I want to know

So this is quite hard......., even choosing the subject for my post is hard, because I have so many questions regarding pregnancy and diabetes, that choosing one topic is simply impossible!

I've had diabetes for quite some time (15yrs), and might I add that I was not always controlled...being diagnosed at a very young age, and rebelling against diabetes and the changes all throughout high school, I now realize that I should have taken better care of myself (as unlike with most diseases, the damage with diabetes isn't always visible on the outside)…but try telling that to a hormonal – rebelling teenager….so now as an adult perspective on this looks a lot different than it use to….

Even though all the test show that everything is still fine with me, with diabetes comes a HUGE responsibility, and now I have some questions to go with my journey of being a responsible, healthy, normal person, who happens to have diabetes....and would LOVE to start a family with her hubby :)  I always laugh when people say, “how can you be a diabetic, you’re so skinny” – my reply to them is always: “it’s not only overweight people who have diabetes, do only bold people have cancer”…. And the look on their faces is priceless when they realize that that is actually quite accurate…..

I'm the type of person that likes to be in control....so I get quite frustrated when people say you have to take very good care of yourself and try and have your sugar levels as controlled as possible (without giving EXACT instructions as to how to achieve this)….I eat healthy, look after my feet, drink loads of water, exercise as much as possible, but I still sometimes get high sugar levels.... well, question number one: what does it mean to have controlled diabetes??? Do people (especially doctors) who do not have diabetes think it is that simple, and that every single diabetic out there's sugar levels and body responds exactly the same way, so what works for some works for all?.....what happens if you are pregnant and your sugar levels seem fine, and then you strike one HIGH, what happens then, and how does that affect your baby?  I’ve been on an Insulin pump for about 1.5 years, and I must say; bless the person who came up with this brilliant little invention, and lets all pray he/she can come up with a cure for this disease soon….

What about when they talk about having good levels pre-pregnancy (I’ve heard that you should have a good average over a three month period before falling pregnant)….is this even possible…..I mean, it is not like you can determine when you will fall pregnant, and there is no way of controlling this (people (well at least some people) do not just fall pregnant at the drop of a hat)….so in actual fact, your sugar levels should always be controlled…..

Then….there is the topic of diabetics having larger babies, can someone PLEASE shine some perspective on this….what is a “large baby” I’ve seen friends’ (who do not have diabetes) babies get born at about 4kg’s (and that baby will then be classified as large)…..what does a large baby to a diabetic look like then?

I know (even with my controlling nature) that some things are just NOT in your hands, but the one thing that I’ve set my mind on, is natural birth – (NO C-SECTIONS FOR ME THANKS) and no offence to anyone who is pro-c-section, it’s just a personal preference to me :) and I want to know if this is even possible, and I’m talking full-term, NO INDUCING….all natural (baby comes when he/she is ready) child birth as a woman who has diabetes…. Is this an option for someone with diabetes?

Then I also want to know what happens when you experience very bad morning sickness – my sister is now 36 weeks pregnant, and she had the WORST morning sickness ever – throughout her pregnancy….I thought to myself “if this is going to happen to me I do not know what I’ll do….managing sugar levels, whilst vomiting and not being able to eat, that just won’t do….and I do not plan on spending 40 weeks in a hospital bed to be “tube-fed and hydrated” ….

Is there anything else I should know about having diabetes and falling pregnant…..?

I want to get answers and shine some light and hope for all the women (and their partners) out there who would love to start a family, but (as I) have a couple of questions that needs sorting out first…..

I look forward to any and all responses!

:)

Our pancreases don't work, so we're going ot have highs and lows.  It's important to have a doctor and healthcare team who get that.  I like this post by Ginger Vaieira on Diabetes Daily

www.diabetesdaily.com/.../dear-doc-3-reasons-why-we-cant-be-perfect-in-diabetes

In pregnancy I had a few highs and lows but they were rare. When you're pregnant it's a lot easier to have tight control because the stakes are high and your blood sugars can impact your baby's development.  Realistically, every diabetic has a few highs and lows in pregnancy.  As long as they aren't frequent and long in duration it shouldn't affect your baby.   I had a 7 A1c but once I knew I was pregnant I quckly dropped that to a 5.1.  In the years since my son was born usually have a 6.5 with few lows.  I'm not anal about my diabetes, but try to dose appropriately and avoid lows. I could definitely have tighter control, but frankly I'm not a disciplined person and don't have the time or temperment to be a diabetes robot.  

Before glucose meters and insulin pumps existed most diabetics had pretty high blood sugars, and the extra glucose in the blood caused diabetic moms to have fatter babies.  If you have reasonable control it shouldn't dramatically impact the size of your baby.  Having said that, babies of diabetic and non-diabetic moms are bigger now than they were in the past.  Most moms take prenatal vitamins and they eat a lot more calories than they did 50 years ago.  And most moms don't smoke, which used to cause lower birth weight babies.  All of this adds to the baby's weight.  The biggest influence on your child's size is genetics.  

That's great that you don't want a cesarean but you will quickly learn as a parent that you're not really in charge.  Your baby will be born when and however he/she is.  

Statistically as a diabetic you're much more likely to be induced early and to have a cesarean.  I'm not sure what the rates are in the UK and other countires.  But know too that in the U.S. something like 30% of all births are now cesarean.  OBGYNs pay the highest rates of medical malpractice insurance and are more likely to be sued than other doctors.  So the impact is that more of them perform cesareans rather than allow their patients to go through natural birth, which is more prone to complications.  While I think cesareans are obviously overdone now, the reality is that cesareans have their place.  Women used to die in childbirth (and still do in developing countries) but since cesareans have become available it's incredibly unlikely that a mother or baby in the developed world will die in childbirth.  

