To ask for my baby to be delivered at 33 weeks?

[Givinguph0pe]

I'm a type 1 diabetic and I'm 32+5 weeks pregnant.
Over the last four days my insulin requirements have fallen by 50%. This is absolutely not the norm. Usually the hormones kicked out by the placenta inhibit insulin and levels increase - which they had done until last Friday.
I've had a scan and baby has grown and apparently blood flow to and from the baby was normal. This means that the consultants are saying that there's probably no imminent danger and that they will keep monitoring me.

However I am extremely concerned that this rapid drop in insulin requirements means the placenta is going to stop doing its job in the very near future. I am not happy to wait any longer than it will take for me to have the steroids for the baby's lungs to be honest. I want her delivered. No one can give me any other suggestions as to why this fall in insulin levels has happened. I am now taking the same amount of insulin as I was before I got pregnant. If I did not have an insulin pump I would be having some fairly severe hypos by this point.
Personally I cannot see what other reason there could be for this - despite what the scan showed - and I'm not sure how much time I have to be honest.

I'm going back to the hospital this afternoon and I'm going to push for them to deliver her. What's the chances they'll agree?!

Errrm, I had DD3 at 35 weeks. She had a number of problems which were mainly related to her inability to maintain her body temperature, and consequently her blood sugar levels.

She most certainly wasn't almost akin to a full-term baby. There were no lasting effects luckily, and she is now a healthy 13 year old. It was a worrying couple of weeks though.

I am nit diabetic, though it was suspected that I may have had undiagnosed gestational diabetes. I had just been booked in for a repeat batch of GTT tests when my waters broke, DD gradually became distressed and it was then a case of better out than in.

I think maternal instinct, or 6th sense perhaps, should definitely not be dismissed.

You probably won't get delivery at 33 weeks without a pressing emergency, but I would have thought you could press for daily scans and possibly for admission for monitoring.

I don't think anyone likes the idea of delivering a baby so early. My ob stopped my early labour at 36 weeks as he said babies born early can have lots of issues even in later life.

Your situation is a little different though. Your medical team would know what's best and would decide themselves to induce labour if they were worried.

But I also understand that Drs get things wrong. I really believe in mothers knowing when something isn't right.
I would make an appointment asap to discuss your concerns about the baby.
for you, you must be going through a lot.

33 weeks is not term, nearly term, or anywhere near term. It really isn't. 33 weekers often need o2 therapy, bipap or cpap. If they get infections they can need very strong antibiotics which have hearing loss as a side effect. They don't have their suck, swallow, breathe reflexes, which means that even if they can suck (34-35 weeks usually), they can't co-ordinate that sucking with swallowing and breathing, so tire very easily. They can develop necrotising entero colitus (NEC) which can be fatal. They can get sepsis. The list goes on, and on, and on.

There are documented cases of lower insulin requirement in the third trimester. Google throws up a few papers.

I think you should ask for more monitoring.

Type 1 diabetic here. Have had 2 pregnancies.

You need to go nuts at them. If they have no idea then surely you shoul be referred to a more expert centre eg Kings College Hospital in London for an expert consult. I would absolutely insist on AT LEAST daily monitoring and probably admission. This is, as you know, not normal and I don't think you can accept "we don't know so it's probably all fine". Of course you want to keep baby in there as long as poss, but something very weird is happening and the risk of stillbirth is uncomfortably high. This is the time in your life to be pushy, difficult and insistent - more than ever before. (Obviously politeness is also helpful!). Do not get fobbed off. My experience is half the doctors just have no idea once you get to subtle issues like this, so unless someone offers you a proper explanation, bland reassurance should unfortunately not be trusted.

PS just as another random anecdata point my requirements dropped by about 10-15 per cent at about 34 weeks. But that is clearly not the same as what you are experiencing.

T1 here daughter delivered at 37+3 as insulin requirements dropped. Professional team held meeting involving specialist diabetic obstetrician to make decision. St Thomas. You need specialist advice. You also need to be admitted and monitored for as long as poss. Get on the steroids and insist. There would be no discussion if you had preeclampsia . Fight your baby's corner but do what you can to keep her in if you can and insist on admission

I'm in hospital and have had the first lot of steroids.
I'm keeping my insulin pump on as they said that I know what I'm doing better than them?! Worrying. So feel a bit on my own and not really sure what sugars will do now as not starting from a stable base point.

They've monitored baby for around an hour and baby is moving now but I still don't understand this huge drop in insulin requirements.

Ask for your diabetic care team to come and see you in ward and discuss your insulin needs. They should be able to send someone over. If they can't now make sure they send someone over first thing. The steroids will mess with your levels so you need the help.

No advice but wanted to wish you luck - hope all goes well and you get the right care. Forewarned is forearmed; I am sure they will be cautious (as they should be) - good luck

Another one wishing you good luck.

Glad to hear you're in hospital. Hopefully you can get closer monitoring now.

