Author Topic: New report published - and a question for you  (Read 2386 times)

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Offline sedge

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New report published - and a question for you
« on: 31 December 2015, 03:44:10 PM »
Have you seen the newly published report on Diabetes care whilst planning or being pregnant? It's the 2013 results they have based it on, its the one in Summaries billed as 'Pregnancy Care for Women with Diabetes'

 See https://www.diabetes.org.uk/Professionals/Service-improvement/National-Diabetes-Audit/NDA-reports/

 It contains all sorts of useful info like the incidence of planned or emergency Caesarians, what general effects higher HbA1cs have, etc.

 One piece of info that caught my eye, was the fact that for ALL diabetic women of child-bearing age, ALL general diabetes appointments should include info on pre-conception and pregnancy. Apparently T1 patients get the right advice more often and quicker than do T2s, since they are much more likely to do all the right things/see the right people earlier. This doesn't surprise me at all because T1s are much more likely to be seen in hospital diabetes clinics than the vast majority of T2 people of either gender. So - bearing in mind the paucity of brilliant GP care for T2 in the first place - these are definitely things that ALL GPs, their surgery nurses and ALL pregnancy practitioners at surgeries and in hospital need to be aware of so that they are able to ensure that patients have access to the right people at the right time.

 I'd be interested to know whether forum ladies of child bearing age DO get that advice at general diabetes appointments, wherever they take place, in the first place?
Jenny

T1 DX 1972, pumping Novorapid 24/05/11

HbA1c - 7/07 8.7, 1/08 7.8, 9/08 8.4, 3/09 7.3, 7/09 7.2, 12/09 7.3, 11/10 8.1, 2/11 8.6, 9/11 6.5 2/12 6.4  5/12 50/6.7  11/12 52/6.9  01/13 46/6.4  06/16 46/6.4  12/16 45/6.4

Offline Dollyrocker

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Re: New report published - and a question for you
« Reply #1 on: 31 December 2015, 07:57:10 PM »
I was given pregnancy advice pre-conception when I asked for it, I wouldn't have appreciated it being given without my asking though, very presumptuous!


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Offline nytquill17

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Re: New report published - and a question for you
« Reply #2 on: 31 December 2015, 08:15:05 PM »
Bearing in mind I'm not at all the target audience for this sort of thing (wrong country, for starters)!

Usually when starting at a new clinic or if it's been a little while since anyone's asked, they will ask whether I'm thinking about getting pregnant in the foreseeable future, because, they go on to tell me, diabetic pregnancy requires serious planning beforehand and serious work during, so it's not something to be undertaken on a whim and without letting the clinic know my intentions! Usually it's just a very casual sentence or two thrown in, just part of a sensible medical discussion and not really obtrusive.

 I think that's sufficient really, and probably what the guidelines are getting at - I don't think anyone needs or wants their doctor to go into full detail about preconception and pregnancy unless it's already on the table! On the other hand, diabetic women of childbearing age need to know that they DO need to put these things on the table to begin with, and depending on the patient education and general standard of care they've gotten, they may or may not realize that. BUT it's important that the message be given out early and often that 1) it is possible to carry a pregnancy as a diabetic and 2) though it is possible, it's still a Big Deal and best not to just "let it happen naturally".  That last, I think, especially for T2s, given that they and their diabetes are so often given very little consideration, or for teens and young women who might not be thinking as many steps ahead as they need to be - who might not realize they need to think any steps ahead at all!


At every appointment though seems a bit much. Once a year, maybe, but eventually you've heard it enough times you don't need to be told again. Seems like the guidelines may have more to do with doctors (GPs especially) forgetting that they need to do this bit from time to time, rather than with what is actually convenient or useful for the patient.
T1 DX 1995
Levemir + Novorapid
 
  ~-~-~-~
"If you can't ride, can you fall?"
"I suppose anyone can fall," said Shasta.
"I mean can you fall and get up again without crying, and mount again and fall again and yet not be afraid of falling?"
"I - I'll try," said Shasta.
  ~C.S. Lewis, The Horse and His Boy
  ~-~-~-~
"There is no answer; seek it lovingly."

Offline sedge

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Re: New report published - and a question for you
« Reply #3 on: 31 December 2015, 09:56:11 PM »
Well Dolly I shouldn't think they'd actually give you any advice there and then per se, unless you responded that you might be thinking about it but just 'casually' enquire if you'd ever thought of starting a family - or adding to it, whatever is an appropriate way of saying it for each person - or even a standard list of questions 'which I'm now obliged by the NHS to ask you' - maybe if it's GPs the one that tickles your toes etc would ask, ie once a year.  Or one for the DSNs if you are the right age.  Like my GP no longer asks seriously when I'm going to pack in smoking - he just mumbles something like that he's obliged to in a resigned tone and then adds in a much friendlier and encouraging way 'Cos don't forget - if you ever do! - there ARE things we should be able to do that might help you!'  And I just say, 'Oh good - there's another NHS box ticked then for this year!' - and laugh.

