More Musings on Diabetes and IVF… and Carbs

I’ve already mentioned that one of the main things I’m doing differently in the IVF cycle is really focusing on my diet. It’s always made sense to me that what I put in to my body has the potential to affect the quality of the eggs that I’m growing. To that end it seemed logical to choose fresh and natural foods in preference to processed ones, and to choose the best quality ingredients available to me. But this cycle, I wanted to think beyond that.

Thanks to type one diabetes, I try to stick to a lower carb diet, since carbs are the macronutrient which has the greatest and most immediate effect on blood sugar levels. Now isn’t the time or place for a dissertation on carbohydrates or my feelings surrounding the recent sensationalism of the so-called “paleo” way of eating, but suffice it to say I’m not interested in labelling the way that I eat, or being particularly evangelical about it. Diabetic since the age of three, I grew up thinking about carbs, and counting them in every meal. I’ve been eating the way that I eat now for more than ten years and I just do what works for me and my health. On a day-to-day basis that means being careful about carbs, but I still indulge in bread, pasta and plenty of cake as and when the time is right. Eating lower carb, however, almost inevitably leads to an increase in the proportion of the diet that is composed of protein and fat. So when I learned before our first IVF cycle that a high protein diet is recommended during the stemming phase, I felt pretty set. I didn’t think specifically about the carbs and I didn’t delve in to it further.

This time I thought I’d check out the evidence for the high protein suggestion that seems to be so widely accepted. A quick Google instantly threw up plenty of results, most of which ultimately led back to a small study, the results of which were presented at the American Congress of Obstetricians and Gynecologists meeting almost exactly a year ago. There are plenty of problems with taking this as gospel. The fact that it is such a small study, with seemingly limited control of confounding factors, and the fact that it has not yet been published in a peer reviewed journal chief amongst them. But the findings are intriguing enough. Especially the specific relationship between low carb diets – less than 40% of calories from carbs – and IVF success rates – jumping up to 80% in this group.

Given that this may well be our last attempt at IVF, I need to feel that I’ve done it right. And suddenly my usual casual attitude to my diet doesn’t seem enough. I feel I need to make minimising carbs an absolute priority because limiting carbs is much less likely to cause a problem than eating them excessively.

I should have left it there. I should have kept my focus that simple and not over-thought it. But me being me, I couldn’t leave it alone. And given that carbs are the subject of discussion, it didn’t take very long until I began stumbling across references to insulin levels and blood sugar levels. And then the fact I’d been trying to avoid hit me in the head.

The conclusion in the popular media is the same one that crops up over and over again when anything to do with carbohydrates is discussed. They apparently cause “soaring blood glucose levels” and it is the blood glucose levels rather than the carbs themselves that are likely to do the damage.

An easy way to annoy a type one diabetic is to talk about food causing “soaring” or “skyrocketing” blood glucose levels in non-diabetics. If you haven’t experienced a blood sugar level of 20mmol/l, you have no idea what “skyrocketing” means. And here’s a hint: if you don’t have diabetes, you haven’t. Blood glucose levels can and do vary in non-diabetics, but by definition, if they get ups above around 6.5-7mmol/l, you’re probably in the club that no one wants to join.

This doesn’t, of course, mean that the assumption that raised blood glucose levels can harm eggs is a bad one. Any female diabetic will know only too well the list of potential complications for an embryo if blood glucose levels are not controlled during early pregnancy. The body doesn’t thrive with too much sugar running around in your blood stream, and it’s clearly not the best environment for creating genetically flawless material. I already know that.

But if the assumption is correct, that higher carb diets are detrimental because of the variations in blood sugar levels in non-diabetics, then what hope do I have? Suddenly this is all about so much more than my diet. Of course I work really bloody hard to keep things as stable as I can. I eat lower carb for precisely this reason – to minimise the swings. But inevitably my blood sugars stray up to the 7 or 8 region more often than in a non-diabetic, and also stray higher than that. And then I have a day like today:

Vibe graph

The red lines are all numbers above 7.8mmol/l. The gap in the graph spans about three and half hours where the sensor was changed over. I wasn’t high that whole time – in fact, I had a fairly epic low. But when I look at the rest of the afternoon, I can’t help but feel that I’ve messed up our chances of this working before we’ve even got to the exciting part.

