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Lizzie G

35 week update

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Lizzie G

Hi guys

 

haven't posted in a while! other than ffeeling hot, uncomfortable and generally sick of being pregnant, things are ticking along quite nicely. latest HbA1C came back today at 5.3%, BP and urine still fine, all other bloods still fine! still eating **** loads of everything and very trigger happy with the insulin. hope everyone else is doing great too

 

Liz x

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Steal

Keep up the awesome work Lizzie! We will make it through this together and then swap pictures of the little ones.

 

-Steph

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Lizzie G
Sounds great!!! I am 5 weeks behind you, everything is going great on my end as well!!

 

yay! glad to hear it. wish pregnancy was shorter tho...

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Steal

Lizzie,

 

This second time around, it feels super fast. When you have a little one to distract you, it goes fast, I promise.

 

-Steph :)

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Jenny868

I can't imagine how hot you must be in the misearable weather! Great job on your A1C, I'm hoping to get there too! You make me hopeful that things will go well throughout the pregnancy. Any word on how you will be delivering? I'm always curious to see how many diabetic women deliver by c-section, natural etc. I am very hopeful but try to be realistic with my expectations. Thanks Lizzie, Jenny.

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Steal
I can't imagine how hot you must be in the misearable weather! Great job on your A1C, I'm hoping to get there too! You make me hopeful that things will go well throughout the pregnancy. Any word on how you will be delivering? I'm always curious to see how many diabetic women deliver by c-section, natural etc. I am very hopeful but try to be realistic with my expectations. Thanks Lizzie, Jenny.

 

Jenny,

 

it really depends on your situation for the delivery. I kept in excellent control but some factors made it so I had to have a c-section. This would have been true diabetes or not. Since I am having children close together, now it is being done for my own safety. Many of us get induced, but that is something that you will need to figure out and chat with your doctor about. There are numerous opinions. I would say, the most important thing to do is stay in tight control and make you womb a happy place for your little one.

 

-steph

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Lizzie G
I can't imagine how hot you must be in the misearable weather! Great job on your A1C, I'm hoping to get there too! You make me hopeful that things will go well throughout the pregnancy. Any word on how you will be delivering? I'm always curious to see how many diabetic women deliver by c-section, natural etc. I am very hopeful but try to be realistic with my expectations. Thanks Lizzie, Jenny.

 

Hi Jenny,

 

Unless there is some other type of complication the chances are that you will be pushed along the standardised one size fits all induction at anywhere between 37-39 weeks route. i dont know quite how it works in the US but in the UK it appears that however tight your control is and has been historically, the obstetrician will regard you as uber high risk regardless and apply exactly the same logic to your case as to someone with piteously poor control. in a meeting last week i was told that i cannot be compared to a 'normal' woman, despite the physiology of my body behaving in exactly that way. we are as yet undecided as to whether to allow them to push us into early induction, or to accept the liability of going to full term, which is what it amounts to.

 

In terms of your expectations. The way i see it, if your HBA1C remains above 6% (particularly above 6.5%) then the risk of complications and issues is undoubtedly higher and you do well to heed all advice given, go to all the over the top appointments, and be induced a little early. If that number has been consistently lower, then whatever nonsense you are fed about 'even people with excellent control' [by the way, there are no studies focusing on people with type 1 with a 'non diabetic' HbA1C, and i think when they speak of 'excellent' they mean in the 6s], then you need to consider your personal situation, what is best for you and the baby, and to push back. words like 'still birth' will be bandied around like crazy to get you to comply with the 'standard protocol'. as far as im concerned if my numbers are normal and my body is normal, the only difference is that my brain and pump do what the pancreas does in a 'normal' woman and the expectation SHOULD be reasonable to be treated like a normal woman. unfortunately many people with diabetes have been conditioned into thinking that the very natural process of conception, pregnancy and childbirth is a ginormous risk, is likely to be wrought with complications from start to finish, and needs to be monitored on a daily basis to make sure it doesnt all go horribly wrong. this is such an alarmist hangover from the days where excellent glycaemic control was not achievable - whilst there are some things outside of our control in pregnancy, you can have a perfectly safe, healthy, and straightforward time without ever having a drop of protein in your urine, pre-eclampsia, even mildy elevated blood pressure. dont be alarmed/taken in by the things you are told; they are told to you for one reason: to make you comply with standard practices, which to my mind, are out-dated and not appropriate for everyone.

