Expecting twins,type 1 diabetes and miscarriage fears

[tonythetyger]

I have a ds aged 4 and have been trying for another child for quite some time. I had a miscarriage nearly 2 years ago and then went through a sort of secondary infertility. I finally got pg again and discovered at the early scan that it was twins and probably identical ones. Bit of a shock to say the least.

Owing to being a type 1 diabetic I got early appointments and today's one informed me that if they share a placenta I'll be lucky to get to 34 weeks and if they don't 37-38 weeks. Is this standard or not? I'm with st mary's in paddington.

Obstetrician also informed me that I'll definitely be having a csec. I had an emergency csec with ds and it was rather unpleasant to say the least but given history of failure to progress, diabetes and twins I guess the odds are rather stacked against me. The only thing I'd like to ensure is if I have to then I get everything I need out of them e.g. 8 weeks worth of pain killers, a room to myself, and proper post natal care.

I'm also still going through quibbles about whether I have any chance of this pg continuing and am refusing to admit it's really going to happen until I'm much further along (most of the time - apart from occasionally thinking "I'm having twins! yay!").

Has anyone got any advice on

1. twins with diabetes,

2.how to survive the joys of hospitals who tell you you're having csecs and won't be able to breast feed (my polite response was I'm open to all options but I don't see why not since I did it with ds),

3.when is a good time to tell work (I don't want to reveal all if I'm going to miscarry again)

1. how quickly you show if it's a 2nd and you've had a csec (I'm 9 weeks and not really showing yet)

any other general advice.

hello, just noticed yr post has gone unanswered so far. i had 3 miscarriages before having my non-id twin boys, now 19 months old. They are my only children. I absolutely know what the fear and worry is like in the early stages of pregnancy when you have previously miscarried. I too didnt dare believe it until i reached 12 weeks. we were 3 years ttc altogether.

policy on twins seems to differ massively according to yr consultant and hospital. If you are not happy with what you have been told you can ask for a second opinion from a diff consultant. Mine was very in favour of natural delivery, i went to 39 weeks and had mine naturally but i realise it may be different with ID twins. Sorry i cant be of more help with yr questions just wanted to reassure you that there are happy endings as sometimes you hear negative stuff too much. Sending you tons of well wishes xxxx

Can't answer any of your questions. But would like to offer a bit of hope about a planned section and early birth.

My boys were born at 32 weeks due to pre-eclampsia, they were fit and well and had no complications beyond needing kept warm and helped to feed for a couple of weeks. They came home after 4 weeks.

My section was an emergency on paper - but as they told me on the Monday it would happen on Wednesday it didn't feel that way. Very calm, with a quick (felt up to driving after a fortnight) recovery. I think the general feeling is that there is a real difference between a (real) emergency section and a planned one.

You don't have to tell work till a certain point (25 weeks is it? They may guess by then!), but if it becomes obvious soon I am sure they will understand if you keep it to yourself until you feel more confident.

Best of luck with the pregnancy. I had a massive bleed just before my 12 week scan and spent the night assuming it was over. That doesn't begin to compare to a miscarriage and I still remember it with horror.

Thanks I think the bigger problem is the diabetes combined with the twins which makes me super high risk before even taking into account a scar and bad statistics on success at vbac. I did try another hospital with my miscarriage and found them far worse than this one. Their basic organisation was dreadful to the point of negligence and this is one of the top London teaching hospitals. At least with St Mary's I know the score and know how to get through the system plus they don't put impossible targets for my diabetes or interfere at all in what I do which is essential to my peace of mind.

I can't say I'm very happy but I had sort of accepted that this would be the safest way to go and bad as an ELCS is a failed VBAC would be worse to recover from. Plus the key thing is to have healthy children and whatever ensures that must win out.

