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?

[teainbed]

Or a burger. A really massive one dripping with cheese and relish and all the lovely extra bits.

Even just mindlessly eating some crisps without being exact about the carbs and weight would be nice.

[Snoodleberry]

So just passed the 26 week mark, and apart from weeks 13-16 where I reduced my insulin quite a bit, am suddenly on a huge insulin hike.

Am on MDI and would normally take total of 18 basal (split dose) and around 22 total bolus insulin through the day.

Since Sunday have had to increase everything daily to my new record amounts taken so far today of 29 basal (split dose) and 40 bolus insulin, whilst still having exactly same diet as last week.

Am wearing my CGM so can see what is going on with my BS, and have changed my insulin cartridges in both pens just in case something had gone wrong with my insulin or delivery.

Is very odd, but I am guessing that as I am expanding so much at the moment, that suddenly my insulin requirements are increasing. Is just madness how quickly I have had to increase my insulin intake and by so much. My carb ratios are completely different this week to last week.

Anyone else experienced something similar?

[Ripley79]

Hi snoodleberry, I think what you are experiencing is fairly normal. For me the increase last time was more gradual than what you are describing but both the basal rates & carb ratios did change considerably by the last trimester (and then came down a bit). If you go back a few pages on the thread you'll find a graph from 'Think like a pancreas' on the average insulin requirements in pregnancy - the rise is quite drastic! How fast it happens is very individual I'd imagine.

[MrsNuckyThompson]

Does anyone have a good cauli rice recipe? I have previously pan fried (a bit soggy!) and roasted (drier texture but a faff). I've tried the pouch stuff and it mings.

Figure if I can sort this then I can keep evening meals very low carb. They are my issue due to hideous dawn phenomenon. The lower but more stable I can get to bed the better.

Thanks!

[teainbed]

Probably too late but after blitzing it in the food processor I just microwave it for 6 minutes. What were you serving it with? Once it's 'cooked' you can just do whatever you would with rice or couscous.

[MrsNuckyThompson]

Not too late - making it tonight. Made a chilli yesterday, so I guess the taste doesn't matter so much as it is going with something quite strong tasting! However, wanted to avoid a soggy texture which was my fear with microwaving... What does it turn out like?

[Esker]

Evening all! Hope the cauliflower rice has come off well and that everyone has enjoyed their respective dinners.

I'm still in the low insulin phase big time. Today's total bolus dose is 3 units (one for breakfast, one correction for post-breakfast high , one for dinner). To be fair I've been quite low carb, but this does feel absurd.

I've got clinic again this week. Does anyone remember at what sort of stage you started discussing birth options with your team? It is still ridiculously early for me to be to be thinking about birth (14 weeks), but I am quiet keen. (And may have been obsessively watching One Born Every Minute, for better or worse).

For those who wouldn't mind saying, could I ask what type of births people had last time (e.g. how many weeks you delivered at, and whether you had VB or planned / emergency section?)

[Ripley79]

Wow, that is a low bolus day Esker. I've now had a few slightly high days so have begun to increase basal a little bit here and there.

Birth plan/options were discussed & set around 36 weeks iirc (I brought it up earlier but was told 'later'). With me there wasn't much of a discussion mind, other than I was very keen to keep the pump and avoid the sliding scale, so that was the main thing on the birth plan.
Labour was always going to be induced around 38 weeks and I had no desire to challenge this. The date was set after the 36-w growth scan.

Induction started 38+1 and baby was born 38+3, 2.6kg VB with forceps. It took a while as it seemed neither my body nor the baby (still very high) were quite ready for it.
Induction methods: The gels had some effect, breaking the waters did more but the real kickstarter was the hormone drip. I found it to be quite nasty stuff, but obviously it worked and that's the main thing...

[teainbed]

I've not had a pregnancy on insulin before as my GD pregnancy was discovered late and diet controlled only. I was induced at 36+6 for BP issues. Actual birth bit was fine but like Esker said your body isn't really ready for it and it took a while to get going. Was also induced the other times for being overdue and BP issues. I assume I won't get past 38 weeks, I think I'd be doing well to get that far.

Quiche with no crust for my dinner tonight, have you tried one before? Surprisingly nice and low carb.

[teainbed]

Sorry I meant Ripley!

