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 child’s current home into a sticky syrup of glucose. That’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 won’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 I’d try and pick out the key things needed to survive, while I’m still in the midst of the harsh reality of it.

To survive pregnancy with diabetes, I would recommend:

• A good sense of humour: even with the easiest pregnancy in the world, there are still going to be many occasions when it’s all just a bit too hard. You’re either going to have to laugh about it or go mad, so you might as well laugh.

• Keeping things in perspective: at first every blood sugar over 8 feels like the end of the world. But it’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, but  don’t beat yourself up over it.

• 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 they’re usually so large it’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 don’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 don’t.

• 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 “just because it worked yesterday doesn’t mean it’ll work today” is fitting. The change is constant, and often unpredictable. There’s no option, you just have to go with it and accept that this is a pretty fast moving rollercoaster that you can’t get off, but it’ll be worth it when you get to the end.

• 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 they’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.

• Continuous glucose monitor: I’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 – 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 I’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.

• Learn from others: there are some great forums out there where I’ve learned so much from people who’ve done this before or are going through it right now. Although its hard to believe you could ever need anything except ShootUp’s top tips on how to manage diabetes 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.

• 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 doesn’t.

• Supportive family and friends: diabetes and pregnancy is bloody hard work. It’s stressful, exhausting, all consuming, uncomfortable, frustrating and emotional. Having family and friends who are there to pick you up when you’re down, to allay your fears, tell you you’re doing a good job and prop you up when you feel like you’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 won’t last forever is quite overwhelming, it is actually true. This will end and you’ll get the best possible reward, so keep going. And remember, you’re doing a great job.

Medicine is full of hazardous things. Dangerous drugs, sharp objects, nasty viruses. But when it comes to chronic diseases, sometimes words are one of the most potentially treacherous tools available to a healthcare team. This is my plea to all healthcare professionals…

Dealing with a pregnant diabetic is admittedly a bit like juggling with lit fireworks. There’s a real chance she’ll explode at any point for no rational reason other than being under a fair amount of pressure and too full of hormones. So this makes it even more important to think before you speak. Diabetes forums are full of pregnant diabetics who’ve just had something stupid/unhelpful/dispiriting/hurtful said to them at a consultation when the same subject could have been covered in a far more productive session simply by choosing some more appropriate words.

I generally cope with incidents like this with a combination of irritation and humour. But last week I had an encounter with a midwife that did upset me. And when I look back on it, it could have been so easily avoided by her simply engaging her brain before she opened her mouth:

The barb that punctured my not as tough as I thought pregnant diabetic skin was: I see you have a history of miscarriages, were they caused by your poor diabetes control? It was an innocently asked question from a community midwife who should have known better. For any other healthcare professionals reading this, can I ask that you think before you speak? She basically asked me did I cause my own miscarriages? Would you ask anyone else that? If you insist on jumping in with both feet without reading my notes (which clearly show I had good control) can I suggest asking open questions in future – what do they think caused your miscarriages? Rather than diving in headfirst with a set of ill informed, pre conceived ideas that really don’t help anyone?

On the less upsetting but still damn irritating side of things have been:

Oh, you have a small baby. What? Hold on. Stop the bus. What did we miss? She’s on the 45th percentile for growth, that’s pretty much bang on isn’t it? Oh yes, but it’s small for a baby of a diabetic. Ok, do you want to just stick to the facts and measure my baby against where it should be, rather than where you judge it should be compared to your prejudices about diabetic women?

Diabetics have big babies. Yes, some do. And some don’t. So shall we just focus on the facts in front of us about the size of my baby. Otherwise, we might as well analyse what size babies people called Alison have and compare ours to that too, it’s about as useful.

In a letter from the hospital to my GP: Her insulin requirements have increased and her basal rates have been adjusted. Ah, how handy to know that the diabetes pixie is changing my basal rates for me. I thought it was me spending the time analysing the data and adjusting accordingly but I must have dreamt that bit. Can I suggest a little nod towards the fact that this stuff doesn’t happen by magic – I’d recommend she has adjusted her basal rates accordingly. This also gives the added benefit of allowing other medics to determine whether the patient is making all their own adjustments or whether the DSN is doing it for them – far more informative that the diabetes pixie getting the credit for everything.

Your HbA1c is 5.3, that’s much better than the last one of 5.6. Really? Much better? They’re both well within target range and beyond that are meaningless without an understanding of how many hypos were needed to get to that level. Shall we avoid getting into competitive HbA1c territory? It really doesn’t help. Let’s deal with the facts rather than subjective opinions which change from Dr to Dr.

So when it comes to delivering healthcare, could people just have a little think about the impact of what they say? It sounds like such a teeny, tiny thing, but when you’re on the receiving end of it week in week out it wears you down. And it devalues the message you’re trying to give.

I always said I wasn’t going to whinge my way through pregnancy, because I’d wanted it for so long and it’s such a positive thing, whinging is just ungrateful. I’m not being 100% successful at this. I catch myself whinging quite often. But a detailed analysis of my whinges show that it’s not really the pregnancy that’s causing the irritations.

Approximately 10.3% of whinging is pregnancy related – normally due to being unable to stay awake, or a little bit short tempered which I’m blaming on hormones.

Circa 27.6% of whinging is related to ridiculous conversations with Drs, or general NHS inefficiencies. An analysis of that shows that less than a third of that whinging is directly related to pregnancy appointments, the majority is driven by diabetes consultations.

And coming in with 62.1% of the whinge vote is diabetes. This is what drives the majority of my kvetching and griping. Mostly it’s down to frustration with the random blood glucose generator that my body has become. But there is also an underlying toddler-esque feeling that it just isn’t fair that I have to deal with all this.

I resent the fact that the first conversations I’ve had with my unborn child have been along the lines of “Agh, mummy hasn’t quite got the hang of this insulin resistance stuff. Why don’t you just chill for a few hours? Or at the very least don’t work on growing any vital organs. Why not have a go at developing your netball skills, mummy’s managed without them for 33 years so you’ll be fine even if the glucose syrup you’re currently swimming in does mangle them.” And “Your mother is a diabetic genius, I’ve been a 5 all morning, you better be building something important today, I’d recommend moving all vital organs to the top of your to do list. Seize the day and all that.”

But when I’m not operating at the mental level of a 2 year old, I can see that having diabetes does help in one respect. Even in the darkest days of the first trimester when brushing my teeth or the smell of toast could make me sick, it was still diabetes that was getting most of the bleating and bellyaching. Diabetes is my whinge sponge, it soaks up all my whimpers and whines and means that I can avoid ungratefully whinging about pregnancy. See, I knew it had a purpose, it just took me a while to find it.