I have been a T1 diabetic for 22 years. Over this time, like many, I have had a complex relationship with this disease. I have had long periods of time as a young girl where I rebelled against having to control and manage my condition and my HBA1C and health reflected this. I’ve also had periods where my control has been better, not perfect, never perfect, but better. I would inject insulin when I needed to, guesstimate carb count, treat hypos, and hope for the best.
I would get by with an average HBA1C of around 8.5 % for many years. It was at this level when I had a conversation with my diabetic consultant about pregnancy. I was 36 by this point and whilst I was not planning a family right then, it was something I was starting to consider.
Her words were brutal…. ‘due to your history and control, it’s highly unlikely that you will fall pregnant and if you did, it’s highly unlikely you will be able to carry’.
I was shocked at her bluntness. I left that office holding back tears. Getting into my car, I let them fall, sobbing, I tried to get my head around the fact that I won’t be having a family, I could not help but berate myself, Afterall, this is all my fault. ‘why didn’t I have better control?’ ‘Why am I such a bad diabetic?’
My logical head told me that beating myself up was not going to help and I knew that my reasons for lack of control were multi-faceted and complex, still, at that point, it didn’t help. I felt like a failure, less than, I had to accept a family was not going to happen for me. I was dejected. Not surprisingly, my HBA1C continued to hover around the same percentage. I did not have the motivation to change.
Fast forward a year, I had just started a new job, was doing a post-grad diploma, and getting on with my life. I’d had some issues with my contraception pill, and I was advised to change to an IUD. I decided to wait a few weeks to have it fitted to give my body a break. Never, in a million years did I think I would fall pregnant, but here I was on the morning of the 19th December 2019 staring down at a positive test!
I was thrilled, shocked, and terrified simultaneously. All I could hear were my consultant’s words, ‘It’s unlikely you will carry’. I was 3 weeks pregnant and my HBA1C was 8.6%.
Everything I read scared me more, The possible complications and risks, deformities, heart problems, big babies, the baby will be born with low blood sugar levels, you will have to have a C section…the list went on. I was consumed with anxiety and convinced I would miscarry.
Going back to the same consultant, her attitude was unhelpfully disdainful, she asked us if we wanted to continue with the pregnancy. Angry and scared, I made a promise there and then that I would do everything in my power to protect my baby and do my best to get my control fine-tuned and where it needed to be. I just hoped that was enough.
She told me ‘this will be the hardest thing you ever do’ she was right, it was relentless, but I had a fighting spirit ignited in me. The motivation to change, to do better, for my baby.
We made a plan. Availability scans the next week and then weekly appointments with her to work on my blood glucose levels. I would have a specialist midwife and have extra scans as we went along.
The night before the 8 weeks scan, I was an emotional wreck, anxious, convinced we were going to have bad news. I am not religious but that night I asked God to give us this blessing.
When we saw our baby and the sonographer confirmed a heartbeat my emotions overcame me, and I cried tears of happiness. I felt overwhelmed with love for this little dot on the screen and fiercely protective. I made a promise to this baby for the second time that I would do everything in my power to help her grow healthily. And I did, for the rest of my pregnancy, I lived, breathed, dreamed blood sugar control. It took over absolutely everything and consumed my thoughts and actions day and night.
I had weekly appointments with the diabetic team and the specialist midwives. I started completing daily BG diaries, something I had not done in 20 years. I detailed carb count religiously, weighing everything I ate. I even took weighing scales out to restaurants! I wasn’t taking any risks or guesstimating anything. I detailed the type of foods I was eating to gage the effect they would have on my insulin levels. I checked my blood glucose hourly and made many, many adjustments on the way. Within four weeks my HBA1C was 6.5 %. The recommended level for a safe pregnancy.
In my first trimester, my insulin requirements dropped significantly. I made the most of eating lots of carbs! I had a lot of overnight hypos despite reducing my basal insulin by half. Juice boxes and jelly babies filled my nightstand and sleep became a distant memory.
