A long overdue post / Anomoly Scan in three parts

Wow, it's been a while. Things have been really hectic, but that's no excuse for failing to post for weeks on end.

I had my twenty week anomoly scan and associated medical appointments at the hospital on 9 December (with a return visit on 14 December). Mum and Dad came with me since S was staying up in London for a couple of days for meetings. It was lovely for Mum to be able to come into the scan with me as my one accompanying adult, although I did feel a bit mean leaving Dad in the waiting room. The anomoly scan can take a while, and I was in for about half an hour whilst the two ultrasound midwives (who both share my name!) measured and checked every part of baby... except for the bits that baby refused to show off, despite all our best efforts. I announced at the beginning of the scan that we didn't want to find out the baby's gender, and asked that we be told to close our eyes when we got to that bit of the scan. However, it turned out that there was no risk whatsoever of finding out since baby was tucked down low in my womb, in a breech position, curled up like a little hedgehog. This meant that we couldn't see the very lowest part of the spine (important to see in order to check for spina bifida). Baby also had a hand over his/her face, which meant that we couldn't see the lip in order to check for a cleft lip/palate. We decided that I should go off for my other appointments and then come back for another go to see if my little passenger had moved into a better position.

First I saw Dr I, who went through my numbers and discussed tweaking doses a bit here and there - especially background insulin. We agreed that my requirements seem to be taking off, and he told me that I can be a little more aggressive with my doses. Recently I seem to have been in a pattern of testing and correcting more than I'd like, and of course, with Christmas coming up I'm going to have to be at the top of my game anyway, given all the naughty food temptations which will be coming my way!! Dr I also dialated my pupils in order to check my eyes for retinopathy. At this point he ducked out for a few minutes whilst one of the Obstetricians popped in to see how things were going. She was surprised at how upbeat I sounded, saying that most ladies tend to complain of feeling tired and run down at this point in pregnancy. Although I have been tired things have gone pretty smoothly for me so far, so I actually feel pretty lucky, all things considered. We then talked a little about what comes next for me in terms of my care - she walked me through the typical care plan for pregnant ladies with pre-existing diabetes and then explained that based on the results of my ultrasound I'd be having growth scans every four weeks starting from 24 weeks. This is good news, since if there was anything to worry about in the scan I'd be down for fortnightly scans instead. At this point she swapped again with Dr I, who checked the back of my eyes. He could see evidence of one or two tiny microhaemmorhages in my right eye, but said they were nothing to worry about - especially given where they were located. We agreed that I'd come back for my next diabetes and obstetrics checks along with my 24 week scan, in early January (Thursday 6th), and in the meantime he ordered a bunch of blood tests (not quite the full works, but most of them!) S, the diabetes midwife took my bloods for me, and then it was off to see the ultrasound ladies for a second time to see if baby was co-operating. The second scan was much shorter, and we managed to tick off the upper lip, but still no luck with the lower spine. At this point I was free to go, although feeling a little tender along my bikini line from all the prodding and poking. I booked to come back to the hospital on Tuesday 14 December, and then headed out to lunch with my parents.

Here are the results of the (first two) scans (which all fell within the normal ranges):

Biparetal Diameter: 47.2mm
Head Circumference: 183.7mm
Posterier Ventricle: Transcerebellar Diameter: 20.1 mm
Nuchal fold thickness: 4.4mm
Abdominal Circumference: 152.8mm
Femur length: 33.2mm

Heart action present, Fetal movements visible, Presentation Breech.
Amniotic fluid: normal.
Cord: 3 vessels.
Placenta: Anterior clear of os.
Heart: 4 chamber view normal.

The following were visualised and appear normal: head, brain, face, neck and skin, abdominal wall, gastro-intestinal tract, kidneys and bladder, extremities, skeleton.

All in all it was pretty amazing. We even saw 10 little fingers!

Here are a couple of pics:


When I went back for the third bit of the scan on Tuesday 14th baby was still curled up in a little ball, and still in a somewhat awkward position, but the good news is that we were able to see the lower spine and the skin covering it. All is fine - the little heart was beating, the baby was moving, and baby's mum is just delighted!

I finally rang up for the results of my blood tests this afternoon. I'm amazed to say that my HbA1C was 6.6% - hurrah! It sounds like my thyroid function might be drifting a little though - so that's one to discuss at the next appointment. I was told early on that I'm borderline for an underactive thyroid, so it's not a total surprise. Everything else was apparently fine, so I'm looking forwards to a more detailed discussion of my bloods when I go back in January.

Things get even busier for us tomorrow, with S's parents arriving for a few days visit. They're staying with us until Christmas morning, when we head off for a few days to see my parents. The way things have worked out this year we'll be having three Christmas dinners in a row - Christmas Eve with the in-laws at our place, Christmas Day with my aunt, and then on Boxing Day we'll all descend on Mum and Dad's. That's a lot of turkey! We've had a few inches of snow in Bristol, so everything's looking very Christmassy indeed. Mum and Dad have also had snow in Berkshire, and S's parents have apparently had a foot or more in South Wales. Fingers crossed that they can travel to Bristol safely.

Merry Christmas to all!

I'll sign off with the obligatory fruit and veg update...

Visiting the Midwife

I saw J, the community midwife, again on Tuesday. This was a pretty short visit - just a chance to get back the results of the various blood tests I had last time, have a BP check, and hear a bit more about what to expect at this stage of the pregnancy.

I've always wondered what my blood group is, and now I know. It's A+, which is the second most common for people in the UK. My husband is O+, for the record (which is the most common). I also found out that I don't have HIV or syphilis (didn't think I did, but nice to have the proof!) I'm also not a carrier of sickle cell or thalassaemia (due to my ethnicity I'm very low risk anyway, but again, nice to have the confirmation). Being a researcher, as soon as I got home I did a little googling to help me understand the results of my full blood count, which just looked like alphabet soup on the page. Here's what I found out about what all of those acronyms mean:

WBC - total white blood cells
RBC - total red blood cells
Hb - Haemoglobin (low Hb= anemia)
Hct - Haematocrit (the fraction of the whole blood volume that consists of red blood cells)
MCV - Mean Corpuscular Volume (the average volume of the red blood cells)
MCH - Mean Corpuscular Haemoglobin (the average amount of Hb per red blood cell)
MCHC - Mean Corpuscular Haemoglobin Concentration (the average concentration of Hb in the red blood cells)
Platelets
Neutrophils - may indicate bacterial or viral infection
Lymphocytes - higher with some viral infections/leukemia, lower in HIV
Monocytes - raised in bacterial infection, TB, Malaria, leukemia and ulcerative colitis
Eosinophils - increased in parasitic infections, asthma and allergies
Basophils - increased in bone marrow disorders like leukemia and lymphoma.

Good news for me - everything was in range, except for the Eosinophils, which were at the very top end of normal. Since I've had asthma since I was four, and also have masses of allergies, this was to be expected.

I also had my blood pressure taken. It was 120/64, which is brilliant for me. I asked whether BP tends to go down in pregnancy, and was told that it can do, although it usually finds its way back up to the levels seen at the booking appointment by the time women reach the third trimester.

We also talked a little about what I can expect to happen over the next few weeks. I'm 17 and a bit weeks now, so I may start to feel baby's movements any time (this usually happens between 16 and 22 weeks, and can be on the later side in first pregnancies and bigger women). The advice from the NHS is that you should expect to feel movements every single day after 24 weeks, although they won't be consistent throughout the day since baby has a cycle of sleeping and waking. If you don't feel a movement, or if you are having noticeably fewer movements, then you should call the maternity unit by 9pm, and they will bring you in for tests. We also talked through the symptoms of pre-eclampsia. This is more common if you have close relatives who've had it (my mum did), if you have diabetes (tick), a BMI of 35+ (tick), and if it's your first pregnancy (tick!) Signs to watch out for include raised blood pressure, protein in the urine, bad headaches that don't go away, blurred vision (or flashing lights/spots in front of your eyes), bad pain below your ribs (especially on the right hand side) and vomiting. Again, any problems, and you call for help immediately!

I'm not seeing the midwife again until I'm 25 weeks, so that will be around mid January. In the meantime, if I want my Mat B1 form before then (which in the UK allows you to arrange maternity leave, amongst other things), I'll need to contact J at 20 weeks, and she'll leave it behind the counter for me at our GP's practice. Next stop in the pregnancy wagon train is my 20 week scan on 9 December.

I also finally had my flu jab today, so I'm typing this with a very sore left arm! :(

I'll finish off with the obligatory fruit/veg pic (although I'm a little suspicious of this one, since I think onions are usually smaller - at least they are when they come out of our veg box or from our allotment!)

A very quick post for World Diabetes Day

I didn't want today to go unmarked on my blog. It's World Diabetes Day.