Rationally I know that people with diabetes get pregnant all the time. They even get pregnant as a result of assisted conception all the time. and they also conceive with less than ideal control and experience no complications. My control was good when we conceived Thomas, but I’m sure I had similar strays in my blood sugars that month. It’s just that it seems like we have so much against us in this. We know that the embryo implanted last time, that I don’t have implantation issues, nor any of the other major leading causes of recurrent miscarriage. So the most likely reason for failure is a genetic one within the embryo.

I just feel as though I can’t possibly do enough. Despite the fact that my conclusions are based purely on assumptions and that the effects of diet are unproven never mind the causation of the effect, I still feel hopeless. Diabetes is a beast that just can’t be tamed all of the time. And I feel as though it has the potential to steal our last chance, no matter what I do.

Diabetes and IVF

One of the reasons I gave for sharing our IVF journey was to do a small bit towards addressing the paucity of information about handling type 1 diabetes alongside fertility treatment. Of course, I then got wrapped up in the actual trying to get pregnant stuff, and so far have mentioned very little about the diabetes side of things.

Before I started IVF, however, I was somewhat frustrated by the lack of information about doing it alongside diabetes. There are a handful of threads of a variety of fertility forums, and a similar number on a range of diabetes forums, but just a few personal experiences recounted on blogs and very little credible scientific or medical literature.

That is not to say there is nothing of use, just not all that much and it would be remiss of me not to share a couple of helpful resources. One of the first sites I turned to is a blog written by Cheryl Alkon which is sadly no longer updated. Cheryl underwent fertility treatment back in 2006 and blogged her way through it, sharing a number of useful insights. She then went on to write the successful book “Balancing Pregnancy with Pre-existing Diabetes” (which I reviewed here). The book itself also contains chapters on fertility treatment. (Some of the information contained in the book may not be strictly relevant for readers outside the US, but it is an excellent starting point.) And another useful resource and personal account of the IVF process can be found on The Kaitake Blog, written by a New Zealand woman, who is happily currently about half way through her pregnancy.

I wondered, though, whether the fact that I couldn’t find more was because the combination of IVF and diabetes is not that common. But looking back now, having actually done it myself, I think it may be more likely that it isn’t talked about much simply because there isn’t that much to say that isn’t standard diabetes advice about frequent testing and adjustments.

And my own quietness on the subject is almost certainly a reflection of there not being that much to mention. I can honestly say that diabetes has not had a major impact on IVF, and whilst IVF has obviously affected my blood sugars to a degree, it has not been horrifyingly unmanageable. After all, if you live with diabetes, you have to be used to a bit of unpredictability!

If you ask people who, by their own admission, know very little about the process of IVF to share what they do know, many of them seem to mention the “induced menopause”. In proper IVF-speak this is known as “down regulation” – the process of shutting off the bodies own hormonal cycle, before starting to stimulate the ovaries to produce lots of eggs. However, this isn’t an inevitable part of the treatment, and not everyone undergoing IVF goes through the down regulation process, otherwise known as the “Long Protocol” (LP).

I was on the alternative option – the “Short Protocol” (SP) in which stimulation of the ovaries begins on around day 2 or 3 of the cycle, alongside drugs to prevent ovulation. As the name suggests, this a quicker treatment cycle, injecting for around 8-14 days in total,compared to 3+ weeks.

This has distinct advantages for people with diabetes. Firstly it is a less dramatic suppression and replacement of your own hormones, so my guess is that it has slightly less dramatic effects on blood sugar levels. And secondly, the shorter duration means fewer days overall of taking drugs with the potential to affect control.

