Before getting pregnant, I had heard that if you are pregnant with Type 1 Diabetes, you will go to the doctor a lot. I had no idea what a lot meant, but it’s a LOT. At least once a week I am seeing someone. My monthly routine is as follows: first week of the month is my endocrinologist, second week of the month is my OB, third week of the month is my high-risk OB or perinatologist and fourth week is my diabetes educator.
Since finding out I was pregnant, the regular OB, endo and diabetes educator have been monthly. So far, I have only seen my high risk once but am going again in two weeks. I’m also throwing in an extra dentist appointment and an eye doctor appointment several months before I’m due for my annual checkup because being pregnant with Type 1 Diabetes poses an extra threat to both your eyes and your teeth. This is all just for the first half of my pregnancy. Once, I get further along I’ll be going even more regularly to the OB and the perinatologist. I’m so lucky that I have a flexible work schedule because I’m not sure how I would manage to make it to all these appointments if I still had my old job.
I’m fairly happy with the team of doctors I’ve assembled, but that hasn’t always been the case. I’ve mentioned my old endocrinologist a few times prior but I was not happy with her. Back in December, I found out that my A1C was not only below seven but also below 6.5! My A1C was 6.4 and my endo at the time gave me the green light for trying to get pregnant. The one caveat though was that she gave me no advice on how to handle my diabetes while trying to conceive or once pregnant. I was basically on my own (and with the Diabetes Online Community help!). In March, I visited the same endocrinologist again to tell her that I was pregnant and again she gave me zero guidance. At that visit, my A1C had creeped up to 6.8 and I was very worried that my recent high blood sugars had done damage to my baby. My endo seemed to think that 6.8 was fine and told me to just keep doing what I was doing.
At that point, I felt completely alone, without any help or guidance on how to handle my pregnancy with diabetes. It was at this point that a friend of mine referred me to Integrated Diabetes Services and I found my new diabetes educator, Jenny. I don’t think I could have survived the first trimester without her help. I email her weekly my CGM uploads and she reviews them and recommends changes to my basal rates or insulin to carb (I:C) ratios. We also have monthly meetings where she gives even more tips and information on pregnancy with diabetes.
I found Jenny after I was completely upset about my endocrinologist but I also decided to make a change with my endo and I’m so happy I did. I love my new endo. She has put me at ease that she has dealt with Type 1 diabetics who were pregnant and has mentioned a lot of the same stuff as Jenny. She has also reviewed my CGM graphs and made recommendations. She even knows my OBGYN (they went to medical school together) so I know they will be talking when it gets closer to delivery. The one thing I wish was different was the fact that I only get my A1C checked every three months, unless I ask for it more and I’m on my own for payment (lovely insurance guideline). I’ve never had an A1C result below 6 before and I’m pretty sure when I’m pregnant will be the only time I’ll ever have it, so I really want to see my A1C result more often than every 3 months (especially while I haven’t become too insulin resistant yet).
With Jenny and my new endo’s help, I was able to get my A1C down to 6.2! 6.2 is my lowest ever! I’ve read that A1C’s once you are pregnant should really be below 6, but both my diabetes educator and my endo seemed perfectly happy with the 6.2 since I didn’t have a huge variation in my blood sugars (not many extreme lows or extreme highs). I have had extreme lows and normal lows, but I think I’ve done a fairly decent job or not over-treating them. Also, with the help of Jenny and my endo, I’ve managed to curb a lot of the lows. I still have them, but they are a lot less frequent than they would be without their help.
I’m very happy with my diabetes team. I also love my OBGYN. I’ve seen her every month and she has answered a ton of my questions and made me feel at ease. I’m not sure exactly how many Type 1 diabetics she has delivered, but I feel confident in her ability. I first saw her when I was 7 weeks pregnant and I had my first ultrasound. It was such an amazing day hearing that beautiful heartbeat. Since week 7, I have seen her once a month (week 12 and week 16) and I’ll be going back at week 20. She mainly listens to the heartbeat, checks my urine and my blood pressure and checks where the baby is in my belly.
The only doctor that I’m not 100% on board with is my perinatologist. I’ve only met with him once (at week 12) so I have high hopes for my next visit. When I first met with him, he basically just read me a text book about what can go wrong during my pregnancy. The one that stuck out the most was the fact that I could go blind while pregnant, so I immediately called my eye doctor when I got home. I felt like instead of telling me about cases he has dealt with, he just regurgitated his medical school textbook knowledge. When it gets closer to delivery, he shouldn’t be delivering me unless I have a problem, so hopefully things go OK. I mentioned to my OB that I wasn’t too happy with him but she said that most of the perinatologist are equal in their ability to deal with problems so I should just stick with him. He is at the hospital I will be delivering at versus having to find a new hospital with a better perinatologist and then I’d have to find a new OB as well.
One thing that worried me about my doctors is that I’ve heard of other Type 1 diabetics, who only see one doctor, their high risk, perinatologist who handles everything. I’ve heard the high risk OB monitors how the blood sugar is doing, checks A1Cs and will also deliver the baby. I admit I’m very jealous of this because I feel like one doctor would be so much more convenient and also would be more knowledgeable about my body versus having three doctors trying to all coordinate their information. However, it seems like everyone is different so despite being worried about having too many cooks in the kitchen, I do think I’ve got a good team assembled (for the most part). I go to see my high risk in two weeks so hopefully my opinion of him will change a little bit.
In terms of actual doctor visits, I had my first OB visit at week 7 (the ultrasound appointment) which also included blood work and oh my goodness, I was not prepared for how much blood work she would take. I think she took at least 8 vials of blood. I think the most I’ve ever gotten drawn before was three so when she took eight it seemed like it would never end. I almost fainted afterwards. The blood work taken at this appointment tested for all sorts of fun things like the Cystic Fibrosis mutation and for parvovirus B19. I’m not sure what all of it meant but everything came back fine so I wasn’t too worried.
I saw the regular OB and the high risk OB at week 12. During this week, they checked for Down Syndrome and trisomy 18 (another chromosomal abnormality) among other things. These tests were done via ultrasound and through blood work. The blood work was using one finger to drop blood onto 5 big circles on a piece of paper. I’m not sure why but I got faint when the doctor was doing this. Everything came back fine though.
Overall, things seem to be going okay so far. My blood sugars seem to be in an okay range and my ultrasounds and blood work have all come back okay too. Fingers crossed that things continue to go well. My next appointment is next Friday (not this Friday) and I can’t wait to find out the sex of the baby!!