[Sugarcoma]

Ripley Thanks so much for posting that - hope you don't mind some follow up qs. What's the sliding scale? And why was the hormone drip especially nasty?

You've worried me with the forceps - I think I read on another thread someone saying that having done forceps for their first DC if they had to be used again for their second they'd rather take a C-Section. What do you think?

And how was your baby's sugar after they were born? I heard sometimes they go a little low after birth.

[teainbed]

A sliding scale is an IV drip of insulin and dextrose that is adjusted every hour according to your blood sugar. The hormone drip makes false contractions if you aren't making them yourself during an induction. They're very strong and a lot of women would need an epidural to cope with that.

The forceps vs C-section thing isn't as easy as making a choice at the time. If forceps are needed it's because the baby is really far down the birth canal and due to say a dropping heartbeat or inadequate pushing you need to get the baby out quickly. If you were to say 'no forceps' at that time and ask for a section you'd waste valuable time but also the baby would have to be pushed back up the birth canal to be born by C-section. Neither option is great and forceps are pretty brutal but they can be lifesaving a quicker than taking you to theatre.

I was a bit sad when I had my midwife booking appointment, she asked if I'd like to come to a birth skills refresher class. I just don't think there's any point as it's likely to be a very medicalised birth.

[teainbed]

I realise that was to Ripley but that's my tuppence worth!

[MrsNuckyThompson]

I delivered at 37+6.

They leave it quite late to discuss what you want to do specifically because so much depends on how you get on, what the growth scans show etc. DS was not big and in the end it was a couple of high blood pressure readings which convinced them to start inducing me at 37+5 rather than 38. Having said that this time they have already starting discussing it and I think you should raise it as soon as you want to.

I had a completely failed induction. They tried the pessary twice and nothing whatsoever happened. They didn't even start on the drip because I wasn't even a single centimetre dilated.

I had a c section in the end. Counts as an 'emergency' because it wasn't planned in advance but it wasn't rushed and all quite relaxed. It wasn't the birth I hoped for but frankly was very straightforward and my recovery was quick and easy compared to many of my friends who had instrumental deliveries with various degrees of tears etc.

DS was fine when he came out and his blood sugar was completely stable. One thing is that it took my milk 4-5 days to come in which was really tough.

If you haven't already looked into it I highly recommend researching colostrum harvesting. It is now recommended by my hospital but last time was something I did on my own. I started hand expressing and freezing my colostrum from 36 weeks so by the time I delivered I had a good supply to fall back on while we waited for the milk to come! Midwives all looked at me like I was bonkers turning up with my stash but it kept DS off formula which was what I wanted in those first few days.

There is a lot more to say. Please feel free to ask any questions.

[Esker]

Thanks so much to everyone for sharing experiences.

I've been thinking about this a lot (obviously), and am keen if possible to have a planned c-section. I guess mainly I'm worried about the seemingly high odds of failure to progress and then having to have a section anyway. I've also read an interesting study about women with T1 apparently having 'poor uterine contractility', which can apparently impede the efficacy of induction drugs. Can share link if anyone is interested. However I do not have a medical background so am first to admit that I may not be the best at understanding the complexities and nuances of the study / data.

I had a very traumatic emergency surgery a couple of years ago (appendicitis - bad infection - burst etc) and had a long recovery, and I fear the possibility of an emergency section. Although, as you say Mrs Nucky, its not likely to be an 'emergency' other than in the sense of being unplanned.

I have no idea whatsoever how supportive or not my team will be about this preference, so kind of want to raise it soon so its on record, in case they are very resistant.

Having said that, I'm not completely opposed to the idea of a vaginal birth - they are the experts, so I will see what they recommend.

Definitely up for colostrum harvesting! Will take ANY tips you have about how to do this

[Ripley79]

Good summary of the drips teainbed !

Forceps were fine sugarcoma. We were already in the theatre and close to a cs so I was very glad the forceps approach worked. It wasn't particularly comfortable and a small episiotomy was needed, but it healed well. No qualms about using them again if needed.

Sliding scale can be great am sure, and it'll let you concentrate on the labour rather than worry about bg levels. I however abhor the idea of giving away the control of my diabetes management, especially to people I don't know. And in a 3 day induction, that's a lot of people...
Sometimes even the endocrine registrars come up with most idiotic things, so I simply couldn't trust an obstetrician or a midwife to do the right things with my levels. But this is just me.

