How long did it take for you to lower your A1C to an acceptable range, so that you could start trying to get pregnant? A few months, a year? I've been working on this process for 4 months and had two 7.0%. I'm hoping for a lower result this month as I'm getting anxious to start!
All three of my pregnancies were total surprises... my highest pre-preg A1C was with my current pregnancy and it was 6.9... most recently it was 6.5. Your A1C will never be perfect, but as long as you try for below 7, things should be just fine :)
Also, if your a1c is high, and you bring it down very quickly, it can lead to retinopathy, so bringing it down slowly is actual healthier for your body. I brought mine down from high to low 6's in a few months, but I'd being thinking about pregnancy for a while... I had THREE pre-pregnancy consults before I finally felt confident enough to try, lol. (I'm a nutcase with stress -- hopefully you'll be a more relaxed pregnant diabetic than I was!)
Hopefully you'll get some good news on your next a1c! (:
Thanks for the advice Sarah! I've been working on lowering A1C since May. It was 7.0. I'm going it to check it next Monday, so hopefully I've made some progress.
I think we are all nut cases when it comes to T1 and pregnancy:)
Well, let us know your news! 7.0 is SO close, I bet you'll be in that pregnancy range!
Do your doctors recommend that you keep your A1C at or below 6 for a certain period of time. I was told at least 6 months before trying and one year would be even better.
[quote user="Kristin"]
Do your doctors recommend that you keep your A1C at or below 6 for a certain period of time. I was told at least 6 months before trying and one year would be even better.
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I've never heard that. The various doctors I spoke to said 3 months (i.e., just one a1c).
I think there isn't research showing outcome differences for each of these small differences, so doctors make recommendations based on their own personal experiences or opinions. Among the 3 endos I talked to about pregnancy, the 2 older ones were much more "relaxed." I think they've have a larger number of good outcomes, so they feel more comfortable (e.g., with a 6.2 vs 5.8 pre-conception). Just my guess...
You can always go to pubmed.gov, the NIH's database of medical research, and look for abstracts about glucose range and newborn outcomes if you're curious. It's sometimes helpful to go right to the source. (:
I would caution everyone to e cautious about trying to make medical decisions based on clinical research that they find. There are are lot of data to sort through and it takes a lot of experience to really determine which is valid and accurate (good quality stuides). You are bound to meet women who never paid attention, had elevated blood sugars/HbA1c and no problems. There will be others with great control and poor outcomes.
One of the reasons that the goal HbA1c is so low is that it is taking into accound the highs and lows that contribute to that value. You could spend 25% of your day >200 but have a good A1c simply because the rest of the time you are low. It is important to strive for great control initially because this is when it is easiest to attain. By the 3rd trimester, many, if not most, women with diabetes become more and more insulin resistant and the ability to maintain good blood glucose values (particularly after meals) is a challenge.
I think the most important question to ask yourself is are you willing to risk it? The consequences can be devastating and are impossible to imagine until you are there. Coping with stillbirth or severe congenital malformations in your child is almost unbearable to imagine. Some people luck out. Others are not so fortunate. Howver, no one really knows into which group they will fall until it happens.
Attaining tight glycemic control is very difficult but not impossible. There are a lot of tools available that could help facilitate your goal. Do you use a CGM? Have you considered Symlin (if post-prandial blood sugars tend to be high)? Do you see a CDE or use a dietician to opimize your regimen, timing of meal doses etc.?
In this situation, I beleive it is best to err on the side of caution. Its worth it in the end.
Hayley - the last I knew, Symlin was not FDA-approved for use in pregnant women. Has something changed?
**Nevermind, I just read your post in the '3rd trimester' thread. Got it. There really seems to be no right answer, is there? I mean, high blood sugars cause harm, but using Symlin could harm too... sigh.
If I could add my 2 cents in, if you choose to use symlin or another not-yet-tested drug during pregnancy, I'd just make sure to work together with your doctors to make the decision. I personally found that just raising insulin doses worked fine in the 3rd trimester, so I didn't find symlin necessary at all. My a1c's rose slightly, but were still in the 5's. Obviously, every person is different. But, you want to make sure your doctors are aware of any of these decisions in case there are any complications.
I was also able to keep blood sugars under good enough control during my 1st pregnancy and now this one (16 weeks along) without the use of symlin. Yes, my blood sugars rise after meals - but the things I do to help control that rise and bring it back down quickly are eating whole grains, trying to eat no more than 40-50 grams of carb in one meal, bolusing a bit before I start eating, using dual-wave boluses for meals higher in fat. I wear a CGM now, but didn't for my first pregnancy and I was testing about 12 times a day to stay in tight control. My average blood sugar reading after a meal is about 120-130...yes I'm higher than that sometimes, but an hour here and there of an elevated blood sugar will be ok in the end and I had zero diabetes-related complications with my pregnancy. I had asked my endo about symlin prior to becoming pregnant the second time around and he said he's not a fan...with patients he's had on it he said that they weren't really able to see that much of a benefit - that controlling your diet and consistently monitoring blood sugars and adjusting insulin levels accordingly were just as, if not more, effective. Just what I've uncovered on this issue.
As for how long it took me to get A1C's down...my A1C usually hovers between 6.0 - 6.5 which is pretty good, so when I decided that it was time to get pregnant, my endo and I looked really closely at controlling post-meal spikes and making insulin adjustments to ensure my blood sugars readings were almost always within the 70-130 range. This took about 3 - 4 months or so. My last two A1C's (I get them drawn every 8 weeks while pregnant) were 5.7 and 5.5