Diabetes and My Son

I was going to entitle this post something like “The Fear That Diabetes Might Affect My Son”. But then I realised that although he doesn’t have it himself, diabetes has affected Thomas almost since the moment he was conceived.

He managed to dodge the higher risk of birth defects, and the increased weight gain that comes from exposure to extra glucose in utero. But he was still evicted from my body by medical intervention before he, or I, were ready for it. And consequently he came in to the world through the sunroof, rather than by the more conventional route. No matter how much the medical profession debate it, we still don’t know all of the potential long term effects of being born by caesarean. An increased risk of developing diabetes is, ironically, one topic under scrutiny. If anything should crop up that could be related to the mode of delivery, then ultimately I’d have to attribute it to my diabetes too.

But it didn’t stop after the birth. My diabetes put Thomas at risk of low blood sugars in the early hours of his life as his pancreas tried to adjust. Fortunately he was fine, but as a result of the risk he endured heel prick tests in those precious first hours. I know they didn’t really hurt him, and he’ll have no memory of them at all, but as a new mother, those pricks may as well have been pricks through my heart and I couldn’t help but cry as his screams pierced the delivery room. If it weren’t for my health condition, he’d have been left in peace to enjoy his first feed. It was my first taste of the guilt that comes with being a mother. I felt, however irrationally, as though I personally had hurt my child. My brand new baby.

Since then, diabetes has cropped up infrequently, yet persistently, in Thomas’s life. There have been times when I couldn’t feed him, no matter how imploringly he looked at me or how much he pulled at my top, rooted around or screamed at me, simply because my blood sugar was too low and I needed to sort myself out first. Likewise there have been occasions where I have had to leave him to cry in his cot because I wasn’t safe to pick him up and carry him down the stairs. It’s heart breaking to say no to your child when they want to play because your head is full of cotton wool and fingers tingle with numbness from a low blood sugar. Or when you head bangs a beat and your tongue is drier than the dessert for the opposite reasons. There are tear stains on the pages of one of Thomas’s books, from the time that I cried when the words swam in front of me and I knew I couldn’t read to him.

I know that, once again, Thomas is too young to remember these things. In the grand scheme of things, they won’t matter at all. He may look at me with an expression of confusion and hurt, and he may stick out his bottom lip, or even scream at me, but I know that ten minutes hence all with be forgiven with a cheeky grin and a big hug. And I also know that I sometimes I have to put myself and my health first in order to be the best parent for my child. Anyone who thinks that sounds selfish doesn’t live with chronic health issues, or more specifically, with diabetes.

But knowing those things in my rational brain doesn’t stop my heart from hurting each time diabetes edges in to a moment of motherhood. It doesn’t stop the omnipresent mothering guilt from eating away at me. Diabetes is an impossible beast to control perfectly all the time, but that doesn’t stop me pressuring myself to achieve the unachievable in order to give my son a childhood where diabetes does not feature at all.

If it’s an impossible dream, though, I want the only diabetes that affects Thomas to be mine. Not his own.

And no matter how strongly I feel the guilt about the impact of my health on my parenting or relationship with my son, it pales in comparison to the strength of my fear that one day Thomas may be dealing with this too. It’s a fear that on a day to day basis I fold up and squash deep down inside me, right next to the place where I lock away any hope of there one day being a cure. But from time to time it rises to the surface in a rolling boil that I can’t temper or tame.

It’s usually provoked by something that might a seem completely innocuous to other parents. Like the time I arrived to collect Thomas from nursery and his key worker mentioned “He hasn’t stopped drinking today”. A “normal” parent would probably put it down to a virus, a sore throat, to hot weather or the fact they hadn’t drunk much the day before. Immediately though, the fear is stalking me that this could be the beginning. The first time his nappy leaked in months and months, down to it being completely saturated in only a couple of hours, I didn’t care about the extra washing or change of clothes and I didn’t rush online to find out how I could better boost his cloth nappies to prevent future leaks. Instead I let the fear swallow me up.