 

good luck and pick your battles; never be bullied into something with the fear tactics, always counter them with a bit of common sense and remember that so many pregnant people with type 1 have dreadful control and thats where this all stems from.

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Steal

Jenny,

 

Lizzie is one of the most well researched and I can't wait to hear her great news for the birth of her son! Go Lizzie!

 

For me, I developed a condition called Cholestasis, this is not related to Diabetes and has to do with the liver releasing bile. During my first pregnancy this went undiagnosed. I was induced at 37.5 and after a very long labor (over 40 hours) had a c-section and they discovered that she was face up and this was making it so that she would not descend. Had they diagnosed the Cholestasis, I would have had an automatic c-section at 37 weeks. It has come back in my second pregnancy, but has been caught super early and they have given me medication that will hopefully help it to subside.

 

For my doctor, it is standard practice to induce Type I Diabetics by 38ish weeks. Other practices do this at 37 and some will let you go until 39. I was in excellent control for both pregnancies and I was and am not worried that my Diabetes has affected my baby and her development. But, for me, I know that even with being in great control, my body is different. It is not something that I am upset by, I have been Type I the majority of my life and this changes our bodies, no matter what our control. My control is excellent, but I was not always in the 5's for my A1C and all of this can have an effect on my body. Anyway, all that I mean by this, is that for me, while I know that I could have been fine waiting to deliver (if I had not developed a different condition), I was not willing to take that risk. For Lizzie, she does not see it as a risk and I think that is amazing. For me, even though I know that I have done everything right, I still didn't want to take any chances. It is a personal decision and whatever you decide will be right for you and your little one and we will all be here to support you and say congratulations!

 

One bit of info that I know Lizzie and I are in total agreement about is pump control. If you are in excellent control, make sure that you discuss with your doctor about maintaining control during your labor and delivery. This is something that you may have to fight for. It is not standard practice in most hospitals and they want to put you on an insulin drip. For me, this is just not an option. I know myself and want to not be worried about maintaining control and monitoring the nurses/doctors. It took some pushing but the doctors are once again on board. They allowed me to control my own pump during my first delivery and with this second one being a scheduled c-section, the control of my own pump was more for the time I am staying in the hospital.

 

Continue to stay in great control and be your own advocate. Ask questions and we are all here for you. Everyone has had a different experience, but reading and learning from them is what can help us all make the best decisions for ourselves.

 

I hope this helps.

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MelissaDawn
Hi Jenny,

 

Unless there is some other type of complication the chances are that you will be pushed along the standardised one size fits all induction at anywhere between 37-39 weeks route. i dont know quite how it works in the US but in the UK it appears that however tight your control is and has been historically, the obstetrician will regard you as uber high risk regardless and apply exactly the same logic to your case as to someone with piteously poor control. in a meeting last week i was told that i cannot be compared to a 'normal' woman, despite the physiology of my body behaving in exactly that way. we are as yet undecided as to whether to allow them to push us into early induction, or to accept the liability of going to full term, which is what it amounts to.

