ColumnsLiving with Type 1 Diabetes

The Imperfect Diabetes Pregnancy

shutterstock_193118162_sunny_pregnant_belly_300pxThere are few women who wake up in the morning glittering with excitement about the changes required of her mind and body during pregnancy, even though the prospect of holding a newborn gives us hope that it will all be worthwhile. Being pregnant with Type 1 diabetes brings an extra level of “Oh my god this is a lot of #*@&% work!” to it, but there is a great payoff in the end.

When I was a teenager, I was terrified of pregnancy. The message I was getting from my pediatric health care team scared the hell out of me. Listening to them, I presumed most women with diabetes would end up giving birth to babies needing heart surgery and/or with giant heads. Later, I realized they were just saying it was important to try for a planned pregnancy with an A1C of less than 6.0 to decrease the prenatal risks.

Such a goal just seemed totally unrealistic at the time. We know that that our blood sugars can’t always be perfect with diabetes, but too often well-meaning doctors make us believe that we have to be perfect during those nine months or the tiny humans growing inside us will be unhealthy. Luckily this is not the case for any of us, or the human race would cease to exist.

I had the unfortunate experience of having to write out logs every day while I was pregnant. Every. Single. Day. Even though I wore a Continuous Glucose Monitor (CGM). I was asked by my physician, who is very close to retirement, to write logs because he was unfamiliar with my brand of CGM (Dexcom). Then, as you may remember doing when you were first diagnosed, he would circle every single number outside of the magical ranges of 60-120 with a red pen. You can only imagine how each red circle feels to a first-time pregnant woman with diabetes who is desperately hoping to have a healthy baby.

The goals set by my medical team also didn’t always help. For example, they tried to make my target range in the 50 mg/dL to 90 mg/dL range, and I did not feel safe with blood sugars in the 50’s. It’s important to remember that it’s okay to talk to them if their goals don’t make sense with your experience with your diabetes,

The first trimester was typical in that my blood sugars ran very low. I am very grateful to have a CGM and would highly recommend it for anyone going through pregnancy even if you don’t want to continue using one afterwards. Even though it was a great tool, it sometimes was the bearer of bad tidings. I saw numbers in the 30’s much more than I would ever care to see again. It was extremely challenging; I was very nauseous and having a hard time keeping food down on top of the increased metabolic needs of my body.

The second trimester was phenomenal in comparison because I could finally eat again and my blood sugars were reasonably normal until about Week 20. The easy living ended when I entered an insulin resistance phase in the third trimester. I then gave up sweets entirely and ate extremely high-fiber foods to help with highs. I also pre-bolused about 20-30 minutes before meals and found it to be extremely beneficial. In the last few weeks of pregnancy my breakfast carb ratio was 1:4, compared to my normal ratio of 1:9. I had an awesome dietician who understood me and worked well with me.

Feeling my baby kick for the first time was one of the most amazing moments I remember during the pregnancy. Suddenly all of the medical debates, doctors’ appointments, and diabetes management became easier to do. I soon found that my baby tended to kick much more when my blood sugar was dropping, almost as if to say, “Uh, hello? Not getting enough glucose in here.” It was very cool to have this internal sensor on top of my CGM.

There is at least one small advantage to being labeled a “High Risk Pregnancy”; because of all the extra ultrasounds and a fetal echocardiogram, I saw a lot more of my little nugget than most people do before they deliver. My husband and I got to see him yawn on the first ultrasound and almost lost our minds with excitement!

The appointments often felt endless and redundant, until they were absolutely necessary. When I was 37 weeks I was at a routine appointment and we were very lucky to catch that there was a problem with my son’s heartbeat. I was induced. The problem turned out to have nothing to do with diabetes. I can’t even imagine what life would be like had I not gone to this appointment.

I gave pregnancy my all and it paid off. My A1C during pregnancy was always in the low fives and my blood sugars were in the target range most of the time. I worked as hard as I could and my wonderful family and friends helped me through the ups and downs. I was not perfect in my diabetes, but my baby, Connor, is 100% healthy. I gave pregnancy my all and it paid off. It is a gift to be able to bring someone into this world, and I am very grateful to have a beautiful baby boy.

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