So far, however, I haven’t acted on my fear. I haven’t pricked his heel, or toes, and tested his blood sugars. I haven’t pressed urine dipsticks in to his nappies to see whether there is any sugar lurking there. I’m determined to try to keep this in proportion. To remember with my head that the scientifically calculated risks and probabilities are on our side, even if that means nothing to my heart. Because if I spend his entire childhood watching him with fear haunting my gaze, that will be just as bad as actually living with diabetes.

A phrase that crops up a lot in parenting circles is “I don’t care, as long as they’re healthy”. It’s always said with the best of intentions, but as time has gone on I’ve realised how much I hate it. It often seems to imply that the speaker somehow wouldn’t be happy with their child if they weren’t healthy. I know it is not what is meant, since no one wants their child to be ill, or to live with a chronic health condition, but it’s what the phrase makes me think. I can tell you now, though, that one thing is for sure. If it happens, I’ll love my son just as much as I do today. And it will be my job to make sure that even if he is living with it, it still impacts his childhood as little as humanly possible.

That’s the best that I can do.

Top Tips For A Diabetic Pregnancy

Plan – Going in to pregnancy with more than 3 months of folic acid behind me and an excellent A1c made the early weeks much less stressful for me than I think they may otherwise have been. Aside from being less worried about potential complications, I didn’t have the problem of trying to drastically adjust what I was doing in terms of diabetes control. I’d already built in lots of good habits, so was free to focus on responding to the changes caused by my new hormonal status. I hated the thought that diabetes could be the thing to stop us trying to conceive once we were ready, but getting everything stable before we started was absolutely worth it.

Sort your hospital care out carefully – This is something I didn’t really do, and I ended up changing hospitals during the first trimester, which made for a bumpier ride than was probably strictly necessary. Think about the logistics of travel to your hospital both for frequent appointments, but also when it comes to actually giving birth. If there is more than one option locally, find out both about the general maternity services, but also what sort of experience they have in managing pre-exisitng diabetes in pregnancy. Ideally, you want to already know your diabetes consultant and DSN, and have a good working relationship with them.

Get used to lots of appointments – It can seem overwhelming. It can seem annoying, especially if you have a full time job to factor in. But all the appointments are there to make sure both you and the baby are well looked after. Try not to view them as an inconvenience and enjoy the unparalleled access to information about your pregnancy. Many non-diabetic women will be bemoaning the fact that they see their midwives so rarely.

However, Don’t be afraid to question what you are told, or what is usual “policy” – A lot of the care for pregnant women with diabetes is based on “one size fits all” policies. It’s essential that you are an active participant in the process though. If something is being suggested make sure you ask why. Ask what the alternatives are and what the risks and benefits of different approaches are. You can’t give informed consent if you haven’t been fully informed. It is often policy to see women with diabetes every two weeks, but in the early weeks, this felt excessive to me, as I was travelling a long way to talk about excellent blood sugars that we could easily have discussed by email. Remember that it is your body and your pregnancy. No one can “tell you” what to do. But at the same time, be sensible and respect the advice and experience of your health care team.

Test, test, test, or better yet, use a CGM – Honestly, I don’t think I have ever tested my blood sugars quite as much as I did during my pregnancy, and I don’t think I could have coped without a CGM to tell me which direction I was heading in at ay given time. The only way to have any chance of keeping your blood sugars as close to normal as possible is to know roughly where they are as often as possible. Testing, and writing down the results, is absolutely essential. You also need to be prepared to act on those results too.

Try to eliminate the lows – When you have the risks of hyperglycaemia drummed I to you frequently, lows can suddenly seem like a friend. Whilst it’s true that mild hypoglycaemia pose no threat to your unborn baby, it can carry risks for you. Frequent lows can lead to loss of the warning signs, which in turn increases the risk of severe hypoglycaemia, which may in turn put your baby at risk. Bouncing back from lows is also a major contributor to high blood sugars and a lack of overall stability. Eliminate the lows and it becomes easier to remain steady. Honestly.

Carb count carefully – eyeballing, or scientific wild guessing are no longer acceptable. The only way you can dose accurately for the food you eat is to know exactly how much you are eating. That means that wherever possible you need to weigh and measure your food. And you need to read food labels.

