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Posts tagged ‘low blood sugars’

Jun 23 / Caro

To the Parents of Children With Diabetes: You Can Do It

I’ve seen a fair few new diabetes diagnoses popping up lately, and a lot of new blogging and tweeting on the subject, from parents who’ve literally just been dunked in the deep end. In my former life as a diabetes-centric blogger I was used to reading diagnosis stories, and tales of all the literal highs and lows of life as a parent to a child with diabetes. There were, and still are, plenty of them out there. What is different for me this time is that these are blogs which I followed, or at the very least was aware of, long before diabetes entered the picture. And something about that fact has really heightened my awareness the sheer smack-upside-your-head-turn-your-world-on-its-axis nature of this kind of diagnosis.

Forgive me. I was three when I was diagnosed. I certainly didn’t have a clue back then and I don’t think I’ve ever appreciated it before in quite the way I suddenly do now, no matter how ridiculous that sounds. I just don’t know what it feels like to go from knowing very little about diabetes to having to integrate it, and all its associated behaviours, in to your life.

What I do know is exactly what living with diabetes means. I know how the specific thirst of a high blood sugar feels. I know what a low feels like, and what the hangover can do to you. I know the fear. I know only too intimately all the bloody frustration. I will never, ever be the person to make one of those ridiculous comments about sugar – or worse – that are all to common. I can tell you that I absolutely understand.

I feel I need to say more, though.

If you are the parent of a child recently diagnosed, or perhaps going through the transitions of puberty, or an adolescent rebellion, I need to say this to you: Diabetes didn’t stop me.

It’s very easy to get bogged down by the minutiae, the day-to-day of blood sugars, boluses and carb counts and not look up, on and ahead. Life is still very much there for the living, and without wishing to trivialise the impact of diabetes, live it you can. Honestly.

Where there is a will, there is a way. Almost everything takes more planning and preparation with diabetes, but I’ve travelled across the globe (alone, at times), gone to University and partied the night away, competed in a variety of sports, lived alone as well as with others. I have a responsible, professional job after years of study and hard work. And most of all I have a wonderful husband and an amazing son. All of it, achieved with – despite, if you like – diabetes. There has been almost nothing that I’ve ever wanted to do thatI have been unable to do because of diabetes.

A diabetes diagnosis changes things, but it doesn’t have to end dreams or goals or the pursuit of a fulfilled life.

I also need to say this to you: It’s a marathon, not a sprint.

Sadly, we have to face the fact that this could well be forever, for this generation, if not for the next. At some point you have to take a step back and look at the bigger picture. Each high blood sugar is not a tragedy in itself. Even a few weeks of high blood sugars is not an automatic passport to complications further down the road. Good control is important, but good control does not mean perfection. I appreciate that there may be an element of luck involved, but if I look back over the last 32 years of diabetes I must have had countless months worth of extreme blood sugars (particularly taking account of that period in time where taking insulin regularly slipped off the bottom of the to-do list, but we won’t go there now) and I’m still kicking. I’ve faced the worst that diabetes has to offer. I’m not proud of my hospital admissions for ketoacidosis, but they’ve happened. I’ve had low blood sugars leading to me passing out and having seizures in public. For the parents of a diabetic child, it’s the stuff of nightmares. I’m not telling you these things to keep you up tonight. And I’m very definitely not suggesting that you don’t try your hardest to avoid them happening. I’m just telling you that I’ve been there and done it – and I’m still here talking about it. Most importantly at all, I’m not some sort of failure because those things occurred. Diabetes, ultimately, is the thing at fault.

IMG_3194

And what you need to remember is that each time you hit the bumps in the road, no matter how bad the numbers seem, they aren’t the only thing that matters. Remember: Marathon; Bigger picture; Don’t obsess over the individual numbers, the single days or even whole weeks. Each time you navigate a storm, you are adding to your metaphorical toolbox – and more importantly your child’s metaphorical toolbox – for the future. Next time you’ll have additional skills to know how to get over those same bumps. Or if you can’t get over them the same way (because diabetes has a nasty habit of throwing curveballs and changing the rules) you, and your child, will have a greater belief that you will get around them eventually.

And having that understanding that you can do it, even if it sometimes takes a while, is the key. It makes an enormous difference.

