I went for my 28 week scan on Monday – the first one I’ve had since the 20 week one, when bubs was all on track and looking pretty normal.
The good news is that he still looks normal, but not so cool is he’s tracking bigger than the average baby of his gestation. I watched as the guy did the scan and noticed immediately when he measured the baby’s head and it came up as the size of a 29 week 3 day old baby, and then he measured round the tummy which came in as a 30 week and 1 day old baby. He wasn’t going to be drawn on making a comment so I waited until I sat down with my physician to really find out how worried I should be.
The answer? Not super worried just yet, because they see this in around 80-90% of diabetic pregnancies at this stage. However the message was definitely one of “don’t worry about it, but there ARE things you need to do to try to stop the acceleration of growth”.
Number one – my overall glucose levels. I was actually madly proud of myself and the HbA1c levels I’ve maintained throughout the pregnancy. Started on 6.2%, after three months I was 6.3% and most recently I was 6.4%. Not that I want it to go up any further, but when you’re facing insulin sensitivity hikes every four days to a week, it’s bloody hard to stay on track. It’s also a lot harder when you are eating a lot more food (because you have a hungry alien inside you), so are more often in that post-prandial stage where your blood sugars are going over the bell curve before they settle again. News from here on in: please return us an HbA1c of <6% next time. Christ almighty! Under SIX PERCENT? This means I’m aiming for between 4 and 6 mmol/l all of the time. Basically straddling a perpetual hypo. Not easy when I’m still running from meeting to meeting and last minute project to client demands to meetings at work, or driving a car or trying to exercise or wait a minute – having a life.
Second message was – good work on the slow weight gain over the last month, please keep that up. Easier said than done when the hypo straddling in number one above means I’m going to have considerably more hypos as I try to maintain that absolutely minute margin of error. And while glucose tablets are calorific, they have failed to fill me up to date, so it means I’m eating the normal amount of food I would AS WELL AS extra calories from hypo fixes. So – low HbA1c and weight maintenance are not good bedfellows, I’ve found in past.
Thirdly – keep up the testing. I’m already testing up to 15 times a day now to try to figure out what the heck is going on and keep ahead of the insulin sensitivity. I expect that I’ll see this go up as I try and drive further and further towards a sub-6 HbA1c. Bring on affordable CGMS monitoring I say.
Finally – and this is an extreme bummer – I’ve been told to stick to very bland foods, and only foods which I (a) know exactly the carb count of and (b) have tried before and know to be blood sugar maintenance friendly. I’ve got ten weeks left of being a spontaneous adult who can go wherever I please whenever I want and I’ve just crossed any cafe or restaurant meals off the list. Booooo.
Anyway – this may sound like an all-out whinge and it is a bit of a whinge but I want to re-iterate that I am very thankful that my pregnancy so far in general has been very manageable. I knew the last trimester was going to be difficult with my T1 and if the three points above are all I have to do then I shouldn’t complain at all. I also have to make the point that both the physician and the midwife who made the recommendations did the all important disclaimer before they made these requests that they understand I’m only human and there’s only so much I can actually do. The physician was lovely – she made a joke about wanting me to stop doing anything at all and to sit on the couch at home taking blood sugars every 15minutes, and eat the same thing at every meal 
.
So – that’s my update…. wish me luck – ten weeks of this very strict regime to go.
NOTE – if you want to see a list of all of the posts I did about my T1 pregnancy, go here.
Posted in Pregnancy
Tagged as Pregnancy
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Alesha wrote
Hi Nic – great update! We’re just over 31 weeks now and all’s going well. Baby is in the 90th percentile for size but still in the ‘normal range’ so hopefully he stays there! I think that Babies of diab mums are always on the larger side of things and that’s the reason alot of us are induced at 38 wks. My Hba1c is 5.7 (up from 5.6 earlier in the pregnancy) and I’m not finding it too hard to maintain although I’ve chosen to be working from home which I think makes things a lot easier and I have been trying to eat a similar amount of carbs at each meal to make things more simple! The insulin sensitivity thing is insane and you do really begin to wonder when it will stop – according to my dietician ‘When the baby’s born’.
It sounds like you’re doing great to me! Like anything with diabetes involved it’s not an exact science and there are trade offs for every decision. You’re on the homeward stretch though! Only 10 weeks left
) If you’re anything like me can’t wait to get this baby out and get your body and simpler diabetes control back!
Erena wrote
My gosh you women are amazing! I was absolutely nowhere near as aware OR careful throughout my pregnancy 5 years ago, I think at best my HBA1c was around 7.5, and true to the stereotype that diabetic women have bigger babies, my daughter was born 7′13″ (and was growing pretty steadily!) 5.5 weeks early by cesarean – I hate to think how much bigger she’d have gotten in the remaining 3.5 weeks had I made it that far:)
All an amazing experience though and I cant wait to do it all again now that I have an amazing diabetes specialist, a WHOLE LOT MORE knowledge, and the pump I am getting in 2 weeks… Im so excited!!