The second trimester saw gradual but consistent increases in my insulin needs. My carb vs insulin ratios doubled, then tripled. I was now on 4 different ratios throughout the day to cover meals and snacks. Towards the middle of the trimester, it got harder. My carb vs insulin ratios were changing twice weekly and I was constantly on the phone to the diabetes team adjusting doses. My BGL would spike drastically in the early hours so I would set alarms 2 hourly through the night to correct them. It was exhausting, but I was determined to stay in control.
When I reached the third trimester, I was hit with the craziest insulin resistance. For breakfast, I Needed 10 x the amount of insulin compared to pre-pregnancy requirements. It was insane! I was offered an insulin pump. Whilst I felt nervous about such a big change so far into my pregnancy, I decided to go for it, and I am so glad I did. It helped considerably and meant that I could sleep through the night again. I found it easier to reduce my carb intake as I went along but was advised to not go under 120g per day. I ate 3 meals a day without fail, something else I had not done in years.
I had extra scans throughout and at each one, I became less anxious as they told me everything is looking good. We were having a little girl! I was filled with pride at how well our baby was doing. She was measuring right on target and I was told I could have a natural birth rather than a c section. The induction was booked for 38 weeks. My HBA1C was now 5.2 %.
At 34 weeks, I started having a lot of hypos again. I started to see a gradual decrease in insulin needs. I knew that this could be a concern as my OB had told me hypos in the 3rd trimester can be a sign of placenta failure. Apparently, our placentas have a shorter life span than non-T1’s.
My OB decided to keep a closer eye and book me in for weekly scans. At every scan, I was told the baby was doing fine, I had an excess of fluid surrounding her but told it was not a worry at this point. Still, we couldn’t give a reason for the hypos. I was worried. I reduced my insulin, kept an extra eye on the baby’s movements, and prayed to get to at least 36 weeks.
The hypos continued and worsened over the next few weeks. I had many NST and the baby was still doing fine but they were still concerned. My OB decided not to take any chances and told me they were going to induce me that day. I was 36 + 2.
Induction began, however, 4 days later and still no signs of the baby. She was not ready to come out and my body was not ready.
I became unwell during labor. My BGL was stable but I developed ketones. I had a low blood count and became anemic and needed a blood transfusion. I had also caught an infection and my blood pressure became erratic. With all this going on, the baby was becoming a little distressed and it was decided to go in for an emergency C section. After 4 days of hard work, she was born within minutes. She peed on me on the way out as if in protest of the early eviction!
Missy-Rae Thomas was born on 30/07/2020. She weighed 5lb 10oz and stole our hearts immediately. She was perfect and passed every test with flying colors, her BGL was normal, she did not need any NICU time and she certainly was not a big baby. We nicknamed her little Dot because she was so dinky!
For all of those months of hard work and anxiety, she was finally here, safe and well and she was worth every second. All the possible things we were told could have gone wrong with her just didn’t happen. For the second time in my life, I spoke to a God I wasn’t sure existed and spilled words of gratitude.
My pregnancy was not without its challenges, it was quite possibly the hardest thing I have ever done, physically, emotionally, and mentally but I put my all into it and did what I needed to. In an ideal world, my HBA1C would have been in range before becoming pregnant. We know we were lucky.
As type 1’s, we are well aware of the risks in our pregnancy, it’s a fact. They happen and my heart breaks whenever I hear of this. But it’s not a certainty. T1’s can have healthy babies and we shouldn’t be scare mongered into thinking that having a healthy baby is a rarity. T1’s can have successful pregnancies and I; Missy-Rae and many others are proof of that.
It’s important that people know this, that we share our stories to instill hope into others. That we begin to break down the assumptions, judgments, and negativity surrounding diabetes and pregnancy and give T1 mothers positive and compassionate support. T1’s are warriors and we make warrior baby’s!
Holly Wright
I work as a mental health counsellor in private practice and work as a low intensity CBT practitioner for the NHS. I love my work and aim to develop further in the field of mental health and chronic illness. I am a fitness enthusiast. I love to lift weights and swim. I also love good food and wine, balance is the key to most things! I have been T1 diabetic for 22 years. I use the freestyle libre and recently went from MDI to the omnipod pump which I’m loving