I need to remind you that you can only do your best. You best is good enough.

Look at me. There have been many times where my best has fallen very far short of perfection, yet I’m still doing it.

And I know that you can do it too.

My words, as always, don’t somehow seem enough. But I see all of you working so bloody hard to keep your kids healthy and safe whilst giving them a normal childhood alongside, where diabetes does not steal all of the focus. And standing here, on the other side, I believe in you.

I really do.

Because you can do it.

You can.

Nov 3 / Caro

Low

I didn’t know how I’d got where I found myself. Sitting on the edge of the bed in semi-darkness, the room pitching and rolling around me. I felt detached from body in so far as I couldn’t control it at all, but at the same time I felt completely imprisoned by the uncontrolled and uncoordinated movements I was involuntarily making.

Yet oddly, I didn’t feel scared.

I didn’t feel consciously aware of the fact that this was a low blood sugar. A really bad low blood sugar.

My awareness of the situation seemed to ramp up slowly, like the world coming back in to focus after a long sleep. I became aware of the sounds I was making. They were guttural sort of cries. The fact that they were coming from me took longer to assimilate. All of a sudden it seemed that my face felt sticky and my hair damp and matted. I became aware of Ian beside me trying to help me get Lucozade down my throat. He was asking me questions. I don’t think they were really directed at me, just a stream of consciousness. A verbalisation of the panic of what to do. Use the glucagon? Call an ambulance?

I still felt slightly numb, and detached from the situation. I knew that I hated this. It felt like it would never end. Yet I still wasn’t afraid that it would turn in to anything more. That it would get worse or end in a bad way. I was only existing moment to moment, incapable of true fear.

I knew I was trying to co-operate. I tried to drink, but the jerking of my body sent a spray of Lucozade across the wall. Another flew across the bed, hitting the pillow. More ran down my neck.

Then I was crying, the tears mixing with the sugar and sweat.

Crying always means that I’m coming back. The tears come long before coherent words.

My body seemed to come back in to my control with startling abruptness. The room came back in to focus. I was aware, for the first time, of my heart hammering out a crazy rhythm in my chest, just as it began to slow. I took a more co-ordinated drink of Lucozade.

I noticed the puddles of sugary liquid on the floor and the splatters across the bed. I saw the orange marks starkly contrasted on the cream walls. Marks that will bear testament to this low until we have time to repaint the wall.

I knew that I was coming out of it. And then, there on the road to normality, I finally felt afraid. Afraid for what might have happened. How it might have been different had I been alone. Where I might have gone had I slept on, instead of sitting up in bed and screaming out – the act which startled Ian awake and allowed him to take control.

I remember nothing of that. My memory is blank from the moment I went to sleep. Ian told me later that it had taken him more than ten minutes to get enough glucose in to me to bring me back from whatever place I’d been to. That diabetes had done this to him made my heart hurt.

The clock said 12.43am. I’d been asleep for a little over an hour. The blood glucose meter, when I finally tested said 1.9. I dread to think from what depths it had risen.

This was the worst low blood sugar I’ve had in years. It’s the worst Ian has ever seen. It’s certainly the only time he’s ever contemplated dialling 999.

I’ve spent the last four years in pursuit of the absolute best control of diabetes that I can manage. From trying to conceive Thomas, through pregnancy, then on to breast feeding and then trying to conceive again, I’ve not dared to let the ball drop. In some ways it’s ironic that the worst hypo of all has come after I’ve abandoned trying to be perfect, since it’s well known that tight control raises the risks for severe hypoglycaemia.

But then again, it’s pretty unsurprising. I dropped the ball. I stopped caring. And perhaps the decision to abandon CGM this past fortnight because I’m burned out wasn’t the smartest.

The first thing I did this morning, through post-hypoglycaemic hangover haze, was wash the Lucozade out of my hair. The second was to insert a new CGM sensor.

Diabetes smacked me down last night. Burned out or not, it’s still a beast that I can’t afford to turn my back on. Otherwise this is what it does.