You sound as though you are doing great Nic, dont forget to enjoy it:):)
Kris wrote
Oh my God – you are being asked to do so much to keep your babies safe – I am totally in awe of the hard work required. Looking after the baby will seem easy after all this… but what happens to your blood sugars with breastfeeding?!
Nic wrote
Alesha – great to hear things are going so well for you and I am SO IMPRESSED at your HbA1c – that’s absolutely incredible! Only seven weeks for you to go – please do drop us a line and let us know what you have and what you name him/her!
Erena – if I’d had a baby five years ago my HbA1c would have been a whole lot higher than 7.5! So good to have people like you on the blog who have been there and done it and can encourage us. What sort of pump did you go for in the end?
Kris – again thanks for the encouragement. I hear breastfeeding brings with it a whole new set of diabetes challenges but I’m not too clued up on that side of things just yet either…. just going to get to the labour part then think about stuff like that afterwards!
Sarah wrote
The baby weight thing drives me crazy – Violet was small, 6.75 lbs at 39 weeks and i was STILL in trouble – small for gestational age, obviously a punishment for keeping my HbA1Cs in the 5s. Even though her 4 blood tests were normal after birth, the midwives were paranoid, threatening to do more random glucose tests even though the paediatrician said she was fine. They made me wake her every 3 hours and squirt expressed milk into her mouth. I have all the non-diabetic friends who have just had big babies, one 39 weeks and 11.5 lbs, and it’s considered a good thing. Sorry, this is turning into a rant, but it just seems to me that if you’re diabetic and having a baby, it is almost impossible to convince people the baby is fine – just doing what its DNA insists it should do.
Sarah wrote
Oh, and what’s with the bland foods? I ate lots of curries, garlic, chili etc throughout my pregnancy, although I did try to eat isolatable carbs – things that could be easily weighed and measured. My family thought I was impossible when I snubbed lasagna and stir-fried noodles. But I could have just as easily been vegan and gluten-intolerant – now that would have been hard. I just wish you could buy a little scanning device that analysed your meal for carb content – anybody out there in R&D?
Lucy wrote
Hi Nic,
Keep it up! I got to 5.7 HBa1c and then crept up to 6.4 in the 3rd tri. I got the same talk about keeping my weight down etc. Its pretty scary and stressful. I felt sooo frustrated that I had worked the hardest I have ever worked to keep my blood sugars stable and it was still not right. A few tears were shed! All i can say is i got there with a healthy and biggish baby (8.3lbs). That was at 37.6 weeks so he would have been a monster by 40 wks!. He is nearly 1 yr now and is average size and doing all the right things.
L
Sianne wrote
Hi Nic
You are doing awesome
I really admire you.
I have been getting a lot of pressure at the moment about when I am going to have kids and when I tell people its not so easy with Diabetes the standard answer I get is “Oh I know such and such who has diabetes and she had no issues having kids…” I always think maybe I’m the only one who finds it so hard to get my BG’s level and then I come here and read about everyones experiences and it makes me feel better. Thanks everyone.
Still trying to work things out on the pump and its getting frustrating at the moment. But I am gonna keep working on it
Nic wrote
Sarah – good point actually… sounds like we all get a talking to no matter what side of the scale we’re on… good to know. The reason they’ve asked for bland foods is mainly just so you don’t end up eating those foods we know have crazy and unpredictable effects on your BGs for extended periods of time – eg curries, fish n chips, pizza, anything Thai, Chinese or pastry-like. Not sure how the rest of you go with foods like these but I normally have elevated blood sugars for some hours after eating these and can sometimes combat them with a combo/extended bolus but haven’t nailed it and find them a bit unpredictable to eat, so will be avoiding for the last tri.
Lucy – good to know I’m not the only one and indeed I spoke to quite a few people at the conference who had had babies with similar patterns – there’s no point fighting what we can’t change but I guess what I can do is what they’ve recommended, within reason.
Sianne – isn’t it easy for people to have these magic friends who’ve breezed through diabetes and pregnancy! I think it’s a tricky one because I certainly wouldn’t want to paint it as the most difficult thing in the world and put people off (because it’s do-able, I’m living proof of that) but it took me a good ten months just to get my BGs lined up, then constant hard work during the pregnancy to be as diligent as poss with BGs as well as all the other things you have to contend with in a normal pregnancy. These magical people your friends have been talking to have probably just not gone into great detail about what was involved, because at the end of the day it just sounds like you’re whingeing, plus can come across as verrrrry dull!