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?

Esker - that is so funny, I'm 28th March on dates, but based on my measurements and my own calculations, I think it is more likely 2 / 3 April. Basically the same as my DC1 (pretty sure we got up-duffed on our anniversary weekend away - we got pregnant the first time on honeymoon!). I also had to go into London yesterday and it was terrible on trains / tube. Wfh today and it is much better!!

teainbed - congratulations! The good news is that you'll likely be able to have an early scan and some proper medical contact sooner rather than later. I think 'normal' women just have to wait until booking and the 12 week scan to see anything, so maybe one advantage. Do keep popping in and let us know how you're doing - I'm only 8 weeks and so is Esker!!

Teainbed - Welcome and congratulations! Hope you're feeling well. I'm on my first pregnancy too so eagerly sucking up advice from the more experienced on this thread.

MrsNucky Funnily enough, I'm 29 March based on dates, but a few days behind based on measurements as well! Having said that, I'm assuming the diabetes team will want me to deliver slightly earlier, so may be looking at any time in latter half of March.

I attended antenatal diabetes clinic for the first time today and by god it was loooooong. I showed up for my 10.30 'appointment' and only managed to leave at 12.45. Everyone was lovely though. I saw a registrar, dietician and obstetrician. I must say being Type 1 is so bloody burdensome but at least we get the VIP treatment with loads of attention, scans and appointments Do you guys find that clinic visits tend to take forever? It was worth it though - good to have a sit down with someone who forces you to actually analyse the patterns of your BG readings. Even though I know I'm always high after breakfast, it took today for me to actually process that I need to actually act on this by adjusting ratios rather than with corrections that lead to a hypo Every Single Day. Got gently admonished for too many hypos so I need to watch that too.

Hope you're all feeling fine and managing to stay cool!

Esker my DS was due 3 April but was delivered 37+6 which was 19th March (this is massively identifying but who else will ever want to read THIS thread, right??). I think it'll be similar this time. For an idea of what to expect have a look at the NICE guidelines on diabetic pregnancy. The accepted wisdom is not to proceed beyond 38 weeks because there is a heightened risk of placenta failure.

Clinic takes AGES. The later in the morning the appt actually is, the further behind they run and the longer I'm there. It's a minimum of two hours each time. I just take my kindle and settle in (impossible to try to do work!). I've just blocked out my diary every clinic morning for the next several months!

At my obstetrician appt this time we discussed delivery options. The consultant in charge was very pro section and anti- VBAC. This lady is younger and more progressive and says no reason not to try a vaginal delivery and has even mentioned some other options for induction this time. I'll weigh it up closer to the time. In some ways it would be good to have a bit more certainty this time. I had so hoped to go into spontaneous labour which didn't happen and after two failed inductions (literally nothing happened) I sort of wished I'd just had a planned section. We'll see. I honestly don't feel as though I've majorly missed out on a life event by not having pushed out a baby

My last post should read: the consultant in charge for my LAST pregnancy was very pro section. Etc etc.

Thank you Esker and Nucky

Feeling sick but otherwise ok. Have woken up low the last two mornings but control is very good otherwise.

Should say it's not my first pregnancy, have 3 DC already. Last pregnancy had a bit of a surprising diagnosis of gestational diabetes (surprising as I am slim, don't fit the GD 'type') but later on diagnosed with an adult type 1 called LADA.

Got a nice positive 1-2 weeks on the CB Digi this morning so will phone and get booked in.

I'm quite surprised at the two weekly clinics. Is that normal or just if you're having problems with control? Going to be some interesting work juggling for me. Read the NICE guidelines last night about T1 pregnancy that were quite enlightening.

If you use CGM or a pump how did you find the change from basal/bolus? It was mentioned at my last Consultant appointment but he said it was something to consider in the future but I wonder if they might push that again.

Hello all! I'm 9 weeks with my 2nd, 1st one is 2 years. Early days yet but so far all good... I'm on a pump and been t1 for 28 years. I wasn't even looking for a t1 specific group as was searching for posts on fetal echo scans, but this will do nicely .
I've recently switched hospitals and the new one doesn't do the fetal echo on diabetics, whereas my last one did. The (endo) doc I saw said that they instead do the 20 week anomaly scan more thoroughly... Which doesn't quite fill me with confidence, so I am now stressing about it.
Do all your hospitals do them, regardless of conception hba1c or is it case by case decision?

Hi Ripley and welcome! My hospital seems to send all diabetic pregnant women for the additional heart scan. I assumed therefore that that was standard, but may practice differs across NHS trusts? Doesn't seem right though, surely if it's necessary, it's necessary... Maybe if you kick up a bit of a fuss they will give in and refer you for one?

