Stealing My Pregnancy Thunder

This is going to sound bratish to the extreme. And petty. And childish. But I’m just being honest.

I was a bit gutted that a work colleague announced she was nine weeks pregnant when I was six weeks. I felt as though she’d beaten me to it. I suppose I felt like she stole my thunder. After months of good natured ribbing from colleagues who knew that I had a maternal side that was desperate to be unleashed, I was so excited to tell them that yes, I”m going to be a mummy. I suppose it sounds bratish because I make it sound as though wanted to be all “look at me” about being pregnant, but suddenly it felt as though the shine had been taken off it, and I thought that by the time I was ready to disclose my own pregnancy at 12 weeks, no one would be excited for me.

In the end it didn’t work out that way. Everyone was just as excited and full of questions for me as I think they would have been had I been the only one with a baby in my belly. But somehow it still didn’t feel right. It’s a small workplace and I felt squeezed, constantly comparing what was happening and what we were doing. Others couldn’t help comparing us either – especially when my bump began to show a couple of weeks ago, and earlier than hers. I felt as though I was being criticised. A fatty with my belly clearing poking out before it was meant to. In all likelihood no one was really thinking anything of the sort. In all likelihood they just aren’t that interested in our pregnancies, but I still feel uneasy about it.

And I suppose being so close to someone – seeing them everyday – who was pregnant at such a close stage sort of rubs my face in the fact that my pregnancy is not “normal”, “straightforward” or “low risk”. And also made that fact apparent to everyone else. It’s highlighted the differences in our pregnancy experiences.

You can’t resent another person for being pregnant. In all probability they want it as much as you. And you can never know someone else’s true story – how long they’ve been waiting and trying or what obstacles they’ve encountered along the way. It’s not jealously that I feel, just disappointment that it’s changed the pregnancy journey for me from how I imagined it would be.

Your Baby is What You Eat

People keep telling us all about the awesome responsibility of being a parent. About how this tiny little person will be thrust in to our arms after birth and from that moment be completely and utterly dependent on us to stay safe, grow and thrive. But I see pregnancy as an extension of that. I don’t think it begins at the moment of birth, it begins at the moment of conception. And in many ways the dependence that an unborn baby has on its mother is even greater than the dependence it will have once it’s on the outside, because absolutely everything that baby is exposed to comes through mum.

This is a difficult and emotive subject for many women with diabetes. In my experience we’re all acutely aware of how our own blood sugars have the potential to impact on our babies. Every time my blood sugar spikes a little higher than I’d like, I wonder if my baby is hurting in there. I wonder what damage is being done to fragile forming organs or, as I progress, what may be happening to the size of our child. I worry about lows that may strike out of the blue, sending me in to unconsciousness and depriving my baby of what it needs to survive.

This awareness might yet be a good thing though. I’ve been known to tell people that living with a chronic illness has some positives. (It doesn’t mean I wouldn’t trade it if I could, but I like to try and look for the silver lining.) Many people who live with diabetes are healthier, on a day-to-day basis, than our “healthy” counterparts because we have a better understanding of our own bodies and a greater awareness of what is happening within them. We’re better at listening to what we need. We see real day to day differences from the food that we eat and the exercise that we do that can often have a positive impact on the way we choose to live. In short, the idea of what we put in to our bodies affecting what we can get out of them is very real and apparent on a daily basis.

As a person with diabetes then, it’s fairly easy to grasp the idea that what we put in to our bodies whilst our babies are growing in there will affect the baby that comes out.

It’s like the old adage “You are what you eat”. Except in this case your baby is also what you eat. And a couple of pieces of research published in recent months have underlined this fact.

One study, reported here , showed how a decreased calorie intake in the first half of pregnancy could have the potential to affect the brain development and intelligence of the offspring. Granted, the study looked at baboons, but plenty of people would argue that I’m a bit of a monkey! I’m not sure that many people would presume excessive restriction of diet in pregnancy would be healthy, but it’s a worrying bit of research in the context of calorie deficit caused by morning sickness, and makes me glad that I continued to shovel food down my throat even if the choices that I made aren’t necessarily regarded as healthy ones. (Mini Mars bar, anyone?) Any food, it seems, is much healthier than none at all.