Low carb can be your friend – Eating low carb is a sure fire way to reduce or eliminate post-prandial glucose spikes. Low or no carb foods are also fantastic when you are hungry at a less than ideal blood glucose level. But don’t go mad. I had ideas pre-pregnancy that I would stick to low carb, and a limited range of foods whose effects I knew, for most of the pregnancy. This isn’t necessary and will make your pregnancy seem to last a lifetime. There is also some evidence that restricting carbs too much can be bad for your unborn baby.

Superbolus is definitely your friend – Minimising the post meal spike is one of the most challenging aspects of good control. The superbolus is a pump technique whereby you take some of upcoming basal along with your pre-meal bolus, and then reduce your basal rate to prevent a later low. This is much more difficult if you are not on a pump, but taking a larger bolus and then eating some of the carbs much later on is also a rough approximation. Bolusing 30 minutes before eating, especially in the morning, also gives your insulin a head start to increase the likelihood of its action matching the absorption of your food.

Don’t panic about occasional highs – this is so much easier said than done. I remember having a full on, tear soaked and snot-ridden melt down the first time I had a high blood sugar. People will throw around all sorts of analogies that are cheesy, but true: the occasional visit to the sweet shop for your baby won’t do them ay harm. It’s a fact of diabetes that highs happen, and you won’t be able to eliminate every single one. Just do your best to minimise them – with frequent testing, accurate carb counting and regular adjustments. Look at the bigger picture when faced with a high number. Frequent and sustained highs are much more of a problem than occasional spikes. It’s also easy to focus on the highs, so writing down all your results can help you to see that they probably aren’t as frequent as you think.

Night times really matter – If you can get your night time basal insulin sorted to keep you steady and in range all night, this not only gives you almost a third of the day within target, but also gives you a good waking blood glucose level which starts the day off much better physically and psychologically than a high or low number. It’s worth making the effort to test overnight frequently. This gets easier in later pregnancy as sleep gets harder!

Get comfortable making adjustments yourself – If you are the sort of person who tends to rely on medical staff to make the bulk of the changes to your insulin regime, get ready to change. The adjustments needed in pregnancy are too frequent to wait between appointments, or for someone to keep calling you back. By all means seek advice as often as you need it, but get used to trusting your own instincts. You live your diabetes every day, so you really do know it best.

Remember that the old rules don’t always apply – Four will probably not be the floor, unless you have severe hypoglycaemic unawareness. 3.5 will suddenly become an acceptable fasting level. Correction doses are no longer reserved only for numbers above , or 10, or whatever you used to use. 6.5 is now a number you can and should correct. You no longer have to wait 3 days to see a pattern. It’s OK to make changes on the fly.

Don’t be afraid to ask for medication for morning sickness – even if it doesn’t seem “that bad”. The effect of morning sickness for women with diabetes is very different than for women without. Whilst there is no doubt it’s unpleasant for everybody, trying to deal with bolus insulin and not knowing whether your food will stay down is an extra challenge you don’t need. If morning sickness is interfering with your efforts for good control, then taking medication is the sensible option.

Don’t expect non-diabetes staff in hospital to have a clue about diabetes – Be prepared to be your own advocate. Be prepared to take care of your own needs possibly throughout labour if you want – but certainly during early labour or if you are admitted for induction. Take plenty of your own test strips and medication. Also take plenty of food and treatments for low blood sugars – don’t rely on the hospital to have what you need when you need it, no matter how shocking that sounds!

Remember to enjoy your pregnancy too – Remember that there is more to this than just blood glucose levels, carb counts and estimated fetal weights. Try to set aside the focus on diabetes at least some of the time and enjoy your changing body shape, shopping for your new addition and feeling them kick and move inside you. Remember that you are a mum-to-be, not just a medical machine.

Remember, it’s only 8 months of your life – By the time you find out you are pregnant, there are only eight months to go. The obsessional focus on everything diabetes is finite. And you have the biggest motivation you’ve ever had. Once the pregnancy is over and you have your child in your arms, it will all seem more than worth it.