Teainbed- sorry I totally didn't realise you have kids already. Congrats on your 4th pregnancy! I've heard of LADA diabetes but not sure what it is- will look it up!

This morning I have whacked up my breakfast ratio and about to board a plane to Austria to attend a wedding! Good luck to me hiding pregnancy news amongst heavy drinking friends oh well.

Hi Ripley & teainabed! Welcome both and congrats on the BFP tea. I've heard of LADA too but don't know a great deal...

As for the fortnightly appointments, the hospital I go to do that as a matter of course, not just if you're having issues. Sometimes I go a bit longer between appts because of work and they trust me to keep things under control. But then recently I've found j really value that check in every two weeks. When I'm seen next week I won't have been for four weeks and that feels like ages - makes me feel a bit out of the loop!

And same goes for the fetal cardiac scans, they're done as a matter of course at my hosp. No idea whether that's a widespread recommendation though - just presumed it was. I'd push for everything you can get TBH. You can't be too careful or checked up on with a diabetic pregnancy I reckon!

And Esker - you jet setter, another week another trip ! Have a fantastic time, good luck trying to hide your teetotal status. Have you got an excuse lined up?!

No I think fortnightly appointments sounds good! It's just such a contrast from my last pregnancy where I had undiagnosed and untreated diabetes until 35 weeks! My Consultant is a professor and specialises in diabetic pregnancy so I'm sure they'll be on top of everything.

Woken up low the last few mornings but 4.7 today so I'm happy with that.

LADA is a slow onset type 1, different antibody from most of you who probably got it as a child or on your teens.

Good you are all getting them! So much pressure, the extra checks help with the nerves a little at least.
4.7 is a great start to the day teainbed, nice.

As I've just switched my care, I don't feel very sure footed. Pushing for extra... In my old hospital I had a great doc-patient relationship, would have been really easy there (tho not needed as they do the bloody echos). Still umming and aahing if I've done the right thing - switch due travel issues .

Will probably get the harmony test done, suppose adding a private cardiac scan on top of that is not much more. Hah. But will wait till I see an obstetrician. I assume they know what they are doing, maybe the approach makes sense once properly explained...

Fortnightly appointments was standard at old place, currently once a month and feeling bit lost tho am confident with adjusting insulin by myself. But hopefully it'll all pick up (and clarify) soon.

I was a bit sad I wouldn't get to see my community midwife this time, but I suppose they'll be around afterwards.

Can I ask if you all what you're doing with carbs? Before last week I was keeping them low, not Keto or Bernstein low but lowish. Is that OK to continue do you think or is it best to add in some more carbs?

Will also probably get Harmony test done.

I'm usually fairly low carb (have been for decades) and for last pregnancy I increased them a bit and seem to have done the same now. Pump says I average about 85 carbs per day - between 50 to 115. So it varies a bit, mainly down to whether I have porridge in the morning. Or cake at some point... Hmm.
I asked a dietician about this (during a very brief meeting) and she suggested somewhere between 100-200 is ok, so might try to up them a touch. She made more of a point about making sure to get enough calcium.

Ok, that sounds good advice. I think I'm around 50g per day but will probably increase that a bit. Dietician told me last time 40-50g per main meal and 10-15g for snacks. I've not eaten that much carbs in a day for quite some time!

www.nice.org.uk/guidance/ng3/chapter/1-recommendations?unlid=97151986920164213052

This was the guideline I was reading that advises what care you should be getting.

Hope everyone's enjoying the bank holiday weekend!

Teainbed - interesting to hear the dietician's carb advice. I haven't actually discussed recommended amounts of carbs with my dietician. Will ask her next time. All we agreed on last week is that I need to actually count them properly and not rely on my usual strategy of guestimation... still not following through on that. Having said that, I could easily put away 40-50g carbs at breakfast and possibly lunch, but never dinner. I just have to avoid carbs at evening meal as I can never get to a decent BG before bed.

Fiddlesticks - wedding in Austria has been great! Bride knows I'm pregnant as she's a best mate. I was a bridesmaid and I'm sure many people suspect, esp other bridesmaids. But I did have a pretty good 'excuse' as I was giving a speech at the dinner so said I didn't want to get drunk before that, and then by the time dinner was done everyone was pretty merry and not paying attention to what I was drinking.

Blood sugars have been generally good over the weekend in spite of lots of quite rich/ treat foods on offer, so that's good. Felt quite saintly avoiding dessert and wedding cake. Fortunately everywhere you look there's always tons of cheese on offer- pregnancy friendly eg Swiss cheese/ Gruyere etc, so I've still had lots of indulgence. I even danced until 3am!

