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Pumps in Pregnancy

Kate Clapham tells us how a pump made her third pregnancy much easier than before

I have had Type 1 diabetes for 23 years, and am mother to Kayleigh, 7, Simon, 5, and Molly 14 months.

Kate Clapham's kids - Kayleigh, Molly and Simon. December 2000

Kate Clapham's kids - Kayleigh, Molly and Simon

Two difficult pregnancies

My first two pregnancies were very difficult - I managed to maintain an HbA1c of between 5 and 6%, but spent a great deal of time suffering from severe hypos. In my first pregnancy, I had nocturnal fits almost every night, and during my second pregnancy, managed to cultivate a waking hypo, which stopped me driving from about 9 weeks into the pregnancy.

I told my consultant about the problems I was having, but as my HbA1c was fairly good, I was just told to continue with what I was doing. I was having too much insulin for the carbohydrate I ate, so causing the hypos, and would then have far too much carbohydrate to bring my blood sugar up. I would then have a correction dose to bring my blood sugar down again, which would cause a hypo... Once on this seesaw, it is very difficult to get off.

Pregnant again!

To say that being pregnant again scared me is an understatement - I would have tried a celery diet, if it stopped me having these episodes! However, when I visited my consultant at Harrogate District Hospital I was offered the chance to go on an insulin pump, and found this a much more attractive proposition.

I started on the pump when I was just over 6 weeks pregnant. I went to the hospital with my husband for a 2-day training course, and started using insulin in the pump on the afternoon of the first day. I have never looked back!

During pregnancy, it is normal for insulin requirements to increase. I found this very easy with my pump, as I was able to add a proportion of my basal rate and adjust this until I got the right balance. I did run for some days on a basal rate of +40%, but could have altered my basal rate earlier - I didn't trust myself to have got it right so quickly.

When I had Molly, I was on a basal rate of about 140 units, compared to 47 pre-pregnancy. Because the increases were gradual, I did not panic, and managed to avoid any severe hypos. The best piece of advice I was given was to use 1 unit of insulin to reduce my blood sugar by 2.5 mmol/L (50 mg/dL). This enabled me to keep my blood sugar "normal" and accurately predict the likely outcome of my bolus.

The delivery

I was able to keep my pump attached while I was in theatre, although as my operation was delayed by an hour, my blood sugar had gone up to 11 mmol/L (200 mg/dL) by the time Molly was born (I only had 3 recorded BGs above 9 mmol/L (160 mg/dL) during the entire pregnancy...). She had a slight hypo immediately after birth, but we were able to sort it out with a small amount of milk, and she never left my side. After my experiences with Kayleigh and Simon, this was all I had dreamed of. I was lucky that Leeds General Infirmary have a transitional care ward where diabetic mothers routinely go for a little extra care, and I had our spaces booked well in advance. I finally felt that I had done it right - and have eventually got over the disappointment of never experiencing labour (really!). I was too poorly with Kayleigh, who was delivered by caesarean at 35 weeks. And Simon was breach, so caesarean again, and then he had respiratory distress syndrome (RDS) so the first time I met him, he was connected to a respirator, a drip, an umbilical catheter, etc... scary.

When I discovered that I was pregnant, my HbA1c was 7.7%, when I had Molly it was 4.7%. I was told that this was too low although I did not suffer any hypos and could still drive when I went in for my caesarean. (I had plenty of insulin to cope with my dietary requirements, but on reflection, slightly less carbohydrate would probably have been more sensible!). I have not shifted much weight since I had Molly - after 23 years of a diabetic diet, the temptation to indulge is very strong and I have never had much will power!

Control afterwards

It has been more difficult to maintain the stability I managed during pregnancy since I stopped feeding Molly - I am sure that hormones play a big part in balancing my diabetes, but my HbA1c is now slightly above 6%, and physically I have noticed great improvements. I have had a patch of necrobiosis on my right shin for 10 years, and this is shrinking for the first time. I have never had problems with my eyes, kidneys or heart - touch wood! You will not be surprised to hear that there is no evidence of any problems here...

I would heartily recommend the pump as an option during pregnancy - but must point out that consultants who think they will get the pump back when junior arrives are sadly mistaken!

Author: Kate Clapham <kate@oddbods.co.uk>. Kate Clapham is not a medical professional. She has Type 1 diabetes and uses an insulin pump. The information given here is based on her own personal experience. More about Kate Clapham...

Created: March 2001; Last updated: Tuesday 5 June 2001

Reader comments

On 26 May 2006 Amanda Reece wrote:

Thank you so much for sharing your story. It has gave me some encouragement. I am 24 yrs. old and have had type 1 diabetes for 16 yrs. now and am interested in becoming pregnant and getting on the insulin pump. I hope all goes as well for me as it has for you. Your kids are beautiful!!!
On 3 Apr 2006 Caroline Nelson wrote:

I'm trying to control my blood sugar levels ready for baby number two but it's an absolute nightmare. After reading this I'm finally going to have the courage to request pump therapy. Thanks for sharing your positive experiences!
On 24 Mar 2006 Natali Gibson wrote:

Thank you for your story! I have had two pregnancies before developing type 1 diabetes and one with diabetes. My pregnancy with diabetes was full of hypos and stress. Now we are considering another pregnancy but I don't know if I have the courage to have such tight control with injections again and go through all the hypos. I think I will look into the pump!
On 14 Aug 2003 Jennifer Corns wrote:

The articles really made me feel better. I am in my 28th week of pregnancy and have been on an insulin pump for about 4 years. My sugars have just started jumping and it is nice to know that I am not the only one that this happens too. I will keep you informed as my pregnancy continues.
On 29 Apr 2003 Yvonne O'Connor wrote:

Kate, Delighted to read your article! Congrats on the kids--they're beautiful! I'm working on my first pregnancy and I've been pumping for about 3 years previously. It definitely is frustrating with all the hormones kicking in and throwing off my control--not used to that. You know us diabetics... we do the best that we can. I'm hoping my story will have a happy ending like yours. Good luck with everything!
On 15 Oct 2001 Peter Hammond wrote:

What a great article! Love the picture of the kids! Hope you're doing well!