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?

Like your bolognese, I often put extra mixed beans into my chilli and then perhaps have it over broad beans instead of rice. Not completely low carb but slow release and a ton better than rice!!

After a bit of advice: last few days I've been running really rather low. Given I've been battling with DP I'd been used to seeing a few more high numbers than I would have liked, but I'm now fretting that something is wrong and it's because my placenta is packing up or something!

I don't remember this happening last time, although the obstetrician said last time that things do level out a lot more in the second trimester.

Does anyone think I should be worrying? I'm 15 weeks today and feel fine otherwise!

Hi MrsNucky, sorry you've been feeling worried. Just to check I understand - are you worried that running low could mean a problem with the placenta?

I haven't heard of anything like this. I've been running low most of the time (apart from odd spike), and I had the harmony test results last week, and they said that I have a really healthy level of some hormone that the plaecnta produces (so sorry I can't remember which one). SO, although I'm not bing very precise here, I don't think running low is particularly linked to placenta issues. When do you next have clinic so you can get some reassurance?

I guess I just meant that I've been struggling to keep on a level due to pregnancy pushing insulin requirements up (part of the reason we need more insulin is we're running a placenta 24/7) So I'm worried that my sudden reduction in requirements could mean that I've had a MMC or something else is wrong! Probably worrying over nothing!

How was the Harmony test? I thought about it but didn't go for it in the end. Would you recommend for peace of mind? Did you do it completely privately or pay via the hospital?

I'm sure there is nothing to worry about. There are so many factors and variables affecting our insulin retirements that it's not possible to pin it down. I guess because mmc is our biggest fear that's the first conclusion to jump to. I had a mmc last year (way earlier than this though) and have felt quite haunted by it. Will you be seeing any medical professionals this week you can ask about it?

From everything I've read so far the placenta thing is only an issue in late pregnancy. If you've steeply dropping insulin needs in the final month.

I'm sure there is nothing to worry about. There are so many factors and variables affecting our insulin retirements that it's not possible to pin it down. I guess because mmc is our biggest fear that's the first conclusion to jump to. I had a mmc last year (way earlier than this though) and have felt quite haunted by it. Will you be seeing any medical professionals this week you can ask about it?

Oops sorry posted my message twice! Also realised I forgot to say about harmony. Obviously the main point is to determine the risks for chromosomal abnormalities (thankfully all came back low risk), but I also felt reassured by having the extra scans. Bit of a scan addict and now enduring what feels like forever until I have the fetal heart scan on 17th October.

We also found out we're having a boy!

Hi there, wondered if I could seek some reassurance from you guys. I'm not type 1, but I'm likely to be diagnosed shortly with type 2 and I'm 6 weeks pregnant. I have foolishly been googling info about the importance of stable blood sugars in the first trimester and scaring myself silly! I've been monitoring bloods for the last 2 weeks. Most 1hour post food readings have been less than 7.8, but my fasting readings in the mornings have generally been more than 5.3 (recommended for me),. They've mostly been 6 or less though.

I saw the diabetic midwife yesterday. She wants me to monitor for another week before seeing the consultant. She's booked me in for a scan next week also. As a newby, I don't have much of a sense about how high is too high. Should I be alarmed at these numbers and try and see a consultant sooner to get put on meds?

Sorry to crash your thread! I feel so scared and alone, I've lost all sense of perspective.

Hi there, wondered if I could seek some reassurance from you guys. I'm not type 1, but I'm likely to be diagnosed shortly with type 2 and I'm 6 weeks pregnant. I have foolishly been googling info about the importance of stable blood sugars in the first trimester and scaring myself silly! I've been monitoring bloods for the last 2 weeks. Most 1hour post food readings have been less than 7.8, but my fasting readings in the mornings have generally been more than 5.3 (recommended for me),. They've mostly been 6 or less though.

I saw the diabetic midwife yesterday. She wants me to monitor for another week before seeing the consultant. She's booked me in for a scan next week also. As a newby, I don't have much of a sense about how high is too high. Should I be alarmed at these numbers and try and see a consultant sooner to get put on meds?