Hormone drip was fine to begin with and seemed to be working, then the dose was doubled and it got insane. Took aaaaages to get the epidural but after that it was manageable again. If I end up with the drip again, I'll probably ask for the epidural straight away. Tho as said, it was fine to begin with so not quite sure.

Baby's bg levels were OK, first 2 readings were in the 2's which sounds low but newborn levels are lower than normal, last one they took was 3 or 4.
I thought the newborn levels are down to the last few days in the womb, but a consultant I saw a couple of weeks ago said they reflect more the last 5 or so weeks... Which I'm not quite convinced by yet!

And I second mrsNucky on the colostrum. At my old hospital the midwives gave small (needle-less) syringes for it in the last trimester meetings & were very encouraging about collecting it. I was pretty out of after the delivery and was very glad we had them for her.

I think I read the same study esker and mentioned it to my endo in 2014. Her view was that maybe there is something in it but she had also seen loads of t1 women having totally normal births despite inductions (and 2nd pregnancy births without inductions) - and the way the bodies work & react just is incredibly individual... Sounds bit faff, I cannot quite remember what she said, but it reassured me to believe my body could do it...

[MrsNuckyThompson]

Ripley - I also didn't go on a sliding scale. I was adamant about it after having found basically no benefits to doing so (different with a GA of course!). During induction (when nothing happened) I was perfectly capable and with the section I was in and out of theatre within the space of an hour, so what on earth would be the point of going on a sliding scale? Medics were bemused but really left me to it.

Esker - I completely understand your thoughts around the planned section. I was very keen to try to have as natural experience as possible first time round but quickly realised it would just not be like that. Even with induction you are 'tied' to the bed by more monitoring than a 'normal' woman and just prayed I'd go into labour naturally. Of course that didn't happen despite my best efforts - even went for acupuncture to try to loosen everything off.

There are down sides to a c-section, even if you heal quickly like I did. Milk does take much longer to come in which is stressful and despite being a good weight coming out (7lbs 11) DS dropped dramatically while we waited for it come in. I also ended up with horrific thrush in my breasts/nipples which is caused by the massive doses of antibiotics they give you! Took weeks to clear and nearly made me stop breastfeeding. The pain was 10x worse than the section.

Having said all that, I am very much leaning towards another section. I don't want to be in hospital for 2-3 days again being pumped full of drugs to make something happen which isn't naturally happening! The uncertainty might kill me this time, not to mention the fact that I'll be away from my PFB!

I'm going to a 'birth choices / VBAC' appointment next week. In particular they've mentioned they're trialling a new type of induction whereby they use a balloon to dilate you and break waters, which is a more natural way to start the labour. Part of me would like to be able to say I've done it. Part of me just wants to stick with what I know!!

teainabed - I know what you mean on the medicalised birth! I felt so sad about it and quite resentful in NCT as everyone was banging on about water births and all the rest. In the end I think I was one of two(out of 7) who recovered quickest from our births. Some were left in agony or traumatised by their natural births!!

[Esker]

Ooh MrsNucky that nipple infection sounds awful! Poor you! And the balloon dilation technique sounds interesting as well. You've all definitely given me a lot to think about.

I had clinic today. Only saw the Diabetic Specialist Nurse as I don't need to see Ob every time as only 14 weeks. Good appointment, happy with readings and going to make another reduction to morning Levemir to reduce afternoon hypos. She made my next appointment for four weeks time so I don't have to go back for a while!

I asked her when I would start to talk to the Ob about birth options and she said 36 weeks, just as others mentioned upthread. I was a bit aghast at this as it feels so late and I asked her what would happen if someone went into pre term labour when no plan was in place. She said in that scenario in all likelihood it would be a c-section.

I told her about my horrid experience of emergency surgery on a previous occasion and started crying . She was very nice and held my hand (literally) and basically said that I would ultimately be able to to have a section if that was what I really really decided I wanted, but that of course I need to hear all the arguments and discuss properly at a later stage with the doctors. So in conclusion I just need to chill and remember that I am only FOURTEEN WEEKS!

Low carb roast dinner this evening: roast chicken and cauliflower cheese

[MrsNuckyThompson]

Glad she was so nice about it. Also remember that although she does this clinic she's a DSN not a midwife or obstetrician. So you might find that the next time you see those folks if you bring it up they'll engage in a bit more detail.

