February 19, 2003
permalink Achieving machine-like control

I was always curious about people who got good HbA1Cs. Was extremely puzzled as to how they could do it. I thought they must have led boring lives - perhaps given up a passionate, spontaneous life in the name of good diabetic control.

I could never seem to do it. Even when I checked myself into hospital as a teenager for stabilisation, or took time, months, away from work to 'work on my sugars', I could never get my diabetes into 'good control'...

As mentioned in my previous posts, when I read material on pregnancy and diabetes, and that the levels aimed for are 4-7mmol, I became depressed and resigned myself to the fact that having children would simply be off the agenda for me.

Then a good friend of mine, who, like me had HBA1Cs around 9, 10, 11 for most of her diabetic life (20 years) suddenly started getting HBA1Cs of 7.2, 7.4. I assumed the little bugger had simply been having constant hypos and must have made massive lifestyle changes. But she said not really. She said I can't really tell you what has changed, and I thought she couldn't have been serious. But now that I too have been getting levels I would have never dreamt about, 6.0, 6.1, 6.4, I have to confess that I too have trouble naming just exactly what it is that allowed me to get control.

So I thought it might be worth having a think about it and writing down what has made this seemingly superhuman feat possible for me.

But once again, I want to emphasise that my HbA1C levels were 9.0 or higher for much of the twenty years I'd had diabetes. I tried to get them down. But never could seem to do it.

So what has made the difference?

- Being on an insulin pump. This meant that I could test two hours after meals and always 'chase my tail' if sugars were high. It also meant I wasn't tied to an eating schedule which I was never good at.

- Having an excellent diabetes specialist (endocrinologist) who struck just the right balance between not letting me off the hook for poor sugar levels and yet being laid back enough to know that I was human and not give me a hard time. I think he also somehow conveyed his belief that I could do it.

- Having a mental mind-set that would risk erring on the side of over-insulinising (and risking a hypo) rather than under-insulinising when I wasn't sure about the amount of carbohydrate in what I was about to eat

This is a major one for me as when I'm not pregnant or trying to conceive, I tend to lapse back into my old ways of underinsulinising in order to avoid hypos. On injections I would feel quite hypoish even at normal sugar levels. On the pump I am able to, for some reason, feel more comfortable at normal sugar levels, less as though I'm about to slip into a hypo at any moment.

- Eating by 7pm at night if possible, to ensure I could test before bed and have reasonable sugar levels over night

- Getting pregnant relatively quickly. I think maintaining the level of control desirable in a diabetic pregnancy can be incredibly difficult and does mean sacrifices to quality of life. Because I conceived really easily I moved quickly from thinking there was a possibility I could be pregnant to knowing that I was pregnant and therefore wanting to do everything possible to increase the chances of having a healthy baby.

- Not being consumed by work stress and having to perform. This is a tricky one. I seriously don't believe in choosing low stress jobs because you're diabetic. A sure recipe for depression and possibly worse sugars I reckon. But I'd had jobs that were incredibly stressful in the past and I think it would have been really difficult to focus on the blood sugars if I was still in these jobs. I found I needed 'space', mental space and time to reflect on my blood sugars and make adjustments, to keep good control during a diabetic pregnancy. My job at the time allowed me to do this.

This all makes it sound easy. It wasn't. But being pregnant is an incredible motivator.

Posted by patton at February 19, 2003 07:59 PM
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