Ah, I'm glad to hear your in hospital now.

Having read only your initial post, I was going to say that the best thing would be for you to be admitted for a bit to monitor the baby more closely.

Every week you can go, up until about 38 weeks, is for the best. But not if it risks the baby's safety. You will be given an induction when you need one - my best friend was recently given an emergency induction at 32 weeks for pre-eclampsia. I honestly believe you're in the best place.

best of luck.

Thanks all.
I just hope nothing catastrophic happens. I'm very worried about the well being of the baby and my own well being simply because I keep thinking of my ds being told something had happened to me.

I wish someone could offer me an explanation for this massive drop in insulin but no one can. The diabetes consultant has apparently never seen it before.

Is "diabetes consultant" an obstetrician with training in gestational diabetes?

It sounds like you need a diabetes specialist/endocrinologist who knows more about type 1 diabetes to advise your obstetric team.

A friend of mine had severe complications (coma) after giving birth as her levels went haywire. An obstetrician is not qualified to deal with that solo.

I think there is a lot to be said for gut instincts, my sister works with a girl and she felt something was wrong and went to the hospital but nobody listened to her, she got into such a state and told the doctor that she truly believed the baby was in danger, he agreed to deliver her the following day. She was actally right! Everything turned out fine but she was lucky, and the baby was lucky she fought so hard, even when everyone was dismissing her. I just wanted to wish you the very best of luck and offer support to you.

What a worrying time for you. I hope they decide/you push for them to keep you in long term. At the moment it sounds like the only viable way to try and balance your baby's safety and her need to stay in as long as is healthy

How worrying for you op.
I've no experience with diabetes in pregnancy(though reckon I may have had GD as DS was 11lb7oz).
Definitely trust your instincts. Mothers intuition is so important. (I spent days in hospital where they were trying to kick off inducement but wasn't working and I refused in the end, said it shouldn't be this hard to start labour going, begged for a section and when i finally got one he was breech and massive so would never have come out, at least not without causing a lot of damage or rushing for emergency section).
I hope everything turns out ok for you. As others have said you really need to kick up a fuss. Good luck

Hi op, sorry I have no advice or wise words, just wanted to say I'm sending positive vibes your way at this worrying time.

Good luck OP!

Don't worry about them saying you know better over the insulin it's because everyone is different and their bodies react differently during pregnancy with diabetes they've probably had no specialist training in diabetes so dont want to tell you to do something and put you at risk a specialist will know what's best.

I'm so glad you are in hospital and wish you the best. You probably are better with the insulin pump than insulin on a sliding scale as you will be able to monitor and change levels much more quickly (hopefully you will be getting advice too ) but I found it a lot easier on the pump when in hospital and had it on throughout ultimately failed induction and c section. Hopefully baby can stay in a bit longer but you are in the best place now to get her out urgently if she needs to. Good luck with it all. I am hoping to hear all about your beautiful healthy baby sometime in the next few weeks.

I explained to the nurse my levels shot up to 10.4 when I went into labour. She responded 'that's great'.

Because you can't eat while on the drip I had to sip Lucozade Sport, my levels were then 2.3 until an hour after he was born.

There was no diabetic specialists to advise if this was ok. I feel your pain at the lack of knowledge.

Glad you are in hospital. Hope you can stay.

Suggestion: a few posters on this thread (cheeseandgherkins lindt and glampinggaloshes) sound like they know of a specialist consultant or team who would know about this. Might be worth PMing those posters to get the names of the specialists, then you can give the names to your medical team and suggest they get in touch?

In what universe is this normal during pregnancy unimaginativename?! Hope you're ok OP. Hang in there.

It is depressing how little is known of diabetes by most midwives - considering it's fairly common.
When I had my son I had a low soon afterwards, it was 2.1 I think. I was trying to treat it but my son was hungry and a midwife berated me for treating the low first. She told me I shouldn't be selfish now I was a mother. I ought to have complained really. No idea.

This time round they keep trying to refer me to the diabetes nurse but it isn't a diabetic problem. My sugars are ok! It's why they've dropped that's the issue but they keep saying 'it doesn't matter how much insulin you take as long as your sugars are good.'
Yes, but why has my insulin dropped by 50%?! No one can give me a straight answer.

Thanks everyone for all the supportive messages and experiences. It has helped. I am very worried as you can imagine.

One of the midwives at work pointed me towards this site: www.diabeticmommy.com/sp-pregnancy-diabetes-bd-faq-answers.html

I don't know if you'll find anything helpful on there but fingers crossed - keep on pushing for answers x

Just wanted to wish you well. I'm type 1 and delivered at 36 weeks after the baby stopped growing for a couple of weeks, it did turn out to be placenta problems. My insulin requirements stopped increasing rather than dropped though.
To be honest we did have a number of issues due to early delivery even at that gestation and baby ended up in NICU for a while. I was very lucky that in my hospital the endo team and obstetrics work really closely together with diabetic mums so I felt very well looked after.