To be honest I'd say that if an T1 went into labour naturally they'd let it run its course (unless something else had been planned of course) Surprised she said straight away a section! But then I'm not a midwife either so what do I know? It's just that first time round there was every encouragement that I might well go into natural labour and if so that would be great. If you think about it the only reason many diabetics are induced and end up with instrumental deliveries and sections is because they're trying to bring the baby out much earlier than its probably ready for.

But ultimately everyone (T1 or not) is entitled to elect a section so stick with it if that's what you want. Just keep chatting to them about it!

[Ripley79]

Same feeling here about the medicalised birth, but there are some positives about it too.... Like not having to stress about when to head for the hospital. And... Well, that's about it .

In order to counterbalance the heavily medicalised & early birth, in addition to the usual raspberry leaf teas, pineapples & curries we also did a hypnobirthing course... I was very sceptical about it, but found it pretty relaxing. It definitely didn't do any harm - was just practically useless thanks to the hormone drip. Really no chance "breathing" the baby out with that stuff pumping through!

I also saw an osteopath (who was strongly recommended by the nct course teacher) couple of times in the last few weeks before birth. No idea if he actually managed to alter the baby's position much but at least it had a positive placebo effect. I think I'd like to try him again this time.

This is going slightly off topic but has anyone here been to a baby-show?
Are they any good? Mainly interested in the discounts on prams as I need to get a lightweight stroller and have got obsessed with babyzen yoyo (can go as hand luggage...) but they cost a fair amount even 2nd hand. Probably totally the wrong thing to buy at this stage, let's just say it's the hormones.
I'm London based and am wondering about checking the next one in end of Oct.

[MrsNuckyThompson]

I never went to a baby show ripley. I'd say go along if you know you can restrain yourself and / or you write yourself a list of things you want to try to find a discount on. Or even just see / touch / try out different products and buy them later.

But otherwise I'd fear you could end up by dazzled by a whole load of gumph you don't actually need or really want!!

Do those yoyo ones do from birth?? If so that's pretty cool. We fly quite a lot and could have been doing with one which goes as hand luggage. So handy!! Having said that I loved my bugaboo and will be using it again this time.

[Sugarcoma]

Thank you so much to everyone sharing their experiences - it's really interesting and helpful to be forewarned!

I saw my endocrinologist this week and although I'm only just 14 weeks actually he brought up birth options, which was reassuring. He seemed quite adamant about the sliding scale though although I also don't like the idea of handing over control to anyone else.

But if you're not on a sliding scale what happens when you've been there for a while, you're not allowed to eat and your sugars start to drop? Do you just drink something sugary?

[MrsNuckyThompson]

Hi sugar - yep you'd just treat the hypo. To be honest I ran just a little higher (dropped Levemir) as I wanted to avoid hypoing. I put DH in charge of prompting me to test.

Top tip to others - am out for girlie lunch today and Bella Italia was the chosen option. Urgh, I though - pizza, pasta and bruschetta. But they've only gone and put spiralized veg on their menu as a pasta substitute!! Very civilised lunch option!!

[teainbed]

Just checking in. Nothing to report except sickness. Sugars are good. Antenatal clinic this week.

[Esker]

Evening all.
Sorry to hear about the sickness tea. I hope is eases off soon.
Great news re spiralised veg at Bella Pasta Nucky! Would be great if more places started doing that. I keep longing for mountains of pasta. Tonight am having my classic vegetable bolognese, which is basically bolognese sauce made with absolutely tons of veg in it so you just eat it on its own as opposed to with pasta. Sometime make sprialised veg but can't be bothered today.

I had been feeling proud of myself as got through a carb fest social occasion (Thanksgiving dinner at a friend's house yesterday) with ok blood sugars. HOWEVER my smugness has been blown by annoying stupid mistake this afternoon which left me with a reading of 10. Forgot to account for the super high fat content of taramasalata, so despite an ok-ish post meal reading it later crept up on me. Pure stupidity on my part not to have thought it through so I"m quite grumpy.

Anyway, need to move on. Close friend has passed on a ton of baby stuff to me: moses basket, cot and lots of maternity clothes. I wouldn't have bought it all so early myself, but as its a hand-me-down, who's arguing?

Hope you are all well!