Fighting diabetes to find a happy endingNew mother Olga Whotton nurses baby Lucas, while proud dad Ian and diabetes clinical nurse consultant co-ordinator Sue Wyatt look on.

FOR most women, the biggest worries during pregnancy centre on the likely impact of a baby on the family budget or the occasional bout of morning sickness. The toughest decisions are which pram to choose or what colour to go with for those first, tiny baby clothes.

But for Olga Whotton, 35, her recent pregnancy was dominated by the stress of rigorously monitoring her glucose levels, the daily pin prick of blood tests and an agonising worry – hoping that everything would turn out better this time.

Whotton is one of the estimated 29,677 Victorians who have type 1 diabetes – a potentially life-threatening condition that occurs when the body’s immune system destroys the cells of the pancreas that produce insulin.

Despite having lived with the disease for more than 20 years, Whotton concedes she wasn’t prepared for the effect it would have on her journey towards motherhood.

“We wanted to start a family a few years after we were married, and then tried for a year to conceive,” she says.

Whotton underwent various tests to determine the cause of her problem conceiving. She was then prescribed an oral fertility medication.

Then she became pregnant. It was a difficult pregnancy and at about seven months, she miscarried her baby boy, James. It left her and her husband, Ian, 41, devastated.

“It was extremely difficult,” Whotton says. “I dug myself into a hole and just couldn’t climb out. I had always wanted to be a mother.”

It was only when she met Sue Wyatt, diabetes clinical nurse consultant co-ordinator at The Alfred hospital, that Whotton started to believe in that dream again.

Inspired to work in the field of diabetes after watching her mother-in-law suffer through “every imaginable complication”, Wyatt had almost finished her specialised diabetes course when her mother-in-law died of a heart attack. The death further sparked her passion to learn more. “I didn’t want other people to end up like her,” she says.

Wyatt’s true passion, though, is pregnancy – more specifically, her desire to give hope to diabetic women planning pregnancy. With type 1 and type 2 diabetes on the rise (Wyatt says there are an estimated 110,000 diagnosed women in Victoria), the timing to get the message across has never been better.

“For women with diabetes, if they are not well prepared, they can have risks in pregnancy. They can have trouble conceiving, they can have foetal abnormalities, they can have miscarriage, they can have problems throughout the pregnancy – babies that are too big. There are lots of risks. Plus they can have worsening of their own health status.”

The preparation she pushes involves the support of a medical team, including an endocrinologist, and tightly controlled blood glucose levels for at least three months before conception.

“That means blood testing at least four times a day, and then you have to maintain that tight control through the nine months of pregnancy. So, basically, a whole year of extremely diligent care and control.”

The results, Whotton says, are worth it.

With Wyatt’s support, she moved through her grief over baby James’ death and found the confidence to give pregnancy a second try.

Nine weeks ago, baby Lucas was born – seven weeks premature but healthy and with no ill effects from his mother’s condition.

It was possible, Wyatt says, thanks to the use of a continuous subcutaneous insulin infusion pump – the best option to stabilise Whotton’s blood glucose, giving her the chance to become pregnant again.

Insulin pumps are small, portable devices that deliver insulin continuously through a small cannula placed under the skin and can be worn attached to a belt or in a pouch inside clothing. For Whotton, it was a change from the insulin pen she had used for more than two decades and one that provided much better management of her diabetes – and the chance to make her wish for motherhood come true.

Despite the positive results, Wyatt says it is not an easy option. After careful consideration, Whotton showed herself to be “the right type of patient” to handle the commitment.

“It’s a very intense form of management – you have to blood test yourself up to eight to 10 times a day,” Wyatt says. “It requires total dedication if you want to get really good control of your diabetes, but because of the way the insulin is delivered, you get a much better outcome with your blood sugar levels.”

Although the option of using insulin pumps has been around for about a decade, Wyatt says the past five years have seen the technology improve “astronomically”.

But there is still a long way to go, and the inequity associated with many emerging treatments is putting the pumps out of the reach of many women who could benefit.

“Currently, insulin pumps are only widely available to people who have private health insurance,” she says. “Public patients can’t access pumps as readily unless hospitals are able to loan them a pump.”

This means many young women are unable to safely manage their diabetes through a safe, low-risk pregnancy.

“If women with diabetes have pre-pregnancy counselling and proper management, they can decrease the mortality rate to 0 per cent and decrease the abnormality rate to about 2.2 per cent,” Wyatt says. “Their risks are then comparable with non-diabetic women.”

Whotton says she is proof that there is a joyously optimistic alternative. “Going through a loss made me more determined to bring a healthy child into the world. Sue – and a good medical team – gave me the confidence that I could do it. It’s completed our lives. When you look into your baby’s eyes, it makes it all worthwhile.”

Treatment produces results

■ In the past two years, about 12 diabetic women have begun treatment at The Alfred hospital in preparation for pregnancy. Of these, 10 have become pregnant and seven have delivered healthy babies. Three more are due over the next few months.

■ There are almost 130,000 Australians with type 1 diabetes, including 30,000 Victorians. Only, 1 per cent treat their diabetes using CSII — just over 6000 nationally.

Role: By Claire Halliday
Client: The Age