So my husband and I have been planning for about a year to begin trying to conceive. My last a1c was 6.5 and the highest I have had in over a year was a 7.2, most were in the low 6s. A1c-wise, we are good to go. However, I have been told by my endo, nutritionist and OBGYN that my day to day BG levels should be under 90 fasting and under 120 at the 2hr post-meal spike throughout the pregnancy. I am just flabbergasted by this as I don't know how this is going to be possible for a diabetic. I feel like they are asking a diabetic's body to not be diabetic...whew! Anyway, I was just looking for some advice about how those of you who are pregnant or have been pregnant have maintained this tight control. And how do you not start to worry if your BG levels are not always in that range during pregnancy? Any advice would be much appreciated!
That's like asking the impossible. It's hard to maintain 90-120 control under normal circumstances, but during pregnancy it's even harder because you have raging hormones that mess with your blood sugars. During the first few weeks of my pregnancy I had insane highs! I increased my bolus and had almost doubled my basal and I still struggled with my numbers creeping up to the 200's. One day I even had my blood spike up to 500 post breakfast. I tested for ketones, had a small trace. I freaked out and called my endo immediately. I was ready to go to the ER I was so scared the spike had hurt the baby. My endo told me to relax. As long as I take a correction dose ASAP and drink lots of water everything should be fine. When I hit 12 weeks I started to get insulin sensitivity. My blood would randomly drop and I don't feel it until it's in the 40's. I pretty much was going without any basal and I still had some very bad lows. That lasted a few weeks also, but has tapered off. Right now (21 weeks) my numbers seem fairly normal, but my endo warns me that I may start to develop insulin resistance. So far I have had 5 ultrasounds. The ultrasound tech looked at them, so did my OBGYN, and a specialist and they feel confident that our baby is healthy and doesn't appear to have any defects. The most important thing is to just test a lot! I test like a maniac! My fingers are so calloused sometimes they won't even bleed and I have to keep pricking myself. I test when I wake up in the morning, before I eat, after I eat, before I go to bed, and often during the night if I wake up to pee. Stay on top of your numbers. If you're high, take a correction dose ASAP. If you're low, fix it ASAP. It's always best to keep something with you incase you go low. As a diabetic, you are going to have highs and lows. It just happens. All we can do is try our hardest to maintain good control. My overall A1c is good, and my endo says that's the most important thing.
that is just a target they want you to aim for, any good endo/educator is going to realize that you can't do this 100% of the time. You just have to test a lot more, eat much better quality food and work hard at it everyday. I just got a CGM today and we're hoping that will help maintain even tighter control. My BGs have been very similar to RachelEmily25's and I'm at 22 weeks, and think I'm just going into the insulin resistant phrase which is normal and our insulin needs will prob double til we deliver. Just keep a positive attitude remember a diabetic mom can't be perfect anymore than a non diabetic mom, we just have to work hard at it and do the best we can.
With a pump you can come pretty close if you're testing often. I use Humalog insulin and am one of the lucky people with a Humalog duration of 2 hours (on average Humalog is active 2-5 hours, differs for each person). So my 2-hour post meal targets were easy to hit. If it takes longer for the insulin to get going for you, you may need to pre-bolus a bit before eating. Also Novolog works more efficiently for some people.
When I was pregnant my pre-meal and 2-hour-post-meal target was 80. I tested probably 8 times a day to make sure my blood sugar didn't go low and could catch highs quickly. If you eat a meal that's hard to bolus for, test one hour after eating and program it into your pump so it can calculate the insulin on board and give an additional correction if you underestimated what you need.
A diabetes educator recommended I eat the same breakfast every morning, since my insulin resistance was worse then. I also did moms in motion exercise classes in the last 6 months, easy stuff like water aerobics and yoga. It was also a great way to meet other expectant moms.
Obviously I wasn't perfect, but I was proud to have a non-diabetic A1c through my pregnancy (5.1). My son has always been healthy and had a normal blood sugar when he was born.
All of your posts have been most helpful to me so far! I've been a T1 since spring of 2006 which concluded my sophomore year of undergrad. It was pretty rough managing at first because I was always super busy with academia and extracurricular activities. Fast forwarding to today (2011) I just took a home pregnancy test that came back positive. My husband and I are very excited! Only, I haven't been doing the best job of managing my daily glucose levels. My fasting BG level in the morning has been averaging 200 lately. I exercise regularly, running at least 9 miles/ week (3 on Mon, Wed, and Fri) I'm scheduling an appt with my Dr. to confirm the test by the end of the week. My concern is 1. is it too late for me to start cracking down and paying closer attention to my bg levels to ensure my baby is healthy? 2. Should I still continue my strenuous workouts? Please advise?
Yep, definitely still time to get under control. Starting.... NOW! :-) I'd begin simply by doing more BGs and fixing more often. Try at least six blood glucose checks per day... if you are good before going to bed and still wake up at 200, you'll want to do an overnight checks - wake up every two hours and record those numbers.
Call your endo team ASAP and get in there this week too. If you can't, see if you can email/fax your BG readings so they can help you start getting those blood glucose numbers back in line.
As for running, I think most would agree that if you were doing it before you were pregnant, you can usually keep doing it, although intensity might need to be ramped down a bit. You'll want to 1) talk to your doctor about your exercise routine and 2) listen to your body - if you are tired, stop. Drink lots of water too - more than you normally would.
My pregnancy was a complete (but happy) surprise and my A1C was a 9 when i conceived I also had run out of pump supplies and there was a mixup with my insurance company so i didn't receive the supplies til just after I found out I was pregnant, I was doing injections and didn't have very good control of my BGs since I was trying to manage them on my own and had been on a pump for so long. Anyways I am now 22 weeks pregnant and so far everything looks good, I got my levels under control as fast as I could and dropped my A1C down to a 6.5. The anatomy scan was last week and I was so scared to see a heart defect or something due to my high initial BGs but everything is looking good on the U/S so they don't think the baby was hurt by them. Just have positive thoughts and our prayers are with you!
That is sooooo good to know. I have been feeling so guilty if I have a carb that I forgot or mis calculated for and then my CGM shows 184 after a meal or worse yet 250. My first reaction is "AHHHHHH I JUST HURT MY BABY". So much guilt and worry.
No one can be perfect :) Not even us diabetic mamas even though we have to try harder, haha. My educator is a lifesaver she makes me feel so much better about everything. Don't let doctor's make you feel guilty and crappy about BGs all you can do is do the very best you can and rely on God.
Thank you all so much for replying to my post! I am glad to hear that I am not the only one with anxieties about trying to do things as perfectly as I can for a pregnancy/baby (and for myself :-)). I am excited to start this journey and as some of you said, can only do the best I can do. Sometimes the "ideal" is not always realistic with the everyday hassles of life as a diabetic and life in general. Thanks again all and I will keep you posted!