Last 14 November I had no idea that there was a World Diabetes Day. Since then, in preparation for this pregnancy I've taken my diabetes in hand, and got my HbA1C down to 6.4% (a number I haven't seen for ten years or more!) I've worked hard, and proved to myself that I can do it... but I haven't done it alone, because this year I discovered the DOC - the Diabetes Online Community. Diabetes, especially Type 1, can be incredibly isolating - but thanks to the DOC I don't feel so alone any more. So, this is my big thank you to all the wonderful D-bloggers out there who've become my support network. YOU ROCK!

Happy World Diabetes Day.

The big reveal, an intense working week, and a huge surprise

1) The big reveal

Once again I've been absent from my blog for longer than I intended to be, so I have lots of catching up to do. After my lovely week off I went back to work on 1 November and finally told them the news that I'm pregnant. Everyone was really lovely about it, and more surprisingly no-one had guessed. I was sure that I'd been busted a few times - especially by my closest friends - but apparently I'm better at this cloak and dagger stuff than I thought. (That's actually a slightly disturbing thought!) I was sure that the number of medical appointments I'd been having would have raised some eyebrows somewhere, but although one or two people expressed a slight concern about my health, it seems that having diabetes can be the perfect camoflague! It's good to know that there are some advantages, huh?

The really good news for me is that work have agreed to fill my post on a fixed term basis when I go on maternity leave in March (for a year), so I'll be able to come back into the same job when I return to work. Since I really like the particular role I'm in this is fabulous news. There's not another job within my organisation that I'd want to do, and I would have been really sad to have to take another role. All my organisation are committed to is to keeping a post open at my grade, not to keep my specific job open, so I'm actually feeling pretty lucky at the moment. There are also some childcare options to start to consider (which seems a bit mad when baby isn't even here yet). My parents, who live about 65 miles away, have offered to come down and look after the baby a couple of days a week. There's also an on-site nursery at work (although it's a 40 mile commute every day, and I'm not sure how fair it would be to drag baby to work with me). Lots to think about. In the new year I'm going to visit the nursery and talk to a couple of mums who do the same length commute as me, to see what I can learn from them.

It's really nice to finally be out in the open, and not to have to censor every word that comes out of my mouth!

2) An intense working week (or fortnight, in fact!)

Since I got back to work things have been manic. I've had to be in London for six out of the last ten working days, with one more trip to go on Monday. As a result I'm exhausted, not least because some of these days have involved either very early starts (5.30am) or late finishes (like the day I got home at 1 am following a lovely night out with American and European colleagues following a big meeting, and a missed train home meaning a two hour wait at Paddington railway station). I was hoping that the tiredness would abate in the second trimester, but given my working schedule I haven't been able to tell if it has! I have been told to take it easy by my boss, and by our director, so I'm trying to dial things back a little now. (Let's see how that goes, shall we?) I am planning a good long break at Christmas, as well, which is not so far off now. I go on leave on 13 December, so only about a month to go. Whooo-hooo! I love Christmas more than any other season of the year, and it's nearly here. I'm busy knitting presents at the moment, and have started to feel the pressure of the clock ticking for the first time in the last few days.

Things on the pregnancy front have been pretty quiet since my appointment at 13 weeks. I've had a couple of one-off episodes of spotting, but very very minor and nothing to write home about. I'm starting to thicken a little around the middle but as I'm quite a large lass I'm still not really 'showing'. I'm really looking forwards to having a proper bump to show off (rather than having people think I just over-indulged at dinner last night). I can feel a tightness in my abdomen that wasn't there before though, so something's definitely starting to happen. In general things are going smoothly, although whenever I spot I panic a little (or sometimes a lot, according to my lovely hubbie). How would I know if something had gone wrong? I have to wait another four weeks for my 20 week scan, and I can't tell you all how much I'm looking forwards to the reassurance of seeing a little heartbeat on the screen. How do pregnant ladies deal with the whole paranoia thing anyway? Or it it just me?!

3) The huge surprise

I had a hospital appointment yesterday morning to see the diabetes team (no obstetricians this time). I'm still getting over this nasty chesty cold thing that I've had for about a month and a half, and to be honest I'm having to work incredibly hard to keep on top of my blood sugars. I've seen some numbers that I really don't like (hitting 13 mmol/l a couple of times a week), and in general I've felt that my control has been slipping compared to where I was when we conceived. Dr Inspiring gave me a real pep talk last time I was at the clinic, telling me that I was still doing brilliantly, and that I shouldn't beat myself up over the odd high number, but although I knew this was totally rational I still felt a bit disappointed that I wasn't doing better. As I was having my bloods drawn at the end of the appointment all I could think was that my HbA1C was bound to be much higher than the previous time, when it was 6.3%.

When I arrived at my appointment this time Dr I asked me how it was going, and I explained that I felt I could be doing better. He had a quick peek at his computer screen and then told me the result of my last blood test (the one I was expecting to be so rotten)... My HbA1C three weeks ago was apparently 6.4%. WTF? You could have knocked me down with a feather. I even asked him to check again, since it didn't seem possible. The only thing I can think of is that it must be a combination of more highs and more lows, whilst the 6.3% was a result of a flatter less bumpy set of readings. I am sooooooo happy. I'd been steeling myself for a number beginning with a 7 at best. Dr I repeated his pep talk from last time, and we agreed that since I was doing so well there was no need to come back before my 20 week scan appointment, when I'll also have an eye examination (pupils dialated, therefore my parents will have to drive me), as well as a diabetes check, an appointment with the obstetrics team, and the all important anomoly scan. So, between now and 9 December I only have one appointment, which is with the community midwife next Tuesday. I'm intending to try and enjoy this little break, since I know once I reach 24 weeks it'll be serial growth scans every fortnight right until the end of the pregnancy. I'll try to blog again next week once I've seen the midwife.

Until then, here's the obligatory fruit update - I'm 16 weeks and 2 days pregnant today, which means since I last blogged I've passed through another two fruity landmarks...

Crazy Busy

I can't believe how long it's been since I last posted. Things have been super busy at work for the last couple of weeks and I've also had a nasty chesty cold for more than a month, but thankfully S and I are now at home for a week on annual leave, which is lovely. I've been incredibly tired, but hopefully I'm now making a dent in my sleep deficit, and with any luck I'll be feeling a bit more human when I return to work next Monday.

When I last wrote I was still battling my thrush, and feeling slightly miserable about the whole thing. I managed to take 6 pessaries before the spotting (this time caused by irritation from the pessaries) became too much. At that point I seemed to be getting better, although I still had the pinky-yellow discharge that was proving so worrisome. In the end I decided to go back to the doctors, and saw the same female locum for a second time. She did an internal examination and told me that she thought the thrush had probably gone now, but that I have a cervical ectropian or erosion. This can also cause yellowish discharge and spotting, and is (thankfully) harmless to the baby. Just to be on the safe side I had a series of swabs for everything else that could possibly be causing the problem (thrush, BV, etc etc) and got the results back today (all clear!) So, no more pessaries for yours truly (much relief) and I can stop worrying.

I had another hospital appointment on 21 October to see the whole team (diabetes, obstetrics) and to have my nuchal translucency scan, which gives an indication of the risk of Downs Syndrome and a couple of the other trisomies. It was a pretty nerve wracking wait, and I'm glad to be on the other side of it now. S and I had decided that we'd have CVS if we came up as high risk, but I'm pleased to say that the results were great and we therefore don't need any diagnostic testing. The results of the scan were as follows:

Crown Rump Length: 68 mm
Nuchal Translucency: 1.8 mm

Estimated risk of Downs (Trisomy 21) -
Background risk: 1:203, revised risk following the scan: 1:897

Estimated risk of Trisomy 13/18 -
Background risk: 1:387, revised risk following the scan: 1:1,231

We also got to get a good look at the littl'un, who was practically turning back flips - lots of jerky movements to be seen. In the end, since the baby wasn't in a good position to do the NT scan transabdominally, I ended up having another transvaginal scan. The midwife had a colleague with her who was learning how to operate the ultrasound equipment, so for her benefit (and ours) she spent quite a lot of time showing different views of my little passenger. We saw all the arms and legs, the umbilical cord, the baby's heart beating, both lobes of the brain, and the bones of the skull.

Here's a picture:



This was also the official dating scan, after the ultrasound midwife refused to date me last time for (allegedly) being less than 10 weeks' pregnant. At that time we were quibbling over three days - I know I was 10 weeks and a day (thanks to the ovulation sticks), whilst the midwife was sure I was 9 weeks and 5 days based on the date of my last period. This time our dates were much closer together - I was maintaining that I was 13 weeks and 1 day pregnant, whilst the scan dated me at 13 weeks. What's a day here or there?