Sep 9 / Caro

What to Say to Someone Newly Diagnosed With Diabetes

As a person with diabetes, I can’t help but experience and involuntary spark of sadness every time I hear about someone else being diagnosed with this condition. True, it’s not the death sentence that is was a hundred years ago, but it’s still a life changing diagnosis, and one that I very much wish no one else ever had to receive again. When the person is someone who I know well, the spark becomes a full blown fire. And a couple weeks ago, it happened. For several days after hearing the news, it came to mind repeatedly. Uninvited and irrepressible, a mixture of shock and sadness flooding my thoughts. But amongst that was also an odd sense of, I guess, responsibility. I knew that somehow, I needed to find the right words to say. I felt a weight of expectation to know how to make this all seem a little bit better. It was something I wasn’t totally sure that I could do.

Here’s the reality: I was diagnosed with diabetes at the age of three. I literally do not know any different than living with diabetes. My diagnosis is pretty much my earliest memory, so I have no specific knowledge of what it’s like to go about daily life without the intrusion of wayward blood glucose levels, finger pricks and injections. My newly diagnosed friend is in her early twenties. She’s used to a life full of carefree fun and spontaneity. She’s at the start of her career, and just gaining full independence from her parents, making her own way in the world.

I don’t know how that feels.

To have your life turned upside down overnight. To have so much that you’ve taken for granted changed. To have very recent memories of a life where carbohydrate counts don’t matter and routine is a foreign concept. To have to suddenly learn to integrate medical procedures in to your day to day.

I was afraid of not being able to empathise with that experience. Not being able to offer any kind of support because it all seemed so far away from my own experience. And add to that the thirty-one years of gradually accumulated diabetes knowledge that I sometimes take for granted, and I was very aware of the gulf between me and my newly diagnosed friend.

I suppose I didn’t want to scare. Or to overwhelm. Or to assume. I wanted to find a way to be supportive without trivialising it, but without making it seem like the worst thing in the world. As always it’s striking that fine balance between showing how eminently possible it is to live well, and fully, whilst making it look fairly easy, and understanding that actually it is serious, and it can be hard work at times. Most of all, I didn’t want to be annoying. I didn’t want to pop up as the person knowing all about diabetes and feel like i was piling on pressure or judgement in any way. I must admit that in a selfish moment, it occurred to me that I would now be seeing on a day-to-day basis someone who will (eventually) have lots of their own knowledge about diabetes and that there would be a possibility that I would begin to be judged for choices, actions and bad habits (hello, never changing my lancet) that others don;’t know enough to judge me for. That thought made me aware of not wanting to be the one putting the pressure on, or seeming to be watching as she finds her feet.

In the end though, it was that thought that saved me. Because when I replayed it over to myself, I realised what I have gained: someone who will also understand diabetes intimately.

What I actually said, when the moment arrived, came completely naturally. It came from my heart, and the tears I choked back as I started were absolutely genuine.

I told her that everything will be OK. It will be different, but it will work itself out, although that will take time. I told her that it would be hard work, but that the rewards are absolutely worth the effort. I was able to share some of the crap things people will say and a way to develop a mindset to ignore them (plus a couple of cutting comebacks!). I was able to help reassure that numbers aren’t something to panic about, or feel guilty about, but are simply information to help us live as well as we can and make the best choices. We talked too about family pressures. Being a mum myself now has helped me understand the desire to take away anything bad from our children, and to always worry about them. I hope I was able to offer some insight and help with the feelings of being over closeted by a parent having experienced now from both angles.

Most of all, however, I was able to simply reassure that I “get it”. I understand. Two short, and powerful words. Our exact experiences may be different, but I know what it feels like to prick my fingers multiple times each day. I know that injections are the easy part, when others recoil in horror and say they could “never do it”. I understand the fear of hypoglycaemia. I know what a high blood sugar feels like. And I’m able to be there as much, or as little, as needed for a advice or a moan, or to celebrate a triumph that only a person with diabetes can understand.

And that really cemented the idea of my own gain. Blessed as I am to have several friends with diabetes and to know where to look for support online, I don’t currently see any of those people on a daily or even weekly basis. Suddenly, after all this time, I’ve gained an ally too. And far from fearing that I’ll be judged, or watched more closely, I feel like part of a team. Someone close to me understands what a middle of the night high blood sugar does to your mood on waking. Someone close to me has the little telltale black dots on the tips on their fingers. Someone else understands what it means to want to control something that does its level best not to be controlled. There is no substitute for camaraderie.