I kind of want to tell work because if I'm going to have to go off earlier than I would normally (I'm anticipating 28 weeks for ID and 30-32 for non-ID) then they will need time to try and work out how to cover my load. The last time I told at 21 weeks which was 4 weeks into a new job and rather nerve wracking. I think I'll just have to see how the next scan in under 3 weeks goes and take a decision then. Maybe I'll leave it till 16 weeks.

Just to reassure you, and elective section is really easy. I was booked in for an elective due to twin 1 being breach, but my waters broke early (35+5) and so I had an "emergency" section, but as I wasn't contracting it wasn't really emergency - more like a planned section brought forward a bit. It was really relaxed and I recovered really well. Much better than my first vaginal birth.

As for telling work, do it whenever you feel ready. Just wear baggy tops for a while. I didn't actually start showing until 17 weeks with the twins, and believe me I don't have stomach muscles of iron - I don't know why I wasn't showing, Just expanded suddenly about 17 weeks.

Congratulations on the twins

Think people are under-estimating the diabetes side.
Surprised at the breastfeeding comment, I bf ds1 and ds2 at Kings college hospital, where their care of me in both my pregnancies, on a pump, was FANTASTIC.
Both mine cs's and I think ELCS would be good for you. Different to Emergency. Accept that now. Or is there an option, to atleast talk to consultant about any other option ?

Hi Oblomov I've met you before (I used to be tigger but changed recently for avoiding RL person purposes). I'm sure I'll get to talk to lots of consultants by the end of this pregnancy . My sister who is also pregnant was apparently complaining to my mother that she only sees midwives whereas I saw lots of doctors, the few times she accompanied me to antenatal appointments. I pointed out that it's much better not to need the special attention........

I was surprised at the breastfeeding comment too but you do get some strange people in the nhs. I suddenly had memories of this ghastly health assistant on the maternity ward who insisted that she knew all about diabetes and that I was being deliberately obstructive and was responsible for ds' jaundice because I was white, shaking and stuffing glucose into me instead of responding to her. When dh said I was having a hypo she said "no, she's just being difficult". Good knowledge demonstration....

The diabetes care is fine and the target is 7.0 for hba1c which is dead easy whereas UCH was 6.0 and I had some rather substantial problems with their system so am nervous to try anyone else. Plus they're giving me a continuous glucose monitor to try out so hopefully that will help with fine tuning.

Kings sounded very attractive on the care front but is really difficult for me to get to both home wise and work wise.

Thanks for your views on the different experiences.

Tigger, I did wonder
so very pleased for you. How exciting. scary !

Laugh at not needing the special care, thanks very much. know exactly what you mean.
And no, I didn't mention kings, in a kind of suggesting you change way. more like, just checking that you were happy with the diabetic care, side of things. which you seem to be. so thats fine. end of.
I personally feel that the diabetes overrides everything else pg related. and if you can get the diabetes right, the pg takes care of itself. But that was just MY 2 experiences, maybe you feel a bit differently given your experience with ds1.
PLUS, I have never had twins. So can only comment SO much.

Must go to bed. But am certainly here, for the ride, if you need any support at all. If I am able to give you any.
Good luck.

That was my view too but I did wonder if I chose badly on the maternity front, which was why I tried UCH the 2nd time. However, after the p*ss-up in brewery experience I decided to return to the not wonderful but slightly better st mary's. I guess nowhere is great in London and I need to work on practicing my zen calm all the time and not just during antenatal appointments to keep my blood pressure down

Agreed. Kings used to drive me ballistic. Just pop in , they'd say ( oh yes, from surry on my 1.5 hr journey, with ds1 in tow. And then they'd keep me waiting for 3 hours in clinic. Thn I'd be rushing to get upstairs for my scan.
What are your plans for coping, later on ?
And will you have ds1 in tow ? when does your ds start school ?
ds1 started school 2 months before I gave birth to ds2.
You sound pretty zen already to be honest. am impressed.

