Hello, just a quick post to update on my pregnancy as a few people have made enquiries about pregnancy and T1 recently.
I was always very daunted by the thought of pregnancy, when I was diagnosed age 26 (and in a fairly new relationship at the time) my consultant made it sound almost impossible and so for a long time I put it on the "too difficult" pile of things I wasn't ready to get my head round.
Fast forward 10 years and I realised time was ticking and if I was to do this it had to be sooner rather than later! The NICE guidance on BG levels before and after meals still seemed unachievable on MDI, and my waking levels had never been good, although I had an HBA1c of around 50-55 so I did ok on average.
I realised from reading on here that a pump would massively help and so I jumped throug hoops to get one... initially funding the Libre myself to show that I couldn't wake to a good level without a nighttime hypo on levemir. 2u at night was too little and 2.5u too much, I was that sensitive. I kept diaries and went to appointments with a DSN and dietician who eventually conceded that a pump was the only answer and put me forward to panel. It was initially rejected as my HBA1c was too good, so I asked to go round again pointing out that a nighttime hypo every night was not good quality of life! I eventually got the pump on the grounds of planning pregnancy. It was brilliant, sorted out the nighttime hypos and morning levels.
To improve post meal readings I cut down on carbs for breakfast and lunch, dinner is still quite carby but I find tends to be slower absorbed. I got my A1c down to 50 and took folic acid (5mg) for 3 months before trying to conceive.
In May 2018, age 37, I got pregnant after about 3 months of trying. Initially my insulin requirements went up by 10%, temporary basal rates were invaluable here. Unfortunately at 8 weeks I miscarried – inevitably I blamed myself but with time I have realised it was just not meant to be. By new year 2019 we were ready to try again properly and I got pregnant in April. I was so anxious about getting hurt again, we just took every step as it came. My DSN was one of the first people we told, before family! We went for a scan at 6 weeks and there were concerns that the heart beat was slow, I thought “oh no, not again”. We waited 2 weeks for another scan and I was convinced it would have died in the meantime, but no, there was a little peanut with a heartbeat on the screen! It was amazing, and after that confirmation we told our immediate families, who were so excited.
We then had scans and clinic appointments at 13, 20, 28, 32 and 35 weeks. I had a bleed just before the 13 week scan and was convinced it had gone wrong again, but there he was waving at us. The combined diabetes-antenatal clinic was very frustrating, inevitably I’d be there 4 hours for a scan and to see 2 consultants, but I work at the same hospital and so at least I didn’t have to travel or pay for parking. I had the Libre funded throughout trying to conceive and pregnancy, which was really helpful, and I couldn’t have done it without my pump. I didn’t actually have that much input from the DSN as I’m happy to adjust things myself, she just looked at the graphs on LibreView. My total insulin requirements went up by a factor of 2, both basal and bolus, after an initial drop. My low carb breakfasts worked well, lunch still caused a spike and so I started blousing for the full carbs 30 mins before eating then leaving some of the carbs to mid afternoon to eat them, which seemed to help.
I had to have a planned C section because I had a large fibroid lower than the baby’s head, which would prevent a normal delivery, so this was booked in at 38 weeks. I was quite relieved to have a plan because I know a lot of inductions end in emergency C sections anyway so I was happy to go with en elective one. At 37wks my insulin requirements dropped by 20%, which can be a sign of the placenta failing, so I went for monitoring, but there he was again super happy, so I carried on with the plan.
So he was delivered safely 3 weeks ago and now I can’t imagine life without him! I kept my pump and Libre on throughout the surgery as my team were happy I knew how to control them and that would give me less anxiety than a sliding scale. The operation took longer than expected because they had to remove the largest fibroid (the size of an orange!) and this caused big bleed and so I had to have a blood transfusion and a balloon left inside to stop the blood loss. Quite scary in hindsight but I knew they had planned for this by getting 4 units of blood in beforehand – I only had 1 in the end as they also did cell salvage on the fluid suctioned out and so I got 600mls of my own blood cells back too. The theatre team were fantastic, and made sure it was still a special occasion, not just a medical procedure!
Spent 3 nights in hospital, then we came home just before Christmas. The baby had low BG after the first feed but I had expressed colostrums in the final week into syringes and he was given these to bring him back up. He got 2 in range BG readings in a row and so they stopped monitoring him. Unfortunately on day 2 he then got very jittery and a BG test was 1.6! (normal for babies is above 2.5). He had to have some glucose and formula to bring him back up then we had to feed him 25ml colostrum/formula until he had another 2 readings in range, which he did by the end of the day. I felt terrible about the hypo and not realising it, but the main thing was he was treated quickly and didn’t need to go to NICU at all. As I had been warned, my insulin requirements went straight back to pre-pregnancy levels after delivery, then dropped about 30% more because of breast feeding. Not quite on top of my new dosages yet, but I’ll get there. Plenty of snacking going on to keep my energy levels up!
So, in conclusion, pregnancy with existing diabetes is do-able, with a lot of hard work and planning, but it is so worth it! Not got a lot of time to pop in here lately but if anyone has any specific questions I’ll try and pop by to answer them at some point!