I didn’t need to worry about what to say. “I understand” was enough.

Vibe CGM Graph

May 22 / Caro

For My Babies

I’ve been living with type 1 diabetes for three decades. Three decades sounds like a long time, but the truth of it is that I don’t remember a time before diabetes, so it only feels as long as my lifetime. Not knowing any different doesn’t mean it doesn’t bother me though. I’d absolutely be lying if I said it wasn’t sometimes an unequivocal suck.

I’ve mentioned countless times before that diabetes is an irritating and pernicious creature. There is nothing predictable about diabetes, and it has the capacity to affect every aspect of life whilst equally being affected by a ridiculous number of variables – beyond the obvious food, exercise and insulin doses comes stress, hormones, the weather and whether the day of the week contains the letter ‘u’.

I’d also be lying if I claimed to have this thing all figured out. I’m not sure that is even possible. There are plenty of times where I simply cannot be bothered with all the effort it takes to try to tame it. Some days I feel as though I’m chasing my tail from high to low and back again without doing anything differently to the day before, when everything stayed nicely in line, and that frustrates me beyond belief. So sometimes I give up and give in, stop trying to achieve the best control and simply coast along.

When I was a teenager, that was the most frequent state of affairs. As a young adult, the balance shifted to more time taking care of myself than not, but still with periods of time where I must hold my hands up and say it was completely neglected. In recent years, things have changed again.

Now, on the days when I can’t face multiple blood tests, the days where I want to eat without counting every last carbohydrate, or exercise without thinking about manipulating my medication, on the days where trying to find somewhere comfortable to wear my insulin pump sends me in to a rage, I try to stop and really think about what I might be sacrificing for the sake of a few minutes thought and effort.

I look at Thomas, and I think about the future. By the time I am my mother’s age and Thomas possibly has children of his own, I’ll have been living with diabetes, and taking insulin, for over sixty years. That is a long time, espeically when you consider that insulin for the treatment of diabetes has only existed for ninety years. But I know that I want to be there to see my son, and any future grandchildren, grow up. And I want to actually see it with my eyes, not be blinded by retinopathy. I want to be active enough to run around with them, and do so on my own feet. I don’t want to miss time bonding with them whilst I am attached to a dialysis machine.

And right now, I want to offer my future unborn child(ren) the very best start that I can. I want to keep finely balanced on the high wire of tight control, just as I did before and during my pregnancy with Thomas.

All my life the thought of complications from diabetes has nestled in the back of my consciousness and been something I’m peripherally aware of. But I’ve never been someone to be actively afraid on a day-to-day basis. It would be fair to say that blindness is one of my greatest fears, and that I’ve always wanted to try to stay healthy for my own sake, but the thought of complications, and their effect on my life alone, as a motivator for good control pales in to insignificance compared to the motivation to keep my babies healthy and to stay healthy for them.

I’m aware that this whole post sounds trite and twee, but it’s honestly true that where diabetes is concerned, I’d do almost anything for my children. I’m still far from perfect, and frequently get it wrong, but I am sure that I will never stop trying.

Walking a tight line

Feb 4 / Caro

Diabetes and My Son

I was going to entitle this post something like “The Fear That Diabetes Might Affect My Son”. But then I realised that although he doesn’t have it himself, diabetes has affected Thomas almost since the moment he was conceived.

He managed to dodge the higher risk of birth defects, and the increased weight gain that comes from exposure to extra glucose in utero. But he was still evicted from my body by medical intervention before he, or I, were ready for it. And consequently he came in to the world through the sunroof, rather than by the more conventional route. No matter how much the medical profession debate it, we still don’t know all of the potential long term effects of being born by caesarean. An increased risk of developing diabetes is, ironically, one topic under scrutiny. If anything should crop up that could be related to the mode of delivery, then ultimately I’d have to attribute it to my diabetes too.

