Thursday, 27 September 2018

Pregnancy and Type 1 Diabetes

I normally write this blog about my personal experience with Type 1 Diabetes, however I am very aware that my experience can be very different from someone else. A big topic that I haven't had any experience with is "Pregnancy when living with Type 1 Diabetes", so I asked my friend Lindsay to write about her experience of pregnancy!  - Alyssa



I was diagnosed with Type 1 Diabetes age 6 and I remember being told several times as a “grown up” in clinic “you really must tell us when you decide to start a family”,  “ diabetics can have problems in pregnancy”,  “ diabetics are prone to big babies and complications during pregnancy"! My thoughts: "Gee thanks guys really make it sound like good fun, and yeah I am now petrified"! 

My husband and I spoke about kids and we knew we wanted a least one (coming from a big family I wanted more but one was a good start). 

I am fortunate to have an amazing consultant, who supported me pre-pregnancy, which was a lot of work. When I was told I would have to keep bloods between 3.9-5.2 and no higher than 7.8 two hours after food, I did think, "is this really for me"! My diabetes has never been textbook and never will be I am sure! I have struggled a lot with DKA (Diabetic Ketoacidosis) in the past and I was not the strictest of person when it came to my diabetes. The thought of this really did scare me but my consultant had given me a script for folic acid (ideally we have 5mgs of folic acid 3 months before trying to conceive) so she must have been happy for me to try. Diabetes has never stopped me doing anything else in my life and why should it stop me doing the most important “job” I want in my life!! 

So I came off the pill and fell pregnant straight away!  Oh my word, I have never been so nervous, scared and anxious but also happy and excited about seeing 2 wee blue lines. My Husband knew first, but very quickly afterwards my consultant and dsn (Diabetes Specialist Nurse) phoned to warn them they were not going on holiday for the next 9 months!! 

Because we found out very early we had a bit of an agonising wait until our first scan (you generally get an early scan at between 6-8 weeks to check viability and everything is in the right place). This can be abdominal and/or internal scan due to size of sac. I had to have both at this time. I was told there was a sac there but that it was very early days and too early to see anything else (slight disappointment) but I was also told I must have got my dates mixed up. I knew that I hadn’t though! This is where my job as a nurse started to become a hindrance, because I knew potentially what this could mean but no one was saying anything to me. So I went back after a few weeks for another scan and blood tests, and there was still no growth within the sac. I had unfortunately had a miscarriage. I was completely devastated, and yeah, I automatically thought it was my diabetes fault. I hit rock bottom with my mood, and depression set in, I did not care about diabetes as in my head it had caused all this hurt and grief I was suffering, and I hated it!  It was horrible. I was told officially by doctors that my diabetes was probably not to blame, and that 1 in 3 pregnancies end in miscarriage, which is a scary scary statistic! 



After a while, my husband and I decided to try again so in January 2014 I peed on that stick again, and there were 2 blue lines: “oh f***”! I was so so nervous, but was I ready for it! My diabetes team were again amazing, I was seen every two weeks in clinic right from the start, and we were working on getting tighter control etc. When it came time for that early scan, I was completely and utterly petrified! I jump onto the bed, wriggle my trousers  done a bit, have freezing cold Jelly on my stomach, and I couldn't even look at the screen. Then those magic words were said“do you see that flicking white dot, that is your babies heart beat and it all looks perfect”. I have never felt joy like that before. There was so many happy tears, I just had to get to next milestone at 12 weeks! 

Those early days seem to drag but I worked on keeping my diabetes in control as much as possible. I would beat myself up if my blood sugar was not in “target”. And oh my word it was tough at times, who knew bread could spike your blood sugar so much after eating it! My appointments with my consultant, dsn and dietitian continued every 2 weeks and I got a monthly hba1c (average blood sugar). Things were improving, however, due to outcome of previous pregnancy I was continually on edge! It was horrible, I wanted to get my hopes up, however I was scared too! So it felt like I was just going through the motions!

The dreaded scan day came again, so many tears that morning before we got to the hospital. I was prettified. I got there, jumped up on the table... jelly applied to my stomach and then we heard the most amazing sound ever! We heard a heartbeat, yep you guessed it, more tears. But happy ones. My baby looked the right size, actually measuring 13 weeks and a day. Heart beat was nice and strong. was amazing feeling being handed our scan pictures.  Everyone was telling me, “ now you can relax a bit”! Were they being serious, I was type 1 diabetic and pregnant, relaxing was not on the cards!




The bi-weekly appointments continued, my hba1c was being done every month. I dreaded this result more than ever because if it was high, I didn't know what damage I could be causing my little one. I would regularly be really upset if my bloods went high thinking of the damage I could be causing! Emotions and pregnancy are not a good mix at the best of times BUT add in the guilt of all of this as well, it was not good and I was often in tears due to this. My 20 week scan came and everything was perfect, our little boy was cooking nicely and measuring right on target. My consultant keep saying to me that I was doing a fab job, but did I believe her?! Nope, I was not hitting the “targets” all the time and I was striving to be better. My hba1c was 6.2% (44mmol/mol, right on target) which is the best it has ever been, but it still was not good enough in my head. 

At 24 weeks we had another scan, but this time it was checking the babies heart. This was so strange,  different from an ultrasound scan as we did not see our wee boy, we just seen all his wee heart chambers pumping blood around. All was fine no problems at all, another hurdle overcome! Could I dare to dream? My dream of being a mum was actually coming true. 