After the scan I saw the obstetrician and diabetes specialists, both of whom thought I was doing really well. My blood pressure was 130/60 at this appointment, so nothing to worry about on that front at present. We talked a little with the obstetrician about travelling, since I have a work trip planned early next year, and S and I had been discussing the possibility of going away for a few days before Christmas. The advice was as follows:

• it's okay to fly until around 34 weeks, with the second trimester being the best time;
• wear flight socks, walk around a lot, keep hydrated, and try to keep flights as short as possible - a couple of hours is the best, long haul not so good;
• any radiation risk is most serious in the first trimester - after that the risk of thrombosis (blood clots) is the greatest worry.

Dr I came in next, and we discussed the fact that I've been struggling a little more with my sugars than I would like, courtesy of my cold/chest infection. However, after a look at my monitoring diary he told me that I'm beating myself up too much, and in fact I look to be doing pretty well. My adjustments have been about right, and I should keep on going in the same vein. Hopefully my insulin requirements will tail off a little once I'm clear of the infection, and then they'll go up slowly in the second trimester, and should only rocket in the third. It's good to have the reassurance that I'm not dropping the ball, even though I wish I was doing better. It's worth noting that in the last few days my meter average has dropped back down to 6.9 mmol/l, which does make me much happier.

I rounded off my appointment by having bloods taken for an HbA1C and Thyroid function, which gave me an opportunity for a gossip with D, the nurse who has diabetes, whilst she tried in vain to find a vein in my arm, before eventually taking the blood from the back of my hand.

I got into work a couple of hours late, but this should be the last appointment where no-one knows my situation. I intend to let my boss and colleagues know our news once I get back from leave on Monday, and that should help with future appointments. I'm next at the hospital on 11 November, just to see the diabetes team, and after than I'll have an appointment when I'm 20 weeks, for a detailed anomoly scan and to see the obstetricians.

After my busy week at work we had a lovely weekend down in Devon visiting friends who live on the edge of Dartmoor. It was the first time we'd seen them since our wedding last year, and we also got to meet their 8 month old daughter for the first time. She's a total sweetie, and we really hit it off. It was lovely to spend some time in 'baby-world' and to pick up some parenting tips. It's also great to be able to inspect some of the paraphernalia that our various friends have bought for their babies too - peeking at prams, high chairs, cots and suchlike. After all, everything's so expensive, so it's nice to be able to learn from people's successes and mistakes.

I'll finish up with the latest size/fruit update. It's fabulous to be into the second trimester, and tomorrow baby will graduate from peach to lemon.

Quick update

I spent most of last week in Edinburgh on a work-related trip attending an academic workshop. I decided not to fly, since the hassle involved isn't worth the time saved. Instead I took the train up on Sunday, and back on Wednesday. It was good to see the fruition of something I've been working on for the last three years, but all in all the trip was pretty draining and I didn't have a moment's time to myself what with workshop sessions, side meetings and meals out with colleagues. Travel's usually tiring, but with an (as yet unannounced) pregnancy in the mix it was even more so. It didn't help that at 1.30 am on the night I arrived the hotel fire alarm went off, which meant we all had to spill into the street. Nothing like meeting all the workshop participants in your PJs and overcoat! I also found it challenging not to be in charge of my diet and eating times. The food was too rich for my taste, and being out of my usual routine I put on a couple of pounds and my average sugars slipped a little higher than they've been (7.5 mmol/l for the week). Grrrr. (Still, all in all I've only put on three pounds since I found out I'm pregnant, so that's not too bad). I also had my first (and let's hope last) taste of morning sickness on Tuesday morning, when someone walked past my breakfast table with a full fry-up including slab of black pudding. Eeeek, did my stomach lurch. I'd have forgone breakfast altogether, if I hadn't already had my insulin.

Whilst I was away the dreaded thrush returned. I took the three pessaries prescribed by the obstetrician on Thursday, Friday and Saturday nights, and on Sunday all the symptoms had gone. Hurrah, I thought, until they came back with the associated spotting on Tuesday afternoon. Grrrrr again. I toughed it out until Friday, when I had an appointment with a locum at my GP practice. She was very supportive, and we decided to try a totally non-evidence based approach (based on gut instinct). So, I came away with a prescription for 14 (yes you read it right) pessaries, and instructions to take 7, and repeat if that didn't work. At least it will see me through to my next hospital appointment when we can regroup if necessary. The problem is that the symptoms disappear when I'm treating it, and come back within a couple of days of completing a course of treatment. Anyway, 4 down, 3 to go, and then we'll see. It might just be worth taking out shares in Bayer, the makers of Canesten, however!! :)

I think my poor system has had enough this week, what with the tiredness, peeing all the time, not sleeping through the night, the thrush and on top of all that a nasty cold. I've had a low grade dose of the lurgy for a couple of weeks now, but on Saturday I began coughing and sneezing like a good'un, and have had a very runny nose. I decided that it would be a bad idea to try to go to London for work on Monday (it would have been a long day, with meetings finishing at 7.45pm), so have been laid up at home for the last couple of days. I've slept practically all the time, so I reckon I must have needed the rest. Am feeling a little less stuffy today, although I'm still needing more than my usual insulin, and I have a horrid taste right at the back of my mouth. Ick. I'll probably go into work tomorrow, and see how I go. I have a fairly quiet week workwise next week, and then S and I have a well deserved and much needed week off - I can't wait. We're planning to visit friends down on Dartmoor over the weekend, and meet their new baby (and flock of sheep) - I'm more excited about the former, S about the latter! Then we're going to slob out at home and enjoy doing nothing. Hooray! I'm planning to tell work about my pregnancy once I go back to work on 1 November.

The only other thing I have to report is that I finally met J, the midwife, yesterday. She works for my GP practice and seems lovely. I spent about two hours with her altogether, filling in the computerised history which makes up the backbone of my maternity notes, discussing how things have been going, and having some routine bloods taken (just pregnancy related stuff, as she won't involve herself at all in my diabetes care). We agreed that it was a slightly strange situation as I've already had lots of contact with the diabetes/obstetrics clinic up at the hospital and therefore wasn't doing things in the usual sequence. Most ladies see J before they ever have a scan or book any screenings, whereas I'm already well and truly within the system. For me she's going to be more of a back up than anything else. I'll see her on and off throughout, but my main care will come through the hospital. I left with a pile of booklets and leaflets to absorb, and I booked another appointment to see J at around the 15 week point (in mid November). I need to go back into the surgery to collect my yellow pregnancy notes tomorrow afternoon. So, next time I go to the hospital I will no longer feel like a defaulter!! I'm back at the hospital next Thursday for appointments with the various specialists (diabetes, obstetrics) and for my nuchal translucency scan and official dating scan (after last time's shenanigans!) Fingers crossed all will go well. I'm looking forwards to seeing my little passenger's progress since the last scan. Hopefully this will be transabdominal rather than transvaginal, and I'm also pleased to say that it should be the last 'bladder full' scan too. I'll leave you with a update on baby's size.


Tomorrow I reach 12 weeks, and baby will graduate to a new fruit (plum). Actually I always thought limes were bigger than plums - one of life's mysteries, huh?!

Happy and relieved post - Eighth Appointment / First Ultrasound

First things first. There was a time this week (a few days ago to be precise), when I didn't think that my next post would be a happy one. It's been an incredibly worrying few days, in which I have swung wildly between optimism and pessimism, rational and irrational, positive and scared. Last Thursday evening I went to the loo, wiped and saw two or three tiny pinpricks of blood. Almost so small that you wouldn't notice, except that the pregnant woman notices everything! A few days before I'd had a little whitish/yellowish discharge that I know can be the herald of thrush, and having done some checking about on the internet about what can/can't be done in pregnancy I treated it with a Canesten pessary. Symptoms got better... then came back, along with the spotting. The first day I didn't worry so much, but then it happened again on Friday. Saturday morning saw me at the pharmacy trying another tack - the internal 5x strength cream. When I applied it I saw a couple of bigger (but still miniscule) clots, and freaked out. Sunday - no spots. Monday - a few tiny spots. Tuesday - some pink staining but no spots. Wednesday - no spots (but by this time a good dose of panic). I'd checked and there were no appointments available at my GP (although I could have called in as an emergency). So, I decided to wait for today's hospital appointment. If I had been in the process of miscarrying, I would have only been sent to the hospital for an ultrasound, and with one booked anyway, I might not have been seen any quicker. Anyway, all the reading I did suggested that I wasn't bleeding that much anyway. Some of the sites I found on the web were super reassuring, others, less so. I found some information about thrush and cervicitis (an infection of the cervix) that sounded like it was what I'd been experiencing, and it said that thrush doesn't cause miscarriages, although it's the commonest reason for spotting in early pregnancy. My head was awash with worries and hopes, and I had the lamest title for a blog post floating around in the background - 'Fear and spotting in Northeast Bristol'. I decided to keep quiet and not to post anything until I knew one way or the other.

S was a rock in all of this - he knew just what to say, and allowed me to run away at the mouth when I needed to get it all out of my system. 'You just have to be brave'.

