Diary of a Type 2 Diabetic Mom-To-Be
After a long nine months, life has resumed to a new normal.
By Rebecca K. Abma
When I look at my smiling, happyand healthybaby boy today, its easy to forget the struggle it took to get him here. Pregnancy complicated by type 2 diabetes comes with plenty of challenges, but in the end, it was more than worth it.
Before getting pregnant, I knew it was a risk. Infants of diabetic mothers have greater odds of birth defects. High maternal blood glucose can cause complications to both mother and child, so it is essential to maintain tight control even before you get pregnant.
About three months prior to trying to conceive, I switched from taking oral diabetes medicines to taking rapid-acting insulin with meals. It took some getting used to. I initially thought the needles would be the biggest challenge, but actually figuring out the doses and getting consistent results was more of a problem.
During pregnancy, hormone levels fluctuate rapidly, which plays havoc on blood sugar control. Before I even knew I was pregnant, my fasting blood sugars were a mess. About a week before I had a added a shot of long-acting NPH to my bedtime routine to correct my fasting numbers, and it worked great.
Keeping tight control meant testing more frequently and keeping in close contact with my endocrinologist. Fasting, pre- and post-meal, and bedtime readings were sent in every week to two weeks, followed by a phone call if I was having problems. My doctor had me follow the three-day rule. If you see a problem just one day, its probably a fluke. When it happens three days in a row, its a trend and you need to alter your dosing appropriately.
The Blood Sugar Rollercoaster
At times, following the three-day rule was more like hitting a moving target. After the initial first few weeks of highs, my blood sugar started to stabilize and then go low for several weeks. As a result, I barely needed any insulin around weeks 10 to 16.
It helped that the weather was mild and I was able to get out and walk every day.
Around weeks 19 and 20, things started to change rapidly. Thats apparently the time when placental hormones start working overtime, causing greater insulin resistance practically by the day. It was frustrating to say the least. My insulin to carbohydrate ratio was constantly changing, making math an essential part of the equation.
To help figure things out on a daily basis, I kept a very detailed log that included all the food I ate, blood sugar readings and insulin doses. I quickly learned that different meals affected me differently. I needed less insulin to cover brown rice than a low-carb tortilla, or more to cover fast-food than home cooking. To keep it simple, I ate the same meals over and over again, and would refer back to my log and factor in the latest trends to decide what to dose.
At one point, I was taking one unit of insulin for every two grams of carbohydrate. I was blowing through 300u insulin pens in a matter of days, when theyd previously lasted me close to a month. And despite all the math and magic formulas I could conjure, it seemed like every day, every meal was a guessing game. I joked that I determined my dose by closing my eyes and throwing a dart.
Among the challenges of constantly adjusting for high blood sugar was the inevitable lows that were to come. Toward the end of the pregnancy, as the placenta starts to slow down, the wicked insulin resistance also declines, resulting in a lot of lows. Id wake to use the bathroom at 2 a.m. and realize I was low when Id bounce off the walls down the hall. One hour, two juice boxes and a jumbo bowl of cereal later and Id be back in the safe zone to go back to bed.
The Emotional Toll
Added to the constant worry about how my blood sugar would affect the baby was the battery of tests and doctors appointments. On top of the standard monthly OB visits, I saw my endocrinologist once a month and met with maternal fetal medicine specialists every few months.
At 20 weeks, we had a level 2 ultrasound, which found everything was going smoothly. As a standard precaution with diabetic mothers, we had a fetal echocardiogram at around 28 weeks, which the baby also passed. By 32 weeks, the real fun began. As part of the normal protocol for diabetic mothers taking insulin, I had regular biophysical profiles (BPP), non-stress tests (NST), and growth scans.
It was great to see my little boy with the frequent ultrasounds (for growth scans and BPPs) and hearing his heartbeat for the weekly NST was reassuring, but the extra tests were still stressful, especially the growth scans. One of the main complications of a diabetic pregnancy is macrosomia, or large babies. During the second half of pregnancy, high blood sugar is associated with accelerated fetal growth. Each week, my son would put on another 10 to 16 ounces, rapidly going from an estimated 30th percentile to 80th percentile.
At the same time, my insulin needs were skyrocketing keeping up with my elevating blood sugars. Emotionally, it was very stressful. I was doing everything I could to keep the baby safe and healthy, but my body didnt seem to be cooperating.
Nearing the End
All these tests werent without cause. Some 20 years ago, infants of diabetic mothers would routinely die in utero, with seemingly no warning. These regular screenings helped to ensure any potential problems would be discovered with time to spare. Also due to the risk of fetal death, the standard protocol is to not allow the pregnancy to progress past 40 weeks.
My doctor planned to induce sometime between 39 weeks and my due date if I didnt go into labor on my own. As my blood sugars became even more unpredictable, and I started having more and more scary lows, my doctor offered to do an amniocentesis to check for lung maturity at around 37 weeks. (Yet another complication of a diabetic pregnancy is the babies lungs may not mature as fast as in a non-diabetic mother.)
Instead of risking it, I opted to wait it out a little longer, keeping glucose tabs, juice boxes and my meter on me at all times, and not driving unless absolutely necessary. At 38 weeks, I thought I was in labor and went to the hospital to discover my blood pressure was dangerously elevated. After a few days on bed rest in the hospital, labor was induced.
My boy arrived via C-section, 30 hours later, weighing in at a slim 5 pounds, 14 ouncescertainly not the big baby wed anticipated. His blood sugar was perfect at birth, 69, but dipped a few times in the days following birth. He also had difficulty maintaining his body temperature, but the doctors assured me this was common for small babies. We were able to keep him out of the NICU and we both left the hospital four days later.
Three months later, my scars are healed, the trauma has faded and life has resumed to a new normal. My son is healthy, happy and growing every day, making the stress and trials of a diabetic pregnancy more than worth it.
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