Type 1 and Pregnancy
One of my best friends just had her second daughter and no one does pregnancy or labors quite like she does. She doesn’t make it seem like the easiest thing on the planet, but she definitely makes it look manageable. While sitting in the waiting room, I started to think about when I decide to get to that point in my life and what that might look like.
I am in no rush to get pregnant, not because I don’t want children, but because being a diabetic makes pregnancy a little less fun. Right now, I can live my life as normal as any other person I just have to check my blood sugars and bolus for my meals. When I get pregnant, I have to be on the world’s strictest diet, be extra crazy about my blood sugars, and worry about the costs of seeing both my OB/GYN and my Endocrinologist on a regular basis. I decided to do some research on what being pregnant with Type 1 diabetes (T1D) would look like for those of you who are curious like myself and for those of you who may be looking into this next avenue of life.
If you are thinking about getting pregnant and have preexisting diabetes be prepared to become anal retentive about checking your blood sugars. Your blood sugar control is the key to a happy and healthy you and baby during your pregnancy. Talk with you endocrinologist about what they would like your A1c levels to be before and during your pregnancy. When you are planning on getting pregnant you want your A1c to be around 6%, but again, talk with your physician, my endocrinologist suggests 6.5%. If your A1c is higher than this and you are struggling to get your numbers under control can I suggest a continuous glucose monitor (CGM)? I loved using the Dexcom. It really helped me notice my trends and learn how to keep a steady line rather than ride the whip as we call it in my diabetes group.
For those of you like me who would rather have an oops baby over a planned one. Do not freak out or feel bummed because you feel you can’t do things as you wish. I actually asked my doctor about this a while back and though it is not the “ideal” situation, you can work with your doctors to get your numbers back under control to have a healthy pregnancy. JDRF even mentioned that with today’s technology most women are not far from a healthy blood sugar range. So, don’t panic and work with your doctors if you are in the situation.
Your blood sugar levels will rise and fall throughout your pregnancy. For example, during your first trimester your body will begin to make it’s own insulin again. Researchers are researching this, but so far are not sure why this phenomenon happens. To help keep your blood sugars under control your doctor will set new blood sugar goals for you as well as put you on a strict diet to keep your numbers in a good range.
American Diabetes Association recommended levels:
- · Before a meal (preprandial): 95 mg/dl or less
- · 1-hour after a meal (postprandial): 140 mg/dl or less
- · 2-hours after a meal (postprandial): 120 mg/dl or less
In your second and third trimester you will become a little more insulin resistant and have to talk to your doctor about changing your daily insulin dose. The extra hormones cause your insulin resistance, as well as, your body becoming a bit larger and your baby getting closer to the size of a baby. Also during these trimesters you will begin having ultrasounds and more than the usual amount most women have. Because of your diabetes your doctor will want to keep a closer eye on your baby and how it’s developing. On the upside of having preexisting diabetes during your pregnancy, you won’t have to take the glucose test. At least you are saving money somewhere right?
When you are in your third trimester, be sure to talk to your hospital about diabetes protocols. Such as, can you have your pump on during the birthing process? How will your blood sugars be managed during labor? And so forth. When asking my doctor about this, she mentioned that my endocrinologist office is contracted with a local hospital in town and that they will be allowed in the delivery room with my to manage my diabetes while my OB/GYN takes care of everything else. I am not a huge fan of the hospital they are contracted with, but I know that I will be thankful when the time comes and I have both my doctors there taking care of me.
Now we are getting to the main event, the birthing process. Just because you have T1D does not mean you have to have a C-section. How your child is brought into this world depends on you, your baby’s health, and your healthcare team. In most cases someone will be assigned to managing your diabetes during the laboring process, they will check your blood sugars regularly and you’ll have to endure a higher amount of finger sticks than normal. This is to make sure that you will not need carbohydrates prior to delivery in the case of an emergency C-section.
Once your baby arrives the doctors will check their blood sugars knowing you have T1D because it is common for a baby of a diabetic to have low numbers. If they do have low numbers this does not mean that they will have T1D. It is just a phenomenon that doctors are aware of and need to treat.
I am feeling a little bit more at ease after doing some research on this topic. I still am not excited about the strict diet and medical bills, but at least I know that I will have a lot of help and will have some technology on my side to help me. I am thinking that my next bit of research on this topic will be to undergo the diabetes diet and see how it goes. If I can conquer all my issues before I get to this stage of my life, then maybe once I am actually there I won’t feel so frustrated. But of course those things will be other blog posts all on their own.
If you are interested in some information on this topic here are some great resources.