But it didn’t stop after the birth. My diabetes put Thomas at risk of low blood sugars in the early hours of his life as his pancreas tried to adjust. Fortunately he was fine, but as a result of the risk he endured heel prick tests in those precious first hours. I know they didn’t really hurt him, and he’ll have no memory of them at all, but as a new mother, those pricks may as well have been pricks through my heart and I couldn’t help but cry as his screams pierced the delivery room. If it weren’t for my health condition, he’d have been left in peace to enjoy his first feed. It was my first taste of the guilt that comes with being a mother. I felt, however irrationally, as though I personally had hurt my child. My brand new baby.

Since then, diabetes has cropped up infrequently, yet persistently, in Thomas’s life. There have been times when I couldn’t feed him, no matter how imploringly he looked at me or how much he pulled at my top, rooted around or screamed at me, simply because my blood sugar was too low and I needed to sort myself out first. Likewise there have been occasions where I have had to leave him to cry in his cot because I wasn’t safe to pick him up and carry him down the stairs. It’s heart breaking to say no to your child when they want to play because your head is full of cotton wool and fingers tingle with numbness from a low blood sugar. Or when you head bangs a beat and your tongue is drier than the dessert for the opposite reasons. There are tear stains on the pages of one of Thomas’s books, from the time that I cried when the words swam in front of me and I knew I couldn’t read to him.

I know that, once again, Thomas is too young to remember these things. In the grand scheme of things, they won’t matter at all. He may look at me with an expression of confusion and hurt, and he may stick out his bottom lip, or even scream at me, but I know that ten minutes hence all with be forgiven with a cheeky grin and a big hug. And I also know that I sometimes I have to put myself and my health first in order to be the best parent for my child. Anyone who thinks that sounds selfish doesn’t live with chronic health issues, or more specifically, with diabetes.

But knowing those things in my rational brain doesn’t stop my heart from hurting each time diabetes edges in to a moment of motherhood. It doesn’t stop the omnipresent mothering guilt from eating away at me. Diabetes is an impossible beast to control perfectly all the time, but that doesn’t stop me pressuring myself to achieve the unachievable in order to give my son a childhood where diabetes does not feature at all.

If it’s an impossible dream, though, I want the only diabetes that affects Thomas to be mine. Not his own.

And no matter how strongly I feel the guilt about the impact of my health on my parenting or relationship with my son, it pales in comparison to the strength of my fear that one day Thomas may be dealing with this too. It’s a fear that on a day to day basis I fold up and squash deep down inside me, right next to the place where I lock away any hope of there one day being a cure. But from time to time it rises to the surface in a rolling boil that I can’t temper or tame.

It’s usually provoked by something that might a seem completely innocuous to other parents. Like the time I arrived to collect Thomas from nursery and his key worker mentioned “He hasn’t stopped drinking today”. A “normal” parent would probably put it down to a virus, a sore throat, to hot weather or the fact they hadn’t drunk much the day before. Immediately though, the fear is stalking me that this could be the beginning. The first time his nappy leaked in months and months, down to it being completely saturated in only a couple of hours, I didn’t care about the extra washing or change of clothes and I didn’t rush online to find out how I could better boost his cloth nappies to prevent future leaks. Instead I let the fear swallow me up.

So far, however, I haven’t acted on my fear. I haven’t pricked his heel, or toes, and tested his blood sugars. I haven’t pressed urine dipsticks in to his nappies to see whether there is any sugar lurking there. I’m determined to try to keep this in proportion. To remember with my head that the scientifically calculated risks and probabilities are on our side, even if that means nothing to my heart. Because if I spend his entire childhood watching him with fear haunting my gaze, that will be just as bad as actually living with diabetes.

A phrase that crops up a lot in parenting circles is “I don’t care, as long as they’re healthy”. It’s always said with the best of intentions, but as time has gone on I’ve realised how much I hate it. It often seems to imply that the speaker somehow wouldn’t be happy with their child if they weren’t healthy. I know it is not what is meant, since no one wants their child to be ill, or to live with a chronic health condition, but it’s what the phrase makes me think. I can tell you now, though, that one thing is for sure. If it happens, I’ll love my son just as much as I do today. And it will be my job to make sure that even if he is living with it, it still impacts his childhood as little as humanly possible.

That’s the best that I can do.