Around rolled this morning, and I set about following the pre-scan instructions to come to the hospital with a nice full bladder. Ladies, I have some advice for you. Two and a half pints of liquid is overkill. TOO MUCH. By the time we arrived at the hospital I was already struggling a little - wow it hurt! And then we waited... and waited... and waited... and waited. The time for my scan rolled past. Then it was 20 minutes later, and my bladder and I were starting to be a little grrrrrr. I asked S if he thought I'd end up like Tycho Brahe (famous C16th astronomer who was so polite that he refused to leave a banquet when he needed the loo, and wound up dying of a ruptured bladder - ouch) but S thought that I'd have to wait a little longer for this to be my fate! Finally I was called. I said to the nurse that I couldn't have waited much longer, and she told me it was fine to go to the loo as I'd already had my scan! 'No, I haven't' said I! Oh. She went to see the sonographer, and then came back and said, 'actually, since not ten weeks pregnant yet, we won't be scanning you today'. I explained that although the date of my last period put me at 9 weeks and 5 days, in fact the ovulation tests and the fact that I knew when we'd done the deed, meant that the obstetrician and I had agreed I was in fact 10 weeks and 1 day, and that was why the scan had been scheduled for today. She relayed this fact to the sonographer whilst S, my distended bladder and I returned to the waiting room. Fortunately a couple of minutes later I was called for the scan! It turned out that although they could just make out the baby and it's heartbeat by scanning me the traditional way (transabdominal), that it would be better to go for an trans-vaginal scan. This meant that I could (finally, oh blessed relief) empty my bladder!

Here's the (very short) summary of the report they gave me, along with one of the wonderful pictures we had printed (at a cost of £4 each - worth every last penny!):

• Normal intrauterine pregnancy (hurrah!)
  
• One baby (relief!)
• Fetal heart action present (even bigger relief!)
• Crown-rump length - 30.9mm (which is around consistent with the dates we were debating - 9w5d and 10w1d).
  

They said that they wouldn't confirm my estimated due date (EDD) until they'd done a rescan, but I'm happy enough with the outcome. We talked about the options for screening for Downs. The usual blood tests aren't deemed reliable in diabetic women, hence the offer of a nuchal translucency scan between 12 and 14 weeks (80% accurate in identifying problems). The alternative is to go privately for an OSCAR test (which combines the nuchal translucency scan with some blood tests - it stands for 'one stop clinical assessment of risk' - about 90% accurate). We discussed what the risk level is for my age group (still in the low risk category at 1/165) and the midwife left the room to dig out a leaflet for us. S and I grabbed a couple of minutes to confirm our earlier discussions about this issue, and by the time the midwife came back we'd agreed what we want. We're going to have the nuchal scan on the NHS, since we both like and trust the clinic where I go, and don't want the hassle of going elsewhere for a private scan (the expense isn't an issue, but the different team is). If we come back as high risk we'll opt for CVS (Chorionic Villus Sampling, if possible) and amniocentesis (if not). The CVS can be done sooner and the risk of miscarriage is about the same (1%) with both. We agreed I'd come back for the nuchal translucency scan in three weeks, when I will be, by my reckoning 13w1d.

Enough already. Here's the best bit of all - the picture (and for a size comparison the last couple of fruit/veggie offerings from The Bump!)


Once I'd finished with the scan, S and I went into one of the consulting rooms, where we were joined first by L, the dietician, who checked my monitoring diary, suggested upping my Levemir slightly (to counteract the effects of my horrible thrush and a nasty cold), and discussed the three very crashing hypos I've had. L reckons that Lucozade might be the answer - apparently it's the quickest fix out there - with the formula being 1/3 of a bottle if you're in the 3's, 2/3 if you're in the 2's, and all of the bottle if you're less than 1.9 mmol/l. Hate the taste of Lucozade (although I haven't tried it since I was under the age of ten), but might have to give it a go. L thinks it's particularly good for beside the bed or in the car. Dr Inspiring also stuck his head round the door to say Hi, and it was nice to introduce him to my lovely hubby S. L and I agreed to cancel the next appointment I had booked (on 14 October) so I could see the diabetes doctors alongside the obstetricians on the same day as my next scan. Seems sensible to me (and has the advantage of doubling up on appointments and being less likely to get rumbled at work before I'm ready to make my big announcement.)

Once I'd seen the diabetes crew, I had my blood pressure taken by one of the healthcare assistants (140/70) and saw one of the obstetricians. She wasn't concerned by the spotting, and agreed that it was probably the result of my thrush. She reminded me that both diabetics and pregnant ladies are more likely to suffer with yeast infections, and given that I'm a diabetic pregnant lady it's not really that much of a surprise that I'm suffering. Given that I've tried (and failed) to self treat twice, she agreed that it was time for the big guns, and wrote me a prescription for three pessaries (one a night for three nights). Let's hope that works. If it doesn't we're out of options, since the oral treatment is contra-indicated in pregnancy. One option would be to put me on a longer term regime of pessaries - one a week - to keep the thrush in check, at least. So, keep your fingers crossed for me. I'm also intending to eat a truckload of live yoghurt (which is supposed to help) - although how I'll manage that between Sunday and Wednesday when I'll be away from home (in Edinburgh on a work trip) I don't quite know! Hopefully the hotel might do yoghurts at breakfast?? The other thing we discussed was the flu vaccination. Having already checked it was okay to have, I'd booked an appointment for this Saturday, but I wanted to check it was okay to have in the first trimester. The obstetrician suggested waiting until after 13 weeks, so when I came away from the hospital I swung by my GP surgery to reschedule. Unfortunately all of the first block of appointments are now taken, so I'll have to try again in a week or so, but it's worth the wait to be careful.

That's all from me for now. It's been a long post, but I've had lots I wanted to say. Hopefully the next few weeks will be a somewhat easier ride. S and I have been grinning at each other all evening in a combination of relief and excitement!

Seventh Appointment - Retinopathy Screening

This morning I was back at the hospital again for my seventh appointment at the Diabetes/Obstetrics joint clinic. Since I knew I'd be having my pupils dialated for my first trimester retinopathy screening I wasn't driving. Instead, my parents came to stay with us last night so that they could drive me to and from the hospital. I'm so lucky to have such supportive folks.

It was a fairly short clinic visit - I was called in to see Dr Inspiring bang on time, and the first order of business was putting the drops in my eyes to dialate my pupils. That done, we moved on to discuss how things were going. I explained a bit about my changing insulin requirements, and about the three horrible hypos I've had in the last fortnight or so, including a doozy last night (S cooked a wonderful roast meal last night, with Pork, Crackling, Roasted Veg, Applesauce, the full works. The usual insulin had me bouncing along the bottom with a sugar of 3.1 at bedtime, and I ended up drinking a box of apple juice and eating a cereal bar and a bunch of chocolate over the space of an hour and a half, before I felt I could go off to sleep - Grrrrr). My sugars have been a little more chaotic since the insulin requirements changed - I've had a few more smaller hypos as well, and the fear caused by the bigger ones has probably caused me to over-treat a little). Still, my meter averages look pretty great, and Dr I was pleased with how I've been doing [7 day = 6.9, 14 day = 7.2, 30 day = 6.7, 60 day = 6.9 and 90 day = 6.9]. We talked a little about how I might avoid the hypos and swings, and decided that the trick might be to eat smaller meals more regularly with a small breakfast, mid morning snack, small lunch, mid afternoon snack, small dinner, bedtime snack, rather than sticking to three bigger slugs of carbs per day. This sounds like a good solution - I'm all for trying it, but wonder how well I'll be able to stick to it, given my slightly hectic lifestyle. It'll probably be much easier on weekends and days that I'm in the office, and harder on days when I'm in meetings or travelling. Still, anything's worth a try, and ultimately my health (and my passenger's) is much much much more important than work.

The appointment finished up with Dr I checking the backs of my eyes. This was the low-tech approach (no camera/photos), but he couldn't see any cause for concern at all, which is brilliant. I was fairly confident about this, since I've had retinopathy screening (with photographs) within the last 6 months, as well as a trip to the eye hospital necessitated by an over-keen optician (result = no problems detected whatsoever, and a full discharge). Dr I said he's always more concerned about the eyes of pregnant women who have some pre-existing retinopathy. So, all in all it was a really good clinic visit. I'm back at the clinic again in a week for my viability and dating scan, and then will return to see Dr I and his team on 14 October (three days after my first appointment with the midwife). Appointments, appointments, appointments... but I'm so glad to be being looked after so well. I can't wait for next week and the scan - hopefully the results will be good and I can feel even more reassured than I did after today's news that my eyes are okay. I'm 9 weeks and 1 day today, so my little passenger has already graduated from embryo status to foetus status. Where is the time going? It seems to pass really quickly in some ways, but quite slow in others (can't wait to reach the scan and then the second trimester).

