Type 1 Diabetes Pregnancy Support Thread

[MrsNuckyThompson]

Wow - with a catchy title like that, who could resist? I was part of a lovely supportive thread like this one during my last pregnancy which was nearly 4 years ago now. I'm currently around 6 weeks pregnant with my 2nd DC. DS is 3.4

Anyone want to join me?

Yeah sorry I meant not to target. Not high. I've still got a bit of endogenous insulin so I wouldn't ever go right off the scale without it.

just impressed how tight a ship you run tea!
5.9 in the morning wouldn't even warrant a blink from me, even by my pregnancy standards...

Yes I was told to relax a bit at my last appointment!

Have been checking every couple of hours today and things are ok so who knows what I did?

I can only dream of a 5.9 in the mornings. I'm happy with single figures. I struggle to get below 10 without major nighttime hypos. Dawn phenomenon is awful and they're talking about a post preg pump for me because of it.

I was also 15 after lunch today fgs. Think I must have just forgotten to inject. Seriously not a good day!!

Taking DS to fireworks tonight - yay!!

So reassuring to hear other people's BG numbers sometimes - I really didn't believe my endocrinologist when he looked at a print out of my blood glucose meter numbers (which he barely skimmed) the last time I saw him and said I was doing fine - but because I never hit the 4.5 fasting and 7.5 post meal targets I was paranoid he was giving me false reassurance!

I'm 19 weeks tomorrow and still don't think I've had that jump in insulin yet but am keeping an eye out...

Hi all, it's been a week of drama for me as I was admitted to hospital with some heavy bleeding on Wednesday. Been here two nights. Bleeding tailed off but they are uncertain as to the reason. Good news is that baby is fine at the moment. See him on lots of scans
They have found a mass above the cervix which they can't decide is a blood clot or a fibroid. Whatever it is, that's what the bleeding seems to come from. The scary thing is that if bleed resumes or gets worse there is a risk of going into labour. I've been fearing the worst and it's really horrible, but my husband and I are taking comfort from the fact that the baby is fine at present, and we're just going to do all we can to make sure he stays put. I'm on bed rest and have no idea if/ when I'll be going back to work.

Diabetes wise, I've had my dreaded encounter with our nemesis, the sliding scale. I was nil by mouth the first night in case they needed to take me into surgery, so that's how they justified it. Incredibly annoying night of hourly blood sugars spiking to highs and lows. Managed to get take off it in the morning and have been doing my own BGs since then. In all other respects the care has been amazing and I feel so fortunate.

Anyway, hoping to be discharged today...
Guess I might start a thread in pregnancy as well to see if anyone else has had experience with fibroids and bleeding. (But don't worry my spiritual home is our type 1 thread!)

I'm really sorry to hear that Esker how many weeks are you now? What plans have they made for following you up after you've been discharged home?

Oh my esker, that's very tough few days youve had. Hopefully the bleed doesn't cause any more worries - have no experience with fibroids... But main thing is that you and the baby are both ok and being looked after. Big hugs.
I'm currently waiting for laser - soon 2h, argh! I hate having it done and being made to wait for it makes it all much worse.

Esker Thinking of you and hope you and baby are both doing OK...

Thanks for your messages people! And thank god for smart phones. Can't imagine how boring hospital stays must have been without access to communication, emails and news content on your phone.

Ripley I hope your eye treatment wasn't too horrid and that you're feeling way better. I've never had to have any sort of eye procedure but can only imagine that it's very scary and uncomfortable. Hope you've had some good results from it.

Tea I'm 19 weeks and so far haven't had any bleeding or issues so this was a real shock. Anyway, hoping it all calms down and we can proceed with a safe pregnancy. It's a bit weird because at the moment I have no idea about whether this will be some sort of anomaly and will just go away, or whether it will make the rest of the pregnancy extremely high risk and touch and go, possibly resulting in a very premature delivery.

Good news is that blood sugars have been behaving ever since I got off the sliding scale. Cue admiring remarks from midwives etc 'You're so good at managing your levels.' And me like: 'Exactly! It's all I bloody do. So feck off with your mad sliding scale '

Hello all.

Sounds like a scary few days Esker. Keeping fingers crossed that all is okay and you can manage to catch up on some box sets/good books to take your mind off worrying whilst on bed rest!

I had 32 week scan today and baby measuring fine which was reassuring as I have a rather large bump now.

Voiced my concerns re sliding scale and monitoring etc when in hospital for the birth, and was told that apparently whilst on it I will have 'perfect control, better than you currently have' - this doesn't seem to agree with anyone else's experience of sliding scale! Apparently the nurses will administer the insulin and glucose, it will not be up to me. I plan to still wear my CGM, but they will take hourly BMs and adjust each hour (my CGM takes readings every three minutes).

