Sugar High Sugar Low: Preparing for pregnancy

Before conceiving I had a lot of things to contemplate such as being fit, healthy, eating well, having tight control of my blood glucose levels and most important of all achieving at least an A1c of 7.0%. Both diabetes and pregnancy combined have their own unique challenges. I knew that I would have a lot of hard work ahead of me.pregnancy tagcloud pictogram

My diabetes appointments are usually quarterly at the diabetic centre. My previous appointment showed that my A1c was 7.5%, so I decided to visit my diabetic team and inform them of my plan, as I did with my first pregnancy. The diabetic nurse retested my A1c and after two weeks I found out my A1C was actually 7.3%. Blood glucose control is vital during pregnancy because if you can imagine even before you’re aware of your pregnancy, your baby’s brain, spinal cord, heart and other organs have already started to form. This totally freaks me out because without tight control I could have possibly affected the way in which my child developed.

I was given the opportunity to have a trial run of the dexcom G4 sensor for a month which I talked about in my post, “Cyborg for a month or perhaps longer”.

Dexcom G4is a continuous glucose monitoring (CGM) sensor which is inserted into the body and is able to give blood glucose readings every five minutes. The sensor automatically transmits this reading to my insulin pump (Animas Vibe) and creates a graph. With my insulin pump I am able to set an ideal blood glucose range. If my blood glucose level goes above or below this range my insulin pump alarms to alert me of either an increase or decrease in blood glucose level.

My trial run actually went on for longer than a month and it was during that time that I conceived. My pregnancy journey had started and with my team we made the decision to continue with the CGM during this pregnancy. To start with the CGM really helped me achieve tighter control and a better understanding of patterns occurring at certain times in the day. After a month my A1c had dropped to 6.4%.

By week five of my pregnancy I had developed severe morning sickness. I was a complete mess. I had no appetite, I lost a lot of weight and I needed far less insulin. My insulin requirement continued to decrease during the next few weeks. The morning sickness continued and to make matters worse my CGM didn’t seem to want to cooperate. The readings on my insulin pump compared to a finger prick reading was completely different. It stopped picking up low and high blood glucose levels. It just did the complete opposite.

I was able to change my sensor and transmitter  a few times but unfortunately every time I got a new one the same problem occurred. No matter where I placed the sensor on my body it would react in the same way. My diabetic doctor seemed to think that it could possibly be the pregnancy hormones interfering with the sensor. I went one step further and decided to contact Dexcom with regards to this. They were unable to conform if this was a possibility or not. I was told that no research has ever been done on the effects of pregnancy hormones and the accuracy of this sensor.

My doctor asked me if I’d prefer to go without the sensor and I agreed to go without it for the duration of my pregnancy. I began my rigorous blood glucose testing and on some days I’d test up to fifteen times.

logbookHaving good control minimised risks such as miscarriage and birth defects. My pregnancy was able to progress well almost as if I did not have diabetes. Four months into my pregnancy I managed to achieve an A1c of 5.7% and it remained that way throughout the pregnancy

With the help of my antenatal diabetes consultant I was able to plan my target blood glucose range so that my blood glucose could be as close to normal as possible during my pregnancy. We also discussed and looked in detail at basal rates, insulin to carb ratio’s and insulin sensitivity. I was able to be in contact with him on a daily basis and then I attended the diabetic antenatal clinic every week. In actual fact I was very lucky to have had a team of people accessible to me which consisted of x3 diabetic midwives, x2 OBGYN’s x1 antenatal diabetes consultant and a dietician. I also still had contact with my diabetes team from before my pregnancy. I WAS VERY LUCKY!

Another important factor with diabetes and pregnancy is the health of your eyes. I had to have my eyes checked every trimester by the Eye hospital to make sure that no changes were occurring. A month after the birth of my first child, I developed changes in my eyes which then corrected themselves strangely enough. However it is routine for diabetics to have regular screenings during their pregnancy here in Manchester.

Preparing for pregnancy and the pregnancy itself was extremely difficult. I had moments when I felt stressed out, happy, anxious, nervous and mostly worried. Regardless, I felt that patience and maintaining a serene demeanour was definitely key to having a healthy pregnancy and ultimately a beautiful healthy baby.

Amina xx

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