Sooooooo busy!

Can't believe that I haven't posted for a fortnight. Things have been super-hectic at work, and I have been so tired every night that I just come in and crash.

Not much to report on the pregnancy front in the last couple of weeks. I did finally hear from the midwife, who has set a first appointment with me for Monday 11 October. That's still a little way off, but since I have two hospital appointments between now and then, including retinopathy screening and a viability scan I'm feeling pretty relaxed about the wait. She called me one evening when I was still at work, so I couldn't really speak terribly openly, but she seemed very nice. I'm not sure if she knows that I'm type 1, and I couldn't ask outright as one of my colleagues was sat next to me at the time, but I think I mumbled something cryptic about attending 'a pre-clinic' at the hospital.

I'm feeling more tired, and am still not sleeping through the night thanks to my overactive bladder. Apparently the need to pee all the time abates a bit in the second trimester - I can't wait! I'm also still getting to grips with my new lower insulin requirements. Since my last post I've had one more big old hypo to contend with. Not the normal tiddly hypos that I have every day or two, but the other kind - the doozy where no amount of carbs seems to make the slightest difference. My second humdinger came not in the morning, but one evening. I'd had a pretty big dinner, and didn't have the slightest desire to eat another molecule of food, but my diabetes had a different plan for me - 14 glucose tablets, a random chocolate bar that was knocking about, and a big spoon of peanut butter, and eventually I came up to a level where I felt confident to fall asleep. By this time it was almost three in the morning, and my exhausted husband who had got up at six in the morning and been in London for the day had taken up residence in the land of Nod hours earlier. This was another really scary experience and I have no desire to repeat it. I think I've got my doses more or less right again, but my meter average has crept up to 7.3 as a consequence. God, I'd love to have a continuous glucose monitor. I know that they're not perfect, but right now having something which would warn me of which direction my sugars are trending and alarm if I was dropping like a stone seems like a wonderful thing. Shame that they're not so widely available in the UK as in the US, and that they are so bl**dy expensive :( I might feel more confident to go to bed with a blood glucose of 5 mmol/l if I was sure I was trending flat and if I had the security of a low blood sugar alarm. As it is, my hypo warning signs have dulled a little and I'm not sure if I'd wake up as readily as I used to if I was to face a problem.

Other things that I've learned in the past couple of weeks:

• If you work a 14 hour day on a Monday, and you're already pregnant and tired, you will be wrecked for the rest of the week!
• It's really difficult to alter your working patterns when you're super busy and no-one knows that you're pregnant yet. (I have still to work out how to justify my next few medical appointments. Diabetes 'helps' in this regard, but people are going to start noticing just how many times I'm visiting the doctor/hospital.)
• It's horrible to have to dissemble when people ask if you're trying/how's it going. I struggle to fib, and have found that the phrase 'we're working on it' covers a multitude of sins.
  
• Constipation is not fun. I'm not suffering badly, but after the day I've had I've decided to go with a big bowl of All-Bran and some fruit for dinner, instead of something more 'dinner-like'.
  

Other than that, all's well in the land of Dia...Betty. I'll finish up with a growth update, since this blows my mind - I just love the fruit and veg analogy and I know I'm not alone in this as I see little references on other people's blogs too :) 'Til next time...

It may be time to revisit my insulin requirements?

I had a frightening morning today. I knew that in early pregnancy insulin requirements can reduce, and hypo warning signs can dull. Here's Gary Schreiner on the subject: 'During weeks 8 to 16 of pregnancy, insulin requirements tend to be lower than usual, followed by a gradual increase in insulin needs until the baby is delivered. Severe hypoglycaemia is three times more common during the first trimester of pregnancy than during the four months preceding pregnancy. This is partially due to the drive for very tight control during pregnancy, and partially due to the uptake of glucose by the growing fetus. Compounding the problem is a suppressed counter-regulatory hormone response to hypoglycaemia. Traditional hypoglycaemic symptoms tend to appear at lower blood sugar levels during pregnancy.' Gary Schreiner, Think Like a Pancreas, (Da Capo, Cambridge MA, 2004), p. 173.* So far I've had the slight dulling in hypo warning symptoms, but my insulin requirements have been holding up to usual levels (maybe even a little more). Until the last couple of days, that is.

Yesterday evening I came home from work and cooked a yummy spiced butternut squash and sweet potato soup, which I served with Irish potato farls on the side. This is an old faithful meal which keeps my sugars nice and level. I took the usual insulin for it, ate my dinner (a good sized portion) and then an hour later I had that horrible sinking feeling. I tested, and sure enough I'd plummeted to 4.2 mmol/l one hour postprandial. 8.0 mmol/l would be the target. So I started the cycle of treating, waiting 15 minutes or so, testing and repeating. Which went on for the better part of two hours. Here's how it went: 10.19pm - 4.2 (and dropping). 10.52pm - 3.3. 11.22pm - 3.4. 11.35pm - 3.9. 11.47pm - 3.7 (down again?) 12.50am - 7.1 (finally!) During this time I forced down a chocolate oat cake bar and half a packet of Dextro Energy tablets (ick). When I woke in the middle of the night to go to the loo ( a regular occurance these days), I did my usual test and found that I'd crept up to 10.7 (at 5am). Took a small correction dose, and by 8am I was sitting pretty at 4.1mmol/l, which is a good place to be.

I felt slightly crappy when I woke up (not surprising really), and decided that maybe this was the beginning of my changing insulin requirements, so I dropped my breakfast insulin slightly and ate a slightly larger than usual breakfast before setting off for my 40 mile drive to work. Here's how it went, and it was absolutely terrifying... 9.06am, test sugars at 3.4 mmol/l, eat five glucose tablets on top of my big breakfast and set off. 9.26am, pull into a layby in a country lane somewhere between Bristol and Bath because it feels like my sugars are going south. Test reads 2.6 mmol/l. Eat more glucose tablets and call work to say that I'm hypo and have pulled off the road so I'll be late. Wait and test again: 9.34 am - 3.9 (coming up - good). Wait some more, still feeling weird so eat more revolting glucose tablets. Test again: 9.48am - 3.3 mmol/l (going down - seriously? how??) Eat the remainder of the packet of glucose tablets. Wait, and test again: 9.55am - 4.3 mmol/l. Give it five more minutes then retest. 10.00am - 4.6. (Woo-hoo - safe to drive). By this time I've received a text from my boss telling me to head home as it's closer. 10.19 am, arrive home and test again - 4.1 mmol/l. Down again? Really? More glucose from the half packet left on the bedside table from last night's excitement. Head thumping by now, I lie down but don't dare to sleep. Set alarm on mobile phone for ten minutes time. Test again at 10.31am - 5.4 finally, and I can doze off for an hour. Test again at 11.51am, and I've reached the comfort of 6.6 mmol/l. However, I've eaten most of the day's calories in one go (and as glucose tablets - eeeew) and I've had enough carbs to put me in hospital under normal circumstances.

Hence my feeling that it may be time to revisit my insulin requirements! What has surprised me is just how fast this has come on, and how scary it is to be forcing glucose down and see your numbers continue to travel in the wrong direction. Looking back, I think this may have all begun on Saturday, when S and I spent the weekend with my parents and brother to celebrate my Dad's 65th birthday. We went out for a beautiful meal in a very posh restaurant and I took my usual insulin to cover this blow out, rather than increasing my doses. I was cruising at 5mmol/l two hours post-prandial. Just wrong really! So, as of today I'm going to start reducing Novorapid doses at each meal, and will also slightly reduce my background Levemir doses too. I'm home for the rest of the day (banned from coming into work by my very solicitous boss, whose wife is a T2, and hence who understands a little bit about diabetes), so I can check my sugars even more than usual and keep a close watch on what's happening. I was supposed to stay in London tonight but have contacted the people I'm meeting tomorrow to say that I'll be doing the meeting by teleconference instead. It's awkward, as no-one know's I'm pregnant yet. I'm planning to tell work once I'm safely through the first trimester, so when I was asked why this might have happened I couldn't say, 'ah, yes - this happens to pregnant diabetic ladies'. Instead I had to fall back on the oldie but goodie 'sometimes things happen to type 1s that don't make sense, it's just one of those diabetes things'. I guess I'm lucky that in almost 16 years I've never had a truly disabling hypo, never had to use a glucagon kit, and never had to call the paramedics. I hope that continues, and I'll be testing and altering my doses all the more to make sure that it doesn't. Oh, my poor fingertips.