36 Week Appointment

I don’t feel like things went very well at the hospital this morning. Maybe my expectations are out of whack, or maybe it’s just all the hormones, but yet again there were a lot of tears.

Things didn’t actually start out too badly. In fact, they started out rather well. My fourth (and hopefully final) growth scan revealed a baby that not only looks completely healthy, but looks a very average size. This is complete contrast to the 28 week  and 32 week scans, which had suggested that they were turning in to a little chubster. I can’t help it; I still see the size of the baby as a measure of my success or failure at pregnancy. So hearing that they are sitting right around the 50th centile, with only a slightly increased abdominal circumference is naturally welcome news.

The less good part of the scan was the re-assessment of the placenta. Back at my 20 week scan  it was noted that the placenta was lying low in my uterus. It wasn’t completely covering the cervix, but a concern was raised about whether it would prevent a vaginal delivery. At the last couple of scans, the sonographers have said that things looked fine, and to be honest it had gone out of my mind. When it came up again today, I instantly panicked that this would be the unforeseen end to my desire for a natural birth.  And then, I was further disappointed that, having made it this far in pregnancy without a single internal ultrasound (with the dildo-cam) the sonographer apologetically informed me that the only way to get a conclusive measurement of the distance of the placenta from the cervix was to go in from the bottom. Cue lots of panic that my bikini line has not yet been prepared for B-Day, and since I can’t see it, I was horrified about what she may be about to witness. Thank goodness for discreet, unflappable sonographers. And thank goodness that after all that, the placenta was in a good position and I was signed off for vaginal delivery.

Things went properly downhill, though, when I went in to see the obstetrician. Bear in mind that I’ve always understood that the hospital (and general diabetes in pregnancy) policy is induction at 38 weeks. Although I’ve agonised a bit about this, mainly because of my desire to avoid an epidural.  I have come around to the idea in order to make sure we end this journey with a healthy baby. (The fact that I’m gettting impatient to meet our baby helps too.) I’ll be 38 weeks in two weeks time, so I was fully expecting to actually make some plans today about when I would come in and how things would progress. I’d gone to the appointment armed with my birth preferences and a list of questions that I wanted to discuss.

But everything got off on entirely the wrong foot when the obstetrician sort of dismissed the scan results and told me not to place too much importance on them. Removed from the situation, I can rationlise that she didn’t mean to be nasty or dismissive of what I was regarding as potentially an achievement. I know she was giving me exactly the same line that she did when the scans gave less favourable results, and I know that she is right that today’s scan could be the misleading one. But irrespective of all that, her dismissal left me feeling utterly deflated and wondering just why I’d been going through these scans. Before I knew it, the tears were on.

It went from bad to worse, as my questions were glossed over. I think my previous deliberations about induction might have been misinterpreted as me definitely not wanting to go for it, because there was no discussion at all of booking a date, just that we’d review it next time. Again, with hindsight I can sort of see this positively, because it means they have no concerns and are willing to let me go a bit beyond that. But at this stage, I really want some clearer idea of what is going to happen. Delivery is no longer too distant to think about. I’ll reach full term between this appointment and the next and it’s possible that I may not even make it to the next appointment. The baby could be here before that.

Some of the things that we did get to discuss were met with unsurprising answers. Like being told that yes, I will be pretty much confined to the bed throughout induction, and there is no hope of me getting anywhere near a birth pool even if I go in to spontaneous labour. I don’t have the fight in me to debate these points. My obstetrician seems to firmly believe that I will opt for an epidural when I’m actually in labour, which just cements my belief that no one really understand quite how much of a fear this is for me.

The biggest chunk of the appointment, though, was devoted to a stand off about something in which I do really passionately believe: my right to take care of my own blood sugars for as long as I feel able during labour. It’s something about which I won’t back down.

I’ve had bad experiences before in hospitals, where non-specialist staff do not understand the first thing about diabetes. Even something as elementary as the importance of uninterrupted insulin supply for a type 1. I could go in to details about the time an IV insulin infusion failed at night and the staff told me replacement was not a priority until morning, 8 hours later. EIGHT hours with no insulin could, likely would, have put me in to DKA. Long and multiple stories short: I don’t trust other people to do it anywhere near as well as I can. I don’t want to transfer to an IV sliding scale just as a matter of course, because I know they can be prone to failure in my rubbish veins, and I will be left with the problem of transitioning back afterwards.