Sorry to crash your thread! I feel so scared and alone, I've lost all sense of perspective.

Esker - congrats! Lovely news that you're having a boy. I may be biased due to having DS but they are just so cute. Being an only child and a girl (obviously!) myself, I wasn't sure how much I would know about boys in general, but they are really simple creatures - at this age anyway!

I might have a look into Harmony. The MW mentioned it but when my nuchal tests came back low risks I kind of put it out of my mind. Be good to know, however, about anything else.

Did you go to a private clinic?

dancinginthedark - I think there are probably T2 / GD support threads around which might be worth looking at. As T1s we all take insulin which makes it a different kettle of fish.

However, I will say that the levels you are talking about might be slightly slightly higher than for a non-pre-diabetic person, but they are still well within acceptable ranges. I have already had one healthy DC being T1 and although I closely managed my diabetes throughout pregnancy there were definitely times when I would be outside the ranges you describe. You generally have to be having chronically high blood glucose over a long period of time in pregnancy to cause significant damage.

The best thing you can do is manage your diet and consider eating a lower or moderate carb based diet. Carbs = glucose (whether that is sugar/ sweets or things like pasta, bread and potatoes). So sticking to lower carb choices will definitely help you manage your blood glucose levels. Try not to worry, and speak to your midwife about it!

Tea- thanks for that reassurance!

Esker - my next scan is the 20 week one and not till 10th November!! They do the fetal heart one after that for me... I had mine at St George's last time and it was really cool to see!

Thanks nucky, that's really reassuring! Good luck with the rest of your pregnancy.

I hope you don't mind if I ask a few more questions about delivery to those who have already been through it once?

Once you're in the delivery room, is there anyone there who is specialised to know about diabetes/endocrinology or is it just midwives and obstetricians? And on the NHS, how does it work with obstetricians - is it just luck of the draw who you get on the day or do you get to meet them before hand?

Esker Congrats on finding out it's a boy! Did you find out via the Harmony test? Also, did I see somewhere you're 14 weeks and in North West London? I am too :)

Sugar - no, there was no one in the delivery room with me who was specialist in diabetes as such, but of course they all knew I was, knew I wasn't on a sliding scale, and of course knew to check DS' sugars immediately to ensure he was ok from that side of things (he was and remained that way through the 48 hours following).

For me it was luck of the draw on obstetrician. I think if you have a scheduled section perhaps you'd have more of a chance to meet them up front. I didn't, so everyone was new to me. To be honest, the only person I actually spoke to in any detail in there was the lovely consultant anesthetist. She was a very calming influence on both me and DH. Actually, all 'diabetes care' ended the minute I went in to have DS. From that point on I was just like 'any other patient' and that included all the after care!

Having said that, my hospital has now introduced a specialist Diabetes MW (they didn't have that last time!). I am hopeful she might at least come to see me if not there for delivery, but I guess they just have 100s of patients in clinic at any one time, so guess it is not possible for her to be there at every diabetic birth!

Btw - I am 15 weeks and live in SW London. Maybe we should have a London meet when we're all on maternity leave (or before!)???

There won't be any diabetes specialists in the labour room or labour ward. The would ring the diabetic registrar if they needed advice on anything but it's all protocol driven. If you were in labour and also in DKA or something they might be but it's unlikely. On the day you're in labour it will be the duty obstetrician in charge nominally rather than your own Consultant although if you happen to go into labour when it's their day on call them they would be. Although again their registrars will be the ones doing the work unless there's a big problem like crash section is needed. Ideally things go ok and you don't need anyone except a midwife.

I should clarify that I was talking about a non-emergency section!

Thanks MrsNucky and TeainBed - I know I have quite a way to go but I'm the worrying type who likes to be very much forewarned!

The reason I'm concerned is because if they induce me a couple of weeks before official EDD, which is likely, I understand that inductions tend to result in more assisted births/EMCs since baby isn't really ready to come out. And it's making me a little nervous about the NHS to be honest, especially after hearing a few horror stories about forceps and lack of beds on the delivery wards.