This post has been a bit of a downer, all in all, but really I'm fine, and by applying all the 'diabetes rules' I got through my scary morning okay. I guess it's all part of the challenge of diabetes and pregnancy. I did have some good news yesterday though, so I'll finish on a high note. My last HbA1C, taken at the hospital on Thursday last week, was better than I expected. I'd been running a little higher than I would have liked for about a week around the time I conceived, so I was expecting a less good result than the previous two. Instead, I improved again! It was 6.3% - a number I haven't seen since my post-diagnosis honeymoon period. Not too shabby at all. So, my little passenger and I are doing fine, despite all the dramas of the last couple of days. Long may that continue. :)

-----------
NOTES:

* Also see this fascinating article for more detailed information: L. Jovanovic et al, 'Declining Insulin Requirement in the Late First Trimester of Diabetic Pregnancy' in Diabetes Care, July 2001, vol 24, no 7, 1130-1136. Particularly interesting is the information that 'In pregnancies that resulted in live-born full-term singleton infants, a significant 18% increase in mean weekly dosage was observed between weeks 3 and 7 (P = 0.000), followed by a significant 9% decline from week 7 through week 15 (P = 0.000).' Might use these percentages as an initial guide for tweaking my doses since I seem to have experienced the increase in weeks 3 to 7.

Sixth Appointment a.k.a. the 'booking appointment'

So, this morning I had my first appointment at the clinic since I found out I was pregnant. It's been a beautiful late summer's day, so I parked the car about 20 minutes walk away from the clinic and enjoyed walking in. Nice to get some exercise, but actually not the best idea I've ever had, since by the time I arrived at 8.30 I was already hypo, and had to treat twice before my sugars came back to normal. Ah well, if you're going to do it there's probably no better place than the diabetes clinic!

I waited for about half an hour before I was seen (could have stayed in my lovely comfy bed a little longer!) by two new faces, a lady endocrinologist called S, and a DSN (Diabetes Specialist Nurse) called D. They had a really good look at my monitoring diary, suggested that I might be taking a unit too much insulin at each meal, but especially lunchtime, and then hit me with a tsunami of information! The researcher in me totally geeked out ;) Rather than try to capture it all as it happened I'm just going to try to pull out the essentials! Thank goodness for my trusty notebook, which is allowing me to reconstruct what was said. They both said they could see why my sugars have been so good and my HbA1c has come into line so well - I'm obviously a control freak! (Maybe the list of questions I'd brought with me gave it away?)

• Contrary to what I'd understood before my care will actually be shared between the clinic and the community midwife team (sorry to my lovely GP who was right on that score). The lines are still a little blurry to me though, as some of my scans and suchlike will not be organised by the midwife but rather by the obstetrics team at the hospital clinic. I guess we'll just have to see how it all works in practice, but attention from two different sources can't hurt! Apparently the community midwives have more time than the hospital based ones, so that's the rationale for the split.
  
• There is no set schedule of appointments for a diabetic mum-to-be - it very much depends on how things are going and how well controlled the person is. Some people go into the hospital every single week, others might not be seen for three or even four weeks at a time earlier on in the pregnancy. Apparently I'm doing brilliantly at the moment so the dynamic duo thought that I'll probably be able to keep on top of changing insulin requirements pretty well on my own behalf, and can use the clinic appointments as more of a safety net. Nice to get the praise, but also nice to know that there is a safety net! One thing they said was that my sugars have been so good recently that my risks of problems are likely to be no greater than those of a non-diabetic woman of my age. Hurrah!
  
• I'm likely to be induced at 38 weeks rather than going into spontaneous labour. The received wisdom (which I already knew from fossicking around on the internet) is that diabetic mums can have problems with their placentas in the last couple of weeks - presumably linked to the other vascular issues we all have - so as a precaution T1s are made to deliver early. When I'm in labour I'll be put on a sliding scale, although I'll still be able to monitor my own sugars as well, if I wish (can you say control freak!?) I'm on MDI, not a pump, so this makes sense to me (although the last time I was on a sliding scale, when I had my wisdom teeth out, it was so mismanaged that I ended up discharging myself in order to get my sugars back down to a number that wasn't in the twenties - that's mmol/l for my friends in the US - or about 360mg/dl plus!)
  
• Delivering early also takes account of the fact that diabetic women can have big babies (macrosomia) if their sugars are high in the later trimesters. We all know that there's also a greater risk of having a C-section, but I was relieved to hear that this particular clinic doesn't push people into having unneccesary C-sections. They'll see how things are going and make a decision based on the evidence at hand.
  
• I don't have the option of a home birth, since it's important for the baby to be monitored closely in the first couple of days - even if my sugars are good there's still a risk that baby's pancreas will be working overtime at birth with consequent low blood sugars. I'm totally at peace with this one. I know some people don't like the idea of a hospital birth, but frankly I'm all about the big old safety net.
  
• I need to keep taking the high dose folic acid until I'm 13 weeks. Once I reach that point all the benefit will have accrued and I can revert to just taking a maternity vitamin with the 'normal pregnant lady dose' (ie. twice the normal RDA).
  
• My blood pressure will be monitored closely as T1 ladies face a higher risk of pre-eclampsia. Both the hospital clinic and the community midwife should be all over this one. I also have a BP cuff at home, so I can keep an eye on this myself. Mum had pre-eclampsia with me, so I'm wary about this possibility.
  
• My thyroid function tests at my last appointment were fine. I am on the edge of what's normal, and have been warned that a pregnancy might just tip me over into having an underactive thyroid, but at the moment all is okay, and they'll watch me closely.
  
• My eyes will be checked once a trimester for any signs of retinopathy. So far I've been extremely lucky and have had no trouble in this regard (retinopathy still terrifies me even though I know most T1s will experience it at some point in their lives and that treatments have improved a hell of a lot since I was first diagnosed back in 1991). I'll be having my eyes checked at my next appointment, which will mean not driving (expensive cab time) and taking the day off work (as I won't be able to get in later in the day, what with the 40 mile commute).
  

I was also able to ask some of my long list of questions (at least the ones which hadn't already been covered in the information tsunami):

• I wanted to know if I should have some ketostix. Honestly I don't think I've clapped eyes on these since I was first diagnosed, and being pregnant I wanted to reacquaint myself! The answer was a resounding yes, and I left the appointment with a prescription.
  
• I also wondered about how much weight I should be gaining in this pregnancy. As those who've read my earlier posts will have realised I'm not a svelte little person. No, I'm what my Dad once described as 'dense'. My BMI is hovering around the 29-31 level, and I'd read that I should try to restrict my weight gain to about 6 kgs (15 lb) instead of the recommended ideal of 11.5-16 kgs (25 lb - 35 lb) suggested for people with a 'normal' BMI. The doctor told me not to worry too much about this. With my levels of control and the kind of doses of insulin I'm taking I will be likely to gain, apparently, but she didn't think that I was in a worrying category weightwise. The trick is to eat for one (with 200 cals extra in the last trimester) and stick to healthy foods. I've been trying to do that for months now, so I hope I won't struggle. So far I'm not really experiencing any morning sickness, food aversions or weird cravings, so that makes things simpler. Fingers crossed that I stay this way!
  
• I've recently been invited for an annual flu jab (all T1s in the UK are considered to be in an 'at risk group' and get routinely invited). I was told that having this is fine whilst pregnant, and in fact is a good idea.
• My final question was 'when should I worry?' I know that the odd high blood sugar is fine (although I'd prefer not to see any!), and that the real concern would be soaking this embryo in persistently high sugars, but I wanted to know if there was any guidance on when I should be worrying more. Apparently pregnant women can be at greater risk of DKA, and if I'm vomiting, not eating or drinking, and have ketones of 3+ (hence the ketostix), I should call the hospital and come straight in. I should also start to worry if my insulin requirements start to tail off (instead of increasing rapidly) in later pregnancy, as this can be a sign that all's not well with the foetus.
  

The first part of my appointment finished with S, the doctor, saying that she'd order a full set of blood tests so we can know exactly how things were when I conceived, and D, the DSN giving me an updated version of the sick day leaflet, and providing me with a couple of extra telephone numbers that I can call if anything goes awry - this included her number, and the antenatal mobile telephone which is with her or with L, the dietician, at all times.

Once I'd seen the diabetes duo, I waited in the same room to be seen by one of the obstetricians. L, the dietician, popped her head round the door for a chat and to congratulate me, so I was able to thank her for the ovulation sticks tip. Turns out the reason she knew they're so great is that she's 18 weeks pregnant herself! I'm thrilled for her, and we had a little mums-to-be gossip for a few minutes, which was nice. I think it might be catching, as I noticed that the clinic receptionist is also pregnant! :)

My next caller was A, one of the obstetricians, who took a detailed history from me to add to my notes, and explained some more about what will happen on the obstetrics side. (I don't have the fabled 'yellow file' yet, which all UK pregnant ladies carry around with them. This is the pregnancy medical notes which will be started by the community midwife and given to me for safekeeping.) A briefly went over the diabetes-pregnancy 101 stuff - bigger babies, risks if sugars are high, possible c-sections, early delivery (although she said that it could be 38-39 weeks, not a blanket 38. It will depend on baby's growth and my sugars). Then she ran me through the various different scans and tests that I'd be offered. These include:

• early viability/dating scan - which will happen in 4 weeks time.
  
