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May 19 / Caro

First Trimester: The Diabetes Edition

In addition to all the symptoms you read about in the ‘Yay, I’m Pregnant, Now What?” books (like the tiredness, and the morning sickness), diabetes brings a whole host of its own challenges to the first trimester party.

It starts just about the moment you see that second line on the pregnancy test , where three seconds of sheer elation is followed by lingering sense of panic. I’m guessing that all women experience some degree of worry during early pregnancy – about the risks of miscarriage and about keeping themselves and their baby healthy. But with diabetes in the mix, the stakes seem higher. Because one of the major factors that may influence the outcome of the pregnancy is directly in your control, but sort of uncontrollable at the same time. The sudden realisation that you need to keep your blood sugars on the absolute straight and very, very narrow day-in, day-out for the next nine months is overwhelming. More-so because you’ve almost certainly been trying to do that for a long time anyway, and know just how difficult, if not impossible, it is to do.

The worry about whether my best is good enough is something that gradually settled down in the background. It’s never gone away, stalking me wherever I go, but it has become a bit less front and central. To a point I need it there, to keep me motivated to put in the huge amount of effort that so far seems to be paying off.

Worry aside, if I had to pick just one word to define my diabetes during the first trimester it would be: hypoglycaemia. Oh yes. The lows moved in to the building and took up very firm residence.

I sort of expected it. Other women with diabetes, and my health care team, had already primed me that lows were a possibility due in part to all the efforts for very tight control, but also just because. I didn’t expect the lows to be so… persistent, though. My basal insulin requirements dropped like a rock, and I was often drinking my body weight in carbs, without bolusing, just to stay ahead of the curve. Which was pretty challenging when I also felt like throwing up the whole time. And there is little worse feeling than knowing you are low as you are vomiting up the juice you just drank to try and reverse the low. In the end, when I did eat I had to sacrifice good post-prandial numbers to avoid crashing lows if I was sick. I learned it was safer to wait at least a little while before bolusing in case the carbs never made it in to my system.

Despite all the sickness and lack of appetite, I still gained a couple of pounds in the first trimester. I can’t help but think this had more to do with all the empty calories from treating lows than it did with the baby growing inside me. My basal needs eventually levelled out at around 13 units per day, down from around 18 units per day before I was pregnant. That drop still makes my eyes pop.

But my A1c, 5.9% at conception, remained in the mid to upper 5s throughout those first twelve weeks. Each time I got a result back, the worry knot inside me loosened just a tiny bit. All the testing, all the insulin dose adjusting and even… even all the lows, seemed worth it if it was keeping our baby safe in there.

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