My first scan
You pee on a pregnancy test stick and it says it's positive and then that's it.
No one checks or does anything to check you're actually pregnant until today. It's all riding on this scan to see if it is a positive pregnancy or not. So many emotions; excitement, anxiety, worry, concern, happiness, hope.
Borders General Hospital is my new hospital and it is very small compared to the other hospitals I had my last two children in (Addenbrookes, Cambridge and Hull Women & Children's). It's much smaller but everyone seems extremely friendly and welcoming.
Time for my scan and they can't see clearly what they need to, but there is baby and a good strong heartbeat. I end up having an internal scan and all checks out well. Congratulations, we are pregnant!
They struggle to accurately date me and so they ask to re-scan in a couple of weeks time to double check.
Referral to the diabetes team
I've not been booked in by the midwifery team yet, but have handheld notes that I was given at my medical practice when joining which I've filled in. The sonographer notes that I have gestational diabetes and calls the diabetes team as it is the antenatal diabetes clinic day (Tuesday, funny as it's the same day for the diabetes clinic at both my previous hospitals...why is Tuesday diabetes clinic day???...answers on a postcard please!)
I speak on the phone with a diabetic midwife and they arrange for me to come back the following week to the diabetes clinic.
Time to meet the diabetes team
Today I'm on my own travelling to hospital and the journey, although very pretty through the winding country roads is quite nerve wracking to drive for the first time. Big steep drops down from the single track roads into the River Tweed and I'm going by sat nav, praying it keeps me on the right tracks. I'm relieved when I arrive at the hospital, 15 minutes before my appointment and I have to say it is so nice not having to pay for parking!
After having gestational diabetes twice, attending two different hospitals in England and from what I've learned about different clinics and practices across the UK and Ireland, although I know what to expect, I wonder what they will make of me with my high insulin resistance, early diagnosis, my knowledge on GD and I'm intrigued to see what test targets they use and what dietary advice they give. Knowing that the Scottish SIGN guidelines are quite different to the NICE guidelines which I tend to follow, with Scottish test targets and times often very different to what I would normally use or agree to.
To give a bit of background, Scottish test targets are often pre-meal only, or alternating days of pre-meal with days of post meal tests, or tests at 2 hrs post meals with high targets such as <8.0 mmol/L. I use the current NICE guidelines as targets and test 7 x a day; fasting, 1 hour post meals, before all meals and before bed with targets of <5.3 mmol/L fasting, <7.8 1 hour post meals (if testing at two hours additionally) <6.4 mmol/L 2 hours post meals and <6.0 mmol/L before meals and before bed. I believe testing before and after my meals helps me gain control of my blood sugar levels much better and I can tweak my diet and insulin doses accordingly from the results. To me, testing only pre-meal levels is pointless as you miss the majority of spikes in blood sugar levels, likewise with 2 hour testing. The only time I find 2 hour post meal testing beneficial is when eating much higher fat meals.
"Hi I'm Jo and I've devoted the last few years of my life researching gestational diabetes and have supported well over 4,000 ladies across the UK & ROI diagnosed with it..."
Another lovely midwife takes my urine sample for dipping and my blood pressure, then I'm asked to wait to meet the diabetes team. This ends up being 6 people in a room! Jeez! I'm pretty clued up on GD and all it entails and yet it is nerve wracking sitting in a room with so many people. Do I mention what I do and what my passion is, do I stay quiet and just see how it goes?
In the room is a DMW (diabetic midwife), two registrars, a student, a dietician and then they call the consultant in to meet me especially too. I get the feeling that they are not so used to someone with higher insulin resistance with just gestational diabetes like myself.
We talk about my previous pregnancies and births, about my family history and then they start discussing my GD, my early diagnosis, my insulin etc. They scroll through my test monitor and start making notes. Typically today my post breakfast level that I've just taken in the waiting room is one of my highest so far, 9.4! Typical
As we discuss more about my GD I then explain what I do regarding the Facebook support group and my website, which they smile and nod about.
The more we talk, the more they seem to understand that I do seem to know a lot about gestational diabetes.
Much to my surprise, I am not given any test times or targets to follow and they seem happy for me to continue the way I am. The dietician also says that as I seem knowledgeable that there doesn't seem to be much point me having an additional meeting with her.
They ask what doses of insulin I'm taking and they suggest starting my Novorapid (rapid release insulin) to help with some of my pre-meal levels. I've already started Novorapid but only as when I've seen a need to and I think this is an approach that they have not dealt with previously.
They seem really happy with me and ask that I return in 4 weeks time for a follow up appointment, however my blood pressure is slightly raised today and so they want to double check that before I leave.
High Blood Pressure
I've not had high BP in my previous pregnancies and so unless it's because I'm getting older, I'm not sure what's caused the high result?
I'm taken up to the antenatal ward and have to have my bp taken every 5 minutes for half an hour. I feel like my arm is going to pop!
After being in big busy hospitals previously, Borders General Hospital is so lovely and quiet! I'm on a ward with 4 beds (although it could take 6) and there is no one there other than myself in a comfy chair, with a cup of tea the midwife kindly brought to me. Where is everybody?... I'm loving living in the country again 🙂
My BP settles and we put it down to the nervous drive along the rural roads, on my own for the first time and then meeting the new diabetes team. I need to chilllllllllll!
Booking in appointment
After being in hospital all morning, I have my community midwife appointment in the afternoon to 'book me in'. Anyone else feel like I may have done things back to front here?!
My community midwife is lovely and I have routine blood tests done, along with another urine dip test and blood pressure check.
With being a high risk pregnancy, under consultant care, I know like in my previous pregnancies I won't see the community midwife much at all. Even still, it's nice to have a contact if I want to discuss something just pregnancy related.
More About me, Jo, owner and author of Gestational Diabetes UK
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