At the start of my pregnancy I developed a coping strategy to try and stop me going mad from the pressure of trying not to turn my unborn childâ€™s current home into a sticky syrup of glucose. Thatâ€™s served me pretty well to be honest, although I am now trying to reduce the level of swearing involved with high blood sugars for fear that her first words wonâ€™t be suitable for public consumption.
But before I actually have the baby and start looking back with rose tinted spectacles at how wonderful pregnancy was, I thought Iâ€™d try and pick out the key things needed to survive, while Iâ€™m still in the midst of the harsh reality of it.
To survive pregnancy with diabetes, I would recommend:
â€˘ A good sense of humour: even with the easiest pregnancy in the world, there are still going to be many occasions when itâ€™s all just a bit too hard. Youâ€™re either going to have to laugh about it or go mad, so you might as well laugh.
â€˘ Keeping things in perspective: at first every blood sugar over 8 feels like the end of the world. But itâ€™s not sustainable to live like this for 9 months. A few one off highs are not going to turn your foetus into a lollypop. Acknowledge them, deal with them and work out how to stop them happening again. Take this seriously, butÂ donâ€™t beat yourself up over it.
â€˘ Skin as thick as a rhino: it can be very trying to spend 9 months being told by every Dr, nurse, pharmacist, street cleaner that all diabetics breed baby elephants and theyâ€™re usually so large itâ€™s a miracle they ever manage to get them out at all without the aid of a tow truck. And if they do manage to haul them out the baby will be fat/lazy/hypo/in special care for weeks/have more bits that donâ€™t work than do. Do your own research, understand the risks and what you can do to minimise them, and ignore ill-informed idiots who should know better but donâ€™t.
â€˘ Lots of patience: for dealing with aforementioned idiots, and also for dealing with diabetes which changes almost daily. More than ever the diabetes mantra of â€śjust because it worked yesterday doesnâ€™t mean itâ€™ll work todayâ€ť is fitting. The change is constant, and often unpredictable. Thereâ€™s no option, you just have to go with it and accept that this is a pretty fast moving rollercoaster that you canâ€™t get off, but itâ€™ll be worth it when you get to the end.
â€˘ An insulin pump: plenty of people manage pregnancy on MDI and I have the greatest of respect for them. Personally, I would sacrifice everything I own (except for my pillows because theyâ€™re the only way I can get my whale-like form into a comfy enough position to get any sleep) rather than give you my pump. The ability to change basal rates quickly, with almost immediate effect makes them ideal for adjusting to increasing insulin requirements. And being able to bolus at the push of a button, and use dual waves to spread boluses means I can help minimise spikes caused by even looking at carbs. And when morning sickness was rife, the ability to reduce my basal rates to help compensate for all those carbs I just reintroduced to the world was great.
â€˘ Continuous glucose monitor: Iâ€™ve found mine to be invaluable, if you can get one, do. I can see easily that my BGs are starting to climb and I need to increase my basal rates â€“ far more quickly than I would with blood tests alone. I can see impending highs and lows and head them off before they become too extreme. I can see the impact of food, and the difference injecting early makes. I can easily try out new tricks, like splitting boluses or splitting meals and monitor the effects. And I can adjust my basals to the point where Iâ€™m confident that I can go to bed as a 4 and wake up as a 4. And I know that if something does go wrong inbetween, the CGM will alarm to let me know. On the down side, it does provide me with an overwhelming volume of data which requires huge amounts of action, but I think the results are worth the extra effort.
â€˘ Learn from others: there are some great forums out there where Iâ€™ve learned so much from people whoâ€™ve done this before or are going through it right now. Although its hard to believe you could ever need anything except ShootUpâ€™s top tips on how to manage diabetesÂ during pregnancy, if you did want to go elsewhere http://diabetes-support.org.uk has a great little community of pregnant and previously pregnant diabetics full of sensible views.
â€˘ A good healthcare team: different people want different things. I want a team who know their stuff, but who are willing to let me get on with it without too much interference. We eventually got to that point and it worked well. Read the NICE guidelines so you know what care you should be getting in pregnancy and talk to your team about what works for you and what doesnâ€™t.
â€˘ Supportive family and friends: diabetes and pregnancy is bloody hard work. Itâ€™s stressful, exhausting, all consuming, uncomfortable, frustrating and emotional. Having family and friends who are there to pick you up when youâ€™re down, to allay your fears, tell you youâ€™re doing a good job and prop you up when you feel like youâ€™ve run out of energy to keep going on the treadmill will make all the difference.
And finally, while the urge to smack anyone who tells me this is only for 9 months and wonâ€™t last forever is quite overwhelming, it is actually true. This will end and youâ€™ll get the best possible reward, so keep going. And remember, youâ€™re doing a great job.