Telling work ? I only told them when I got my first appointment thta clashed with work time (I work 2.5 days). I am assuming thus, because of diabteets AND twins, you are considered high risk/priority/special case and thus will have more appointments and thus will need to tell them earlier.
I think in hindsight having so many appoinments was extremely draining. I was diabetic clinic, and also being scanned every 2 weeks and that was tough.

Re work. I love my job and couldn't wait to get back , more to have a break from children. But am I right in assuming you won't be able to returning , after the twins are born. I only ask because it makes a difference to your attitude, I think, towards work, throughout your pg.

I work full time at the moment, ds is in nursery of a school near to us and will hopefully start reception in September (providing we get a place). I have childcare in place so get to attend all appointments by myself. If the twins are not attached to the same placenta then I will apparently not have more appointments or scans than I would with a "normal" diabetic pregnancy. If they share a placenta then it will go beserk. I didn't have that many scans with ds. It was only fortnight appointments from 28-36 weeks and then weekly till induction. They tend to do everything in one place (scans, obs and endo) so I don't have to trek around too much.

I've already had 4 appointments (at 9 weeks), have another 2 in 3-4 weeks and have been trying to persuade the diabetic nurse to insert the monitor early in the morning so I don't have to absent my self anymore. If my line manager has noticed he'll either think I'm horribly sick or taking the mick.

I do plan to go back to work. I started an amazing new job 4 months ago which I love and I don't want to give it up. I might have to consider slightly less hours but I'll leave that till nearer the time.

I haven't quite got my head around how much help I'll need when I'm on maternity leave and particularly after birth. I think I'm going to leave that one until I'm about 20 weeks and more sure it's really going to happen.

Im currently 29 weeks pregnant with my 2nd set of twins and I have gestational diabetes that I cant control and Im now on insulin injections and tablets.

I had gestational diabetes last time but escaped any meds as the girls decided to come at 33 weeks.

The one big problem I have come across this time now is that I have too much fluid around twin 2 and they have basically told me they are expecting me to be having them very shortly and im not going to get much further at all!!!

Last time I was scanned every 4 weeks and thats a non ID pregnancy (even though mine are actually ID!) until one stopped growing at 28 weeks so was put on every 2 week scans then I had them anyway due to waters breaking. was seeing the consultant every 4 weeks too.

This time non ID pregnancy again (supposidly) and being scanned every 4 weeks again and seeing the consultant fortnightly at the moment and midwife monthly.

If they are ID then you will prob be scanned every 2 weeks and see a consultant then too.

Thanks for the comments

Hi, I'm Dbi mum of twins (12 months last week) and have type 1 diabetes! Mine lasted inside till 32 weeks and spent 6 weeks in neaonatal! I'm also a single mother who had no intention of children till found she was having two (8 weeks gone!)

Anyway if you haven't already go the answers to your questions heres my opinion;

1. Get an insulin pump if you haven't alrteady got one - it brought my diabetes into control HBAC1 to 6.5 (never had that before) made looking after myself alot easier. This can be done for gestational diabetes too (for the harrygracejessica) and is worth looking into!

2.how to survive the joys of hospitals who tell you you're having csecs and won't be able to breast feed (my polite response was I'm open to all options but I don't see why not since I did it with ds), I expressed for the 6 weeks whilst they were in hospital but also weaned them onto bottles a were too little to breast feed, you can do it though and expressing helps when you cannot be there all the time - you will need rest too! I am shocked they have already said you cannot when your not even that close to hving them yet! I had pre-eclampsia which was controlled and they had to come out due crashing hypos (sign the placenta may be failing) and managed to express at 32 weeks a whole 1ml an hour after the op - if the hospital isn't happy or supportive - is there another one near??