 

In terms of your expectations. The way i see it, if your HBA1C remains above 6% (particularly above 6.5%) then the risk of complications and issues is undoubtedly higher and you do well to heed all advice given, go to all the over the top appointments, and be induced a little early. If that number has been consistently lower, then whatever nonsense you are fed about 'even people with excellent control' [by the way, there are no studies focusing on people with type 1 with a 'non diabetic' HbA1C, and i think when they speak of 'excellent' they mean in the 6s], then you need to consider your personal situation, what is best for you and the baby, and to push back. words like 'still birth' will be bandied around like crazy to get you to comply with the 'standard protocol'. as far as im concerned if my numbers are normal and my body is normal, the only difference is that my brain and pump do what the pancreas does in a 'normal' woman and the expectation SHOULD be reasonable to be treated like a normal woman. unfortunately many people with diabetes have been conditioned into thinking that the very natural process of conception, pregnancy and childbirth is a ginormous risk, is likely to be wrought with complications from start to finish, and needs to be monitored on a daily basis to make sure it doesnt all go horribly wrong. this is such an alarmist hangover from the days where excellent glycaemic control was not achievable - whilst there are some things outside of our control in pregnancy, you can have a perfectly safe, healthy, and straightforward time without ever having a drop of protein in your urine, pre-eclampsia, even mildy elevated blood pressure. dont be alarmed/taken in by the things you are told; they are told to you for one reason: to make you comply with standard practices, which to my mind, are out-dated and not appropriate for everyone.

 

good luck and pick your battles; never be bullied into something with the fear tactics, always counter them with a bit of common sense and remember that so many pregnant people with type 1 have dreadful control and thats where this all stems from.

 

Lizzie,

 

With regards to early induction, isn't part of the problem with diabetics is that they don't know what causes the placenta to degrade? Do they know that it's poor control and not just the same factors that led to the diabetes in the first place? After all, even with great control, my immune system still did the original damage that caused the diabetes. It was my understanding that they don't know which of these things contributes to early placental degradation in diabetics, and that's why they like to induce early even with excellent control... but I haven't researched it, so maybe you have. What have you learned about it?

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Jenny868

Thank you guys for all the information! I just keep hearing things over and over and it gets me nervous about being pushed into a category and not having the freedom of choice. Either way in the long run I know everything will work out. I am a strong advocate of keeping my pump on and being in control of that during delivery, I work in a hospital and I see women who aren't allowed to control it and they struggle. Steal, I'm sorry to hear about your condition and 40 hours of labor! That is intense! Way to be strong through all of that, I can't imagine that was an easy task! I am continuing to do my research and being a strong advocate. I have a great healthcare team behind me, for the first time since I was diagnosed 15 years ago, THANK GOD! It makes all the difference in the world when you have strong people behind you that believe in you. I'm going to continue to ask them plenty of questions along the way. I have my second trimester genetic screening blood draw coming up so that will be nice to have completed as well. I can't wait until my 20 week ultrasound! All of these first time experiences are truly remarkable and breath taking! Thank you guys for your constant feedback and answers! You have helped immensely!

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Lizzie G
Lizzie,

 

With regards to early induction, isn't part of the problem with diabetics is that they don't know what causes the placenta to degrade? Do they know that it's poor control and not just the same factors that led to the diabetes in the first place? After all, even with great control, my immune system still did the original damage that caused the diabetes. It was my understanding that they don't know which of these things contributes to early placental degradation in diabetics, and that's why they like to induce early even with excellent control... but I haven't researched it, so maybe you have. What have you learned about it?

 

this is indeed true. there is a lack of pertinent research on the subject. however, the more i have spoken to various medical professionals, the more it seems that the risk more than likely is linked to control more than anything. its also worth bearing in mind that this is not standard protocol for other autoimmune conditions, which are not linked with placental degradation, and surely if this were an immunological issue, these ladies would also be at the same risk? another thing i always think is, well, common sense really. the placenta is a sensitive structure made of vessels and arteries, the same things in eyes, kidneys, nerves. it's the high glucose levels that cause damage in these other structures, im sure it wont be long before medical science proves this to be the case. every obstetrician can quote a woman with 'excellent' control that had a stillbirrth, but equally, they can quote a woman without diabetes that has the same: unexaplained stillbirth is an unfortunate and unpredictable horror that happens to ladies with and without underlying medical conditions.

