Type 2, early pregnancy and insulin

[Hanniegator]

Hello, I’m Hannah and I’m 9 weeks pregnant, age 36. I was diagnosed type 2 about 10 years ago after a period of depression and anxiety. I have carried a lot of shame about my diabetes over the last 10 years and ultimately it’s led to being very poorly controlled. I went to see a private endocrinologist in April and was about to start Mounjaro as he said my body was ‘not ready for pregnancy’ due to high BMI and HBA1C. Lo and behold my body disagreed and 2 weeks later I found out I was pregnant - a very happy surprise!

As soon as I found out I got in touch with the GP and the diabetes midwife team at my hospital who took me off gliclazide and empagliflozin and put me on insulin, metformin, folic acid, and gave me a libre sensor. It has been an absolute whirlwind getting my sugars under control and in 6 weeks I’ve got myself from spending basically 100% of the time at 13+ to now 45% in range and the rest of the time in 7-12 range. I had a scan at 6 weeks and saw a little heartbeat which was a relief but not scheduled for another scan until 12 weeks so I’m going for a private one today.

For the first few visits I had with the diabetic team at the pregnancy clinic they were great about everything, they explained the potential concerns but were very happy with the progress I was making (week by week 0% in range then 12%, then 24%, now 45%). But when I went to the clinic yesterday I saw both an obstetrician and an endocrinologist who were really negative and the endocrinologist just kept saying my numbers were ‘scary’. I know they have to do their jobs and tell you the risks and things, and obviously I know I still have work to do - but I’ve also had other members of the team tell me that my sugars coming down too quickly can also be a problem so I ended up feeling utterly terrified yesterday.

Between this and the fact that I’m (trying not to be but) really stressed about a problem with the sale of my flat/financial concerns I’m feeling very anxious and I’m concerned it’s affecting my sugars as last night they came down to 6 after dinner then went back up to 9 and stayed there even though I didn’t eat anything.

I don’t really know anyone who’s been through this before and my partner is super supportive but trying to play catch up just like I am. I guess I’m just looking for a bit of support, any advice or thoughts anyone has. I feel like I’m trying my best, but it’s just not good enough.

 

[Inka]

Welcome @Hanniegator and congratulations 🙂 Firstly, get rid of those ideas of shame. It’s not your fault and you shouldn’t be ashamed. It’s great you’ve got the folic acid, insulin and Libre. That’s exactly right, so feel proud that you’re in control and on top of things. You’ve also made massive improvements to your blood sugar🙂

I’m Type 1 not Type 2, but I’ve had three pregnancies with diabetes. They’re hard work because we have so much more to do, but I found the support excellent. To be honest, I wouldn’t bother with another scan. Just wait till your 12 week one. There’s no need, it won’t tell you anything and can cause extra anxiety. Later on in the pregnancy you’ll have more frequent scans to check things.

Have you been told the pregnancy targets? They’re very strict. I guess your team were referring to those and trying to inform you without worrying you. It’s a hard balance.

What insulins are you taking?

 

[PhoebeC]

You’ve made brilliant progress so should be proud of yourself.
Yes it is important you have tight control when pregnant but they don’t know your history so don’t take it to heart.
And you are doing your best which is the most important thing.
I would add the same about the scan, I would wait until 12 weeks you will have plenty of extra scans as you get further on and they will be keeping a very close eye on both you and baby.
Most importantly congratulations and try to stay positive

 

[LilyS]

Hi Hannah, i am 8 weeks pregnant and type 2.
This pregnancy was unexpected but luckily my latest HBA1C was 5.3% in May so i am trying to keep my bloods in range. I have my first community midwife app on the 15th July but I havent been contacted by the diabetic midwifery team in my local area.
Did you reach out to them or did they contact you first? I am concerned I havent been contacted yet but also not sure who I need to try and contact.
Congratulations to you, and wishing you the best with your pregnancy!

 

[Inka]

You should phone them @LilyS Have you got the special high dose folic acid prescribed? Ask your GP if unsure. I phoned my hospital, asked to speak to the Diabetes Centre, then told the DSN.