More interesting though is this study  which shows how the diet we are exposed to in the womb could alter the function of certain genes, which in turn can have later health consequences. This particular piece of research focused on the effect of low carbohydrate diets on childhood obesity. Logically you might have thought that stuffing yourself with carbohydrates would have the potential to lead to a bigger baby and fatter child, but in fact the reverse is true. A lower carbohydrate diet is actually linked to increased rates of childhood obesity. In fact, the size of the mother and the birth weight of the baby are much lower determinants for obesity than the level of carbohydrate in the diet.

This one is worrying to me because lower carbohydrate eating a powerful weapon against post-prandial blood glucose spikes. Current thinking on blood glucose management is beginning to look towards the size of glucose spikes (assessed by the standard deviation of blood glucose numbers) having as much effect on complication risk as the overall control (as assessed by the HbA1c).  This is particularly thought to be true during pregnancy and is the thinking behind the current guidance to keep the one hour post-prandial levels so low during pregnancy. And of course spikes themselves negatively impact the HbA1c anyway. Since carbohydrates raise blood sugar, minimising carbohydrate intake minimises post-prandial spikes and helps maximise stability and glycaemic control. Win-win? Except that this study has thrown a spanner in the works!

Before I ever got pregnant, I speculated with Ian – and only half in jest – that I would have to spend nine months eating a very consistent diet so that I knew exactly how to dose insulin for every meal and that most importantly I’d need to stick to a low carb diet. In the pre-conception period low carb worked very well for me and certainly contributed to me lowering my HbA1c below 6 for the first time in years. In the light of this study it seems fortunate that morning sickness hit me hard and threw any pre-conceived (pun intended!) ideas out of the window. I’m also thankful for so many low blood sugars which meant I got my quota of carbohydrates in Lucozade if nothing else.

This pregnancy thing certainly is a minefield. I feel like I can’t do right for doing wrong. Obviously I need good blood sugars, but the diet that helps me achieve those may be harmful in itself. All I can hang on to is that making the decisions about what I should and shouldn’t do whilst this baby is inside me is good practice for the millions of decisions I’ll be making for its welfare throughout its life.

Right. I’m off to find a chocolate biscuit!

Peek-a-Boo. We See You!

Our official “twelve week scan” was at our new hospital. It turned out to have been a very good thing that we’d already had our NT scan done privately since by the time the scan came around I was already at 14 weeks and past the cut off point for the NT measurement. Which meant that this scan, last Tuesday, just turned in to an opportunity to spy on our little beanie in there.

He or she was rolling around, stretching their little arms and legs out. And it was pure magic to watch.

I still. Cannot. Believe. This.

Diabetes Care Decisions

I’ve been going to the same diabetes centre for almost 12 years. I transferred there as a twenty year old student when I hit a brick wall with my previous doctors about transitioning to a pump.

They not only got me up and running on my first pump, but they saw me through my entire twenties. They took care of me through my battles with non-diabetes related health issues and helped me come out the other side. They saw me qualify as a dentist and turn from student to professional. They’ve seen literally hundreds of highs and lows, and everything in between, with me.

As a twenty-something woman, pregnancy was a bit of a recurrent theme at regular review appointments. In particular, the importance of not letting it happen without proper planning and of course the advice that if I should fall pregnant, I should tell them straight away, almost even before I told my partner!

In the event, I didn’t tell them quite that soon. Ian was with me when we did the pregnancy test, and both of our sets of parents heard the news straight away. But I did have an appointment the morning after my positive pregnancy test, and so my doctors were the next people, and the first non-family, to know. I was happy, sitting in that waiting room, waiting to share good news, wondering which familiar member of staff I’d encounter first. And when I went in to the consulting room I almost bubbled over. Everyone was happy for us too. They did another pregnancy test and concurred that yes, I was very definitely pregnant. And with a diabetic pregnancy, that’s when everything kicks in to high gear.

Or at least, it seems to. Suddenly there are more appointments than you know how to deal with. Your A1c has never been tested so often and your blood glucose records come under closer scrutiny that your average tax return. Everyone is working towards a healthy mum and a healthy baby at the end of the nine months, and is there to support you to help that happen.

