A day in the life of a pregnant diabetic – by Helen German
Waking up, my husband always asks me if I slept well. In the early stages of my pregnancy the answer was an easy no. Between aching hips, sore back, pins and needles in my arms and hands, or the need to wee every night at 3am… Then, no, I did not sleep well! But today the answer is yes. In fact I slept so well, I don’t remember falling asleep; I don’t think I moved at all. But do I feel rested? No. I feel like I’ve simply been switched off for the night.
I immediately reach for my glucose meter as I do every morning when I open my eyes. I test my blood sugars. The result is 15.4! I immediately sit up and deal with the storm of questions I now need to find answers for. How has this happened? My bedtime blood sugar was 4.8. Did I hypo during the night and not wake up? Has my liver then chucked out some glucagon overnight to deal with the low? What did I eat for dinner last night? Was it low GI and slow release? Did I count the carbs right? What is my basal (background) rate three hours prior to this morning’s blood test? I need to think about increasing it, but should I do 10% or 20%? Is this a baby growth spurt that means my basal needs looking at again, despite adjusting it only last week?
And I need to wee. Badly! But I don’t move until I’ve told my pump to give me a correction bolus of insulin.
As I trudge to the bathroom, my thoughts turn to my baby. It hasn’t moved much yet, considering it is first thing in the morning. Did it have a rough night of sugar overload from mum? Naturally, all the worse-case scenarios filter through your head but the truth is, it is impossible to know just how much sugar has passed through the placenta. The standard threshold is set at 8.0 mmol before it is believed glucose starts to be passed to the baby, although this is not set in stone and naturally will differ for every woman. So I don’t really know what the implications of my deep, hyperglycaemic sleep are for bubs, but that doesn’t stop the worry.
To Eat or Not to Eat
Breakfast is no easy decision. I’d rather not eat until my blood sugars have come down. So I gulp a couple of pints of water and test for ketones in my blood. It comes back negative. I am hungry. But I choose not to eat. I don’t want my blood sugars climbing any higher. So I choose to give the correction time to work; meanwhile I check my pump infusion set for air bubbles and change the cannula just to rule out a pump malfunction as the reason for the high sugar level.
Once I return from the doctors after getting a blood test done for my appointment next week, I test my levels again. They are 9.9 – show me some toast! Baby kicks in agreement.
After breakfast, my blood sugars are 7.7, just within the post-meal range. The plan today is to go shopping. So I pack my handbag with a bottle of Lucozade and some digestive biscuits. I check I have enough blood test strips in my meter and enough insulin in my pump. And I also throw in my ketone test kit just in case! Puts a new spin on taking a bag for life!
Before driving, I test my levels again. DVLA states blood sugars need to be above 5.0 in order to legally drive. Mine are 6.4 so I’m good to go.
Aisle be low
Halfway through my shop, I start to feel tired. There’s not just one type of tired for a diabetic, let alone a pregnant diabetic. Am I tired from coming down from a high blood sugar all morning? Am I tired because I’ve been walking around Tesco? Am I tired because my levels are high again? Am I tired because I’m hungry? Am I tired because I’m low? Am I just tired because I’m pregnant? Or am I tired because I’m tired?
I carrying on pushing my trolley up and down the aisles, and then start to feel confused about what it is I still need to get. I am yawning every few minutes. I can’t be bothered to be here, shopping. I start to feel agitated. As I get to the checkout, my eyes are going funny, like I can’t focus on anything and the room is moving of its own accord. Whilst waiting in line I test my blood sugars. I know I’m hypo; I knew probably at the tired stage but denial is all part of being low. The result is a 3.4 and then the sweating and shakiness starts.
I somehow manage to pay for my shopping then grab a seat at a nearby bench and guzzle three big mouthfuls of Lucozade, hoping it’s about 100ml which is 15g of rapid acting sugar. And then wait the long 15 minutes, wiping the sweat from my brow and back of my neck, trying not to draw attention to myself.
Fifteen minutes later and I am back on planet earth. Levels are 5.2 and I feel like I can take on the world again. So back I go for round two of my shopping. I suddenly remember what it is I’ve forgotten!
High-Low-High-Low, It’s off to work I go
With the shopping packed away, I grab myself a quick lunch and get ready to go to work for the late afternoon, early evening shift. Before lunch, my sugars were 8.0, no doubt due to the hypo I had. I have a sandwich. That’s two slices of wholegrain bread, 15.1g per slice equals 30.2g. My lunch ratio is 1.4 units for every 10g of carb so my pump works out my insulin at 4.2 units, plus an extra one unit to correct. The correction factor is that one unit of insulin lowers my blood sugars by 3 mmol…
If I have an apple, or bag of crisps, or glass of juice, or chocolate biscuit, or yogurt, then this all needs to be carb counted and then the total is put into the pump. It works out my insulin, but if my post-meal blood sugar starts to rise then I’ll need to re-program the ratio and set it higher. In pregnancy, especially the third trimester, this starts happening nearly every week.
I test again before driving. And I’m good to go!
At work I have another hypo.
And again there are questions I need to answer. Is my lunch ratio too high? Did I count the carbs accurately? Is it my basal rate that’s dropping my sugars? Or is it more likely a low sugar from being on my feet and active at work?
I opt for the latter question, and put the hypo down to the fact I didn’t set a Temporary Basal Rate (TBR) during my working hours. No doubt the same reason I hypo’d during shopping. How much should I reduce the basal rate by for the remainder of my shift? 20%? I set an 80% TBR for the next 3 hours after treating the hypo and hope it keeps me steady.
Once home, I eat dinner. Everything is measured and weighed and carbs are counted. The ratio for my evening meal is 2 units for every 10g of carb, so the bolus is going to be double for what I’m actually eating. The difficulty is when my eyes are bigger than my belly – and that’s saying something in pregnancy! But if I do my insulin 15 minutes before dinner and then can’t eat everything I’ve bolused for, then I’m in trouble…
But tonight I have no such problem. In fact, I’m still hungry after dinner! But I avoid eating anything else so I can make sure my dinner ratio is right two hours after eating. The result is 4.8 so I help myself to a late snack, either a couple of biscuits, a yogurt, or banana, or just a hot chocolate – which I still have to count and do insulin for.
The test before bed is 8.1 but I did have a snack, and I’ve still got insulin working for up to another 90 minutes so I set my alarm for a 3am check. No alarm is needed as by 2am I wake up drenched in sweat, and hypo at 2.4. I treat with Lucozade, try to cool myself down, and change my pajamas. Fifteen minutes later they are still low at 3.6 so I treat again and wait again.
I start to shiver from the chill while I try to figure out the cause for this hypo. Is it the ratio for my snack? Is it the adjustment I made to my basal rate to deal with today’s high blood sugar? Is it baby just taking what it needs?
I never get to re-test my blood sugar. I fall asleep with questions still whirling round my brain…
And wake up in the morning feeling tired and head-achey but prepared to start the testing and questioning and trial and errors all over again…
Did I sleep well? No, I did not.
And just to help me out, baby kicks me awake.
This is just one day of my life. I’ve had diabetes ten and a half years so multiply the above by 3,832 days and counting…
Every diabetic will understand the above. It is our ‘normal’.
Every non-diabetic doesn’t quite realise just how busy their pancreas is every day.