I mean at Kiddy hospital in the 1970s, once we got a proper - and much younger mentally! - DSN, she had used to casually enquire whilst she was doing my BG, and asking me generally how my health and attitude had been and were - just a nice chat type of thing - so I was aware even then that you could get much closer attention through a pregnancy - and that they expected to give it you - than you got if you weren't.
Jenny

T1 DX 1972, pumping Novorapid 24/05/11

HbA1c - 7/07 8.7, 1/08 7.8, 9/08 8.4, 3/09 7.3, 7/09 7.2, 12/09 7.3, 11/10 8.1, 2/11 8.6, 9/11 6.5 2/12 6.4  5/12 50/6.7  11/12 52/6.9  01/13 46/6.4  06/16 46/6.4  12/16 45/6.4

Offline Venomous

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Re: New report published - and a question for you
« Reply #4 on: 01 January 2016, 12:15:26 PM »
Short answer-nope.

Longer answer- I've rarely discussed pregnancy with a doc before I've been pregnant. It's been more of a case of "hey doc I think I'm pregnant" rather than how do I do that.... I have had docs casually throw in "don't forget you should be taking folic acid". I did discuss pregnancy with docs following my stillbirth, but then I actively wanted to be pregnant and sought out that advice and treatment.

At my six week check post partum, I was told not to have another pregnancy with them citing my diabetes as the main reason not to, plus PPH (post partum haemorrhage), tricky cesareans etc.  Though my consultant put much more nicely, "if you want to, we'll support you of course, but it would be risky and we wouldn't recommend it".

I do think that I had really good care whilst pregnant.  I was seen at least every 2 weeks right from the beginning of pregnancy and then weekly scans from 28 weeks. That test they do early on to measure the blood flow through the pelvis was very accurate as when everything else looked great that one test said we'd need to deliver early, something about the way the resistance of the blood flow through the placenta, our results were off the charts, really high. The consultant said, well we know this is likely to happen.
T2 and PCOS. Just had large serous adenofibroma removed with ovary and fallopian tube. Bp is now normal!

Novorapid, levemir, trulicity, metformin.

Offline Lucy

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Re: New report published - and a question for you
« Reply #5 on: 01 January 2016, 09:07:07 PM »
In my appts (at the hospital) i'd say about 50% of the time i'm asked if there is any chance i could be/become pregnant.
Type: Lucy. A1C 44 / 6.0% Jan17.
Lantus, Victoza and Apidra. Metformin XR, Bisoprolol (for SVT). Dexcom G4 with xdrip and nightscout.

Offline sedge

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Re: New report published - and a question for you
« Reply #6 on: 01 January 2016, 10:40:24 PM »
Well that's ONE confirmation that they do as they say!
Jenny

T1 DX 1972, pumping Novorapid 24/05/11

HbA1c - 7/07 8.7, 1/08 7.8, 9/08 8.4, 3/09 7.3, 7/09 7.2, 12/09 7.3, 11/10 8.1, 2/11 8.6, 9/11 6.5 2/12 6.4  5/12 50/6.7  11/12 52/6.9  01/13 46/6.4  06/16 46/6.4  12/16 45/6.4

Offline Dollyrocker

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Re: New report published - and a question for you
« Reply #7 on: 02 January 2016, 11:31:04 AM »
You know what, on second thoughts my consultant has asked me at pump clinic if I have any intention of having another, my answer for the last 2.5 years has been 'hell no!' If he asks me this time my answers would have been 'maybe' if I hadn't just been made redundant :( I don't think I've been asked by a DSN though, but they've known me for 18 years now so they are well aware that I would ask if I had any intention.

Having had one it's less likely I'd need much guidance anyway except for getting the prescription for folic acid


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Offline Pattidevans

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Re: New report published - and a question for you
« Reply #8 on: 02 January 2016, 12:41:34 PM »
Really sorry to hear about your redundancy Dolly.

Anything in the pipeline?
Patti


Type 1.  Mis-diagnosed T2 May 2003, finally had CPeptide test 15/7/11 and proper diagnosis 1/9/11.  Now pumping Apidra with Roche Spirit Combo pump. Hba1c 6.1 April 2016.


© 2015 Patti Evans

Offline sedge

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Re: New report published - and a question for you
« Reply #9 on: 02 January 2016, 12:50:03 PM »
My feeling was actually that if we attend a hospital clinic as most T1s do, then it's much more likely it will be raised or at least the fact that 'help' is available will be disseminated.  But - there are now a lot of T2s to whom this would apply, who are much more likely to only be seen in GP surgeries as long as they are coping alright so I wondered whether they got the relevant info too.  Probably not when you see the proportions of ladies knowing about pre-conception advice, extra strength folic acid (which assuming the A1c is OK is actually the most relevant here) etc.