And yes, MrsNucky - I'd love to do a London meet-up, maybe before mat leave?

I think that's a risk we don't get much choice in. Get induced at 38 weeks = 'safer' but yes more likely to have some sort of intervention OR wait it out but risk placenta failing or shoulder dystocia from macrosomic overcooked baby! The NHS is under a massive amount of strain especially in London and the stuff you're probably hearing is accurate. Presumably your DH or DP is your birthing partner? They need to be the ones that can speak up for you and know what you want before you give birth so they can support you when the time comes.

Makes sense sugar. But you should know that they WILL induce you or do a section at 38 weeks or earlier. Doesn't matter if your growth scans are fine (mine all were and DS was not large) but the real issue is failing placenta as tea said. There is no real way for them to monitor that so NICE guidelines are 38 weeks. Of course you could refuse induction but I think risk is too great personally.

I was also v worried about a very medicalised induction / birth / instrumental intervention. I think the only way to totally avoid that is to elect a section (meanwhile of course praying you naturally go into labour early). Whilst not what I wanted, and as I said upthread my section was extremely smooth and really no drama.

Most important tip I can give you is not to get too hung up on the birth itself. What matters is you and your baby being safe and well. Delivery pales into total insignificance after your bundle arrives

I've had a forceps and it wasn't fun but it was the way I got to meet my DS.

My 2nd induction was the best, no pessaries or drip they just broke my waters and I had my daughter 6 hours later. So it's not always bad.

Feel as though I am being unnecessarily chatty on this thread!!

ANYWAY- had BAC clinic appointment today (birth after caesarean). Very interesting. Confirmed they would not go down pessary route owing to previous section - too great a risk of things moving too quickly and rupturing scar. However, they have started trialling and have offered me the chance to try this non-drug method of dilation and breaking waters to bring on birth.

It is using this gadget: www.cookmedical.com/products/wh_jcrb184_webds/ . They basically put the tubes and then inflate the balloons enough for them to get access to break your waters which, in theory, should bring on labour in short order but naturally. They let 'normal' women have 24 hours to see if it works, but they'd only give me 4-6 hours. I'm seriously going to consider it because it's a much more natural start to things, but also I'll no quickly if it isn't going to work so in theory I'd have my section the same day if it isn't working....

Thoughts anyone?!

Incidentally, I also mentioned I'd been concerned about running low for the last week or so. NIce midwife couldn't offer any diabetes advice (as she's the BAC specialist midwife) but she did kindly offer to let me listen to the baby's heartbeat to ensure all was ok. Nice loud, strong, FAST heartbeat in there. Yippee!!

*know quickly

(tsk)

I think it sounds good! If you're primed and ready and it gets you started why not? Your body will be more ready for it than the first pregnancy when it really is an uphill battle against a closed cervix. Think I said up thread but my second induction was really easy, they just broke my waters and I had DD 6 hours later. Perhaps this gives you a chance and if it's not doing anything you've not wasted a great deal of time or energy?

Can I ask a question? Not been on insulin for anywhere near as long as you lot! Do you correct if you are above your target? Do your team advise that? Mine have said not to correct (don't know why) but on the odd occasion I am above target I don't like just leaving it. So occasionally I have done a correction but like today I have plummeted and now on the jelly babies again! Very frustrating. The other thing I have noticed is activity, so if I inject for my breakfast then go to work and sit at my desk I'm fine, if I eat the same breakfast but I'm off work and more active I often end up low.

I usually correct.

The thing is, it CAN lead you into a crazy up and down cycle and the reason for THAT is because of the extremely tight targets set during pregnancy.

Novorapid has a 1-3 HOUR profile. It peaks around the one hour mark so if you give your bolus about 30 minutes before you eat and then test after an hour that might see you ok. But the insulin will happily keep working - at a reduced level - for quite some time. So then you might end up hypo and then your liver dumps glucose to fix the hypo (or you eat jelly babies!) and before you know it you're high again and all over the place.

But in answer to your question, my team does advise me to correct and I do it all the time when needed. If you find you are hypoing, considering reducing your correction dose down a bit so that you don't end up the other way.