 

[LilyS]

You should phone them @LilyS Have you got the special high dose folic acid prescribed? Ask your GP if unsure. I phoned my hospital, asked to speak to the Diabetes Centre, then told the DSN.

Hi Inka, i've called the GP today and spoke to my diabetic nurse, she was helpful and called my GP directly to discuss a higher dose of folic acid. Its being prescribed today so i'll start taking that. She also confirmed the local midwives at my 1st appointment will refer me to the specialist diabetic midwifery team.

 

[Inka]

Great news @LilyS 🙂 You should find the diabetes pregnancy team very helpful. I got excellent care from mine. You’ll get extra scans, checks and advice. You might also see your regular local midwife in between specialist checks.

 

[PhoebeC]

Hi Inka, i've called the GP today and spoke to my diabetic nurse, she was helpful and called my GP directly to discuss a higher dose of folic acid. Its being prescribed today so i'll start taking that. She also confirmed the local midwives at my 1st appointment will refer me to the specialist diabetic midwifery team.

Diabetic nurses are worth their weight in gold if you find a good one.
Great progress @LilyS. Hope your well. Take care x

 

[PhoebeC]

@Hanniegator how are you getting on?

 

[LilyS]

Great news @LilyS 🙂 You should find the diabetes pregnancy team very helpful. I got excellent care from mine. You’ll get extra scans, checks and advice. You might also see your regular local midwife in between specialist checks.

that's great, i keep reading very scary information online of possible risks and getting scared!

 

[LilyS]

@Hanniegator how are you getting on?

thanks for your reply, i am getting a bit scared and trying not to stress too much. I keep reading scary information online about possible risks and panicking a little. I am trying to keep my bloods in range, i found a document for diabetes in pregnancy and the NICE guidelines and trying to stick to those. My fasting hasn't been in range yet, the document suggests 5.3 mmol and im usually around 6 or under so trying to keep low carb.

 

[Inka]

that's great, i keep reading very scary information online of possible risks and getting scared!

Remember that the vast majority of women have a healthy baby 🙂 There are risks with everything really, eg crossing the road, but you can reduce those tiny risks by being sensible. It’s the same with the diabetes: take your folic acid (and aspirin, if prescribed); eat well; keep well; have all your checks, etc.

Many of the scary things you read are from years ago when we didn’t have as much knowledge or treatment options. One thing I will say though is that knowledge is power. Read up on diabetes, read up on pregnancy, and you’ll be well-prepared 🙂

 

[PhoebeC]

Many of the scary things you read are from years ago when we didn’t have as much knowledge or treatment options. One thing I will say though is that knowledge is power. Read up on diabetes, read up on pregnancy, and you’ll be well-prepared 🙂

This! Read the right sources, ask the right questions. I didn't start doing this until the end but great a note book / use your phone and note any questions / concerns you have for your team as they crop up and then you will be prepared for your appointments.
Progress is the main key, and slow and steady. Rushing to change them to quickly isn't always the best idea, just keep doing as you are and try not to panic.

I was closer to 8 hb1ac when we found out, we had an awful pregnancy I struggled so much with levels and a horrible birth but now she is very healthy active (grumpy) 13 year old. Worth every moment and she never gets ill.

 

[42istheanswer]

thanks for your reply, i am getting a bit scared and trying not to stress too much. I keep reading scary information online about possible risks and panicking a little. I am trying to keep my bloods in range, i found a document for diabetes in pregnancy and the NICE guidelines and trying to stick to those. My fasting hasn't been in range yet, the document suggests 5.3 mmol and im usually around 6 or under so trying to keep low carb.

I'm still usually around 6 fasting despite being started on SR metformin by pre-pregnancy diabetes clinic but they were reluctant to increase it too much as my HbA1c is good, not sure yet it that will change once pregnant (they will switch me to the pregnancy clinic then though it is the same staff - diabetes specialist nurse and dietician). I hope that you do feel supported by your clinic!