Only, it didn’t quite feel that way. My frustration set in at the very next visit, the following week. I saw a new registrar who I’d never met before and didn’t know my history. A whole bunch of stuff relating to my complex endocrine story was dragged up again. Stuff that had been previously laid to rest long before we’d been given the go ahead to try to conceive. No one had mentioned this stuff again in a long time, but suddenly I was left with a horrible feeling that maybe I’d been foolish to get pregnant at all. None of my other worries or fears were addressed at that visit. There was quite a lot of “I don’t know” and even more “We’ll deal with that later”.

The issues got resolved, and I did get some fantastic support and reassurances from staff that know me better. But at the same time, I couldn’t help but feel that the stress with getting to these appointments was far greater than any positive outcome from them. It all started to feel a little bit pointless. I had the diabetes regime down pat. I knew everything there was to know about the risks of poor control and what I needed to do to stay healthy, and I was achieving excellent results. Now I just needed some normal pregnancy support. You know, the kind of care that non-diabetic and “regular risk” patients get in early pregnancy.

It wasn’t forthcoming. By the time I was approaching ten weeks of pregnancy and still all we’d done was talk about my numbers, it was getting a bit thin. I didn’t feel pregnant anymore… I felt like a numbers machine… a science exeperiement. Spending £25 and a two and half hour round trip to look at DexCom graphs that Ian and I can look at together at home, or even email to the hospital if we need extra input, was starting to really grate. And the final straw was when I was told that  got a “gold star” for my A1c of 5.8. “It’s brilliant I was told “We don’t normally see numbers like that until much later in pregnancy, when the blood volume really increases and the red blood cells turn over faster. This is the first time I’ve seen a number so low so early in pregnancy.”

That made me think “Whaaaaat…” Because it made me think that maybe they can’t be so hot at this diabetes and pregnancy thing if an A1c in the 5s gets remarked upon. But more than that it really cemented the fact that travelling all this way wasn’t worth it. As far as they were concerned, I was already doing great. I could agree on the diabetes front, but I wasn’t so sure about the rest of my pregnancy.

I’ve always been a bit of a diabetes care rebel. Not in terms of not doing what needs to be done, but more I terms of doing things my way. My parents started the trend by giving me extra insulin for treats as a child. They were frowned on at the time, but a quarter of a century later it’s the accepted norm. The thing is though, I didn’t want t be a rebel anymore. Becase suddenly this isn’t just about me anymore. It’s about our baby too. So I wanted to toe the line and do what was best for both of us. Which is why I felt so frustrated when the care we got didn’t feel like “best”. By default, they drove me to rebel.

First of all, I put my foot down and said I was only coming once a month, instead of once a fortnight.

But that still didn’t address the fact that I felt as though I was getting no routine pregnancy care. I didn’t like the fact that the hospital was so far from home, and couldn’t see how that might work if I went in to a spontaneous labour at the end of my 40 weeks. So I made a pretty big decision to move all my care to my new local hospital. It would mean that I could get my pregnancy and diabetes care closer to home, and deliver the baby just a few miles from home as well. Their reputation may not be as an internationally renowned teaching hospital, but they can provide excellent pregnancy knowledge and care, and as much diabetes support as I need.

It was strange, attending my first appointment at the new hospital this week. The people seem lovely, but of course I don’t know them like I know the people I’ve been working with for over a decade. I don’t know how the system works at the new hospital, or where anything is. But I do feel that I’ve made the right choice for my health, and my baby’s health, during this pregnancy.

I’m planning to return to my old diabetes centre just as soon as pregnancy is over. They haven’t really done anything wrong. It just wasn’t the right place for the pregnant me.

First Trimester: The Diabetes Edition

In addition to all the symptoms you read about in the ‘Yay, I’m Pregnant, Now What?” books (like the tiredness, and the morning sickness), diabetes brings a whole host of its own challenges to the first trimester party.

It starts just about the moment you see that second line on the pregnancy test , where three seconds of sheer elation is followed by lingering sense of panic. I’m guessing that all women experience some degree of worry during early pregnancy – about the risks of miscarriage and about keeping themselves and their baby healthy. But with diabetes in the mix, the stakes seem higher. Because one of the major factors that may influence the outcome of the pregnancy is directly in your control, but sort of uncontrollable at the same time. The sudden realisation that you need to keep your blood sugars on the absolute straight and very, very narrow day-in, day-out for the next nine months is overwhelming. More-so because you’ve almost certainly been trying to do that for a long time anyway, and know just how difficult, if not impossible, it is to do.