 

i guess the point is, a difference in the way people look at risk. medics always behave in the most risk averse manner (unless it costs more, otherwise we would all have C sections, by far the safest delivery method!). so what we are talking about here, is a risk factor increased from say 1 in 5000 of stillbirth, to say 1 in 3000. so the doctor behaves in the most risk averse manner and has a standard protocol to induce early, rather than explaning to her patients the actual risk (i wonder how many people with type 1 for instance, are under the impression that if they werent induced early their child would be lucky to survive?). i agree that the mechanism of the placental degradation is unknown, however, glycaemic control does seem the likely culprit, definitely more research needs to be done, but women with diabetes should be offered the type of options that 'normal' women have if their pregnancy is uncomplicated, and not be automatically swept along this path to a highly medicalised labour and delivery.

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Steal

My doctor never spoke with me about the placenta degradation until I brought it up. She just said that induction by 39 weeks is standard for Type I Daibetics. While I was in great control, I was one that felt ready and was not willing to take the risk. I agree with Lizzie, there are many types of "risks" and as moms we have to make so many of these decisions. I did what felt right for me. My friend, who I met on the forum, went to UCSF which had the standard procedure of induction at 37 weeks. I would speak with your doctor, do your research, and see what feels right for you. I wasn't willing to wait and see, but that is how I am with most things. My daughter was induced at 37.5 weeks, but this also did end in a c-section. There are many sides to this and no decision is absolute.

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MelissaDawn
this is indeed true. there is a lack of pertinent research on the subject. however, the more i have spoken to various medical professionals, the more it seems that the risk more than likely is linked to control more than anything. its also worth bearing in mind that this is not standard protocol for other autoimmune conditions, which are not linked with placental degradation, and surely if this were an immunological issue, these ladies would also be at the same risk? another thing i always think is, well, common sense really. the placenta is a sensitive structure made of vessels and arteries, the same things in eyes, kidneys, nerves. it's the high glucose levels that cause damage in these other structures, im sure it wont be long before medical science proves this to be the case. every obstetrician can quote a woman with 'excellent' control that had a stillbirrth, but equally, they can quote a woman without diabetes that has the same: unexaplained stillbirth is an unfortunate and unpredictable horror that happens to ladies with and without underlying medical conditions.

 

i guess the point is, a difference in the way people look at risk. medics always behave in the most risk averse manner (unless it costs more, otherwise we would all have C sections, by far the safest delivery method!). so what we are talking about here, is a risk factor increased from say 1 in 5000 of stillbirth, to say 1 in 3000. so the doctor behaves in the most risk averse manner and has a standard protocol to induce early, rather than explaning to her patients the actual risk (i wonder how many people with type 1 for instance, are under the impression that if they werent induced early their child would be lucky to survive?). i agree that the mechanism of the placental degradation is unknown, however, glycaemic control does seem the likely culprit, definitely more research needs to be done, but women with diabetes should be offered the type of options that 'normal' women have if their pregnancy is uncomplicated, and not be automatically swept along this path to a highly medicalised labour and delivery.

 

Thanks for sharing what you know. Fortunately, I have a doctor I trust and he even stated today that if I hadn't naturally gone into labor by 39 weeks and everything still looked okay, he'd consider waiting until my due date. I'm not against induction, but its nice to know he's not ready to jump. I haven't had the control you've had (6.3 HbA1C -- good, but not nondiabetic normal), so I'm okay moving forward if it seems a safer course.

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Lizzie G
Thanks for sharing what you know. Fortunately, I have a doctor I trust and he even stated today that if I hadn't naturally gone into labor by 39 weeks and everything still looked okay, he'd consider waiting until my due date. I'm not against induction, but its nice to know he's not ready to jump. I haven't had the control you've had (6.3 HbA1C -- good, but not nondiabetic normal), so I'm okay moving forward if it seems a safer course.

 

you are so lucky to have an open minded and flexible doctor. very few of us are able to say that! is that the obstetrician? i wish i was working with someone like that. it feels like i work so hard and i sometimes think why do i bother!