As it worked out for me, I spent a month taking the contraceptive pill before commencing the active part of the treatment. This is common as it allows clinics to time your cycle, as well as reducing the risk of cysts (ha – that obviously didn’t work for me!) or the uterine lining not being thin enough. I’ve taken the pill before, albeit a long time ago, so I had some idea what to expect. Typically taking external oestrogens raises my requirements for insulin by around 25%. So I raised my basal rates around the clock and kept a close eye on the CGM. Which worked out well.

I then had a break of about six days between stopping the pill and starting to inject Burserelin, the medication which prevents ovulation. In my previous hormone-using days, I had a different profile set up in my pump for the hormone free week. However the week off medication was a stressful one, with discovering a cyst of my ovary and having it drained. I realised afterwards that I had maintained the increased basal rate with only a modest increase in hypoglycaemia during that time. And when I started Burserelin, everything fell back into place.

The leaflet included with Burserelin specifically mentions that it may cause raised blood sugars in people with diabetes. And based on my experience, I’d say that effect is equivalent to the effect of oestrogen. Your diabetes may, of course vary, as it is a completely different hormone. My best advice is to test, test, test.

The stimulation drugs – I was on Menopur – by contrast, had very little noticeable effect on things. I had a number of stubborn and sticky highs, but an equal number of troublesome lows. Overall, I’d say my blood sugars seemed a bit more volatile – swinging more from high to low – than has been normal for me of late. But stress and anxiety during fertility treatment have a lot to answer for too, and obviously it becomes impossible to tell for sure what is affecting what.

The bottom line, however, is that IVF with diabetes is totally do-able. Compared to the changes you will experience in pregnancy (which is the intended outcome, after all) it really is a walk in the park. As with everything diabetes, frequent testing helps. A CGM helps even more. And a pump provides the flexibility to react day-to-day and hour-to-hour much more than multiple daily injections.

I’ll definitely do it again if we have to. And diabetes would be a very long way down any list of reasons not to.

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.

Am I Right to Accept Induction?

I can still say no to this. Right up to the moment that they actually start the medical process, I can decline to be induced. With forty-eight hours to go, it’s something that my mind still keeps returning to.

I know that I’ve had the best blood glucose control of my diabetic life in the last nine months. I know that my blood sugars have averaged similar to a non-diabetic, with very few major spikes. I’ve essentially had an uncomplicated pregnancy. I feel like I’ve mitigated the risks from being diabetic far better than I could ever have imagined, and the numbers suggest that my chances of problems at this late stage cannot far exceed those of a “healthy” woman. If I’m honest, I feel I deserve a straightforward birth experience as much as any one else.

I know that many women don’t get anything like their ideal, or straightforward birth. But I can’t help feeling that by accepting induction, I’m not giving myself the best chance.

I don’t want to be induced because I know that it carries risks. Chief amongst them, the increased risk of needing a caesarean section. And we know that I don’t want that . In fact several studies have suggested that increased induction rates are the single biggest reason for the rising caesarean birth rate. Even if caesarean is avoided, there is a greatly increased chance of other interventions including episiotomy, ventouse or forceps delivery. Induced labours generally require continuous fetal monitoring, which restricts the options for active birth, further increasing the risks of needing assistance.

These are all things which don’t sit well with my ideals for birth. And then add to that the fact that induction can also lead to breastfeeding difficulties and you can probably understand my personal apprehension. Furthermore, yet more evidence is also beginning to come to light that babies born between 37 and 39 weeks gestation are at risk of more health, developmental and behavioural problems than those born after 39 weeks. Unsurprisingly, the internet is littered with articles urging women not to be impatient and to let labour start of its own accord.

But…. I’m not doing this for convenience reasons, or solely because I’m impatient to meet our baby. I’m doing it because its what my medical team have advised me is the safest thing.