Do you think it is even worth me raising questions over whether it will be easier/better/more successful for me to self monitor if they are determined that I must be on a sliding scale?

Hi Snoodleberry, great news that your scan went well!

I can't advise as to the merits of sliding scale in labour as this is my first baby. Other posters have though so I'm sure they can give opinions specific to labour.

As to my experience of sliding scale in general though... The reason they wanted a sliding scale, and that I agreed, was that I had to be nil by mouth in case of needing to be anaethestised for emergency surgery. I hadn't eaten since lunch and it was 9pm, so I was worried about the baby not having nutrients and getting dehydrated. So they gave the saline drip, which contained glucose, and then also an insulin drip to offset it. The default setting for the insulin drip was 4 units per hour. That adds up to way more insulin than I would normally be having (not sure what the rate of delivery for glucose was). I told them that it would send me hypo, and sure enough it did. Then their correction of glucose made me high (and so it went on all night).

I think, in theory, if it were managed expertly, a sliding scale could lead to good control. BUT, as far as I can see, the people managing it aren't as experienced as we are at managing blood sugar, nor are they familiar with the individual patterns and nuances of our particular bodies.

Delivery for me is, I HOPE, a long way off, so we haven't discussed sliding scales etc. However in light of this experience I plan to be firm in refusing one. I remember Ripley saying that she kept an hourly log of blood sugars during labour and was able to use that to prove that she was managing it herself and didn't need sliding scale.

In addition to all that, I expect the experience of labour will not be improved by being hooked up to a drip, which is utterly loathsome and to be avoided at all costs in my view!

Whilst I haven't been on a sliding scale before I would also have concerns about the doses being too high as my insulin requirements at the moment can be low. I think my Consultant would probably write up a modified sliding scale for me in that case with smaller doses so you can ask about this too.

On the other side of the sliding scale though it is very formulaic so it doesn't require much thinking about and just adjusting to the chart. It gives staff a feeling of control in a condition that they aren't generally experienced in.

I've been in labour before, not with T1 obviously, but there is NO WAY in the world I would have been able to manage checking blood sugars, correcting highs or lows whilst actively labouring. So I'm thinking during the induction I would want to manage it myself but whilst actively labouring I don't think there's any chance I could do that. And that means relinquishing control for a bit but I don't really know what else I could do. My husband certainly couldn't do it.

Hope you're ok Esker?

Are you now back home Esker? Feeling ok any case I hope.

4 units per hour?! That sounds like a crazy amount... While doing my researches I'm sure I came across a document where it said the standard rate should be 1 unit/h, with flexibility depending on how many units per day the patient is taking normally. And if bg is higher/lower than desired then that affects it too.
I'll have a look for itIagain, it was a whole paper on the thing...

Re labour: My bg readings log was I think every 30min most of the time throughout labour. Bit ott, perhaps... but meant I really was on top of it .

Snoodleberry We talked about the pros & cons of sliding scale a few pages back, but to recap: For me, I feel I know myself/my diabetes FAR better than stranger (albeit a HCP) will, plus in order to reduce the already medicalised birth I wanted to keep my pump on.

But I know there are ladies who have been equally strongly opposed to the scale, who have ended up having to go on it during labour and have had absolutely fine & problem free (from diabetes point of view at least) deliveries. It's a fairly frequent topic at the pregnancy forum in diabetes.co.uk as most do find it a dubious thing :).

If interested, this was the document with the suggested rates, among a whole lot of other stuff:
www.diabetologists-abcd.org.uk/jbds/JBDS_IP_VRIII.pdf

Just coming to the thread for the first time in a few days.

Esker - really hope you and the baby are ok. Very worried about you! Please update us when you get the chance. Xx

On sliding scales. It is so ridiculous to suggest control would be 'perfect' on a one size fits all scale with inexperienced midwives administering the glucose and insulin. If it was as easy as giving a standard dose every hour we'd all have perfect control.

I dealt with this in hospital by simply saying 'no thank you, I won't be going on a
Sliding scale'. Ultimately they can't make you so if you are clear you don't want it just sat so.

Having said all that by the time you're having the baby one or two random highs or lows are neither here nor there and won't be the end of the world either!!

Hope everyone is going ok. I've had a terrible weekend of readings. Think I need to get control back under control (!!) and adjust some ratios. Like others have said I'm often a bit reticent to change things and fear hypos particularly at night.

Half way tomorrow!! 20 week scan this week, fetal scan the week after next.

Thanks Nucky! Sorry I should have said before - I'm home now. Hallelujah! Got let out yesterday morning. So lovely to be lolling around on my own sofa.

