Maybe more than you wanted to know?

In light of entering my 32nd week of pregnancy, and by extension the 2-4 doctor visits per week that I will be having, I thought I would take a minute and explain just what I am doing at the doctor's office/hospital so. insanely. often.

There is of course the normal OB appointments every other week and then every week, like any other pregnant woman. No big deal there. Then there are the appointments with the diabetes doctor every 3-4 weeks, where they take an A1C and we talk and troubleshoot any problems with my blood sugar control. Again, not a big deal.

Where the doctor appointments start to get ridiculous is at Maternal Fetal Medicine, the specialists who have been keeping close tabs on me because I have type I diabetes. Up to this point I've gone in every month for an ultrasound. Starting at 32 weeks, they are starting me on Non-Stress Tests (NST) twice a week. Here's why they are doing the NST.

With diabetes, especially type I diabetes, you have an increased risk of several complications in pregnancy, including a higher risk of stillbirth. The risk of stillbirth comes because diabetes can affect placental health. Apparently higher levels of glucose in the blood and just having diabetes in general can damage the placenta, and if the placenta has issues, not so good for the baby. This isn't too surprising, as high levels of glucose/diabetes in general can cause eye problems, kidney problems, vascular problems etc in the same manner. Anyway. During the NST, they hook me up to some external monitors and watch the baby's heartbeat and amniotic fluid levels for about 1/2 hour. These two things are indirect measures of placental health. So, if everything looks good with the heartbeat and fluid levels on their tests, they can say pretty safely say that the placenta and by extension the baby are good for the next week or so.

Additionally, the risk of stillbirth is a lot higher after 38 weeks (I believe that's when anyway). I think the incidence of a lot of other complications increases at that point as well. It has been standard then to induce at 37 weeks to avoid all this stuff. However, since they will be doing all of these NST and ultrasounds as well, and if I have generally good blood sugar control and don't start developing pre-eclampsia, then they are willing to wait a little bit longer before inducing me. Its incredible motivation to keep my blood sugars as good as possible (although lets face it, its been really tough lately. All I'm saying is that yesterday I used about 110 units of insulin, whereas prepregnancy days I used 35-40 a day. That's a huge increase. The whole insulin resistance thing really throws you through a loop). Anyway, blood sugar control is a big deciding factor as to when to induce, and if I'm not dilated really at all at 37 weeks, there is a good chance they would just schedule me for a C-section. Really really reallllllllyyyyyy trying to avoid that one.