And the medical reasons to induce are, at least at first glance, extremely compelling. And particularly now I’ve managed to carry this little life safely inside me for almost nine months. I’d obviously never forgive myself if something went wrong right at the end that could be avoided. The bottom line is that if I decline induction, anything that goes wrong after that point will lead to me wondering if an induced labour would have avoided that problem. Ergo I feel somewhat obliged to go with what is, after all, the medical standard.

It’s the medical standard for a reason. Contrary to popular belief, big babies  are not the primary reason for early induction, although it does follow that delivering a big baby early avoids the opportunity for it to increase yet more in size and so decreases the chance of delivery complications including shoulder dystocia.(In reality, this is still questionable.) The most important reason, however, is the increased risk of stillbirth.

Yeah, that’s something that doesn’t bear thinking about.

Pre-existing diabetes in particular, and especially that which has been long standing, is associated with vascular changes that can lead to more rapid deterioration of the function of the placenta. If the placenta fails and the baby is not born within minutes…. Well, you get the picture.

And of course if you start asking questions about whether the risk is correlated with glycaemic control during pregnancy, or what the actual percentage risks are of stillbirth if waiting until 41 weeks, no one can tell you. Because early delivery is the standard of care. Because the potential risk exists, no one is going to give ethical approval to a study to quantify it which would mean putting women and babies at that risk. In fact, a recent systematic review of the evidence to support reasons for induction conspicuously excludes type 1 diabetes, mentioning only gestational diabetes, which it puts in the category of having no solid evidence to support routine induction. In fact, it concludes that there is little evidence for the majority of reasons given for induction.

But even if a study were carried out which proved that the risk of stillbirth in women  with type 1 diabetes waiting until beyond 40 weeks was, say 10%, that’s meaningless if you’re the one in ten and your world comes crashing down. To be honest, once you’re aware of the risk, it’s hard to do anything but contemplate getting the baby born safely as soon as possible.

To look at it another way, though, as an individual you’re still extremely unlikely to suffer adverse complications. As one article puts it:

“Fortunately, it is uncommon in this day and age for a baby born at full-term to die around the time of birth or experience serious illness or injury. However, these outcomes still occur despite advances in obstetric and neonatal care. Doctors or midwives may recommend inducing labor as a way of lowering the chance of these problems happening. However, it is impossible to know which women should be induced because injury and death are often unpredictable. As a result, thousands of women may have labor induced to prevent just one injury or death, and all of those women and babies will be exposed to the risks of labor induction, which may include cesarean surgery, instrumental delivery (assisted by forceps or vacuum extraction), and newborn breathing problems.”

I wish there were more definitive tests to establish individual risks. I wish that this process of giving life weren’t so fragile and precarious. I wish I could just let it go and accept that what will be will be, rather than continuing to agonise over choices that don’t really exist. It was different before I was pregnant and I could indulge in being idealistic, with my image of a “normal” pregnancy and natural, spontaneous labour. I naively thought that so long as my control was good, I could be managed like a healthy person, rather than an ill person.

That was before I had a second heart beating inside me. Before I knew the kind of love and powerful, instinctive protection you can feel for someone you’ve not yet met.

My reasons to decline induction are largely selfish, and now that I’m about to be a mum, I can’t be selfish anymore. I don’t want forceps or a caesarean, but the risks of these procedures to my child seem less than the potential risks of not getting labour going sooner rather than later. I don’t want anything bad to happen to my baby either way.

Am I right? I’m right, right?

Supertight

An almost “No-hitter” (A day in which there are no breaches of either the high or low alert thresholds on the CGM).

I’m ridiculously proud of this achievement, because obviously the closer together the lines, the harder it is to stay within them. This is supertight control.

I’ll be honest though, I cannot wait to loosen up these targets a bit once the baby is out of my body.

In A Funk

I know that I’ve written a number of times about how much I’m looking forward to this whole pregnancy thing being over, and how much I’m not enjoying the diabetes stress and pressure. I’ve already talked about it this week. But I’m not sure that I’m really able to capture just what sort of state I’m frequently finding myself in, nor just how much my neverendingly patient husband has to talk me down and how good he is at doing it. And in that, today was a case in point.