I was always very daunted by the thought of pregnancy, when I was diagnosed age 26 (and in a fairly new relationship at the time) my consultant made it sound almost impossible and so for a long time I put it on the "too difficult" pile of things I wasn't ready to get my head round.
Fast forward 10 years and I realised time was ticking and if I was to do this it had to be sooner rather than later! The NICE guidance on BG levels before and after meals still seemed unachievable on MDI, and my waking levels had never been good, although I had an HBA1c of around 50-55 so I did ok on average.
I realised from reading on here that a pump would massively help and so I jumped throug hoops to get one... initially funding the Libre myself to show that I couldn't wake to a good level without a nighttime hypo on levemir. 2u at night was too little and 2.5u too much, I was that sensitive. I kept diaries and went to appointments with a DSN and dietician who eventually conceded that a pump was the only answer and put me forward to panel. It was initially rejected as my HBA1c was too good, so I asked to go round again pointing out that a nighttime hypo every night was not good quality of life! I eventually got the pump on the grounds of planning pregnancy. It was brilliant, sorted out the nighttime hypos and morning levels.
To improve post meal readings I cut down on carbs for breakfast and lunch, dinner is still quite carby but I find tends to be slower absorbed. I got my A1c down to 50 and took folic acid (5mg) for 3 months before trying to conceive.
In May 2018, age 37, I got pregnant after about 3 months of trying. Initially my insulin requirements went up by 10%, temporary basal rates were invaluable here. Unfortunately at 8 weeks I miscarried – inevitably I blamed myself but with time I have realised it was just not meant to be. By new year 2019 we were ready to try again properly and I got pregnant in April. I was so anxious about getting hurt again, we just took every step as it came. My DSN was one of the first people we told, before family! We went for a scan at 6 weeks and there were concerns that the heart beat was slow, I thought “oh no, not again”. We waited 2 weeks for another scan and I was convinced it would have died in the meantime, but no, there was a little peanut with a heartbeat on the screen! It was amazing, and after that confirmation we told our immediate families, who were so excited.
We then had scans and clinic appointments at 13, 20, 28, 32 and 35 weeks. I had a bleed just before the 13 week scan and was convinced it had gone wrong again, but there he was waving at us. The combined diabetes-antenatal clinic was very frustrating, inevitably I’d be there 4 hours for a scan and to see 2 consultants, but I work at the same hospital and so at least I didn’t have to travel or pay for parking. I had the Libre funded throughout trying to conceive and pregnancy, which was really helpful, and I couldn’t have done it without my pump. I didn’t actually have that much input from the DSN as I’m happy to adjust things myself, she just looked at the graphs on LibreView. My total insulin requirements went up by a factor of 2, both basal and bolus, after an initial drop. My low carb breakfasts worked well, lunch still caused a spike and so I started blousing for the full carbs 30 mins before eating then leaving some of the carbs to mid afternoon to eat them, which seemed to help.
I had to have a planned C section because I had a large fibroid lower than the baby’s head, which would prevent a normal delivery, so this was booked in at 38 weeks. I was quite relieved to have a plan because I know a lot of inductions end in emergency C sections anyway so I was happy to go with en elective one. At 37wks my insulin requirements dropped by 20%, which can be a sign of the placenta failing, so I went for monitoring, but there he was again super happy, so I carried on with the plan.
So he was delivered safely 3 weeks ago and now I can’t imagine life without him! I kept my pump and Libre on throughout the surgery as my team were happy I knew how to control them and that would give me less anxiety than a sliding scale. The operation took longer than expected because they had to remove the largest fibroid (the size of an orange!) and this caused big bleed and so I had to have a blood transfusion and a balloon left inside to stop the blood loss. Quite scary in hindsight but I knew they had planned for this by getting 4 units of blood in beforehand – I only had 1 in the end as they also did cell salvage on the fluid suctioned out and so I got 600mls of my own blood cells back too. The theatre team were fantastic, and made sure it was still a special occasion, not just a medical procedure!
Spent 3 nights in hospital, then we came home just before Christmas. The baby had low BG after the first feed but I had expressed colostrums in the final week into syringes and he was given these to bring him back up. He got 2 in range BG readings in a row and so they stopped monitoring him. Unfortunately on day 2 he then got very jittery and a BG test was 1.6! (normal for babies is above 2.5). He had to have some glucose and formula to bring him back up then we had to feed him 25ml colostrum/formula until he had another 2 readings in range, which he did by the end of the day. I felt terrible about the hypo and not realising it, but the main thing was he was treated quickly and didn’t need to go to NICU at all. As I had been warned, my insulin requirements went straight back to pre-pregnancy levels after delivery, then dropped about 30% more because of breast feeding. Not quite on top of my new dosages yet, but I’ll get there. Plenty of snacking going on to keep my energy levels up!
So, in conclusion, pregnancy with existing diabetes is do-able, with a lot of hard work and planning, but it is so worth it! Not got a lot of time to pop in here lately but if anyone has any specific questions I’ll try and pop by to answer them at some point!
