Now this is quite heavy subject matter, all about the inner workings of my (semi-dudd) body. It’s kind of a weird thing to talk about on a blog, and if health and medicine don’t interest you, I won’t hold any grudges if you give it a miss and come back for a recipe next week. If you’ve been following me on Twitter, you’ll know that recently I’ve been talking about diabetes a lot and some of you have registered an interest, so that led me to the decision to talk about Having Diabetes a little bit more.
I’ve alluded before to the fact that conceiving a child can be difficult when you are a woman with diabetes. It’s actually not necessarily conception itself, it’s more the carrying a healthy baby to full term thing. My knowledge about this is basic, and I was actually in the dark about the subject on the whole until recently – until the doctors deemed me to be of an “appropriate baby-making age and circumstance” (read: over 25 and married). My reaction to that wasn’t necessarily positive, as you might have guessed, and initially I was very cross. I still am – to an extent, but there are reasons that it happens this way and all that stuff is for another blog post. For now, we’re covering the practicalities of how to get and stay pregnant when you’re a person with diabetes. You know… the medical stuff.
Disclaimer: I’m not a medical professional, only a “patient”. Therefore, try not to get your knickers in a twist if my facts aren’t always exactly straight. In fact, if you know better, please correct me down in the comments. I’m learning, after all, and I’d really appreciate your help.
Let me walk you through it. In layperson’s terms, as a person with diabetes (pwd) my blood sugars move in peaks and troughs. With self-administered insulin, even with a pump, the doses I am giving myself are reactionary. Your pancreas, as a healthy person, measures the sugar in your blood and acts accordingly with the correct amount of insulin every single time, so there’s never an error, and you never stray out of those 4mmol/l – 7mmol/1 parameters. For even well controlled pwds, there’s a lot of guessing involved with basal insulin rates and dealing with carbohydrate on a day to day basis. Calculations are made and quantities decided on, but it will sometimes, inevitably, go horribly wrong. As a pwd, I’ve learnt to accept that and put it down to experience. That’s something that most diabetics will go through, because frankly, otherwise there’s a tendency to go a bit mad. As I understand it though, the thing with diabetes and pregnancy, is that the peaks and troughs can’t be there. Or at least, they need to be down to a serious minimum, so the graph of my blood sugar over a 24 hour period must not be a zigzag, but a smooth, undulating line.
For me, and for most, this will take a lot of work.
Because the first trimester of pregnancy, especially for those with diabetes, is the most important, these things can get complicated. A lot of the time, pregnant ladies may not even know they’re “with child” until at the very earliest a few weeks, and more realistically 6-8 weeks gone, by which time some of the crucial development for baby is already complete. Therefore, there’s a training process. Pregnancy Training. When you say that to people, the initial response is usually a raised eyebrow and a sheepish grin. LOL sex! You need to practice having sex! Yeah… that’s not the bit I need to work on, thanks. Awkward for everyone now, right? Welcome to my life. Let’s move on quickly.
Just so you know, the risks of being pregnant and not having your diabetes under control are the following (quoted directly from NHS Choices). Please proceed with caution if you are a lady with diabetes and you haven’t necessarily read a lot about this before:
If you already have type 1 or type 2 diabetes, you may be at a higher risk of:
- having a large baby – which increases the risk of a difficult birth, having your labour induced or a caesarean section
- having a miscarriage
People with type 1 diabetes may develop problems with their eyes (called diabetic retinopathy) and their kidneys (diabetic nephropathy), or existing problems may get worse.
Your baby may be at risk of:
not developing normally and having congenital abnormalities – particularly heart and nervous system abnormalities
being stillborn or dying soon after birth
having health problems shortly after birth (such as heart and breathing problems) and needing hospital care
developing obesity or diabetes later in life
Cheery stuff, eh?
So, in light of all that, there are certain hoops I need to jump through in order to qualify to be able to “start trying”. I don’t really know what those are officially. Apart from the main thing, get my HbA1c (that’s my three month average) down to an acceptable level. That’s around 48, or 6.1%. I sit, generally, at 60-65 but in times of stress or activity or during burnout, that has at times risen to a rather frightening 80. 48 is a scary number. A number that, of the pwds I’ve met, most wouldn’t deem within their reach without some serious lifestyle changes. When I first started doing my research, there was talk of no post-meal blood sugars being over 7.0mmol/l. I can’t really explain to you, if you’re not a pwd, what kind of fear that struck in my heart the day I found that out. I still don’t know if that’s true. But if it is, I’m in for a tough few years.
So what are the alarm bells that ring in my head, now, towards the beginning of my journey?
No carbs. Less fat. No alcohol. No big days out. No big nights out. No exceptions. Mostly, no carbs.
And the questions that spring up as a result of those alarm bells?
Is it all worth it? Do I want a kid that much? If it means no chips, no bread, no sneaky Milky Way Crispy Rolls at 4pm on a particularly boring day in the office, or glass of red wine to celebrate a good day?
At 27 years old, and I hope you can appreciate my honesty here, that’s not a question I can really answer yet. I think the answer is yes, it is all worth it. And I know it must sound ridiculous, not to mention insensitive, to consider giving up a chance to have a child in exchange for complex carbohydrates, mind-altering liquids and the faint glisten of animal fat on the surface of my plate. But it seems like an awful lot of work. An awful lot of hospital visits, blood tests, monitoring and, most of all, an awful lot of self-control. Which, as someone who since their 13th birthday has perpetually been three stone over-weight, has never been my strong point. It’s worth mentioning now that none of those alarm bells are strictly fact. They’re exaggerations, on the most part. But they are based in fact, and they do weigh on my mind.
I think that’s why I’ve decided to write it all down. And this might not be the right place for it, who knows, I might move my updates over to Medium or somewhere more appropriate. But for now, I wanted to be honest, share my life experiences and keep you guys in the loop. I wanted to get my thoughts out on the biggest “issue” in my life at the moment (hopefully the biggest issue I’ll have to face for the next few years). Also, as mentioned in my original Having Diabetes post, I’d like this to be a sometime place for me to share parts of journey in figuring all this stuff, diabetes on the whole, out, and a place where others can come as a resource. Because during my process of research, I’ve found those resources to be seriously lacking.
Errr, so yeah. I suppose I’ll be back with progress reports over the coming months. Please give me any feedback you can on this post, even if you feel like diabetes is none of your business but enjoyed the read. I’m really interested to see how people feel about this kind of update.