I’ve worked so hard on my control since before I fell pregnant. I’m not letting go right at the end. All I really want is for Ian and I to be in control, including the ability to say “actually, we don’t want to be in control now, so please take over and put up an IV sliding scale”. I didn’t expect this to be a problematic point. I thought the team knew me well enough, knew what a control freak I am, how important this is to me and how well I can do it. I thought I’d proved all of that. But what I was met with was that it was “inappropriate”. That I had to “learn to be a patient and let go”. And that I couldn’t ask Ian to help me, never mind that he wants to, because it’s such a massive part of our everyday relationship. He’s happy, at this point, to know he’ll have a definite way in which he can help me during labour. And if it all goes pear shaped and we can’t do it on the day, then we’ll say so. It’s not as though we have to commit to what will happen right now.

My tears were a mixture of frustration and downright anger.

I have no control over where or how I give birth. I’ve accepted that the process needs to be medicalised to degree to keep me and the baby safe. This is the one thing – ONE THING – that I want to be in control of. I can’t understand why that is being denied to me. I understand that I’ve never been in labour before and that I might find that when it comes to it, I don’t want to be worrying about diabetes. What I’m asking for is the space to make that decision at the time, when I am in labour and I do know how I feel.

The appointment stalled around this point. I had more questions, although I can’t really remember them now. Mainly about what will happen after the birth. But I was too worked up to go on. I felt as though I was being treated like a silly, naive little girl who knew nothing about what she was discussing. When the obstetrician asked to see the piece of paper I’d scribbled my notes on, something snapped internally. I told her I’d asked them all, even though it wasn’t true. Because suddenly I don’t want to do it their way. I don’t care about the answers to those questions, because I’m determined to try and makes the answers be what suits me. I absolutely DON’T want to sacrifice the health and safety of my baby. But that, ironically, is exactly why I don’t want to relinquish my diabetes control.

I was so angry when I walked away that I almost wanted to hire an independent midwife who’d be prepared to work with me for a home birth, ridiculous as that sounds. But having realised how much nobody wants to listen to and work with me, I suddenly felt very lost. I’ve not felt frightened of labour at all during this pregnancy and I’m still not frightened of labour itself. But I am petrified of how I will be treated. I can envisage clearly now how I’ll be dehumanised and treated as a medical entity. A problem. A number.

Is it really too much to ask to be treated as an individual, rather than simply a “pregnant diabetic”.

I haven’t put a question mark to that question, because after today I feel like the answer is definitive. And it’s yes.

I’m not sure where to go from here. I thought I’d have an induction date planned. I have an appointment in two weeks, where I’ll probably be given a sweep. I wouldn’t really turn my back on hospital care, because I do know it’s the safest and best place for me to be. But I feel so let down. So misunderstood. So disrespected.

So no, things did not go well at all at the hospital today. But all I can do is keep waiting and keep refreshing my resolve that when it comes to it, I’ll stand up for myself and for my unborn baby. I will do what is truly best for us, not what is best for the hospital staff.

A Crisis About Clothes

I’ve been having a bit of a crisis about baby clothes. Or more specifically, about baby clothes not fitting our baby.

Since we’ve elected not to find out the gender of our child, we actually haven’t bought that many clothes. This is partly because we might want to buy some more gender specific clothes once they’re born, but also because it’s actually remarkably difficult to find that many unisex clothes, even in newborn size, unless you want to dress them purely in white or cream. Most of the ones that we have found seem to have a bit of a boyish bent too, but I may just feel that way because I’m convinced we’re having a boy. So we’ve bought a small selection in a mixture of Newborn size and 0-3 months size.