I had problems with the midwives as was admitted couple of times before they decided to take my two out - the midwives are terrible at understanding diabees and I took care of myself alot (thatsa ok I'm a nurse) but felt that I was ignored alot on the ward. Once had them I was constantly in the neonatal and not on the ward so they gave me paracetamol when asked - one thing after csection was I needed to gt downstairs to see the twins so the following day dressed myself (with difficulties) and by day three walking normallly with no painkillers (drove by fortnight) speedy recovery as needed to be by the twins side, differs when one baby full term probably can taske it slower.

3.when is a good time to tell work (I don't want to reveal all if I'm going to miscarry again)
I didn't tell work until 20 weeks following anatomy scan, this gave me plenty of time to ensure all was well wth them first and over the (perceived) danger point for miscarriages. I know a shared placenta is more risky (had one of each myself) so my advice is losts of rest - do not do what I did and work till 30 weeks before weas made to go off sick!! It's gong to be tiring and a worrying time once born too (although not as bad if alls well) feeling stressed ver work will not help all three of you - think advice is 27 weeks, and I would go with that, they may well have stayed longer had I rested more! The are perfect though so no issues!

1. how quickly you show if it's a 2nd and you've had a csec (I'm 9 weeks and not really showing yet)

They were my first and although clothes were alot tighter way before, I only popped out once told everyone, then became huge very quickly!!

any other general advice.

Its gonna behard juggling twins nd diabetes, once they are here (nevermind the fact you have one already too) for the first month or two my consultant left me with 10's in BMS and didn't want me going lower, then slowly we started addressing the poor control again. I found it hard until recently to do more than one BM a day - so tired, twins and single meant no spare time for me! But getting there, HBAC1 still high but fingers crossed for review this month its lower and will continue to improve. Top tips which you probably already know, get lots of those feed sorters (bottlefeeding) and measure out bottles all in one go, have flask with loads of fresh boiled water handy and don't bother getting dressed if you can help it - just enjoy the two (when they arrive) they are special in many ways (Diabetes, Premmature and twins) and return all the worry and love in the funny amazing things they do once they notice each other, don't miss out watching them! I haven't and love every minute although still tired!!

Good luck with the pregnancy, will make sure prays sent for you to have beautifully healthy twins!!

Thank you for your experience - it's very enlightening. I'm not too concerned about my levels as with ds my highest hba1c right at the end was 6.2 so I know I can manage my sugars although it isn't fun.

Interesting on the work point. Does your job involve a lot of physical effort as a nurse? I have a desk job so only moving around is going to meetings and mental effort.

I know what you mean about any nurse/mw and diabetes. They're all completely hopeless. And don't get me started on some of the junior endocrinologists....

I think blood sugars go funny after birth anyway twins or not as your experience doesn't sound so different from mine with one. I know it's something to watch out for again.

Thanks for taking the time to respond.

I have type 1 diabetes and had dtd last year (they are now 15 months). My experience is that I was told I would be induced at 38 weeks, if I got that far. I had expressed a preference for a natural birth & to breastfeed, and these seemed to be encouraged at the antenatal appointments (although I was made aware that there was a high likelihood of a csec).
I, too, had a couple of miscarriages and was very wary during the pregnancy. We made it to 36 weeks before being admitted with suspected pre-eclampsia. After this was confirmed, I was advised to agree to a csec. Unfortunately the Neonatal unit at my local hospital had a serious infection so I had to be moved to a hospital 25 miles away to have my csec, meaning that I had no contact with my antenatal care team (Consultant obstetrician, Diabetes consultant & diabetes midwife). In fact I didn't speak to any diabetes specialists following the birth until I had a severe hypo whilst in a parent room in the Neonatal care unit.