Dec 1 / Caro

Top Tips For A Diabetic Pregnancy

Plan – Going in to pregnancy with more than 3 months of folic acid behind me and an excellent A1c made the early weeks much less stressful for me than I think they may otherwise have been. Aside from being less worried about potential complications, I didn’t have the problem of trying to drastically adjust what I was doing in terms of diabetes control. I’d already built in lots of good habits, so was free to focus on responding to the changes caused by my new hormonal status. I hated the thought that diabetes could be the thing to stop us trying to conceive once we were ready, but getting everything stable before we started was absolutely worth it.

Sort your hospital care out carefully – This is something I didn’t really do, and I ended up changing hospitals during the first trimester, which made for a bumpier ride than was probably strictly necessary. Think about the logistics of travel to your hospital both for frequent appointments, but also when it comes to actually giving birth. If there is more than one option locally, find out both about the general maternity services, but also what sort of experience they have in managing pre-exisitng diabetes in pregnancy. Ideally, you want to already know your diabetes consultant and DSN, and have a good working relationship with them.

Get used to lots of appointments – It can seem overwhelming. It can seem annoying, especially if you have a full time job to factor in. But all the appointments are there to make sure both you and the baby are well looked after. Try not to view them as an inconvenience and enjoy the unparalleled access to information about your pregnancy. Many non-diabetic women will be bemoaning the fact that they see their midwives so rarely.

However, Don’t be afraid to question what you are told, or what is usual “policy” – A lot of the care for pregnant women with diabetes is based on “one size fits all” policies. It’s essential that you are an active participant in the process though. If something is being suggested make sure you ask why. Ask what the alternatives are and what the risks and benefits of different approaches are. You can’t give informed consent if you haven’t been fully informed. It is often policy to see women with diabetes every two weeks, but in the early weeks, this felt excessive to me, as I was travelling a long way to talk about excellent blood sugars that we could easily have discussed by email. Remember that it is your body and your pregnancy. No one can “tell you” what to do. But at the same time, be sensible and respect the advice and experience of your health care team.

Test, test, test, or better yet, use a CGM – Honestly, I don’t think I have ever tested my blood sugars quite as much as I did during my pregnancy, and I don’t think I could have coped without a CGM to tell me which direction I was heading in at ay given time. The only way to have any chance of keeping your blood sugars as close to normal as possible is to know roughly where they are as often as possible. Testing, and writing down the results, is absolutely essential. You also need to be prepared to act on those results too.

Try to eliminate the lows – When you have the risks of hyperglycaemia drummed I to you frequently, lows can suddenly seem like a friend. Whilst it’s true that mild hypoglycaemia pose no threat to your unborn baby, it can carry risks for you. Frequent lows can lead to loss of the warning signs, which in turn increases the risk of severe hypoglycaemia, which may in turn put your baby at risk. Bouncing back from lows is also a major contributor to high blood sugars and a lack of overall stability. Eliminate the lows and it becomes easier to remain steady. Honestly.

Carb count carefully – eyeballing, or scientific wild guessing are no longer acceptable. The only way you can dose accurately for the food you eat is to know exactly how much you are eating. That means that wherever possible you need to weigh and measure your food. And you need to read food labels.

Low carb can be your friend – Eating low carb is a sure fire way to reduce or eliminate post-prandial glucose spikes. Low or no carb foods are also fantastic when you are hungry at a less than ideal blood glucose level. But don’t go mad. I had ideas pre-pregnancy that I would stick to low carb, and a limited range of foods whose effects I knew, for most of the pregnancy. This isn’t necessary and will make your pregnancy seem to last a lifetime. There is also some evidence that restricting carbs too much can be bad for your unborn baby.

Superbolus is definitely your friend – Minimising the post meal spike is one of the most challenging aspects of good control. The superbolus is a pump technique whereby you take some of upcoming basal along with your pre-meal bolus, and then reduce your basal rate to prevent a later low. This is much more difficult if you are not on a pump, but taking a larger bolus and then eating some of the carbs much later on is also a rough approximation. Bolusing 30 minutes before eating, especially in the morning, also gives your insulin a head start to increase the likelihood of its action matching the absorption of your food.