The problem is that I’ve completely convinced myself that we’ll be having a big, fat baby. And lately, I’ve convinced myself that big and fat means way more than 10lbs, which means that “Newborn” size (generally “Up to 10lb”) won’t fit even when they are actually a newborn. For some reason it’s become the focus of all my fears about the baby’s size. Ridiculously, I feel sad, to the point of tears, that some of the cute sleepsuits we’ve got might not actually fit our baby. I’m also worried that because we’ve divided our buying between the two sizes, we might find that we have way too little stuff to actually dress them in, if half of it doesn’t fit at all. In really irrational moments I can actually imagine the midwives tittering about the silly girl who didn’t bring any clothes to fit her baby, as they try to rustle something up to dress it in whilst Ian makes a mad dash to the shops in the first hours of our baby’s life.

It may seem like a silly thing to worry about, but it’s actually keeping me up at night. Along with the question of how much to unpack and wash. I can’t decide whether to keep some of the newborn size clothes and vests in their packages and unwashed, until we see if we will need them. That way, we could swap some for the next size up. Or do we just swap them all anyway, on the basis that 0-3 is likely to fit pretty much from birth in any event, and that way I guarantee not wasting any clothes. And not feeling bad that I don’t get to see our little bundle in some of the stuff we’ve picked out. These thoughts go round in my head at night, chased by all the numbers I’ve seen on my meter that day as I try to calculate the probability of not having a big, fat baby

Written down like this, they do seem such silly, trivial worries. But they represent something much deeper for me. It’s this nagging fear about having a big baby, which leads back to the worry that I’m not doing a good enough job of looking after myself to keep him or her safe. I’m even beating myself up with sleepsuits now. Teeny, tiny cute sleepsuits, but they pack a right punch.

Thirty Two

Thirty-two weeks pregnant. Holy cow, I’m getting close to the finish line – four fifths done. And holy cow, I’m getting big. I can’t remember what my feet look like and putting shoes on is a massive struggle that adds several minutes to the time taken to leave the house.

This morning was a busy morning. I had the 32 week growth scan, followed by an antenatal clinic (ANC) appointment, and then my third trimester eye dilation and retinal photographs. It didn’t start out well when I found myself waiting first ten minutes, then twenty minutes past the time of my scan appointment. Then I reached the time I was due to be in antenatal clinic. Fortunately the two clinics are adjoining and do actually speak to one another, so I was assured they wouldn’t fail to see me in ANC. By the time I was called in to my scan though, I’d worked myself up in anticipation, and because I was worrying about getting away from the hospital to make my eye screening appointment.

The sonographer performing the scan was the same one who did my 28 week scan. She complimented me again on the fact that I must be taking good care of myself. But I could hardly bear to ask just how big my big baby had got.

When I looked at the print out of the scan measurements, I couldn’t suppress my tears. The abdominal circumference measurement is now above the 95th centile – even higher than it was before. And it’s the abdominal circumference that suggests a diabetes-induced big, fat baby. Fair enough, it’s not that far out of proportion of all the other measurements. (Except femur length – Flangelina obviously has short legs. Like their Mum.) And the estimated fetal weight is only at about the 65th percentile, but I feel like such a failure and there really is nothing more to say.

When I made it around to the antenatal clinic, I was stressed out enough that my blood pressure had climbed to a ridiculous 140/95. Which sent me in to a panic about pregnancy induced hypertension and pre-eclampsia . My obstetrician firstly reassured me that it was only a blip because I was worked up and she wasn’t concerned, plus there was no protein in my urine. Then she tried to move straight past the numbers in the scan report. She reminded me that scans are not totally accurate, a problem that may be accentuated by having the same sonographer do two consecutive measurements, as their bias in reading the values may be higher. She trotted out the old line about how I am doing such much more, and so much better than all their other patients. How the effort I am putting in, and the results I am getting out, are second to none. How it’s “normal” and “common” to see these kind of increases in babies of diabetic mums, and how they still turn out healthy and OK. But I don’t care about anyone else, or their babies. I care about my own pregnancy concluding safely. I don’t want to have a “normal diabetic” pregnancy. I want a “normal normal” pregnancy. I felt frustrated and resentful and noting was going to get me out of that funk.