I"m not going to work this week. I've got 20 week scan tomorrow and then follow up scan with foetal medicine unit on Wednesday to assess whether the mass (blood clot? fibroid?) has changed / grown. I guess they will determine their more long term care plan from then. Then I've got clinic on Thursday, so will be visiting hospital 3 out of 5 days this week! (But hopefully NOT as an inpatient!)

esker - so happy to hear it. Definitely take the week off and relax if you can. All the medical appointments will probably be good as it'll be reassuring. Really hope this has just been a minor glitch!

Clinic today. Good strong heartbeat, everyone happy enough with readings (tho have been quite a few more highs and lows lately) and have been booked in for all my growth scans now. Have 20 week scan this week, cardiac in 2 weeks and then growth scans at 28, 32 and 36 weeks. It was so weird typing them into my calendar in my phone knowing that by then my baby will be almost here!!!

Esker - how are you? All still ok?

How is everyone else?

That's good news. I was given 4 weeks off clinic for good behaviour but have community midwife next week. 15 weeks tomorrow. Numbers are good and nausea is finally settling!

Hi all, am writing from hospital as I got readmitted. Nothing so serious as last bleed, but I was having some ongoing bleeding (thankfully 'old' looking blood, not fresh) and they decided to keep me in. Had 20 week scan yesterday and everything was looking healthy, and I have my follow up scan with foetal medicine tomorrow to assess how / whether the blood clot/fibroid mass has changed.

Thankfully there hasn't been any business of sliding scale this time - just managing everything myself. Until today I've subsisted exclusively on a diet of M&S salads / sandwiches brought to me by husband and mum, however today I had to take the plunge and have hospital lunch. Shepherds pie with cement mash. I HEROICALLY declined carrot cake and custard for desert, although I would have loved to have it.

I'm on the antenatal ward and tend to be in rooms with women who are being induced. Quite eye opening. The poor woman next to me last night was in such discomfort... we were both very glad when she finally got transferred over the to the labour ward at 3am!

Great news on clinic visits tea and nucky. I've got clinic on Thursday. Hoping they'll give me a pass on my post breakfast highs, which continue to feature, in spite of taking way more insulin now. Being almost completely stationary isn't great either as I'm used to being far more active!

tea - good news that you are feeling a lot better sickness wise. I'm still finding myself 'off' food especially in the evenings, and am secretly hoping it means I won't reach the immense proportions I did last time (tho DS was a perfectly average 7lbs 11!)

Esker - yikes, can't believe you're in again. What a nightmare for you. Sooooo glad that scans of the baby are looking good. Sounds as though this is something unrelated which happens to be in the wrong place at the wrong time. Hopefully they can give you some more reassurance soon.

Hospital food is a joke. I mean imagine giving a diabetic patient shepherd's pie AND mash AND cake?!? I found there was a lot of that - tons of pasta, potatoes, sandwiches, baked potatoes. A nightmare in many ways. But you can only do what you do. Hope you have some good things loaded onto an iPad or Kindle to pass the time!

Esker hope things settle down. Good that they are monitoring things.

You must be going spare in hospital. I have also been on a ward where women were getting induced, it was really uncomfortable listening to them all night (not their fault clearly!). I did not sleep well! Post natal wards were also fairly unpleasant I found.

Interesting about the food, did they make you choose a diabetic menu at all? I wouldn't want to have any food that a hospital thought was suitable for a diabetic! I am expert at leaving the potato on shepherds pie or picking pastry off things so hopefully can just chose from the normal menu. That post birth toast is going to taste amazing!

Morning all!
Very pleased to say that I was discharged from hospital yesterday. Scans show that the baby is well. They have decided that the mass in my uterus is in fact a haematoma, but they are not sure of the reason for the bleed, as the blood is clearly separate from my placenta (a few centimetres away). The typical reason for such bleeding would be to do with the placenta partially detaching, so they're not sure about the source of it my case. However, it is good that it's not to do with the placenta, as that can be very risky.

It was so good to be back at home in my own bed! I'm off work for at least the next two weeks, when I will have another scan to review the size of the haematoma. Strange times.

Funnily enough I am back in hospital right now, but just to attend clinic. Fortunately, the consultant who discharged me happens to be the lead consultant for diabetic pregnancies, who I hadn't yet met. I'm really glad that she is now aware of my case and the problems I've been having.

I still have some bleeding ongoing, which is scary, but it is all 'old' blood and I just have to go in if I get anything bright red. It's horrible being back to the 'knicker checking' stage , but every day we make it is a step in the right direction!

Blood sugars have been ok but not great. Tea I'm not sure if they offered a diabetic menu or not. They did come round as ask if I needed a special menu (eg Kosher or Halal), and I just said no. I expect if I had enquired there would have been some sort of diabetic option, but I couldn't be bothered as I thought it would be rubbish. I was in for 5 nights in total and I only had to eat one hospital meal, and just ate from M&S the rest of the time, so I think that's the best course of action (if you're able to have people bring you stuff!).

I hope everyone else is well and having a good week!