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MelissaDawn

He's a perantoligist (spelling?). I had him recommended to me by a nurse who worked in the field, and have really liked him. I also learned in my birthing class that the policies he's changed for the branch of hospitals he works for have lowered the C-section rate to one of the lowest in the country. That included a change in the induction policies.... so I'm very fortunate. He's very open minded and trusts that a diabetic can have a healthy baby if they stay healthy.

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MisterP
Hi guys

 

haven't posted in a while! other than ffeeling hot, uncomfortable and generally sick of being pregnant, things are ticking along quite nicely. latest HbA1C came back today at 5.3%, BP and urine still fine, all other bloods still fine! still eating **** loads of everything and very trigger happy with the insulin. hope everyone else is doing great too

 

Liz x

 

Lizze,

 

Congratulations on the good news. I'm kind of new to diabetes. I don't have it but my fiance has had t1 since she was 9. I've known her since we were 8 but we've only been together a year and yet we're already crazy about each other. I know she's the one. I'm learning all I can about her diabetes and now we're thinking of children, which raised the question of the possibility. We are going to see a doctor before hand to make sure, but I was wondering if you had any advice. It's already a great relief to know it's possible and to maintain her health. She has brought her A1C down over the years from 13.2 to 6.9 and everything just keeps lining up perfectly. I hope everything continues to go great for you and congratulations again.

 

Matt

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Lizzie G
Lizze,

 

Congratulations on the good news. I'm kind of new to diabetes. I don't have it but my fiance has had t1 since she was 9. I've known her since we were 8 but we've only been together a year and yet we're already crazy about each other. I know she's the one. I'm learning all I can about her diabetes and now we're thinking of children, which raised the question of the possibility. We are going to see a doctor before hand to make sure, but I was wondering if you had any advice. It's already a great relief to know it's possible and to maintain her health. She has brought her A1C down over the years from 13.2 to 6.9 and everything just keeps lining up perfectly. I hope everything continues to go great for you and congratulations again.

 

Matt

 

Hey Matt,

 

Thankyou, thats very kind. And massive congratulations to your fiance and doing a great job, thats an amazing leap, shes obviously got lots of determination and is really committed to you and your future family - i would say that is about 9/10s of the battle with diabetes. yours sounds like a wonderful love story!

 

the only advice i would give, would be to just generally keep a happy balanced lifestyle, take exercise, eat well, keep on top of the control and try and improve it even more. also, it would be a good idea now to do stuff like have eye and kidney checks to make sure she doesnt have to have any complications, or that any she does have are kept under control - these things dont make it impossible to have children at all, but just make it extra important to keep the control as tight as possible to make sure they dont get worse.

 

does your fiance use an insulin pump or shots? a pump does make life a lot easier to fine tune, especially during pregnancy. i wont lie and say its an easy fix, but if you put the hard work in, you reap the rewards.

 

Good luck to you both! x

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MisterP
Hey Matt,

 

Thankyou, thats very kind. And massive congratulations to your fiance and doing a great job, thats an amazing leap, shes obviously got lots of determination and is really committed to you and your future family - i would say that is about 9/10s of the battle with diabetes. yours sounds like a wonderful love story!

 

the only advice i would give, would be to just generally keep a happy balanced lifestyle, take exercise, eat well, keep on top of the control and try and improve it even more. also, it would be a good idea now to do stuff like have eye and kidney checks to make sure she doesnt have to have any complications, or that any she does have are kept under control - these things dont make it impossible to have children at all, but just make it extra important to keep the control as tight as possible to make sure they dont get worse.

 

does your fiance use an insulin pump or shots? a pump does make life a lot easier to fine tune, especially during pregnancy. i wont lie and say its an easy fix, but if you put the hard work in, you reap the rewards.

 

Good luck to you both! x

 

Thanks! She is currently on omnipod and it has helped a lot. It frustrates her when i ask her to check her bg in public so i've gotten used to doing it myself. I'm doing everything i can to help and keep things as best as possible. Hope your good luck continues!

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