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.
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