At the other scans at 28 weeks and 32 weeks, everything was still spot on, apart from my little monkey deciding be good fun to turn into breech position. If I was to have my dream of a natural delivery he needed to turn round. At 36 weeks he was still breech, so we were given a date for a planned c-section, with the option of a scan that morning to check if he had moved, and if he had moved I could be induced and have a natural labour. The date I was given was 11th September... no big deal, you might think, but it was my birthday that day too. This would be the best birthday present ever. I would be at 38 weeks and 2 days at time of delivery. I was so proud of myself for getting that far in a pregnancy with no complaints, no mega problems. Of course, I had hypo, I had to change my basal and insulin to carb ratio on my pump a lot during pregnancy as insulin requirements change SO much. But I honestly had the best control ever during my pregnancy, and I was determined from the start that I was not having a big baby. I was not going to be another “ diabetic mums have big babies statistic”. Yeah, my diet changed a bit during pregnancy too more low GI (glycemic index) foods to avoid the blood sugar spikes after meals but, you know what, it was not as bad as people make it out to be. Diabetes and pregnancy takes planning and is very time consuming for the 38-39 weeks but it can be done!! 

Anyway, on 11th September at 8am I went to the hospital, having fasted for theatre. They had wanted me to stay in the night before because I was “high risk”, however I stressed to them that I had been a “high risk pregnancy” right from day one and because it was my birthday the next day, I would be going home, going out for my dinner and be in the morning! Yeah I can be stubborn at the best of times!

I went to theatre for my c-section, peanut, as we called him, had not moved from the breech position! The whole experience was very calm and relaxed in theatre, my husband was in with me too, I had my insulin pump on still, no sliding scale and I knew what to do with basal rates etc as soon as baby was born!




At 10.17am our gorgeous LITTLE baby boy (7lbs 6oz) Logan James Milligan entered the world and he was perfect!! I've never been happier in my life! And he was tiny! My husband got the first cuddle and then me, and it was the best feeling in the world!

His blood sugars were “borderline low” all day but the midwifes were happy for him to stay with me and just try to encourage feeding. Come 10pm I was not happy and I wanted a doctor review, as he had borderline low blood sugar all day and he was a very drowsy baby! The decision was made to take him to neonatal department overnight and tube feed him to try and help his blood sugars (yeah I felt mega gutted but I knew this was the best outcome). The next day his blood sugar was fine and I had my wee boy back where he belonged beside me. 




He has been perfect since, and now I have a wee whirlwind of a 4 year old that I would not change for the world. He has no medical issues at all, yeah he has a slightly increased chance of having diabetes but we would cross that bridge if we came to it. 

So yeah diabetes pregnancy can be tough, stressful, frustrating and lonely at times BUT it is doable. I had the best control ever during my pregnancy, and it was not as bad as I thought. Would I go back for another go... possibly just need to wait and see.  




Thanks for reading! If you have any question etc I am happy for to answer, or if it is of a personal nature send me a wee personal message: mcdougalllindsay@hotmail.com

Thursday, 13 September 2018

The Difficulties I Face Daily

I just want to be as honest as possible, and that is the reason for this blog. I often give the illusion that I am doing well, and when questioned, I almost always say that I am fine, even when I'm not. 

I am at a stage in my life where I am independant, I do a lot myself and I am very busy, but I walk about life terrified. I desperately want to be a model patient, because Type 1 Diabetes is *technically* controllable, but when it is complicated with Epilepsy which gets triggered with low blood sugar, like mine is, it gets tricky. On one hand I desperately don't want to let living with diabetes affect my life, I also don't want to end up having a seizure, which would impact on my life and the lives of the people around me.

A smile can hide a lot


In my mind I know that having high blood sugar is bad for me in the long term, it can cause complications such as eye damage and kidney problems, however it is hard for me to weigh them against the very pressing and iminant risk of having a seizure, so I make my blood sugar go high when I have something important going on that I don't want to ruin. Of course this makes me feel horrible, cranky and lethargic, but I don't feel scared and short term, that is really important.

At the beginning of the year, I had an amazing piece of technology called a CGM (continuous glucose monitor) which was a sensor that I wore on my arm, and it esentially tests my blood sugar every 5 minutes and sends a signal to my insulin pump. It would then alarm if my blood sugar was dropping or rising too fast, and if my blood sugar did go low, it would suspend my insulin flow. This was such a peace of mind, it allowed my blood sugar to be in range without me worrying. I knew that if I had a seizure whilst I was by myself, I would be okay because my blood sugar would eventually come up itself. I don't have this anymore, and I am trying to get back from the hospital, but it has been really difficult for me to adjust to having the safety net of having my insulin stopped to bring my blood sugar back up, to now having to manually test my blood sugar, which really isn't the same.

An old picture of a CGM on my arm
 One of the main things I struggle with is not wanting to burden anyone. My family members, especially my sister and mum, have had to help me when I have had seizures before. My sister tells me all the time that she doesn't like going places with me by herself in case something happens to me, and I don't want to put her or anyone else in that position.

I am not saying any of this for pity, I want to be honest. I don't want to sugarcoat living with Type 1 Diabetes, I have both good and bad days, and I know that it is okay not to be okay, but that doesn't make things easier. I don't want to write about my experience with health and only write about the positives, because that just isn't reality. I just want to show people that although I go through a lot daily both physically and psychologically, I still can do anything I put my mind too. Also everyone's health is different, so this is just my experience of living with both Type 1 Diabetes and Epilepsy, but it is important to not judge anyone, because you never know what people are going through.  

Until next time,

Alyssa x