Diabetes in Pregnancy

One of the first things that was said to me when I was diagnosed with Type 1 Diabetes was “Are you planning on having children?”. I was fairly taken aback. I had just been diagnosed with a lifelong disease and here we were discussing a future family. A family I knew I wanted but I had no idea when I would be ready for. My fertility remained a fascination of my consultants for the following 3 years. Every appointment he brought it up, he seemed pretty confident a pregnancy was happening soon. And how right he was.

In this post I don’t want to cover the guidelines for diabetes in pregnancy (if you’re interested in this please check out the NHS Website). I am more focussed on my experiences and how it affected me personally. Everyones body is different and reacts in different ways – Your Diabetes May Vary!

First Trimester

The first trimester was a strange one. Before I even knew I was pregnant I noticed changes in my blood sugars. I was constantly having low blood sugars and changing my insulin doses to accommodate them. I passed it off as increased activity and the warm weather, but in hindsight it was fairly obvious something was going on.

Reduced insulin requirements is a very common in early pregnancy – or so my Diabetes Specialist Nurse told me. As I was finding I needed to eat regularly to keep my morning sickness at bay I was regularly not taking any insulin for snacks to keep my blood sugars up. I quite enjoyed the freedom!

I started taking a prescribed dose of folic acid at 5 weeks pregnant and continued until 18 weeks. My insulin pump team saw me at around 8 weeks and spoke to them every 3 weeks over the phone from then on. I saw the antenatal team 3 times in the first trimester. I found these early meetings pointless for me personally as they are unaccustomed to patients on insulin pumps.

Second Trimester

The second trimester was fairly quiet at first. I found my insulin needs starting to creep up, but it was always gradual and I could keep pretty well on top of it. My basal insulin (background insulin) was the only one changing at first, the insulin to match with food was unaffected. I had been told it was possible to basal to more than double during pregnancy and, as my requirements were so low previously, I was preparing for a big jump.

I didn’t see the antenatal team between 12 – 20 weeks which suited me fine. The option was there to make an appointment if I felt I needed some support. I am more than comfortable adjusting my doses, and so I carried on alone.

The second half of the second trimester saw the start of an increase in my bolus insulin (insulin required to match to carbohydrate I eat). I had to give my insulin further in advance of meals than I was previously used to in order to keep my blood sugars within the target range. I was clearly doing something right though as I was having a streak of the best blood sugars I’d ever had.

At 20 weeks I started to be booked into scans every 4 weeks. In these Piglets abdominal circumference, head circumference and amount of amniotic fluid were measured. Piglet measured bang down the middle in all of these which was great – an increased abdominal circumference is the risk in diabetic mothers.

Third Trimester

The third trimester was when things got interesting. I had been told by my consultant to be prepared for Piglet to arrive as early as mid February (he meant due to early induction – he hadn’t anticipated him pitching up of his own accord!). However, Piglet was growing nicely and showing now issues so the plan never altered from induction at 38 weeks.

My insulin needs went through the roof. I was increasing settings on my pump pretty much daily. Hats off to all of those who handle pregnancy on multiple daily injections rather than a pump – I don’t know how they do it! It was getting harder and harder to keep my blood sugars within the guidelines but I tried not to get too stressed about it, as that simply raises my blood sugars further. By the time Piglet arrived I had more than quadrupled my pre-pregnancy insulin requirements.

At 32 weeks I had a phone consultation with my pump team to make a plan for labour and for after delivery. I agreed to go on a sliding scale (this is when I have both insulin and glucose being given to me via a drip). I was really against the idea, but I really had no choice as the midwives are not trained in how to use an insulin pump and I would most likely be unable to manage it myself while in pain (or completely off my face on drugs…… which I was).

At 36 weeks the antenatal team started to make a plan for Piglets arrival. As he and I were both doing so well we agreed to go to 38+2 for an induction.

Labour

As planned, I went onto the sliding scale during labour. Jonathan checked my blood sugars for me via finger prick every hour, unless it was too high or too low in which case it was every half an hour. Throughout both labour and delivery they successfully kept me pretty much within range.

After Piglet arrived however, it was a different story. We had been left along with Piglet for a while when we heard a machine pinging. Jonathan got someones attention, they came in and turned off the noise and left. I assumed the problem had been solved, however they had simply muted the beep and not actually solved the issue. The glucose drip had run out, so they were pumping large quantities of insulin into me with no glucose to balance it out.

As you can expect, my blood sugar plummeted. I can come prepared with some lucozade (much to the disgust of the midwife who kept insisting I have a digestive as it is “better”. She was wrong) and swigged it as rapidly as I could. The insulin drip ran out at this point too and I refused to have it refilled, instead I reconnected my pump. I have always preferred to control my own condition, no one knows my body like I do.

So there you have it – diabetes in pregnancy a la Kim. If you have any questions about it feel free to ask! I am trying to stay away from medical jargon but I’m sure a few things have slipped in that might not be clear. I’m always happy to try and explain!

What Next?

Why not join our Facebook Group which is hub for women with all different types of diabetes. It is a safe place to ask questions, share knowledge and be open about how you are coping.