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Report on pregnancy and type 1 diabetes
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My boyfriend and me were together for quite a long time when we decided that only a child might increase our happiness. So I stopped taking the pill in august 2003. My HbA1c level was relatively poor at that time. It was about 9% and this was a situation not ideal to get pregnant. But we did not care about it and readily started to try to get pregnant. My diabetologist knew about our plans and did her best to improve my values. Besides the pump therapy (first the Minimed 508 and then the Paradigm 712 with humalog) I had to take a metformin tablet in the morning and in the evening. But my blood glucose did not change at all. After ten months of unsuccessful trial I finally got pregnant in the middle of June. But at this time our relationship was stuck in a crisis. And now something happened that was not planned: He broke up with me. The same day I made a pregnancy test which resulted positively. The first three months of pregnancy I really felt f***** up. I perennially felt sick and had to throw up several times a day and I did not feel like eating because I was lovesick.
And so I lost 12,5 kg in the first three months of pregnancy. My values improved remarkably. Once a month my Hba1c was checked. Every time it had improved around 0,5% (+/- 0,1). At the end of my pregnancy I reached a Hba1c value of 5,9%. And this without taking metformin (I had to stop taking the tablets as they might be a risk factor). In the 11th week my gynaecologist noticed a transparent neck band and an enlarged abdomen. Those can be indicators of Down's syndrome. She referred me to a specialist who came to the same results (the values of my child meant that the probability for my child to have Down's syndrome was 1:300) and advised me to have a biopsy of the chorionic villi. This means that a needle is inserted into the placenta. The biopsy was very painful and I felt as if I had to wait years for the results. The sample they had removed from my placenta was divided into two. On half was checked after 24 hours and the other half was installed as a long-term culture. For the results of the second sample I had to wait three or four weeks. After 24 hours I could call the laboratory and get the first result. The chromosome complement was normal (Down's syndrome is a malformation of the chromosomes). As the sex can be identified by a chromosomal analyses and as I was quite curious, I asked to be told the sex of my child. I was to have a son. In the middle of October the next problem occurred. Maxi (that would be the name of my child) was unusually big on the sonograph (which might be because of diabetes). By that time my Hba1c was around 7,0%. Therefore my doctor send me to the clinic in Großhadern in order to make further examinations of Maxi and to stabilize my diabetes. There the suspicion of my gynaecologist was confirmed: Maxi was too big and in addition he had a big head (I always said that he inherited it from me, the size of my head was 39 cm when I was born). After 2 weeks I could leave the clinic. My blood glucose was not better but on a moderate level.
But in the clinic I had a really mad experience. For the first time I could feel Maxi's movements. I do not know how to describe this feelings to women who never were pregnant. But this experience had advantages as well as disadvantages. A disadvantage: I spent a lot of sleepless nights because Maxi was very active during night and kicked me a lot. The advantage was that now I could be sure that my child was well. The following months passed by without serious incidents. Every two weeks I had to see my gynaecologist and two weeks later I had to go to Großhadern. Maxi developed very well but still he was too big. Therefore it became clear quite early that he would be delivered via a cesarean operation. In the middle of January (in my 32nd week of pregnancy) I had to return to the clinic because the doctors presumpted gestational venenation. Symptoms of a venenation are protein in the urea, hydropexis, high blood pressure and irregularities of certain blood values. When I was already leaving the hospital because they did not find anything, uterine contractions set in. I immediately was attached to the bolus-tocolysis. I have to say that this were really strong drugs. The tokolysis influences everything: I felt hot the whole time (I was standing on the balcony in winter and did not feel cold) and I started crying without a cause. This was pretty strange. In the second week of my stay in the clinic my blood values worsened from day to day. I was next to gestational venenation. In the morning I had to keep an empty stomach because I had to be ready the whole time. Every morning my blood values were checked and if they suddenly should get worse, Maxi would have to be delivered.
The constant feeling of sickness grew worse in January. In the clinic I did not mind skipping breakfast and always was afraid of lunch. I only had to look at the food and grew sick. It always was a contest to make it to the toilet in time because I had to separate the bolus-tocolysis from the electricity before I could start running. It took some time until the doctors and the nurses found the right medicine to treat my nausea which could affect my diabetes as well as my pregnancy. I always got an infusion of vomex. Sometimes I was attached to the infusion before I ate so that at least something would remain in my stomach. The blood glucose level at that time was a game of chance. I am really grateful to the diabetes team in the clinic because they were always there for me. In consultation with the chef doctor of the infant station the doctors who were treating me decided that I should get matured lungs although I was already in the 34th week. If a child is born before the 34th week, the lungs are still immature. To reach maturity of the lungs, the mother is given two injections of cortisone in 24 hours. As cortisone might increase the blood glucose, my diabetologist visited me before I was given the first injection. We agreed on keeping the basal rate on 110% and I had to watch the values carefully. I passed this difficulties without serious incidents. In the night between the 30th and the 31st January the cardiotocogram (CTG) was very bad. Maxi's heartbeat was too regular. I was brought to the delivery room immediately. After several examinations (sonograph, blood values, CTG) the doctors decided that Maxi should not be delivered yet. But the next morning a nurse came to shave me. The blood values had worsened once again. I was shortly before giving birth to my child. Around eleven o'clock I was brought into the OR. The whole morning I was cool but in the last seconds I started being anxious. I was trembling and wanted to run away. But my fear, especially of the PDA was ungrounded. The OR team was really nice and I felt "comfortable" (this may sound funny, but as far as one could feel comfortable in such a situation, I did). In a conversation before the operation the anaesthesiologist had explained to me that I would feel something of the cesarean operation. I was lying there and waited for the operation to begin but felt nothing. So I asked the anaesthesiologist when they would start and she answered that they were already in the middle of the operation and that my son might be born every second. And shortly afterwards it happened. My son Maximilian Alexander screamed for the first time on the 1st of January in 2005 at 12.18 o'clock. What I felt, I cannot remember now. There were so many sensations: joy, relief, anxiety, everything and nothing at once. When I was lying on the intensive care unit later (my blood pressure was as high as the Himalayas because of the gestational venenation) the infant nurse told me that Maxi was very well. He was hypoglycaemic and was given a glucose infusion but everything else was fine. He was 48cm big, he weighed 3175 gr and the size of his head was 34,2 cm. Those are relatively "normal" figures for a new-born baby after 40 weeks. But Maxi was 5 weeks early... By the way, he needed the glucose infusion for only three days. In the week after his birth my basal rate was very instable. Sometimes it fell to 10% sometimes to 30%. When we left the clinic two weeks later my basal rate was around 50% compared to my values shortly before the birth.
Breast-feeding worked well although I had had a cesarean operation and suffered from diabetes. But when Maxi was six weeks old, difficulties occurred. I became hypoglycaemic twice in one week. After the second attack I had to stay in a clinic for a week. Until the end of the nursing period (I was nursing Maxi for 4 months, at the end alternating with the bottle) no more problems occurred. On what concerns my diabetes, when I was checked for the last time, my Hba1c level was at 5,9%.
To summarize, my pregnancy was everything else but easy. From the beginning to the end I felt sick and threw up at least once a day. Twice or thrice a week I had to see doctors. But today, when I look at Maxi and he happily smiles back at me, I forget all the difficulties and strains of my pregnancy. Of course I would have another child, if only I had the right partner...
Michaela Zink
Translated by Jella Eifler
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