• Downs screening. The usual blood tests aren't valid for T1 ladies, so they offer the nuchal scan instead. This usually takes place at 12-14 weeks.
  
• A detailed 20 week anatomy scan.
• Regular growth scans from 24 weeks onwards.
  

I'd already agreed with the diabetes duo that I'd keep my appointment for 23 September when I'd have my eyes looked at. A checked with the sonographer and was told that the earliest they'd do a dating scan was 10 weeks, so I also had to make an appointment for a week later for my dating scan. (The reason they don't do it earlier is that it can cause anxiety if people don't see what they expect to!) It's going to start getting challenging to find reasons for all of these medical appointments before I can tell my colleagues at work what's up. They're used to the eyes thing, so maybe I'll take a strategic flexi day the next week and that way no-one will know I'm back at the hospital.

Once I'd seen both the diabetes and obstetrics teams all that remained was to have some bloods taken and produce a urine sample (no worries for me these days - my bladder's already working overtime). On the way to have my bloods taken I ran into Dr I, who stopped for a 5 minute chat to offer me his congratulations and see how things are going. All in all I was at the clinic for two and a half hours, and everyone is so great it's almost like being in a parallel universe (certainly compared to the clinic I used to attend for many years in another big city).

Once I'd booked my next appointment and confirmed the one I already had booked (and changed its designation from pre-pregnancy to pregnancy) I headed home, with the notes A had made tucked in my bag for inclusion in the yellow file once it's been started. This afternoon I went to arrange my first appointment with the community midwife at my GP surgery (which involved some form filling and sharing of dates I can and can't do). She'll apparently call me to set a time to meet sometime between weeks 8 and 12. I also had my prescription dispensed, so I'm now the proud owner of a box of ketostix that I hope I never have to open :)

So that was my day. Pretty busy, and I'm feeling tired now. I also had a busy day yesterday visiting my friend L, her son J, and her new baby daugher L. We went on a long walk in the sunshine and had a lovely time, and I told her my news. L's a hugely trusted friend who's been through a lot pregnancy-wise, and she's going to be my pregnancy buddy and mentor. That was supposed to be it for the telling people - I don't want to spread the news too far and wide just yet as it really is early days. S has told one friend (his best man), I told L, we've told both sets of parents and when we see my brother this weekend we'll tell him. However, another extremely good friend, J, rang out of the blue last night for a chat and to invite us to go and stay with her and her husband and meet her 6 month old daughter. I can't wait, and I'm afraid I cracked and told her too! Obviously it's still early days, and things could go wrong for me, but S and I agreed that if we were going to tell a select few people it would be in the full knowledge that we'd have to be able to face telling them we've had a miscarriage if anything does go wrong. L and J are two of my best friends, and I'd tell them anything, so I feel comfortable with telling them this news. We share stuff. However, I'm now drawing the line around my inner circle. Anyone else who asks (and actually J did ask outright) will be told 'we're working on it' - which is not untrue, just not the whole truth either!

Wow. Just realised I've been typing away for ages. S has arrived home from work whilst I've been tapping the keyboard. Must be time to check the old sugars and see what's for dinner. Bye for now!

Bank Holiday Update

It's Bank Holiday Monday in the UK, so hubby and I both have the day off work. Hurrah! I've actually been off work since last Thursday, using up some annual leave, and I'm not going back until next Monday, which is a huge luxury. As I said in my earlier post, S could only take a couple of days off with me, so this has been a bit of a staycation, allowing me to catch up with all kinds of errands (which has actually been more fun than I thought it would be). For the last few days now I've been doing what can only be described as a very belated spring clean. I've been tidying up cupboards, emptying the few remaining boxes from when we moved in (two years ago, the shame!), and vacuuming like a demon. Mum says I must be nesting, but it's a little early in her opinion - in her experience it usually hits at 38 weeks! Maybe, but at 38 weeks I'd be the size of a house, whereas at the moment I can still crawl around the floors on my hands and knees, and I can still fit under the beds :) S has also been brilliant - I found him mopping all our wooden floors on Saturday!

Not much to update on the pregnancy front. I'm really looking forwards to my appointment on Thursday when I'll get to see Dr Inspiring and his crew, and can ask the gazillion questions I'm collecting. Most of all, I guess I just want to know what the next few months will hold, medical appointment-wise. How often will I need to attend the clinic, when, and what for? I remember at my first appointment they waved a schedule at me and briefly explained that this was the shape of things to come, but now I want to get my hands on that piece of paper!!! I'll be six weeks when I go to the clinic. When I spoke to Dr I last week he said something vague about it maybe being too early to see a heartbeat on an ultrasound, so I don't know if I'll have one or if they'll wait. It's a weird feeling at the moment - I know I'm pregnant, but still can't quite believe it! I'm doing everything I need to, diabetes-wise, and my 7 day meter average has now come down to 6.6 mmol/l, which is where I'd like it to be (and round about where it was when I had my last fab HbA1c). I guess I just need a little reassurance that all's okay, so far. My breasts are still very tender (I drove over a pothole last week and... ouch!), and I've continued to need to go to the loo more often than usual, although I'm starting to get more used to that, and don't notice as much. I'm also not sleeping through the night - I usually have to get up to go to the loo at around 4am-5am, so I take the opportunity to check my blood sugars and have a little correction dose if necessary. My overnight sugars have been pretty good the last week or so, which is brilliant, as that's where I always struggle the most.* The other slightly weird thing is that I've lost weight since I found out I was pregnant - 4 lbs by this morning. I guess that's because all my energy's going into making a healthy placenta? I have been pretty tired too, so it's been lovely to have a few days off to catch up on some sleep.

I did go to see my own GP on Thursday, to let him know the news and to sort out one or two things. He was thrilled for me, which was really nice. He's also been a huge support, what with checking my rubella status and folate levels, arranging regular HbA1cs and referring me to Dr Inspiring's clinic. We agreed that I'd delay my smear, as the histology clinic struggle to read samples from pregnant ladies. He also upped my repeat prescription for Levemir, as I seem to need more of it that I did of the Lantus. Finally he printed off a letter letting me know how to register with the surgery's midwife. He seems to think that my care will be shared between the diabetes/obstetrics clinic up at the hospital, and my GP practice. I'm not so sure he's right on this one, so I'm going to wait to talk to Dr I and co on Thursday before I do anything more in that regard.

The one thing I am doing a lot of is reading pregnancy books and websites and trying to digest as much as I possibly can. Cheryl Alkon's book (Balancing Pregnancy with Pre-existing Diabetes) is fabulously reassuring - thanks Cheryl! and I'm also enjoying Prof Ian Greer's book, Pregnancy: The Inside Guide, which has lots of useful information for people with a whole host of pre-existing medical conditions. One statistic which has blown my mind is just how fast my little passenger is growing. According to TheBump.com he/she has already grown from the size of a poppyseed (weeks 3&4) to the size of an appleseed (week 5)! How amazing is that??



Well, can't think of any more to say for the moment. I'm off to test my blood sugars (I'm up to 15 times a day, and the ends of my fingertips are wrecked!)

PS. S says that he should maybe have a right of reply on this blog, as I write about him too. Well honey, I love that you read, I love you, and you're always welcome to comment :)

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Notes:
* The week before I had one really hellish night where I had a very, very, very persistent hypo - 3.2 mmol/l for over three hours, with bucketloads of carbs having no effect at all - followed by a rebound to 15 mmol/l which then persisted despite a whacking great correction dose. Sometimes diabetes just sucks!

Taking it all in...

So, my blog's finally out in the open and I had comments from Brooke and Kerri, whose blogs I follow, which made me smile.

This week's been my first at work since finding out I'm pregnant, and I'm not sure if I'm imagining things, but I'm pretty tired. One more day to go before I have a few days' holiday, and to be honest I can't wait! Unfortunately S has to work, so it's going to be a bit of a 'staycation' and I'm really looking forwards to a few days of chilling out and relaxing at home. Our trip to Cambridge at the weekend (via my parents' house) was great, but it was a long drive and Saturday was a late night catching up with all of S's old friends, including lots of people I haven't met before. At one point the conversation came around to babies and S and I spent the next few minutes nudging each other under the table and giving each other meaningful looks, but we didn't crack. So far, so good. We managed to keep quiet! On the downside, I found myself surrounded by smokers, and just wanted to make them stop. It's one thing to blow smoke in my face, another entirely when I have a little sprog on board. I did my best to keep away from the worst of it, without being antisocial. I also managed a pretty good set of sugars considering that I was eating to someone else's timetable (ie. later than usual) and snarfing down sausages and bbq chicken. Scoreline: Me - 1; Diabetes - 0!

