DIABETES AND PREGNANCY
Sunday, July 9, 2017 – 13:37
Let’s start at the beginning…
It was February 2012 – Valentines’ Day to be precise. I had made an appointment to see my family GP, as I had been feeling incredibly tired, thirsty, and was going to the toilet frequently. I had lost 11 kilos in the matter of a couple of weeks. Furthermore, I had been having these really strange headaches accompanied by nausea for a month or so. Admittedly, I thought it had to do with a dental procedure I had in January – I had all four wisdom teeth taken out “in the chair” (what was I thinking?!), and recovery was very long and traumatic.
Within minutes of entering the GP’s room I was diagnosed as having diabetes. My blood sugar level was 26.7mmol/l, and I was immediately driven to Royal North Shore Hospital to see an endocrinologist. The endocrinologist took some bloods and had it sent off to be examined for GAD (glutamic acid decarboxylase) antibodies; this was to determine whether I had type 1, type 2 diabetes or LADA. Sure enough, GAD antibodies were detected, and thus I was diagnosed as having type 1 diabetes… at the age of 26.
Next, was a visit to the onsite diabetes educator – a lovely, softly-spoken lady, who had been educating for well over a decade… but who, quite frankly could have been speaking Japanese and I wouldn’t have noticed. I was in so much shock and disbelief at this stage that I didn’t really know what was going on around me. The only thing I kept hearing in my head was “you have this for life” and “there’s no way out of this”. To my now-husband Leo, and my family during these first few days, I was still the same optimistic, cheeky, strong Amanda they knew – I would try and play down my feelings about the diagnosis, so that no one would fret over me. I was also fearful that Leo would find the whole thing too hard and break up with me; an irrational thought yes, but let’s face it, 95% of our worries are! My biggest fear however was the thought of not being able to have children. This fear occupied my mind every morning upon waking. This fear was further exacerbated by a health care professional my Mum had seen who told her “your daughter will be lucky if she can give birth”. Admittedly, this comment also angered me to the point I actually booked an appointment to see them without a proper medical reason and I asked them face-to-face firstly to clarify their comment and secondly to explain to me why they felt the need to communicate such an unhelpful and pessimistic opinion – their answer was even more ridiculous: “I actually don’t know much about type 1 diabetes per se, I just have this friend who has type 1 diabetes and who has been struggling to fall pregnant”. I nearly fell off my chair laughing.
The day I found out I was pregnant
I was driving to an appointment to see one of my customers when the song “Happy” by Pharrell Williams came onto the radio. It was at this moment I thought to myself that I should pick up a pregnancy test from the local pharmacy after my work appointment. I couldn’t wait until I got home so I ducked into the shopping centre’s restroom and took the test there. Those two minutes waiting in the cubicle were the longest two minutes of my life! As my eyes adjusted to the results window of the pregnancy test and I could start to clearly see two faint little lines, I let out a little yelp and immediately took a photo of the results window from my phone and sent it to Leo. He called me within 30 or so seconds from receiving the photo and said “ok babe, let’s not get too excited just yet, the lines are only faint!”… So in true Amanda form, I went and bought another five tests from the local pharmacy and throughout the course of the day tinkled on each one of them… when Leo returned home from work and walked into our bedroom he was astonished to see that I had lined up each of the tests on the bed, all with the same two faint lines clearly in view. And in true Leo form, his response was “let’s confirm it with a blood test before we get too excited”. Off to my family GP I went and within 12 hours, I received a big fat positive. “Congratulations dear, you’re pregnant!” After 5 months of working hard to get my blood sugar levels under control – at an hBA1c of 6.2% – with the insulin pump (Medtronic Veo), and a short stint on CGM (Minilink), we were able to finally celebrate!
First, second, third trimester
is more common also due to the amazing effects of morning sickness), I experienced mixed emotions. Although I was so incredibly happy at the thought of being a Mum, I was also terrified at the thought something going wrong as a result of the diabetes. It was during this time that I started having nightmares. I remember one in particular where my tummy wasn’t growing and another where my baby was growing too quickly and exited my body via my neck! It’s fair to say that I had some freaky dreams to say the least! While apparently irrational dreams are a normal part of pregnancy, I couldn’t help but think that because I had diabetes my baby was somehow going to be negatively impacted throughout the pregnancy and I couldn’t stop feeling this sense of guilt. The guilt was obviously misguided because I knew deep down I was doing all the right things – I was eating well, monitoring my sugars regularly, drinking plenty of water and getting plenty of sleep. Furthermore, my endocrinologist was happy with my progress and was incredibly encouraging and supportive throughout my pregnancy, which was also reassuring. With all that being said, I just couldn’t shake the anxiety. It was truly exhausting for both myself and Leo, and something I wish I had learnt to control earlier. On that note, if there’s just one piece of advice I would like to give you when you’re in your first trimester and indeed throughout the whole pregnancy, it’s that you remain accountable. This means keeping your stress levels down, checking your BSLs regularly and treating the highs and lows accordingly, eating well, drinking plenty of water and of course staying in regular contact with your healthcare team. These are all things you can control… the rest is up to fate/destiny/nature/whatever you may believe in.
