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. :)

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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!