The worry about whether my best is good enough is something that gradually settled down in the background. It’s never gone away, stalking me wherever I go, but it has become a bit less front and central. To a point I need it there, to keep me motivated to put in the huge amount of effort that so far seems to be paying off.

Worry aside, if I had to pick just one word to define my diabetes during the first trimester it would be: hypoglycaemia. Oh yes. The lows moved in to the building and took up very firm residence.

I sort of expected it. Other women with diabetes, and my health care team, had already primed me that lows were a possibility due in part to all the efforts for very tight control, but also just because. I didn’t expect the lows to be so… persistent, though. My basal insulin requirements dropped like a rock, and I was often drinking my body weight in carbs, without bolusing, just to stay ahead of the curve. Which was pretty challenging when I also felt like throwing up the whole time. And there is little worse feeling than knowing you are low as you are vomiting up the juice you just drank to try and reverse the low. In the end, when I did eat I had to sacrifice good post-prandial numbers to avoid crashing lows if I was sick. I learned it was safer to wait at least a little while before bolusing in case the carbs never made it in to my system.

Despite all the sickness and lack of appetite, I still gained a couple of pounds in the first trimester. I can’t help but think this had more to do with all the empty calories from treating lows than it did with the baby growing inside me. My basal needs eventually levelled out at around 13 units per day, down from around 18 units per day before I was pregnant. That drop still makes my eyes pop.

But my A1c, 5.9% at conception, remained in the mid to upper 5s throughout those first twelve weeks. Each time I got a result back, the worry knot inside me loosened just a tiny bit. All the testing, all the insulin dose adjusting and even… even all the lows, seemed worth it if it was keeping our baby safe in there.

Morning, Noon and Night Sickness

Morning sickness is a misnomer, in more ways than one.

For starters, it doesn’t just happen in the morning. It happens in the afternoon. It happens in the evening. It happens all through the night as well. And secondly it’s not as simple as “sickness” which sort of implies that you throw up a few times, feel better and then move on. The worst part of morning sickness isn’t the actual throwing up part, it’s the constant, unrelenting feeling of nausea and the complete inability to face eating food even when your stomach is empty and protesting by attempting to digest itself.

For the first twelve weeks of my pregnancy, this was how I felt. From the moment I awoke to the moment I went to bed, I felt a bit like I was at sea in a small boat in a rough storm. I had peaks of nausea as soon as I got up (which led to some very icky moments, like throwing up in the shower) and also at around 5pm, but the feeling of sickness never really went away. I got used to figuring out where the nearest toilet was and never going anywhere without a stash of plastic bags and tissues in my handbag. (Have I mentioned yet about what a classy girl I am?) I got pretty adept at planning my work day so I could seize appropriate opportunities to relieve my stomach and I was either very good at being quiet, or blessed with spectacularly unobservant work colleagues as I got away with it without arousing suspicion long before I’d announced my pregnancy at work!

I tried every remedy under the sun. I tried ginger biscuits. Eating before I got out of bed (it ended up back down the toilet). I tried sucking ice. I attempted to eat often, keeping food in my stomach as much as possible and I tried drinking lots of water. I tried sucking on mints. I tried getting plenty of fresh air. Nothing really made that much difference. I hated to do it, but eventually had to resort to medication, which did work. I felt like I had little choice in the end, because the nausea was affecting my food intake to such a degree that it was beginning to interfere with my blood glucose control.

During this time, my appetite basically packed up and moved out of the building for several weeks. For a while the only things I could stomach were yogurt, jelly, mini Mars bars, Hula Hoops and Special K or Cheerios. Oh, and macaroni cheese, which would be fine other than it’s a diabetic’s nightmare food at the best of times, nevermind when you’re aiming for super tight control and post prandial readings of less than 7.5 at one hour. I had to send up another prayer of thanks for my unobservant colleagues, as I managed to explain away my sudden diet of nothing but yogurt for lunch without any of them asking if I was pregnant. Which was pretty surprising.