It started with a headache. The third one in three days, and it was just enough to tip me over the edge from tired, hormonal pregnant lady to mad, irrational, hormonal pregnant loon. And the worst part was that I knew I was high without having to test my blood sugar and definitely without the insistent and irritating reminders from the DexCom, which just served to make me all the more crazy.

As I whirled around the house gathering up fresh insulin, an infusion set and (yet another) glass of water, I sort of snapped.

“These high numbers are ridiculous. And they just take so long to come down. Before I was pregnant, if I was high, I’d bolus and be down within an hour. But now I seem to hang out in the high numbers for hours. And now! Now! When it really matters. “ I think my anger was all too apparent as I spat the words out quickly.

Ever the calm, rational voice, Ian reminded me “It’s what insulin resistance does. You’re testing and adjusting. You’re dealing with it.”

“I know. I know. But it’s doing my head in” I retorted. “I’ve been high so much this week that Flangelina will definitely have put more weight on. So much for my blood sugars being easier to control once on maternity leave – they’ve been a hundred times worse. And so much for enjoying my maternity leave! The lie in was nice, but now I just feel stressed and grotty and ill.” I was unstoppable, the words falling out over themselves. “I suppose my overnight was good. It’s just food that screws everything up” I added, in a small voice. And it was there, hiding in that sentence. My guilty conscience and the feeling that I’m to blame for this, because I’m finding it hard to stick to the straight and narrow, and that food is really my downfall. “I’m feeling a bit of a failure again today” I almost whispered.

“Well don’t. This is a new and different challenge. Your routine has changed. It’ll take a while for things to settle down. And maybe we’ll just have to be more boring with food for the next few weeks.” Ian rationalised. I don’t know if he realised then that this is exactly what I am having trouble with doing.

The thing is, I’m used to being able to get away with eating different things whenever I fancy, so long as I bolus appropriately. But it’s all different in pregnancy. And now I just feel guilty for not doing better with what I’m eating. Even the bolusing appropriately part is tough, because psychologically I’m not adjusting well to the new sizes of these insulin doses. I can’t shift the notion that they’re too high and they’re going to kill me. That’s a major part of the problem. I’m afraid of being low with masses and masses of active insulin. Ordinarily if I have 12 units of insulin still acting a low blood sugar I’d be needing to either get through about 200g of carbs, or go to hospital.

“This isn’t ordinary” Ian reminded me, when I told him.

I do know that, but I still can’t get comfortable with it. I also know that we could go low carb again. It would be very unlikely to do the baby any harm. But low carb is incredibly hard, especially when you’re pregnant and hungry. I know that I shouldn’t, but I just want to keep stuffing my face. I want to eat chocolate biscuits. And I know that they’re no good for me, and no good for my blood sugars and no good for Flangelina, but somehow that makes me want them even more.

I know I signed up for this. And I knew it would be hard. But today it feels too hard and I feel like I’m failing.

“Honey” Ian said, forcing me to look at him “You need to concentrate on why you’re doing this and that the end is in sight. In six weeks or so you’ll be able to eat what you want and things will get easier. You’re doing so well, and it really isn’t that long.”

“It feels like forever when you’re the size of a house and you’re bloody hungry.” After a moment’s silence, I added “I’m never doing this again, you know.”

“You’re doing fine. It’s tough. And when you see the happy, healthy baby at the end, you’ll wonder why you got so stressed.”

“I know I really wanted children, and I still do really want this baby, but I don’t want to do this stupid, stupid pregnancy thing ever again. I’m just screwing it up”

“You’re not screwing it up. Your body and placenta is actively fighting you.”

“Stupid body”

“It’s not stupid, it’s doing what pregnant bodies do.”