Esker - it was a quick meeting so not sure if the 100-200 was more a guideline for someone on low carb or a general one. 200 is not low tho so I suppose it's flexible enough for both? Would be interested to hear what advice you get.
On the counting: I'm still guestimating a fair bit too but once insulin resistance etc kicks in later on the error margin reduces drastically - it can get tricky to keep within targets unless really anal with amounts. I ended up weighing stuff a lot on the kitchen scales (yawn).

Yes weighing stuff is boring but really makes a difference doesn't it!

I emailed my diabetic nurse this morning about the targets and she emailed me back, in the meantime I'd phoned the normal booking line and they gave me a community midwife appointment in 5 weeks and a scan appointment in October!

Was a bit confused by this given what you've all already said about early scans and two weekly appointments.

Anyway just got an email back from the diabetic unit and they want me to go to the antenatal clinic tomorrow! Feels a bit weird to be booking in at 5 weeks but anyway...

So I went to the ante-natal clinic today. All was fine and they were very happy with my numbers. I will get an 8 week scan and two weekly appointments. Had retinal photos done.

Saw the dietician who said diet should be 60% carbs. Mentioned 225g per day. I will need to have a really long think about this as that's tons more than I've been eating.

I wonder on what grounds they recommend all the carbs? I thought low carb diets were OK in pregnancy. Will ask my dietician next time. Not that I'm low carbing right now exactly off to eat a pork pie

Many NHS dieticians still tout the low fat, high carb nonsense even if they are supposed to be experts for diabetics. It is complete rubbish and anyone actually managing their blood of glucose well knows this deep down! With the targets they set it is completely unachievable if you eat 60% carbs. I firmly believe you'd be in a constant state of highs and hypos.

Interested to hear of others' targets. Mine are fasting 5, 5 before a meal and 7.8 or lower after one hour. Imagine trying to achieve that after eating a sandwich and a fruit salad!!!

Oh and additional fetal heart scan is completely standard here too. Had it with my last pregnancy. Absolutely fascinating scan and the doctor who did it really took us through everything. DS was doing star jumps during it so took a while!

If you haven't already, read the NICE guidelines for diabetic pregnancy (not just the gestational diabetes one). From memory the heart scan is recommended in there. I found reading the guidelines really helpful last time both in terms of managing my own expectations but also for being able to challenge if I felt something was not quite right.

I will also shortly start banging on about you all having to express colostrum before you give birth to take to the hospital with you. I think all women should do this but I know for us it was a life saver for breastfeeding as it took 5 days for my milk to come in. Google it if you aren't already familiar!!

MrsNucky, my targets are 4.5 fasting (usually meet this one); 5.5 pre meal; and 7 one hour post meal (this is the one I routinely fail).

I eat carbs at lunch, within reason, but tend to stick to the routine of fish/meat + non carb veg for dinner. We have had plain white fish and broccoli for dinner two days on the trot. Rock and roll! (Although today to celebrate first day back at school I had a Becks Blue and chips at the pub!)

I am keen to hear all your advice about colostrum- please feel free to bang on about it as much as you like!

225g per day? Eeek.

My current hospital has had no interest in talking about targets so far...
Very glad this is not my 1st pregnancy and that the last hospital had a different attitude! So am following their advice still, which was:
Less than 5.5 before breakfast and between 4 and 7 mmol/L 2 hours after meals.
With low carb meals less than 7 is doable for me 1h after but generally I aim for the 2h target (check after 1h to see if it's roughly ok).
And I try to inject about 20min in advance, which makes a difference.

Feeling bit despondent regards the hospital right now. Am still (constantly) thinking about switching back. Argh. Will once again ask them about the cardio scan at next appointment, but as the NICE guidelines are not rules don't think I can push for it if they don't think it's necessary.

On another note: My insulin requirements feel different this time - with my first I think they were rising slowly right from the start, this time round have been having to drop them. Sort of expected my body to behave as it did before, but seems not.

There is no way I'm going for 225g a day! I think that was based in the general crap NHS guidelines for a 'healthy' diet and nothing to do with actual evidence about the carbs needs in pregnancy or diabetic control.

That said I had a small fish and chips last night for my tea and must have absolutely nailed the bolus and timing as BG stayed steady all evening.

Cardiac scan wasn't mentioned at my hospital appointment either but it's still very early obviously. Only one choice of hospital where I live so I've got to lump it!

teainbed how did they diagnose your LADA? I am also a 'surprise' GD in my second pregnancy and they have said that from tests etc they suspect type I is lurking ready to pounce!