Diabetes and pregnancy: an eye opener

Helen-German-150x150It’s recommended that diabetics have retinal screenings done at least once a year as part of their general healthcare and diabetes management. This is where drops are placed in your eyes to dilate the pupils so the backs of your eyes can be photographed and examined for any diabetic damage.

Diabetic retinopathy is one of many complications that can occur with continuously high blood sugars and poorly managed diabetes. The increase of glucose in the blood can damage the blood vessels at the back of the eye and if it isn’t treated, it can cause blindness.

When pregnant, as seems to be the case with anything diabetes-related, the eyes are more susceptible to changes. The first retinal screening is due just after the first 12 weeks of pregnancy, and then every three months after that. After birth the next retinal screening will be in six months.

It’s just another consequence to be wary of when managing the roller coaster ride that is diabetes. In fact, for me, the risk of blindness was one of the major factors that pushed me to ensure I had an acceptable HbA1c prior to conception. Next to all the other horrifying dangers of falling pregnant, the idea of going blind and never being able to see my baby broke my heart.

When I first told my diabetes nurse I was pregnant (something she knew I was working towards and the reason why I eventually accepted pump therapy), she gave me lots of advice but the one that stuck in my head was about retinal screening. She told me that your eyes will change, regardless of your management. It’s just one of the many things that come with diabetes and pregnancy, but they will settle down again afterwards. And so far she is right.

My first retinal screening was fine. However, my most recent one showed signs of “diabetic activity” (high blood sugars) and also evidence of high blood pressure. And yet my average blood glucose since falling pregnant is 5.6 mmol. There is no doubt in my mind that the retinal screening result is connected to a recent diabetic meltdown.

It was there, in the throes of sobbing my heart out, that I accepted the ultimate bottom line, despite all my positivity and strength: diabetes with pregnancy is hard. People will ask how you’re doing, and comment on how well you look, and it’s just easier to say “yeah. I’m doing OK” than to explain the trials and tribulations of diabetes, and to a point that they will understand. As I lost all ability to keep strong, I faced the fact that managing diabetes in pregnancy is so hard.

My meltdown came all of a sudden, and not without other stress factors. There had been a nightmare week at work, then a bad hypo during an afternoon nap, and then a bad attack of hypo hunger, followed by high blood sugars that would not come down from 16 despite lots of correction units of insulin. The rapidly sizzling fuse exploded when I went to test for ketones after eight hours of high blood sugars, only to find my pharmacist had given me blood test strips not ketone test strips. BOOM.

I sobbed and cried and shook and wailed, “I can’t do this anymore, I can’t be diabetic anymore, its too hard! I can’t do it”. My poor husband consoled me, told me how brilliantly I was doing, how proud he is of me… to which I simply cried all the more. My eyes were on fire with tears.
I saw my doctor the following day; we discussed what happened with my blood sugars, why they suddenly went off the scale. Unbelievably, I cried some more. We reached the conclusion it was an accumulation of hypo, hypo rebound, hormone influx (I’d had a random return of morning sickness that day), growing baby, and an incorrect correction or insulin-sensitivity ratio for the evening. Add to it an incompetent pharmacist getting my prescription badly wrong for the second time, plus work stress and no wonder I had a meltdown.

I was signed off work for a week. I spent the time relaxing and focusing on me. I kept an eye on my diabetes, but it was the only ball I had to juggle. It has settled again, for now… But it’s certainly been an eye-opener. I have the habit of just getting on with it; never mind if I feel stressed, never mind if I feel down, just keep going, keep moving, diabetes is what it is, you can handle it…There are people far worse off than you!

Truth is: a little self-sympathy and acknowledgement that dealing with diabetes day in and day out is bloody (excuse the pun) hard work. Sometimes you just need to hold your hands up, accept when enough is enough, take a step back, close your eyes, and spend some time hibernating.

Just the three of you: me, the bump, and diabetes.

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