I was a hormonal, tearful mess. And like I do, I descended in to panic about everything. Suddenly I couldn’t cope with the whole diabetic pregnancy a moment longer and wanted to be the same as all the carefree women in the waiting room receiving happy news from their scans and appointments. Of course, there were bound to be women there receiving far worse news than me with my little fatty. And after a ten minute melt down, I realised it, and remembered to thankful that nobody was suggesting that Flangelina is not healthy. Just big. And big is not necessarily bad.

We managed to discuss, through more tears, my fear of spinal anaesthesia and hence of a c-section. I’ve been waiting for several weeks now for an appointment to see a consultant anaesthetist to really discuss these fears, and whether they are founded. I’m beginning to panic that it won’t come through and I’ll be in established labour before I get to talk about it. The reassurance here was more concrete, as they called through to the consultant’s secretary to confirm that I was in the system, and an appointment will apparently be with me shortly.

We also discussed a bit about antenatal collection of colostrum and fortunately the reaction was very positive. I was, however, advised that I needed to wait until 37 week because of the risk that nipple stimulation would cause labour. Having Googled the topic, I’m sceptical in the least about this statemet, and I’m sure my body would only go in to labour if it were ready to. But since I need sterile syringes from the hospital to collect the colostrum in, I’ll have to stick with them on this. The amount that is leaking out, I don’t think I’ll have a problem collecting enough in just a couple of days.

Despite the lateness, and all the tears, I made it to my eye screening on time. They never give anything away whilst your there, but everything has been fine up until this point. I have enough else going on, so I’m not going to dwell on the possibility of something cropping up in my eyes. I am just very glad that I’m now on maternity leave, as there is no way I could have gone back to work with my red-rimmed and hugely dilated, blurry eyes – a combination of crying and dilation for the retinal photographs.

So, what now? Keep working at it I guess. If the baby is already fat I can’t make it actually slim down in utero, but I guess I can try to stop it gaining too much more weight. I have no idea how, because I really feel like I’m doing all that I can. But I suppose I just have to do even more.

My Big Baby

Today’s 28 week growth scan brought mixed news.

The Good: Flangelina has turned. The belly rumbling and rolling that I felt this weekend was obviously the outward manifestation of their internal gymnastics, because Flangelina is now hanging out upside down like a bat, and pretty low down in there. This is a big relief as it’s one hurdle that would reduce the chances of a natural delivery out of the way. So long as they stay that way of course. But I’m keeping up with birth ball bouncing and swimming to encourage that, and I feel much more confident about them not being breech than I did before.

So, yay!


The Not So Good: Flangelina is beefing up in there.

It’s not catastrophic. In fact, the sonographer commented on how well I must be controlling my blood sugars as she was writing up the data. She said I was doing really well and the baby looked great. She then casually, as if it was no big deal, added that the baby’s abdominal circumference had jumped up to the 80th centile.

And I lost it. Started crying big, fat silly tears. Because last time everything was measuring right around the 50th centile. And when a baby gets big because of diabetes, it is invariably the abdominal circumference that enlarges ahead of the curve since that is where the extra fat gets laid down. In other words I’m not simply growing a larger than average baby. I’m growing a little fat baby.

Instantly I felt like a failure.

But I also felt frustrated. Because I don’t know what else I can realistically do. I’m wearing the DexCom full time and testing 10 or more times per day in addition. I’m carb counting like a pro and pre-bolusing where I can. I’m getting as much physical activity as I can and generally working hard. For the most part, I’m seeing excellent results. The DexCom tells me that I’m inside my tight target range of 3.9 – 6.8 more than 70% of the time. And a large chunk of the remaining time I’m actually spending too low, which whilst not ideal for me, won’t be packing the pounds on Flangelina. These are numbers that are nearer to normal than I’ve even been since I was diagnosed as a small child, and it’s frustrating to think that they still aren’t good enough.

Both my obstetrician and diabetes specialist nurse did their best to reassure me. Scans are not that accurate. The numbers say that I am doing fine. Big babies are not unhealthy, they just may be a bit more difficult to deliver, and all the evidence points towards higher birth weights actually being healthier in the long run. They were at pains to point out how much more seriously I take this than the majority of their patients, and how the results really reflect that. HbA1c’s of less than 5 aren’t common, apparently.