Don’t panic about occasional highs – this is so much easier said than done. I remember having a full on, tear soaked and snot-ridden melt down the first time I had a high blood sugar. People will throw around all sorts of analogies that are cheesy, but true: the occasional visit to the sweet shop for your baby won’t do them ay harm. It’s a fact of diabetes that highs happen, and you won’t be able to eliminate every single one. Just do your best to minimise them – with frequent testing, accurate carb counting and regular adjustments. Look at the bigger picture when faced with a high number. Frequent and sustained highs are much more of a problem than occasional spikes. It’s also easy to focus on the highs, so writing down all your results can help you to see that they probably aren’t as frequent as you think.

Night times really matter – If you can get your night time basal insulin sorted to keep you steady and in range all night, this not only gives you almost a third of the day within target, but also gives you a good waking blood glucose level which starts the day off much better physically and psychologically than a high or low number. It’s worth making the effort to test overnight frequently. This gets easier in later pregnancy as sleep gets harder!

Get comfortable making adjustments yourself – If you are the sort of person who tends to rely on medical staff to make the bulk of the changes to your insulin regime, get ready to change. The adjustments needed in pregnancy are too frequent to wait between appointments, or for someone to keep calling you back. By all means seek advice as often as you need it, but get used to trusting your own instincts. You live your diabetes every day, so you really do know it best.

Remember that the old rules don’t always apply – Four will probably not be the floor, unless you have severe hypoglycaemic unawareness. 3.5 will suddenly become an acceptable fasting level. Correction doses are no longer reserved only for numbers above , or 10, or whatever you used to use. 6.5 is now a number you can and should correct. You no longer have to wait 3 days to see a pattern. It’s OK to make changes on the fly.

Don’t be afraid to ask for medication for morning sickness – even if it doesn’t seem “that bad”. The effect of morning sickness for women with diabetes is very different than for women without. Whilst there is no doubt it’s unpleasant for everybody, trying to deal with bolus insulin and not knowing whether your food will stay down is an extra challenge you don’t need. If morning sickness is interfering with your efforts for good control, then taking medication is the sensible option.

Don’t expect non-diabetes staff in hospital to have a clue about diabetes – Be prepared to be your own advocate. Be prepared to take care of your own needs possibly throughout labour if you want – but certainly during early labour or if you are admitted for induction. Take plenty of your own test strips and medication. Also take plenty of food and treatments for low blood sugars – don’t rely on the hospital to have what you need when you need it, no matter how shocking that sounds!

Remember to enjoy your pregnancy too – Remember that there is more to this than just blood glucose levels, carb counts and estimated fetal weights. Try to set aside the focus on diabetes at least some of the time and enjoy your changing body shape, shopping for your new addition and feeling them kick and move inside you. Remember that you are a mum-to-be, not just a medical machine.

Remember, it’s only 8 months of your life – By the time you find out you are pregnant, there are only eight months to go. The obsessional focus on everything diabetes is finite. And you have the biggest motivation you’ve ever had. Once the pregnancy is over and you have your child in your arms, it will all seem more than worth it.

Nov 26 / Caro

Diabetes During Delivery

What I didn’t include in all my lengthy posts about Thomas’s entrance in to the world is mention of my diabetes. I didn’t really want diabetes to intrude on those memories. To be perfectly honest, I didn’t want diabetes to be a part of it at all, but unfortunately there are no breaks from chronic medical conditions and even amongst all the turmoil of a failed induction and a very much unwanted c-section, my blood sugars still needed to be managed.

When I was admitted for the induction, it was agreed that I could stay on my pump, and monitor my own blood sugars, until I was in active labour. You may recall that I’d already had a frustrating discussion with my obstetrician about what would happen from that point. I’ll admit that I never had any intention of letting the hospital get in the way of what was best for me, but made a conscious decision to take things one step at a time. I was happy that they were happy to leave me to it to begin with, meaning I could save any battles for later. I was, however, told that if my blood sugar went above 8, I’d have to be transitioned to an intravenous sliding scale.

