have you considered ordering Dreamfield's from netrition.com? They offer flat rate shipping.

[VanessaJ]

I agree with this 100%! I have had to be admitted to the ER because my doctor gave me all four medications for diabetes and it was causing my BS to go from 700 down to 40 in an hour. I got away from that doc and have protein powder every morning, so that has leveled me out immensely!

http://photosnag.com/img/2711/y09w0131xdtc/82(2).gif