I don’t really care how much better I’m doing than other people though, if it still isn’t good enough. If others choose not to take it seriously, that is their problem and it doesn’t mean that I can justify doing the same. My health and my baby are what matters to me. And I’m still worried. I can’t help but think it’s just a sign that I’m not as on top of things as I thought. I’m afraid that it means failure of the placenta is more likely. And that caesarean delivery is more likely. I feel like my body is failing my baby. I’m failing my baby by not being successful enough at keeping my body in check. I’m not minimising the risk of problems.

Flangelina will have their whole life to hate me for the things I do (or don’t do) to embarrass them. But I don’t want them to have reason to resent me already. And, if I’m honest, I don’t want other people to have reason to point the finger at me and say that I couldn’t keep my baby safe in the womb.

I suppose I need to re-focus. I need to avoid the tendency to complacency that such a low A1c and steady CGM graphs have given me. Nothing can be taken for granted.

It wasn’t all doom and gloom though….

The Fun: We told the sonographer that we’d been for a private 4d scan. Not to be outdone she exclaimed “Oh yes, we can do that with this machine”. In an instant the grainy 2d image on the screen had flipped to a moving three dimensional picture and we enjoyed several minutes of indulgent baby-gazing.

Flangelina is beautiful, that’s for sure. Every chunky inch of him or her.

I’m sorry, baby, that I’m feeding you a diet of sweeties. I promise to make it up to you when you’re born.

Fetal Hyperinsulinaemia and Epigenetic Change:The risk of lasting health effects from diabetes in pregnancy

I’ve mentioned a few times now how one of the principal risks of diabetes to the developing fetus is macrosomia  which in turn is mainly a problem for delivery. In truth, however, this is a simplification of the situation – a situation about which thought is rapidly evolving in line with the emerging area of developmental biology known as epigenetics.

I’ve touched on epigenetics before. Essentially it’s the study of changes in the way that genes are expressed which are caused by factors other than changes in the structure of the DNA itself. Amongst these factors are environmental conditions to which we exposed throughout our lives, and as far back as during fetal development. Epigenetics looks at how what we do during our lives may affect our genes and therefore our offspring, which is in direct contrast to the long held beliefs surrounding genetic inheritance that essentially suggested that no matter what choices you made in your lifetime, your genes would remain unaltered and so your children unaffected.

The specific environmental factor which is unique to babies born to mothers with diabetes is hyperinsulinaemia – production of a high level of endogenous insulin in response to hyperglycaemia caused by glucose crossing the placenta from the mother. There appears to be some evidence emerging that hyperinsulinaemia may be the factor which connects maternal diabetes to an increased risk of obesity in later life. An interesting article in far more depth can be found here.

Or, to cut a long and complex story short, failing to maintain normal blood glucose levels during pregnancy may lead to genetic changes for our children which alter their metabolism and predispose them to obesity, and all its potential sequelae, later in life.

I’ve not really written about this up until now, partly because it’s still an new area of investigation and scientific understanding is still rapidly evolving. But also, it doesn’t make easy thinking for a pregnant type 1 diabetic. There are enough well established risks to think about such as macrosomia and increased risk of stillbirth or birth defects. There is a lot of focus on getting the pregnancy safely concluded and a healthy baby delivered. You know by now that I’m doing my absolute utmost to minimise these risks and reach that goal.

When I start to think beyond that, about whether my health conditions and the things that I am able to achieve during pregnancy might have a more far reaching effect in terms of lasting heath risks, it becomes overwhelming. I’ve pushed aside the thought that our child may already have a slightly increased risk of developing diabetes. If I start to dwell on the fact that I may cause them to face life long metabolic disruption – to start three steps behind in the race to avoid obesity – then it goes beyond motivating and becomes just plain scary. I know these risks are very present, but the path to minimising them is the same as the path to minimising the more immediate effects.

I have to keep on keeping on. Because the baby’s birth won’t be the end of the story. I don’t just want a healthy baby, I want a healthy child who will grow in to a healthy adult capable of having healthy children of their own. Helping them to do that starts now.