Of course, given that I was responsible for monitoring my own blood sugars, the easy way around this was not to tell them if I went above 8! But equally, I knew that there were good reasons for keeping tight control of my blood sugars at this final hurdle. So I set about managing them with military precision, using the task as something concrete to focus on during all the anxious waiting. Here, I can be honest and say that I did have a couple of blood sugars over 8, but since these were post-food and always came down quickly as the bolus insulin took effect, I wasn’t ready to own up to them. Similarly I stuck to treating lows myself with the stash of Lucozade and Jelly Babies we had amongst my bags. I didn’t trust the hospital not to want to treat low blood sugars with something wholly inappropriate – like milk, or hot chocolate, as I have experienced before, or rush to get me on to IV glucose that could start a whole unnecessary roller coaster soaring up high, and crashing back low.

On the day of Thomas’s birth, things were further complicated by the fact that I wasn’t allowed to eat anything in preparation for surgery. Since a c-section seemed so likely, I was actually made to fast from around 2am. The biggest challenge with fasting is avoiding hypoglycaemia, since treating it requires ingestion of food and so would instead have been an automatic transfer to intravenous glucose and insulin without passing Go and without collecting £200. With birth so imminent, I didn’t want to risk highs either, for a variety of reasons including not wanting to have a raging thirst, or hunger, whilst fasting, worry about healing less well if the surgery was performed at a higher glucose level and of course worry about increasing the chances of low blood sugars for my baby. My new “acceptable range” was between 4 and 7.

I’ll admit that I felt under pressure, if only from myself. With everything else slipping out of my control, I wanted to do something the way that I really, really wanted. By a strange twist of fate however, my body picked that very day to act a little as though I was cured. If it couldn’t do labour “properly” at least my blood sugars were behaving! I actually ran a temporary basal rate of close to or at zero for much of the day leading up to going down to theatre. I bounced along nicely just above the lower limit on the CGM, testing with a finger stick every 30 minutes to confirm. I was also tossed a life line by the lovely anaesthetics registrar who said that consumption of Glucogel was absolutely fine as it was so rapidly absorbed it would not pose a problem even with GA. In the hours before going down, I did consume the best part of a whole bottle to keep myself on the right side of the line. My final stroke of luck was having a midwife who herself had type 1 diabetes, and therefore completely “got” my need to do things my way, and fully supported me in that.

Testing Times

I was due a new insulin pump infusion set on the day of Thomas’s birth and I elected to put this in my arm so that it would be well away from the operating field. The CGM was more problematic. The week old sensor was on the left side of my abdomen, on the front of my hip. Right on the edge of the operative field. I assumed that I’d have to remove it and was nervous about flying blind. There wasn’t time to insert a new sensor and get it working, and since the first day often throws odd numbers anyway, I wouldn’t have felt the same confidence had I done this. To my utter surprise, however, I was allowed to leave the sensor in place, covered by a fresh piece of Opsite tape, which meant I could keep the CGM going throughout. Ian also kept my testing kit in his scrubs pocket whilst I was in theatre, although I can’t recall that we actually used it!

Once in theatre, diabetes went clean out of my head. I had bigger concerns about the spinal and whether or not I was dying. Ian, however, stepped up to the role we’d always planned for him to have, keeping a close eye on what was going on. We’d clipped the pump to the neck of my hospital gown and Ian diligently checked the DexCom line for me. Either the stress or the Glucogel caught up with me and he informed that I had double up arrows, indicating that I was rising fast. I opted to take a very tiny bolus to head off the high, but switched back to a zero basal rate again, ready to mitigate the effect of the removal of the placenta. I really didn’t fancy a crashing low. I did breach the high cut off, right at that last moment, but by then they were already opening me up and it was really too late to worry about.

I think the fact that I managed to keep such tight control, along with a few helpful healthcare professionals and not drawing too much attention to diabetes is what allowed me to get through with minimal fuss. Getting through with such brilliant blood sugars is a victory I want to claim all as my own, though. I’m still ridiculously proud of this graph form the day of delivery.

A short while after my transfer back to delivery suite, the DexCom sensor ended and needed to be restarted. Once I’d eaten, I commenced the pre-programmed lower basal profile on my pump – a profile much lower than my pre-pregnancy doses with the aim of avoiding hypoglycaemia whilst dealing with a newborn and to balance the possible blood glucose lowering effects of breast feeding.

Beyond this, diabetes doesn’t really feature any more in my thoughts or recollections. I am proud, for I have much to be proud of, but I’m so glad that this is the extent of what I can remember about diabetes on the day I became a mum.

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