I wish I had been told about the following:

1. that I was at high risk of pre-eclampsia and therefore what symptoms I should be looking for. I have since read the risk factors and I tick nearly all the boxes. If I had have known, I could have contacted someone once my feet started to swell up, rather than wait for my next weekly appointment.
2. That there was a high likelihood that my babies would be admitted to SCBU / Neonatal care. I was only told this approx. 2 days before the girls were born, as it was the reason we needed to be moved to another hospital. Obviously having children in SCBU is very stressful, especially not knowing how long they will be there (dtd were there for 10 days as they had some feeding difficulties but were otherwise healthy). I would have liked to have prepared myself for this possibility.
3. How bf would impact on my diabetes control. My girls required bottle-feeding whilst I was still in theatre following the csec, so I was recommended mixed feeding. I felt I could not live with the wild variations in my blood sugars (e.g. going from 22mmol/l to 2mmol/l in 30mins) for more that the first 8 weeks. The only advice I was given was to eat more, but I could have done with more advice on the effect of bf on blood sugars and when the best times are to test blood sugars, take insulin and eat in order to cope with the fluctuations.

Perhaps you could ask questions about whether these points are relevant in your case.
In the same way as DP2302, I have found having twins with type 1 diabetes incredibly hard work, but also extremely rewarding. I wish you all the luck in the world.

Late reply, but I'm type 1 (pumping) and have a surviving identical triplet plus a 4yo DD. I'm in S London and care was split between St Helier and St Georges - good experiences of both hospitals, especially the specialist diabetic antenatal clinic St Helier runs, with a MW then DSN then both consultants in the same room with you to go through stuff. Takes ages, but definitely worth it.

The diabetes was not particularly harder in PG with triplets/twins than it was with a single tbh. They arrived at 31 weeks, emergency CS after my waters broke and a scan showed he was extended breech. They had developed acute TTTS at just under 24 weeks, he was the only survivor of the laser ablation I had & the other two were stillborn, so no experience of diabetes and multiples post-birth sorry. He spent 5 weeks in neonatal, I BF him for a year - he's 16 months now. Without the TTTS I would have been booked for a CS at 36 weeks exactly, which is the norm I believe now for ID multiples.

Watch out for hypos in the 3rd trimester, as it's a sign that the placenta is failing and it's a higher risk with multiples as that puts more strain on the placenta too. Make sure anything like that is checked out pronto.

Make sure you pack a bag full of food to take with you to hospital, I always find the hospital meals don't have enough carbs in them to keep me going.

If you're having IDs then watch out for any sudden increase in bump size, any extra breathlessness or similar as this can be a sign that TTTS is developing. Catching it early and getting it treated gets you a much better outcome, usually it's considered "chronic" (much like diabetes lol), we were unlucky and got the acute version which normally only develops during labour - which is why they like to whip ID multiples out via the sun roof.

Good luck, I hope everything goes well for you.

Thanks for the responses (I'm TTT under a different name). Tinytoes I had that experience with bfeeding ds and think it's just a normal post-natal/bf effect unfortunately but at least I'm prepared for it this time.

Xalala - really sorry to hear about the loss of two of your triplets. The food point had already been taken on board after an appt at 15 weeks when I was stating that I wanted a vbac because I wanted to be out of hospital asap and that all my nightmares were currently centring on post-natal rather than being cut open e.g. being told supper's coming, therefore injecting and then discovering none for me as order times are early in the morning and I hadn't got to post-natal yet. Obs response was "well you shouldn't have injected" and "what do you think this is private?". In my view if you're given information and medicine you go with what you're being told and keeping people in for 24 hours with no food is not exactly medical care! So obviously I will be taking my own supplies..... and the lovely health care assistant who knew all about diabetics but when I had a hypo said I was being obstructive and tried to take ds from me and bottle feed him when I had been struggling and finally overcoming nipple rejection. (dh says I will now just use my authoritative tone to inform relevant people that I fed ds until he was 11 1/2 months so do know what I'm doing thank you very much)

Thankfully the twins are DCDA so at least that part of me is relatively low risk. In fact I don't get any more appts than a normal diabetic pg.

I'm thinking again about delivery. Although I am more or less resigned to another csec if labour did start off by itself I might have a chance dependant on dt1's position..... Am I mad? Probably.