If you have bad morning sickness like your sister you should be able to deal with it using your insulin pump.  Hopefully that won't happen, but if it does you can handle it.

There's a good book by Cheryl Alkon called "Balancing Pregnancy with Pre-existing Diabetes."  It might help answer some of the questions you have.  

Hi Leanda!

First, a little about myself so you can know where I'm coming from: I was diagnosed with diabetes in Feb 2011 with an A1C of 11.6 or something. It got down to about 7.6 by May, which is when I got unexpectedly pregnant. My A1Cs where then 5.9 and 6.2 during pregnancy, and I gave birth to a 7 lb. 20 in. baby girl (pretty much perfect size!) 2 days before her due date, who never had a too-low blood sugar (which is a concern for infants of diabetic mom's- IDMs- immediately after birth). So it IS possible to have a healthy, normal-sized child even if your sugars/ A1Cs aren't perfect 3 months before, or during pregnancy.

However, I had a regular Obstetrician who wanted to induce me, which I fought up until the end- I started getting nervous for the baby, so I agreed. It ended in a c-section (which I was NOT happy with- I wanted to go all natural as well). However, keep in mind that a c-section is not the end of the world, and some women (though rare) really do need one. In the old days, before c-sections, many woman and babies died during childbirth, which thankfully is extremely rare now in industrialized nations.

I take it that you are living in the UK? I believe there, they are more open to home births and midwives, and that is probably what you need if you want to go all natural. At least in the States, obstetricians are very opposed to letting diabetic mommy's (or any mommy's for that matter) go all natural, and even to their due-date. Here, they don't seem to know how to help a normal birth progress naturally- all they know is medical interventions like pitocin, cytotec, and of course, cesarian surgery. A traditionally-trained home-birth midwife, however, can help with common hiccups in birth without all of that and in the comfort of your home.

However, as a diabetic, you HAVE to keep good sugars for that to be safe. I'm talking A1C of under 6.0 always, ideally under 5.5 (the A1Cs of non-diabetic women). So that the baby will be the right size for your body to deliver (a big baby does not mean it's too big for your body, but if it's only big because of high A1Cs, it may be too big) and so the placenta does not break down too early (also a concern with high A1Cs).

I think my baby would have been fine to wait for and to have at home, but I got too nervous to do that (and my mom and hubby were nervous too) so we erred on the side of caution, especially since I knew my A1Cs were higher than most non-diabetic women, especially at the beginning.

Notice that I keep saying high A1Cs, NOT simply high blood sugars. You will certainly have some highs in the 200's during pregnancy (hopefully not higher than that) but an occasional high here and there will not hurt the baby. It's the sustained, frequent highs that hurt the baby, so as long as they are rare, and/or are brought back to under 120 quickly, the baby will be fine.

Also, it is easier to obtain a lower A1C during pregnancy because you won't feel the lows as much. Normally, if I'm 70, I feel low, but during pregnancy I am sometimes 60 or 55 before I feel low, and that is okay for the baby and for me.  

So... keep good A1Cs (test often during the day, eat right, exercise), find a good home-birth midwife (which may be hard to find since your diabetic, but if you can show her that you've been taking good care for a long time, and that you are basically as healthy as any other woman, you just have to work harder at it, they should be fine with taking you on), and be positive! You can do it!

Good luck and God bless!

Thank you KatherineW,

I appreciate your response. I am actually from South Africa, and the doctors here are fairly open-minded when it comes to birth, except when you mention the fact that you have diabetes, then it seems they loose all confidence in themselves and they freak out, even the midwifes....but most doctors are that way it seems. I have yet to hear of a single doctor who actually affirms his/her diabetic patient on progress made with their diabetes treatment.....

Warmest Regards!

Leanda

Are the doctors specialized in diabetes as well? If not, that is probably the reason they are very worried. In the idea of taking care of yourself, I started a journal while being pregnant because it was not planned and my a1c was 8 at the start. In the journal I wrote my fasting blood sugar and my blood sugar an hour after the meal. typically the doctor wants the levels to be between 60 and 90 for fasting and 100 to 130 after the meal. If the sugars are too high or low, they will adjust the insulin. It is also good to see what you are eating throughout the day and get an idea why you have a higher blood sugar or lower than what is appropriate. Having controlled diabetes means not having sugar levels that are scattered all over the place. As stated before, a few highs and lows are going to happen, it just is.

I do not think that a doctor believes that diabetes is easy to take care of but they do want the best for you so you can have a normal life. And doctors do know that each person is different, that is why we all have different settings on our pumps for bolus and basal rates. It is difficult, I know. But for me, once I know I was having a baby, that is all that matters and you will do whatever it takes to keep your sugars as controlled as possible. I have never been so good as I am now.

And yes, diabetic women can have large babies but only if you have uncontrolled high levels. Your baby will swell because of this and their pancreas is fragile to the highs. But from what you have posted of yourself, I don't think you will have this problem. As for a C-section, that will only come about if there is a problem with the pregnancy and that is the best option for you and your child. Other than that, my doctor and I are set on me going natural vaginal birth.

I do feel there are a lot of horror story's with diabetes and pregnancy, but everyone is different and we just have to take it one day at a time. I wish you much luck on this wonderful new journey. :)