It was lovely visiting my parents on Friday night, and the look on my Mum's face when we told them our news was priceless. Total shellshock. They're both delighted, although Mum can't quite stop herself from worrying about me, what with the diabetes and my crazy job. S did a slightly less effective job of telling his parents when we got home on Sunday evening. I cooked dinner whilst he had his regular phonecall with his folks, and when the food was ready I called him. 'So, what did they think?' I asked. 'Oops - forgot to tell them!' said he. Talk about laid back. My husband could win the gold medal if it were a sport!!

The last couple of days I've worked extra hard on keeping my sugars in check, and so far things are pretty good. My averages aren't back to where they were, but they're going in the right direction, and I'm planning to be pretty aggressive with my adjustments and correction doses. Only 246 more days to go! Eeek - that's terrifying in so many ways. I have noticed that I'm needing slightly more insulin than usual though. According to one of the pregnancy books I'm reading that can happen, although typically requirements will go down for a while in early pregnancy. I can see that this is going to be quite a balancing act! I also managed to book an appointment with my GP, and to speak to Dr Inspiring's secretary as requested. So, I'm seeing my GP on Thursday afternoon, and will be able to give him the big news, ask him to up the amount of Novorapid and Levemir on my repeat prescription, and put off my smear test until after the big event. Unfortunately the smear I had a couple of months ago was no good (due to an 'insufficient sample') so I'm supposed to have it repeated. However, circumstances have intervened, and now I'll have to delay, since you're not supposed to have a smear whilst you're pregnant, according to advice from the NHS. Dr I's secretary managed to bring forward my clinic appointment to next Thursday, whilst I'm on leave, which is great. I explained I'd been told to keep the appointment I already have booked for later in the month, but she told me that the clinic appointments staff wanted me to get it cancelled since it's an appointment for pre-pregnancy counselling don't you know! Barmy - surely they can just re-label it, since it's for the same clinic and with the same staff. She said she'd check with Dr I and let me know. If I do have to get the appointment cancelled they'll be able to rebook me when I see Dr I next week.

So far my pregnancy symptoms seem quite mild. I've already mentioned the tender boobs (although I think I'm getting used to it, when S gives me a hug I sometimes feel like I'm going to jump out of my skin). I'm also visiting the loo a lot, although I'm not peeing any more (in terms of quantity) than normal. Once in a while I feel a little crampy thing going on, but nothing more than twinges. Also apparently quite normal. I'm a big one for normal!! :) I've been eating really well, getting all my fruit and veggies, and sticking to high fibre, healthy options - except when I fell off the bbq wagon at the weekend. This morning I was down three pounds on where I was when I weighed myself a couple of weeks ago. I wouldn't expect to have gained, but losing was a bit of a surprise. I've also had some interrupted nights' sleep - and have needed to visit the loo in the wee small hours. It does give me the chance to test my sugars and correct if necessary - every cloud has a silver lining, huh? Otherwise nothing much to report. I can't wait to have my next clinic appointment and find out what's on the horizon for me. I know the next few months are going to be full of appointments, and I'm really looking forwards to the journey.

BIG NEWS!

I don't know how to start this post as my brain's all of a whirl! So I'm just going to plunge in with a stream of consciousness...

I was expecting my period to start on Wednesday (two days ago), but it didn't appear. Nor did it arrive on Thursday. I've had extremely tender boobs for the last couple of weeks, which could have been an early pregnancy sign, or might just have been the normal hormonal stuff. On Tuesday, Wednesday and Thursday I was getting little gripey stomach pains, and I had a slightly upset stomach - both of which can be a pre-period sign for me, so I assumed that it was on it's way and started gearing myself up for disappointment. I was desperate to take a pregnancy test, but since I was sure I was going to get my period I did my best to wait.

Yesterday morning I woke up, and seeing no sign of my period at all (it usually arrives slowly with a bit of a stain on my knickers) I got as far as peeing in a cup, before talking myself out of doing a test. This morning, I woke up at 7.30am (it's my day off) and thought, what the hell. Pee... cup... 3 minute wait... whoa... hold on... I see something... it's faint, but darkening... two pink lines... TWO. The leaflet says that means... I'M PREGNANT!

Thinking I was hallucinating (yep, always assume the worst), I went and got my camera to take some photos. Nothing like corroboration, I thought. Besides, the line might disappear again (!) By the way, I know that's not a terribly rational response!! :)

Here's the picture.

S was still dozing as he's working from home today and didn't have to leap up to cycle to work. Kind wife that I am, I kind of woke him up to tell him the news. I even let him have a little 'I told you so moment' - since he did. "I guess you're not dried up after all" he joked! It does make me realise that all the worry was unneccessary - after all, four months isn't so long to be trying. I feel soooooo lucky (and strangely I always used to say 4 was my 'lucky number' when I was a little girl). Personally I think the ovulation strips were the thing that did the trick, so L at the clinic will be getting a very big thank you from me when I see her next.

We are so happy and excited. I went onto the internet to look at EDD (estimated due date) calculators. Assuming that we conceived on 4 August (I had the positive ovulation test and we did the deed late on 3 August) then my EDD is 27 April 2011. If you go by the date of my last period then it's 1 May 2011. I'm working on the earlier date, since I didn't ovulate in the middle of my cycle, but instead on day 12.

Once my head had stopped spinning we treated ourselves to breakfast in bed and had a little cwtch (welsh for cuddle, don't you know). I have to admit that I keep looking at the lines to make sure they're still there. As S points out, they will fade within 48 hours, so really I should stop checking every 10 minutes and start to believe it. Blimey. Still doesn't feel real, though.

At 10am I called Dr Inspiring to let him know. As I explained in an earlier post, he gave me his mobile number at our first appointment and said I could call whenever I needed to. I had assumed that he used this as a sort of mailbox, always letting it go through to voicemail, listening to messages and then calling back. But no, he answered on the second ring! We had a quick chat about the fact that my next appointment is due on 23 September, and he said I should keep it. I should be around 8 weeks by that point. He said that he'd try to squeeze me in for an appointment in a couple of weeks' time, but that it might be too early for an ultrasound to confirm a viable pregnancy. He gave me his secretary's number and suggested that I call her on Tuesday when she's back from leave, to give her my name and hospital number and let her know that I have a confirmed pregnancy. Then they'll try to find me an appointment. He asked how my sugars have been, and I explained they've not been bad, although I have had a couple of really high readings either in the middle of the night or early in the morning. My two week meter average is 7.9 which is rubbish compared to the earlier averages I've had of 6.5 or so. But I know that two or three very high readings have skewed this average, and as Dr I says, these things happen. Just keep testing and tweaking, testing and tweaking. I think I might have had a little infection as I have had a pretty sore throat recently, and even more nosebleeds than normal.* Dr I congratulated me and told me to have a good weekend. "I think I will" said I!

We're off to visit some of S's friends in Cambridge over the weekend, which involves a fairly long drive,** so we're intending to stay with my parents tonight. We talked a little bit about who to tell and when. "You'll burst if you don't tell your parents tonight" S pointed out. Probably true. If we weren't seeing them I'd probably try to go another month or so before saying anything, but as it is I don't reckon I'll be able to hold it in. I know that this might not work out - it's very early days, and there are no guarantees, after all. If we do tell my folks then we'll also tell S's. Otherwise we'll be keeping schtum until the 13 week point. Only 9 weeks to go then! The only other person I might tell a little earlier is my friend L, who has been such a support to me. Part of me wants to shout it from the rooftops, and part of me wants it to be a little secret for S and I to share. Oh, and my blog, which I always intended to de-cloak once I had some good news to share (writing under my pseudonym, of course)!


NOTES
* I haven't mentioned this before, but I have a bit of a track record with nosebleeds. I had a huge operation (a septoplasty) on my nose when I was 20, and since then it's been a little dodgy. In the last 12-18 months I've had loads of spontaneous nosebleeds - sometimes as many as 3 a day - which can happen at the most inconvenient time (including during meetings, whilst driving to work, etc). Have had the 'bleeding patch' cauterised twice (horrible procedure, hasn't worked) and even had a CT of my sinuses (nothing worrying found). I have the slight fear that being pregnant is only going to make this worse, since bigger blood volumes can cause nosebleeds and bleeding gums etc. in pregnant women anyway. Oh well, what can you do?
** I'll be driving S's car, since I had to be rescued by the AA last night when my car broke down outside work. Some clever rewiring later and I was back on the road. When I called the AA, I explained I was diabetic and asked them to make sure I didn't have to wait too long. They were fab - a lovely AA man arrived within half an hour and chatted with me whilst he fixed the car. He made sure my sugars were okay and offered me a Kit-Kat, which he keeps just in case of diabetic customers and we talked a little bit about what it means to have T1. I wonder if they'd have arrived even earlier if I'd known I was also a tiny bit pregnant??? ;)