Sunday, 24 March 2013

Pregnant with Diabetes - 1st Diabetic Clinic Appointment

When I was 29wks pregnant with my 4th I developed Gestational Diabetes. Gestational diabetes is a type of diabetes which occurs during pregnancy when the body cannot produce enough insulin to meet the extra demands of the pregnancy. A simple blood test, known as the Glucose Tolerance Test, can test for gestational diabetes. To do this test a blood test is taken on an empty (fasting) stomach and another blood test is taken two hours after a sugary glucose drink (such as Lucozade). By comparing the sugar levels with blood tests, they can see how well your body has coped with a large influx of sugar. What surprised me the most, was that I developed gestational diabetes with my 4th pregnancy, yet passed the glucose tolerance test with my previous 3 pregnancies. However, as I developed type 2 diabetes just 18mths later after the birth of my daughter, it seems that I was already on the path to developing diabetes and that my pregnancy just speeded things up a little. 



You can read my story of gestational diabetes here

Now I find myself pregnant again and this time I already have diabetes. One of the biggest risks to your developing baby is having high sugar levels and your blood sugar levels not under control when you concieve and during those first few important weeks when the baby is developing. This is why a diabetic is recommended to have her blood sugar levels under control and below 6 when they concieve and not to get pregnant until they have their sugar levels under control. Sadly, that wasn't the case for me as my pregnancy was a shock! I wasn't planning anymore children, but God obviously had other plans for me as I fell pregnant whilst on the pill! As I wasn't testing my blood sugar levels regularly, just a blood test every 3mths, I have no idea if my sugar levels were good or bad, but judging that I concieved around Christmas, I doubt they were that good. However as soon as I suspected I might be pregnant, I immediatly started being very careful with what I ate and watching my diet to try and reduce the amount of sugar I was injesting (remember it's not just sugar as glucose is also present in carbohydrates such as bread, potatoes, pasta etc). I was reluctant to take a pregnancy test for a while, convinced I was just about to come on and I wasn't actually pregnant, until hubby brought one home and ordered me to find out! Deep down I knew I was pregnant, even though I don't suffer from morning sickness, but even then I was still surprised to see two pink lines. 



I made a doctors appointment as soon as found out for sure and at my appointment I asked if I could start testing my blood sugars so I could try and monitor my diabetes and they agreed and from that moment on I was pricking my finger twice a day to see what my readings were. 

The biggest problem with a surprise pregnancy, was that I didn't know what my due date was or how many weeks pregnant I was as I couldn't remember exactly when my last period was. We made a guess and when I finally had my scan I discovered my guess was only a week out as I was 13wks which gave me a due date of the 22nd August. Reaching 14wks was such a relief as I had had a previous miscarriage at 13wks and now that I had come to terms with the fact I was pregnant, I didn't want to lose the baby and was happy to have a new additional to our family!



Wednesday was my first appointment with the diabetic clinic. This is because it's very important that I keep my blood sugars under control to help the baby and also to prevent any complications for both of us. I took my son with me as it was his 10th birthday a few days later and as a pre-birthday treat we were spending the day together, just the two of us, and buying him some new clothes as he's grown out of all of his (what a cruel mum I am making a boy have clothes for his birthday present LOL).

We were at the hospital for 2hrs. First I had to be weighed and have my blood pressure checked, then I had to have a blood test so they can see how my blood sugar levels have been over the past 3mths. 

Finally it was time to see the diabetic doctor. He asked me about my diabetic history and looked at my blood sugar readings over the past 8 or 9wks. He explained that whilst they were good (I was averaging around 7) they were still slightly too high for pregnancy. He asked what medication I was on and I told him I took 1 500mg tablet of Metformin twice a day and he decided to increase my dose to 2 500mg tablets twice a day to try and get my readings below 6, especially in the morning. He also told me he wanted me to test my blood sugars more often, so now, as well as pricking my finger when I get up and before I go to bed, I have to test an hour after every meal. I also have to arrange to go for a retinopathy scan to check my eyes as pregnancy can increase the risk of diabetic retinopathy. Diabetic retinopathy is a common complication of diabetes which occurs when high blood sugar levels damage the cells at the back of the eye, known as the retina and if it isn't treated it can lead to blindness. Which is another reason why it's important to keep not just my blood sugars but also my blood pressure low. 

Finally we went to see the diabetic obstetrician. He had a group of students with him and I was asked if I was ok for them to be there, which I was cos everyone has to start somewhere! Thankfully he had a strong accept so my son couldn't understand what he was saying, although I could. He told me all about the risks and concerns there was with regards to my pregnancy and why it was so very important I keep my blood sugar levels as low as possible. Some of them I already knew, but finding out that not only is there a risk of miscarriage, but there is also a risk of unexplained fetal death was a bit of a shock and a worry. There is also a risk that the baby doesn't develop properly which is why my 20wk scan will be more thorough and detailed than a non-diabetic 20wk scan. I also have to have several growth scans to check the baby's size as it will get some of my excess sugar which means that it could be a very big baby (which when you realise my eldest 3, with whom I didn't have diabetes, were 8lb 13oz at 40wk, 10lb 14oz at 41wks and 9lb at 39wks means it could be a very big baby indeed! My 4th was 8lb 15oz at 38wks but I had gestational diabetes with her). Another worry is he told me it is very important I keep my stress levels down and my blood pressure doesn't rise. High blood pressure is a serious risk in a diabetic pregnancy and could cause me to develop pre-eclampsia, a serious condition which left untreated can kill both me and the baby, add to that the fact my mum suffered with pre-eclampsia and high blood pressure in her pregnancies, means I have a higher risk so I need to try and keep it as low as I can (are you listening children since you're the biggest cause of my stress!!!). Because of that risk he prescribed me aspirin to thin my blood as this should help keep my blood pressure down and reduce the risk of pre-eclampsia. He also asked me to do a 24hr urine collection so that they can get a baseline of any protein in my urine as this would be one of the first indicators of problems with my diabetes and pregnancy. Thankfully, since I have to return the sample to hospital myself, they are willing to wait 2wks until my next diabetic clinic appointment as it's a 120 mile round journey to hospital. 

All in all it was a lot to take it, and made me even more certain that I will be sterilised after this pregnancy!

I have to go back to the diabetic clinic in 2kws to see the diabetic doctor, but I don't need to see the diabetic obstetrician for 8wks. I've also been given a date for my 20wk abnormality scan which is the day after my diabetic clinic appointment so I'm trying to change it to the same day. 

Some good news is that we were finally able to pick up the baby's heartbeat on my home fetal monitor yesterday, which pleased the kids and gave me some reassurance that everything is ok!

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