Once the medication kicked in and the nausea settled, my appetite improved. It was still a bit limited, but finding healthy options to eat was much easier. I figured that much as I wanted to avoid medication, I was being kinder to my developing baby by being able to provide proper nutrition and better blood glucose control. The risks are very tiny anyway, and seemed outweighed by the risks of carrying on as I was.

The only thing that medication could not help with was the unrelenting tiredness that seems to come as part and parcel of the first trimester too. This isn’t like the kind of tired you get when you haven’t had enough sleep. Or even the kind of tired you get after running a half marathon. It’s a all consuming, bone crushing kind of tiredness, that’s leaves you feeling like a soggy blanket, as of your brain is filled with glue and your feet are firmly embedded in a muddy bog. It’s almost impossible to relieve. Even sleeping doesn’t really help, but I often tipped the dental chair back at lunch time for a quick 30 minute nap, just to try and take the edge off.

Actually, I’m starting to think my colleagues can’t have been that unobservant. I was practically wearing a six foot neon sign screaming “I’M PREGNANT”. I think I’m actually blessed with the world’s most sensitive and discreet work colleagues instead!

Mini Meltdown

Last night, I had a bit of a meltdown. I’m guessing it may have been good practice for Ian on what we have in store as this baby gets older because it was a bit like a toddler tantrum, with shouting and tears – lots and lots of tears. And snot. Plenty of snot too. I’m a classy bird, me.

I wish could say it was the first time in this pregnancy that I’ve lost the plot a little bit. But in truth, I first lost the plot within a few days of that second pink line appearing. While I’m sure all mothers-to-be, and especially first time mothers-to-be, experience plenty of early pregnancy anxiety, the source of my distress was very definitely diabetes. On that first occasion, my blood sugar had risen seemingly inexplicably to something like 13mmol/l. I panicked, in a very full on hyperventilate-y way. Even though I was aware of how ridiculous I was being even as it happened, I could not stop the strong sense of fear overtaking my rational, sensible side. All I could imagine was the harm that high number could be doing to the delicate little beginnings of new life inside me. The result was a crying fit that it took Ian a good thirty minutes to talk me down from.

What that first high number really underlined for me was what a mammoth task I’ve taken on. I was, and still am, totally and completely scared by the awesome responsibility of building a new life. I’m so, so afraid that I can’t do it. That I can’t keep up the necessary blood glucose control and fit in the weekly or bi-weekly hospital visits required of me, all whilst continuing to do my job well. I’m afraid that my broken body will let me down. I’m afraid of letting Ian down, by not providing the very best environment to nuture his child. Most of all, I’m afraid that I will let our baby down.

The rational and sensible usually prevails, but I can’t suppress those fears all the time.

I cried at each and every one of my first few hospital visits. I cried to my diabetologist, expressing my concern that if anything goes wrong in this pregnancy, it will be my fault for not managing my medical conditions, and most specifically my blood sugars, well enough. I do understand that even if I were perfectly healthy, and a model mum-to-be, that things could go wrong. But if something does happen, I’ll never know the exact cause and I will always tend to assume that it’s down to me. My consultant tried to reassure me that any problems would be the fault of diabetes, not me. But diabetes is under my control. If I fail to control it well, any problems *will* be down to me.

I’ve cried at hospital appointments just because of their intensity. I don’t want to feel like a medical experiment. I don’t want to feel continually petrified of what I am doing to our little baby in there. I want to be a mum more than anything, but I also want to at least enjoy pregnancy a little. The amount of time spent at the hospital reinforces that pregnancy just seems too hard for me. That would see me dissolve in to tears again.

Last night I had a melt down because my DexCom was throwing screwy numbers, and a fingerstick revealed a much higher number than I thought I’d been sitting at. It sent me in to a spin, wondering just how long the DexCom had been giving inaccurate readings. Had I been high for the 3 hours since I last took a fingerstick reading? And that of course made me curse my laxness, for going too long without a “proper” blood glucose test. I’d been slacking and I was paying the price.

I know that I need to lighten up. I know that there is every chance the stress I’m putting myself under will do as much harm as the occasional elevated numbers I’m getting. But I also think that much like I have to accept that high blood sugars will happen occasionally during pregnancy, I also have to accept that these kind of panics and melt downs are par for the course with a diabetic pregnancy.

Luckily for me, Ian certainly seems to be accepting it.