Secret
D Women’s Business
with DR JENNY
CONN, endocrinologist from the Royal Women’s’ Hospital
and KELLIE BASU, groovy young diabetes nurse educator
It was with great anticipation I attended the ‘Secret D Women’s
Business’ workshop. There were so many attendees we had to
get more chairs!!
Jenny and Kellie have been kind enough to allow me to utilize their
presentation slides to give you a run-down on their workshop. Thanks
a lot guys!!!
Here ‘tis:
Jenny leapt straight into the talk, beginning with pregnancy. Her
opening point was “Planning is the key to success! ”
Jenny went on to dispel some myths such as, “You can’t
get pregnant if you have type 1 diabetes”, “Women with
diabetes can’t have babies” and “It’s too
difficult to have a baby if you’ve got diabetes”. Once
again the word ‘planning’ got a mention, with advice
on good contraception and the types available.
Jenny also advised you should discuss your pregnancy planning with
your Endo or GP, as well as getting in touch with a specialist team.
She covered things like taking folic acid, good BSL control, ensuring
your complication screenings are up to date, then, pre-pregnancy,
testing for things such as Coeliac and Rubella antibodies, Thyroid
function, Gynaecology check, and finally (phew!) Smear test (Pap
test).
Describing the pregnancy trimesters was interesting, with the information
that many women experience the following:
-
Increased risk of hypos and increased insulin sensitivity
-
Morning sickness and altered hypo awareness
-
The pursuit of perfect control (they can take that
one and do you-know-what with it!)
She went on to advise that good glycaemic control is important,
namely:
-
Fasting blood glucose < 5 mmol/L, 2 hours after
meals < 7 mmol/L and
-
Reviewing food intake often occurred with Multidose
insulin or pump dose alteration.
Other interesting facts were:
During the first trimester, the risk of miscarriage was
-
In non-diabetic women 15%
-
In diabetic women with good control 15%
-
In diabetic women with poor control 30%
As for the risk of problems with the baby, the risk increases with
Hba1c.
During the second trimester, most women experience changing insulin
requirements and need regular ante-natal checks – usually
every two weeks.
During the third trimester, common experiences are:
-
Increased resistance to insulin
-
Frequent visits to Antenatal Diabetes Clinic
-
Planning delivery – ie need to discuss with
both your doctor and the hospital regarding delivery.
An interesting conversation that arose from this
was that some hospitals have certain insulin delivery policies
in place ie. one may like to use a drip, others injections, others
let the person control her own insulin. While some women commented
they were more than happy to have someone else look after their
sugar levels while they were in labour, others spoke about how
it was an unpleasant surprise to discover this during labour and
were more than happy to have the doctors/nurses manage their BSLs….
-
Caesarean section is more common, as is induction
of labour
With labour and delivery, frequent insulin doses were common, while
after labour, many women experience a sudden drop in insulin requirements.
Breast feeding is encouraged and once you’re home - Chaos!!!!
With this wealth of information and discussion, Jenny handed over
to Kellie, who started her presentation on women and body image,
talking about the mental picture of how we think we look. It’s
usually based on our opinion about our size, shape, weight and other
parts of our body, and is often closely linked with our self-esteem
– referring to how much a person values or accepts themselves
for who and what they are.
Kellie than gave us some reassuring facts (well to me they were):
-
40% of women aged 25-24 yrs estimated they were
heavier than their BMI indicated
-
Over 27% of women who were underweight , thought
they were in the ideal weight range
Also, that we actually NEED fat on our hips and things, some of
the reasons being:
-
Fertility and lactation purposes
-
Prevention of osteoporosis
-
Healthy skin, eyes, hair, teeth
And the reminder that it’s often somewhat out of our control:
‘Don’t forget it is in your genes (as seen in your
jeans)!!’
Plus, what is it about a person’s body image and how we perceive
them – Kellie talked about the ‘f’ and ‘t’
words – are they more than just a physical condition??
“Fat” is often perceived as a person who is lazy, bad,
greedy, unfeminine, having a personal problem or unhappiness
“Thin” is often seen as someone who’s happy, successful,
good, strong-willed and feminine and that thin people have more
chance of getting a partner!!
And what about the Type 1 vs Type 2 diabetes….!#?!#?
Kellie then discussed the various influences on our body image
a.k.a.
-
Puberty / Menopause, pregnancy, disability, surgery,
Illness -
-
Diabetes
-
Advertisements, magazines, movies, bill-boards,
fashion shows, beauty salons and the worst of them all -
-
Trying on a pair of hipster jeans!!
Yet we actually think there is something wrong with us!
So what do we do!!! We go on a diet!!
-
98% of women have dieted at some point
-
95% regain the weight within 5 years
-
You feel deprived, depressed, and associate ‘good’
and ‘bad’ foods with “I am good or I am bad”
-
Effects on your immune system can make you sick
and decreased concentration – dieters perform worse for
reaction times, rapid information processing and memory
and then what else do we do!!
Some women exercise like a woman possessed, or even stop taking
their insulin in order to stay thin – scary!! An interesting
fact arose that 30-40% of women may have manipulated insulin to
assist weight loss but with significant health risk
So what do we do…
We need to take a sensible approach, set realistic goals –
and a realistic plan of action
REMEMBER:
Your body shape is your own and it is unique and is the target of
lots of companies and their wallets.
Your identity is determined by:
Great food for thought…Jenny then presented her talk on the
other E word – Er… er …er …..Exercise
It burns energy and helps weight control, helps regulate appetite
and improves BGs, lipids and blood pressure and also reduces risk
of osteoporosis later in life.
We should try to…
-
Do at least 30 minutes of moderate intensity exercise
on most days of the week
-
Take the stairs not the lift!
-
Make small changes to your daily habits and do
something you ENJOY!
Jenny herself had been seeing a personal trainer and couldn’t
stop saying how great it was……….hmmm…….
Then, Jenny started talking about What, How and Why to Eat (with
thanks to Kerryn Roem, dietitian extraordinaire, for help in preparing
the presentation)
What should we eat?
-
Select low-fat alternatives (learn to read the
labels!)
-
Use low fat cooking techniques
-
Trim fats from meats before cooking
-
Use small amounts of ‘good fats’ like
olive oil
-
Eat low GI carbs
-
Limit alcohol, andeat a balanced diet
-
Be aware of the difference between normal ‘eating
too much’ and over-eating as a habit
-
Establish a regular meal pattern
-
Become more aware of physical hunger and use this
as your guide when to eat
-
Eat enough to deal with hunger but no more
-
Avoid ‘diets’ and unsustainable eating
plans
-
Plan ahead! Try to take healthy snacks and meals
with you to work
-
Make sure there’s healthy food in the ‘fridge
when you get home from work
-
Identify your triggers for over-eating –
ie boredom, feeling depressed or lonely, feeling angry or stressed
-
Develop alternative coping behaviours!
-
Understand the relationship between body image
and self-esteem
Diabetes and Weight Control
-
Avoid having hypos!!!
-
‘over-treating hypos’ is fattening!
-
Eat every 2 - 4 hours
-
Make sure you always have healthy food with you
-
Remember: EATING is the best way to lose weight!!
Well, all of the above was covered in just under 2 hours –
including lots of discussion……..way to go!!!
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