Yeah - I was going to ask about the employment situation too.

Let's hope New Year - new job - if it hasn't happened already.
Jenny

T1 DX 1972, pumping Novorapid 24/05/11

HbA1c - 7/07 8.7, 1/08 7.8, 9/08 8.4, 3/09 7.3, 7/09 7.2, 12/09 7.3, 11/10 8.1, 2/11 8.6, 9/11 6.5 2/12 6.4  5/12 50/6.7  11/12 52/6.9  01/13 46/6.4  06/16 46/6.4  12/16 45/6.4

Offline Dollyrocker

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Re: New report published - and a question for you
« Reply #10 on: 03 January 2016, 12:26:22 PM »
Really sorry to hear about your redundancy Dolly.

Anything in the pipeline?

Thanks Patti, no, nothing really positive, bad time to be looking really and the industry I work in is in decline (hence the redundancy) keeping my fingers crossed that something suitable will come up in the new year


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Offline Pattidevans

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Re: New report published - and a question for you
« Reply #11 on: 04 January 2016, 09:37:05 AM »
Oh dear, I'll keep my fingers crossed for you Dolly.
Patti


Type 1.  Mis-diagnosed T2 May 2003, finally had CPeptide test 15/7/11 and proper diagnosis 1/9/11.  Now pumping Apidra with Roche Spirit Combo pump. Hba1c 6.1 April 2016.


© 2015 Patti Evans

Offline gemsa

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Re: New report published - and a question for you
« Reply #12 on: 12 March 2016, 07:40:16 AM »
I have always been asked "Are you pregnant or planning to? Make sure you speak to us before you do" at every appointment since I was 16. HOWEVER I wasn't told why until I did DAFNE aged 29. I just assumed it was preventing teenage pregnancy extended care/discouraging young people type of thing that just seemed to keep going past my teen years, I had absolutely no concept about the additional risks and complications of a diabetic pregnancy!  My current consultant however has said WHY they need to know and runs pre-conception clinic etc etc.  She jokes that as soon as you see the two lines on the test you are allowed to tell hubby but she absolutely needs to be next in line and only a fraction behind hubby.

UCHL is currently doing research on diabetic pregnancies and I think the knowlegde of the rest of the system (i.e. the non-diabetes of the pregnancy) and their awareness of diabetes impact.  My community midwife would always ask "and how are your bloods?" and she'd often write a more negative angle on my notes like "suffering from highs" when I'd mentioned one or two post-meals were higher than I expected. I soon learnt just to smile and nod and say "all fine thanks". Next pregnancy I plan to only see the community midwife for the 12 week booking in appointment as the hospital diabetes antenatal clinic covered everything I needed and actually had knowledge of what was going on.
T1 diagnosed 1985, DAFNE Oct 2012 (HBA 9.2%), started pumping April 2013.
HBAs: Feb 2013 8.6%, Jan 2014 7.4%, June 2014 5.9%, Jan 2015 7.5%
Healthy baby delivered Nov 2014 predicted 97th+centile but actually 50th centile.

Offline himtoo

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Re: New report published - and a question for you
« Reply #13 on: 12 March 2016, 12:38:20 PM »
Really sorry to hear about your redundancy Dolly.

Anything in the pipeline?

Thanks Patti, no, nothing really positive, bad time to be looking really and the industry I work in is in decline (hence the redundancy) keeping my fingers crossed that something suitable will come up in the new year
only stumbled into this topic today
and saw your redundancy post.
really sorry to read that .
I have been there a couple of times.
have you signed up with any kind of agency ?

all the best !
T1 Dia Aug 1972 -pumping omnipod since 29/09/15  Losartan 100mg , simvastatin 40mg,Furosemide 40mg, Omeprazole 80mg , Doxazosin 8mg
Hba1c - 06/2013 6.1 02/2014 43(6.1) 07/14 42(6.0) 08/14 40( 5.8 ) 12/14 39 (5.7) 08/15 41 ( 5.9) 10/15 44 ( 6.2 ) 03/16 49 (6.6)
cholesterol --nov 2011 4.3 june 2012 4.4 June 2013 4.1 Feb 2014 4.1 dec 14 4.5 oct 15 4.4
Dafne grad. necrobiosis lipoidica on legs
laser treatment on both eyes 2002 and 2012, injections left eye 3 , wearing Noctura mask since oct 2014

Offline Dollyrocker

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Re: New report published - and a question for you
« Reply #14 on: 12 March 2016, 10:24:43 PM »
Ah, thanks guys, I actually started a new job this week in...








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7/2014 7.2 (55) / 4/2015 7.3 (56) 1/2016 7.0 (53)
pumping with a shitty Accu Chek Insight