Fear and anxiety in the first trimester – by Helen German

After I found out I was pregnant I booked an appointment to see my doctor straightaway. She gave me the number for the hospital maternity service and before I knew it I had my first couple of appointments with the midwifery and diabetes team, the first of many blood tests, and a dating scan all booked in my diary.

I’ve always had a positive relationship with my diabetes – yes we’ve had our ups and downs (excuse the pun) over our ten years together, but we’ve always worked through them. But now, suddenly for the first time in ten years, my diabetes petrifies me. And this overwhelming fear is mainly what I felt for the first twelve weeks of my pregnancy. Everyone will say how it is “completely normal for any pregnant woman to be afraid”, and I find this dismissive response that having Type 1 diabetes doesn’t change your experience of pregnancy really irritating.

The fear in the first twelve weeks was for me totally disabling, whether awake or asleep. It crawled into every second of every day. I’d wake up in the morning and my first thought would be: what are my blood sugars? Did they drop or rise overnight? What has that done to my baby? Then breakfast would bring a bombardment of more fears: is my carb counting accurate here? Should I still do a 1:1 ratio for insulin?

One hour later after eating, and the attack starts again: what are my blood sugars? Oh no they’re high! Do I change my ratio at breakfast? Let’s do a correction. What has this done to my baby? Do I have ketones? I need to drink more water to flush my sugars. I’ll have to retest again in a couple of hours, make sure the correction has worked…What has this done to my baby?

And then repeat all of the above for each meal. I suddenly found myself testing up to twenty times a day, which is quite normal. But that’s twenty times a day I grappled with fear and anxiety. And then there’s the night shift. Just going to sleep was a nightmare. I always worried about the blood sugar I was falling asleep on. Is it too low, will I hypo in the night? Is it too high? What will this do to my baby? Since being pregnant I wake up every night at 3am to go to the toilet so I always manage to test my sugars. Depending on the reading, I would find myself in turmoil again as fear magnified the worst case scenario. And let’s not forget, this fear is in addition to the general pregnancy fear!

And there is a reason why this fear is so controlling in the first trimester. Whenever diabetes and pregnancy is mentioned there is a long list of horrific possible outcomes that accompany it: miscarriage; stillbirth; spina bifida; larger baby therefore a difficult labour and birth, to name but a few. Yes all of these are potential risks in any pregnancy, but there always seems to be a degree of inevitability with diabetes. Having a healthy baby when diabetic seems to be against all the odds and so unsurprisingly fear takes over.

There was one time however when my fear won. I’d met the diabetes team for the first time on this day and was warned all about the dangers of high sugar levels, especially in the first trimester and the serious issue of ketones. Ketones are worse for the baby than high sugars as the placenta doesn’t stop them from being passed over. And because the baby isn’t fully equipped to deal with ketones they are ultimately poisonous. The first step I had to take on managing my diabetes in pregnancy was to adjust my basal (background) rate on my pump. This involves doing a fasting test throughout the night and testing my blood sugars every two hours.

So after my appointment I made sure I had my last carb meal before the allocated time and then started the basal test. Two hours in I was fine. Another two hours and my sugars had risen. I didn’t correct but waited another two hours and then all Hell broke loose. My blood sugar had doubled to 14.9mmol! I stopped the test and corrected but I was already terrified of what four hours of rising sugar levels had done to my baby, who was not even five weeks old. As if I wasn’t upset enough, I then checked for ketones based on the information I was given earlier that day. I tested positive. The reading was 0.5, any higher than 0.6 and I would need hospital admittance. It was one in the morning. There are actually no words to describe my fear but I all I could think about was how diabetes had poisoned my baby. I had poisoned my child. I was distraught.

My husband tried to calm me down, but I was beyond rationality. It was all emotional, a complete tidal wave of despair. I have to get through nine months of this? I can’t even manage nine weeks. What have I done?

I frantically found my DAFNE (Dose Adjustment for Normal Eating) course book and looked up the rules for sick days and managing ketones. I worked out 10% of my TDD (Total Daily Dose) and gave a bolus of insulin to try and rid my body of ketones. By 3am my sugars were 6.6 and I had 0 ketones. By 4am I was hypo, and then again at 7am. With the cold light of day I saw the end of the worst night of my life. I was exhausted. I was beaten.

But you have to go on. And this is diabetes and pregnancy. After this incident I vowed to no longer freak out with a high sugar level. But of course I still do! I just try to focus on the fact that I am doing the best I can. I can’t take control of my diabetes more than I already am. In fact, this word ‘control’ has always bothered me. Diabetes is unpredictable, it will have its good days and bad days but you can’t control when this happens. All we can do is manage.

And manage is what we do, 24 hours a day, 7 days a week, 365 days a year, for the rest of our lives. It is, I guess, like parenting!

Fear will take over. I don’t think mine will ever go away. I still have a little panic if I see a high sugar level, but remember they are inevitable. They’re just not allowed to be frequent. The odd high blood sugar will not harm the baby, continuously high sugars will. I remind myself every day that so long as I’m testing, taking action, and always watching what my diabetes is doing then, despite how I feel, I am coping. I am managing.

The following week after this ketone catastrophe, I had my dating scan. And within the black and grey depths of the ultrasound screen we saw the little white flickering of our baby’s heartbeat. Strong, stable, secure.

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