Diabetes

Diabetes + Conception: A Journey

Graph

Just to drive home my point, this is today’s graph. The blue is where I should be.

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:   

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.

 

 

Having Diabetes

Having Diabetes

On New Years Eve 1992, I spent my first night in hospital. I was five years old and my parents had taken me to my GP because I’d started feeling ill. I lost 5lbs, was guzzling water by the pintful and, errr… I was weeing a lot. I felt sick and tired and I couldn’t get the energy up to do anything much other than nap. Or so I’m told. I don’t remember much. Within hours I was admitted to a children’s ward and diagnosed with Type 1 Diabetes.

22 years later and I’m not a model diabetic. I’ve had my highs and my lows. As a child I adapted well, dealt with the needles and blood, wasn’t squeamish and worked hard with the help of my parents to maintain good control. But as expected, puberty rolled around and with it came the cliche rebellion phase. I ate all the wrong foods, skipped injections to save being embarrassed in front of friends, went an afternoon or five without testing my blood sugar. Thankfully, those things didn’t last long. I was just testing the limits. Overall, as diabetics go, I was pretty standard.

Stay with me… I’ve got a point, I promise.

Type 1 Diabetes, or diabetes mellitus, results from the autoimmune destruction of the insulin-producing beta cells in the pancreas. Essentially, my pancreas doesn’t work. When you guys eat, your pancreas will secrete insulin, a hormone to help regulate the levels of sugar in your blood. Without insulin, the sugar levels in my blood are not regulated. This means they naturally run high, and I have to administer insulin manually in order to combat it, making my sugar levels run in a zig-zag-esque fashion that can peak or drop, instead of the smooth, regulated wave that a healthy person’s would.

As I grew up I got better at controlling my sugars again, adapted to normal life as an adult and didn’t let my diabetes affect me too much. But this last year or so, I’ve let things slide a little due to a few massive life events (getting married, buying a house, being self-employed… you know, the usual) and I’ve been becoming less happy with the way I feel, health-wise. On top of that, it’s no secret to those who know me, Matt and I are planning to have our first baby within the next few years. Pregnancy and diabetes is a difficult mix for a number of reasons I won’t go into at the moment – but lets just say, it involves a lot of monitoring and some hard work from me to carry a healthy, bouncing baby to term.

Thing is, people don’t always take diabetes seriously. “You’re basically fine though, right?” is a common reaction, “You can pretty much do what you want?” another. “Do you have the fat kind?” is also a classic (No, but thanks for asking). While it’s true that, indeed, I basically can do what I want, people tend not to understand the work that goes into being a diabetes sufferer and staying healthy. Without tight 24/7 monitoring and control, diabetes can lead to ketoacidosis, coma and death, not to mention kidney failure, blindness and loss of limbs. Plus there’s an increase in the risk of heart disease and a reduction in life expectancy of 12 years. Pity party this ain’t, but it would be irresponsible of me to play the complications down.

You’d think that Type A personalities like me would find diabetes easier to deal with. “Treat it like a job, babe” said one friend after I received a particularly sub-par blood test result and a stern telling off from my doctor. Well, yes. She had a point. I could throw myself into a healthier diet, monitor and analyse full time and while my health still wouldn’t be perfect, it would be a lot closer to it. The thing is, and I’m not sure if any of you know this, I really love food. So while being a home cook and interested in the nutritional value and origin of what you eat is a plus point, eating out multiple times a week and having a particular penchant for potatoes and butter, well… that isn’t.

So you see, when I say that food is my life, I mean it literally.

I wear an insulin pump. I’m sort of like a robot. I have this little piece of machinery attached to me 24/7, via a piece of plastic tubing and a cannula, feeding me a constant drip of insulin. That drip has to be regularly monitored, amounts calculated and tweaked. I then have to adminster a “bolus” of insulin everytime I eat. I work that amount out by counting my carbs. The grams of carbohydrate I eat directly correlate to the units of insulin I have to feed my body. And there are carbs in things you don’t realise there are carbs in. The more you eat out, the less you know about your food, the more you have to guess at what quantities you’re eating. Get it right and you might maintain blood sugars in the safe zone. But that’s without factoring in stress, activity and hormones, all of which have their own impact. In short, it’s a battlefield. A battlefield paved with potato dauphinois and Curly Wurlies.

The point of this post was to explain the change. I’m conscious that now that my life has become a constant rotation of blood glucose testers, iPhone monitoring apps and online forums again, I might be dropping the d-bomb more often, both here and over on Twitter, and I didn’t want it to come out of nowhere. That’s the kind of thing that encourages comments like “Oh, she’s a diabetic? I saw her eating a piece of cake last week!”. It’s a common misconception, but people with diabetes can eat whatever they like. We just have to account for it. We all have to work out a system that works for us. For me, everything in moderation works, so that’s what I’m going with. Life without a Twix or a Chinese takeaway doesn’t bear thinking about.

So things might be slightly different around here. That doesn’t mean there won’t be complex carbohydrates in abundance. I promise you that quinoa will never form the bulk of my diet. But there will be low sugar, low carb recipes every now and again. Sometimes I might like to share my experiences in trying to get that perfect HbA1C result, or the reasons why I’ll never eat a Dominos pizza again (lies, every time). I also want this to be a place where other people with diabetes, friends or family members can come as a resource, a place to ask questions and learn something new. We’ll see.

So that’s that then.