Pregabetes Part 3

Pregabetes Part three coming to you now even though I am well and truly post-partum from my second baby.  Sorry for the delay but my pregnancy management was free and easy and I did not know how to post that on a public forum without getting in to trouble and I didn’t want to be judged and deal with negative comments about some of the things I was doing especially when I was also constantly being told by the medical profession that by doing the things I was doing and hoping to do that I was risking the life of my baby.  Yes, that is what you have to deal with if you are trying to do the best for your baby.  The constant judgement that you do not know and that you are not educated enough is overwhelming.  Granted, I am a Registered Nurse and a Diabetes Educator so if they were going to believe anyone, it might have been me, but it generally wasn’t, with the exception of a few wonderful specialists that I was involved with.

Now that I have had a happy and healthy baby boy I can share my experiences without the fear of all of the negative things that the medical profession suggested may happen.  Fair is fair though, bad things unfortunately do sometimes happen in diabetes and pregnancy and that is why the medical profession needs to be careful with people who are straying from the norm but I am here to tell you today that the norm is not the only way, and it was not for me. 

Please do bear in mind that I am not sharing these stories from a medical perspective and do not take any of this information as advice or suggestions.  What happened for me may not be the same as what would happen with someone else.  Do your research, listen to your body and your little baby floating around in there and do what you think is best for you both in collaboration with the specialists who are helping you on your journey.  You must always have a plan A but be open to succumbing to plan B if there are reasons that plan A is no longer feasible or safe for you or the baby.

Let me tell you a bit about our families’ history and philosophy with our first pregnancy. My diabetes has been well controlled for a long time with Hba1c’s in the 5’s and 6’s since 2000 and before.  Like any person with diabetes I had my highs and my lows and I had periods of crazy BG levels that were unexplained but I always was quick to troubleshoot and fix them whether it be through exercise, food choices, insulin or all three. 

Management during Pregnancy was certainly more difficult in some ways; managing increasing insulin resistance and increasing insulin requirements is not a piece of cake but I had the knowledge to make changes to my insulin pump settings and I did this regularly to combat the changes that happen so regularly throughout pregnancy; YOU are with your diabetes 24/7 and you know the most about it, you can use this knowledge to improve your levels.  Talk to your team to work out how you could safely do this in collaboration with them. 

At our first visit to the diabetes clinic where I live the advice was that as a lady with diabetes I would deliver my baby by induction at 37 weeks gestation.  It was only after the pregnancy and labour classes we went to at the hospital that we started to question this idea.  We did not know much about what induction was until hearing a little bit about it in these classes.  There were a few sentences said that didn’t sit right with us;

“Induction is for people with chronic medical conditions because these people have other risk factors such as high blood pressure.  Induction should be offered to a diabetic at 37 weeks or earlier if there are other complications such as high blood pressure.  Induction forces the baby to come early, the baby may require assistance with breathing, mums milk may not come in soon after birth because the labour has been mechanically induced.” 

Following learning all of this we went to do more research and decided that induction was our last resort and we wanted to conceive naturally if possible and if no risks were to arise.  My husband did some great research but could only find papers on people with poorly controlled diabetes in pregnancy.  The outcomes of these research papers included large babies, nicu due to low BG levels, high blood pressure, eye problems, placental degradation or death.  Where were the studies on people living with well managed Type 1 Diabetes?.  Discussing this with my endocrinologist went well.  He was very happy with my Hba1c and my control pre pregnancy and he said that if anyone were to be able to come to term in pregnancy that he didn’t see why I couldn’t.  The obstetricians were not so keen but said that they would see what happened week by week after 37 weeks and that it was possible for me to deliver naturally if that happened.  They did not miss the opportunity to discuss the risks of placental degradation, rupture or foetal death.  This was a reminder that came up at every single appointment I had with the obstetricians.  It was difficult to be strong with such dire consequences thrown at us but I was able to talk to my husband and him to me and we were able to remain strong in our wishes despite the possible consequences.   

Through first trimester I was exercising regularly, as I had been doing while trying to conceive and before.  I attended a group boot camp class three times a week in the morning which was so much fun and which I did not feel was pushing my abilities at that stage.  I advised the coaches that I was pregnant and I did not do certain activities or altered some slightly to be more suitable.  Eating through first trimester was mostly by the book.  I avoided alcohol, I did not eat red meat, cheese or oysters and I tried to eat wholesome and healthy foods.  I did eat chicken and fish especially raw salmon when I could.

Yes, I gained a lot of weight in my pregnancy and I had increasing insulin resistance and insulin demands but my blood pressure was maintained at a normal level, my blood glucose levels averaged in the 5’s, with an hba1c of 5.2%, I felt kicks throughout, the baby was of normal size for all of the scans and was moving happily.  I did not want to bring that baby in to the world before he was ready.  I did not want to induce if it wasn’t absolutely necessary.  I stressed to my team that whilst I am aiming for full term natural delivery that if anything were to go wrong or anything were to indicate that I should deliver earlier I was happy to induce earlier but I needed some indication that this was necessary.  This never eventuated thankfully.

Working with a specialised medical team when you are pregnant with diabetes is absolutely necessary but conforming to the mould that they create is not.  They are advising you from their history in dealing with hundreds of people with diabetes and their pregnancy outcomes but you are only 1 of 100 people and your case, just as your diabetes, is different to everyone else’s.  This is your pregnancy and it is your choice, to some degree, when and how you deliver.  You can work with your team to come to a happy medium.

During the later stages of my pregnancy, my food choices certainly became less strict because I was realising that my ways were not causing any damage, in theory of course.  My baby remained on the 50th percentile size wise and there were no complications.  Also doing further research I couldn’t really understand why some things were eliminated from a pregnant person’s diet.  I am not suggesting that anyone else should do this, but I did begin to include red meat, raw fish, coffee and a glass of wine on occasion.  I continued to limit my caffeine intake as recommended and I continued to take folic acid and pregnancy supplements throughout. 

To cut a long story short, my first baby, Austin, was born weighing 3.2kg at 39 + 6 weeks gestation.  Through some miscommunication between the hospital and myself I did end up inducing on that day but thankfully we only needed to use the gel.  From there I began to labour naturally, my waters were broken in the morning at 6am and I had a happy, healthy and sweet baby boy born later that morning, he did not have any BG level problems.  Throughout labour my BG level remained under 8mmol/L, I continued to manage this with my husband’s assistance using my insulin pump and continuous glucose monitor.