“Yes, but most pregnant bodies also fight back. Mine is too stupid and lazy to do what it’s supposed to do. And I’ve had enough of doing it for it. Or rather trying to do it, and failing.”

Once I started to unravel, it came quickly

“I’ve been nothing but high for days. SEVENTEEN for half the afternoon on Tuesday. TWELVE for most of yesterday morning, and then nine to ten for a good chunk of the afternoon and evening, and now TWELVE again this morning. These are crappy numbers even if you aren’t pregnant. And when I’m not pregnant, a week of crappy numbers is nothing in the grand scheme of things. But since Flangelina has 40 weeks in there, which is really only 38 for normal women, and probably only 36 for me, an hour is an eternity. I need to keep everything down and stable as much as possible. And it’s just not happening. I’m really failing at this. I want this to be over. I just want the baby here safe.“

“I know. But you’re not failing. For starters we’ve looked at the data together, and I know that you’re exaggerating” he smirked at me. “And for now, the best place for the baby is definitely with you.”

“Is it? I don’t think so. I think I’m doing it more harm than good. Please don’t hate me for being crap and not being the best mummy for our baby.” I’m not really sure whether I was pleading with myself, or with Ian.

“I don’t hate you, honey. I could never hate you. I love you and you are the best mother that there could possibly be for my child.”

The tears were falling really fast now, as he swept me in to a hug. I think I sort of knew that I was beaten, but I waved my hands around, gesturing at the room, as I sniffed and said “But it will have a messy house. I’ve been too big, and hot and demotivated to do anything today.”

“Honey…” Ian raised his eyebrows at me “It’s not messy in here.” I think he was trying not to laugh.

“Maybe. I just want everything to be perfect. But I can’t do perfect.”

“No one can do perfect” Ian said calmly. “But you’re close enough.”

And I know that he meant it. I just need to work on believing it.

Stability Rocks

Swinging blood sugars are almost the hallmark of type 1 diabetes. I’ve spent twenty-eight years on a rollercoaster that has as many daily peaks and dips as flat bits. The truth is, it’s hard to stay level. I don’t have the energy at this stage to defend that extensively, but it isn’t because “I eat too much sugar” or “don’t do enough exercise” or because I’m “non-compliant”. It’s because the tools and methods we have to control diabetes, as advanced as they are, are crude in comparison to the body’s own system. It’s because juggling the millions of factors that affect blood sugars is really, really hard. And once you start swinging from one extreme to another, it can be difficult to stop the cycle – it’s easy to over-bolus for a stubborn high, which leads to a crashing low, which is easily over-treated in the panic and fog that descends. Before you know it you’re looping the loop and sick to the stomach.

Pregnancy and diabetes is hard work too. I’ve made that pretty clear I think. So imagine my delight over the past few weeks to have discovered that someone seems to have pressed pause on the rollercoaster. I can’t believe how steady, stable and even my numbers have become, without any sort of specific effort. If I wasn’t still taking so much insulin, I’d think I had some sort of cure. Don’t get me wrong, I’m still seeing variations, but they seem to creep on slowly. The DexCom shows gentle upwards crests that I have plenty of time to intervene on. And they float just as gently back down, instead of crashing like a rock.

I think in part it’s the amount of insulin I’m now taking which helps. My meal boluses are so much larger than before, that even if I haven’t taken quite enough, there is enough insulin floating around to prevent a sudden spike. And the insulin resistance that’s causing these big doses seems to be doing a good job of preventing the rapid falls too. Those are the only explanations I can come up with for this sudden smooth ride.

I don’t like taking this much insulin. It still seems precarious and uncomfortable, despite the fact that it is obviously working. And I absolutely hate the frequency with which I now need to fill my pump. (I hate filling pump reservoirs more than any other little diabetes task.) But man, this stability rocks. When I glance at my DexCom graph and see a nice smooth line instead of a series of peaks and troughs, I can’t help but smile.

I hope that Flangelina is enjoying the steady ground too!