Now the second trimester… well that was a breeze! Although my insulin requirements had increased by some 50% and I was hungrier than ever, I had loads of energy and my levels remained relatively consistent on a daily basis. It was during this time that I decided to take a break from CGM, for no other reason than cost (maternity leave was only just around the corner!). I stayed on my pump, as I liked that I was able to easily adjust my basal/bolus rates as my pregnancy progressed, the convenience of changing my infusion set/reservoir only once every three days, and essentially the peace of mind it gave me. Even though I felt far more relaxed than I did during the first trimester as baby was growing steadily and I felt that I could finally enjoy my pregnancy, I knew I still had to be vigilant with regards to checking my sugars so I continued to finger prick 4-6 times a day… much to the delight of my endocrinologist.
When the third trimester finally came around, my insulin requirements had more than doubled and I started to feel the effects of my growing baby; suddenly I was racing to the bathroom constantly and my back was aching to the point I couldn’t sleep more than a couple of hours at a time each night. The pump was a great help in terms of managing the increased insulin requirements though, because it just did its thing without me having to think about administering basal insulin, fiddling with needles etc. It just made the whole pregnancy journey that much easier.
The birth
At 36 weeks, Leo and I were sitting at a car dealership purchasing our new family car when I started feeling cramps. They weren’t overly painful; they just came and went within a few seconds. It was when I started noticing that my tummy appeared to be much harder than usual that I felt the need to call the hospital and seek advice. The midwives weren’t too alarmed but suggested I pop into the hospital for a CTG scan “just to be sure…” Thankfully I went, because I was already 4cm dilated, and that ‘hard tummy’ I had wondered about at the car dealership was due to a suspected placental abruption (apparently just a ‘thing’ that can happen). Within 45 minutes I was already in theatre with Leo scheduled for an emergency C-Section. You can imagine the panic that started to set in, given I wasn’t due to give birth for another four weeks! This was worsened when the anaesthetist administered the epidural too high in the spine and numbed my body from neck downwards. At this point, the only thing I did have confidence in, was the blood sugar levels – they were fine, which admittedly surprised me given my cortisol levels were probably at an all-time high!
Following 30 minutes of birthing chaos (which also included a post-partum haemorrhage), little Rose arrived safely into the world. After a quick long-awaited embrace and a kiss on her warm little forehead, Rose was whisked away to the special care nursery. As a result of her being premature, her lungs weren’t fully developed, so she spent a couple of days in a CPAP machine, and then a further couple of days under the lights for her jaundice (admittedly Leo and I thought she had lovely tanned skin thanks to his Brazilian heritage). She also had a mild case of hypoglycaemia – something I had been told to expect – for the first couple of hours, which was treated with some dextrose via a drip. Her blood sugar levels subsequently returned to the normal range of 4mmol/l post-drip, which was a big relief.
Breastfeeding
I was surprised to learn that I was much like a dairy cow when it came to producing breast milk, especially since I was advised by a couple of medical professional that it was unlikely – as someone with type 1 diabetes – that I would produce much milk! When the milk came in on the fourth day, I felt as though I needed a couple of tin buckets to collect the stuff! In fact, Rose found the flow too fast (the poor darling was practically drowning in it) that I ended up having to express first for fifteen minutes on each side AND wear a nipple shield prior to feeding her.
I did notice that my blood sugar levels dropped a fair bit 30 or so minutes after expressing/breastfeeding especially during that first week at the hospital but also when I returned home… unfortunately I wasn’t on 640G with SmartGuard back then as I was using the older style pump, the Veo, so I resorted to toast with lashings of marmalade or a glass of apple juice (and whatever else I could find to get me feeling normal again) to treat the hypos on numerous occasions. Honestly I think, if I was on the newer pump back then, I probably would have dropped a couple more kilos, as I wouldn’t have needed to defensively eat/drink so much to treat the hypos (the 640G with SmartGuard suspends insulin before hypos in 80% of cases).
Back at home, life with our newborn Rose was both amazing and incredibly challenging for Leo and I. Although I wasn’t used to sleeping a whole lot especially during that last trimester of pregnancy, I wasn’t expecting to feel so sleep deprived that I could barely think for myself. I was also expressing most of the time, as Rose wasn’t latching properly, so this made motherhood that little more challenging. This was yet another situation where the insulin pump came in handy – it was a relief just knowing that this amazing technology was doing a lot of the work while I focussed my attention on my beautiful new daughter. If I had my chance again however, I would go on the CGM at this time to further assist in the management of my rapidly changing levels; it’s a worthwhile investment for peace of mind.
So there you have it! Pregnancy is complex and is much like a rollercoaster, with or without diabetes. Of course you can expect a few more ups and a few more downs when you’re living with type 1 diabetes (or any type of diabetes) – in terms of your blood sugar levels – but you have this amazing technology at your fingertips to make the ride that little bit smoother and more enjoyable, so I would recommend that you get on to the insulin pump with CGM and feel the difference!
Amanda Silva
Medtronic Diabetes Australia
Clinical Specialist, Diabetes Group
Diagnosed at 26, Amanda’s “BIGGEST fear was the thought of not being able to have children”. On her unique journey to becoming pregnant, Amanda overcame multiple hurdles and as she explains, “Pregnancy is complex and is much like a rollercoaster, with or without diabetes”.
*The information provided in this blog is an individual account specific to the writers experience in the management of their own diabetes. Before considering any changes to your diabetes management you must consult with your healthcare professional.