Getting pregnant with A1C higher than 6.0

Pregnancy
1

does anyone have experience with getting pregnant when their A1C is over 6.0?

i will never be one of those diabetics that is able to get it that low. i've come to terms with it, i've gone 16years with pretty high A1Cs(before i went on lantus/novorapid i never went under 9.8) and the closest i've gotten it was 7.6(on the pump after 3months i got it to 7.4 but i was having no less than 3 lows a week..). i have no complications to date and my bloodwork always comes back perfect.

i've been pregnant twice, but kept neither due to a miscarriage the first time(incomplete pregnancy i was told caused that) and the second being in a very unideal situation(dumped alcoholic/coke head boyfriend + his fucked up family and moved out of our place two weeks before finding out). i doubt i'll have trouble actually getting pregnant, the women in my family are pretty fertile and due to the fact i was on the pill for the first, and had stopped the pill only a week before for the second(gave me morning sickness for two months straight, wasn't put on anything right away)..my doctors agree!

the problem is, i dont have a regular pattern to my levels. everyday is different, everyday is a different extreme, even as my life becomes more regular/less random with work, life and eating. i'm working really hard right now to get my a1c back to 7.6 at least, since my last four were 9.9, 9.8, 8.4 and 7.6 at the beginning..but i really don't think i'll EVER get it down to 6.0.

the pump wasn't the best option to fix this, as my insulin needs seem to change on a daily basis, figuring out a basal that would work one day but not cause me to drop repeatedly the next, was near impossible. my bloodsugar isn't enough of a pattern to determine what days i need more, what days i need less. even with a regular schedule. i can do the exact same thing three days in a row, and get three different results.

i don't wanna end up like this girl i know who was in the maternity ICU for the WHOLE pregnancy, with a feeding tube and IVs, etc...and i realize she was in a MUCH worse state than i am now to begin with. she never took care of her diabetes, is part of the reason i don't mix with diabetics very often in my life other than online, and was already in and out of the ER on a weekly basis for years leading up to this final pregnancy(she's had a lot of miscarriages and abortions..she has some issues with needing love that comes from her fucked up family life). she was on so many meds, the baby has to be put into NICU to get weened off the medication! he's doing fine and she's since had her tubes tied(due to her endo telling her another pregnancy could kill her)..but it still don't wanna risk having anything like that happen.

have any of you gone through a pregnancy, had an alright time(aka avoided 99% of the above story), had a healthy baby and had your A1C higher than 6.0 before/during the pregnancy?

2

hey Batts.  Sorry you've been having such a hard time.   Sounds like you might have insulin absorbtion or resistance issues or something.  I guess my concern would be what will your numbers do when you are pregnant - insulin needs for me were more than 4X what they are normally.  I have like 1:10 carb ratio not pregnant and was 1:2 at end of pregnancy.    Have you tried working with a high risk OB?  They have TONS of experience with women with diabetes & pregnancy and may know some things that you can try or can tell you if it's advisable or not to get pregnant.    Also have no idea if you've tried different endo but that might be worthwhile too.  

I actually didn't spend too much time below 6.0.  If my A1C is in the 5s I'm having too many lows and start to lose ability to feel them.  My doctors and I agreed to low 6s and that's what we shot for.  I was never above 6.5 when pregnant though... and lowest was 5.5.  Sounds like it will be a struggle for you to get there, but I urge you to keep trying.

Wondering when you tried pump therapy too?  I know my endos are way better at managing diabetes on pump now than they were six or seven years ago.  They can download the data from the pumps with graphs, etc.  WAY better management tools.  Lots of insurance companies will pay for CGM for pregnant women too - (they don't want a pregnant woman with diabetes having complications or the baby having complications), even if they wont' pay normally.  That would definitely help

Sorry, no real answer for you.  Just hoping I can encourage you to keep trying.

3

Thanks for the advice :) I'm not looking to get pregnant quite yet(I'm only 22 and am actually shooting for probably closer to my 30's like my mom) but I was just reading some of the posts and started to get curious almost as to if anyone was like me and had a successful pregnancy.

I know I'll be talking to many doctors, only just my endo, as I have at least one issue other than diabetes that flairs up during pregnancy. Unfortunately, I am very limited where I live for endos, but I am lucky as mine(and the one he shares an office with, who the girl i spoke about is with) is among the top in BC. I may look into seeing a high-risk OB before I actually start planning for a pregnancy though, to see if it will help in general..that might be a good idea!

I actually JUST got rid of the pump. I started in October and removed it December 23, the courier picked it up Xmas eve to take it back to Animas. I had my appointment with my endo the day before I took it out, and he pretty much told me that he hopes they come out with a pump can adjust my insulin needs on it's own in real time. That would be his ideal pump. He did agree with me about going off of it, as I even had a low in his office while discussing it with him! A few hours later, I napped on my boyfriends cough for an hour and woke up low once again! My control wasn't much better in the pump, only a few points, and i found it very frustrating, restricting and it effected my self-esteem in a way as well. I've always maintained that I have diabetes but diabetes isn't what defines me, it doesn't have me..and the pump almost reversed that, as I started having to spend HOURS trying to find something to wear to go hang with friends, go out dancing, go to work, go to the gym..everything. We're gonna look at the pump again in a year and see where I'm at and where the technology is though. He saw no reason for me to continue due to my problems and the fact that I had similar control with shots, which I was used to and found easier to deal with.

I think when I do get pregnant, I will make use of the CGSM devices, and may after pregnancy try the pump again.

4

Hi there!  I was never able to get my A1C below 7.4 before and during my pregnancy.  I'm pretty sure i have an absorption problem- shots, lantus, the pump all don't work well for me.  However, I did get pregnant by accident and was able to carry and deliver my baby with no problems.  My perinatologist didn't seem too concerned and monitored me throughout.   I was pretty intimidated by many of the posts on this website because everyone seems to boast A1C's of 6 and below and quite frankly, that just doesn't seem realistic to me. 

I also do not have regular patterns- seems like the wind direction can affect my blood sugars!  haha.   My baby boy was delivered at 36 weeks via c-section (i went into labor naturally but didn't progress so they did a c-sec) at 5 pounds 3 oz.  He is gorgeous and healty.

 

Please let me know if you want more information about this- remember that you are human, and that every therapy regimen doesn't work for all diabetics.  There are the resistant ones like you and I.  I too cannot take the birth control pill- it makes my blood sugars even more erratic.. I constantly worry about getting pregnant again! Not ready for that just yet :)

 

best of luck.

marlena

5

Hey Marlena,

I'm glad to hear someone out there went through their pregnancy fine with something higher than 6.0! I will of course aim to keep it as low as possible(without going too low!) but the idea of 6.0 blows my mind!

My friend, who was also my "mentor" when i was dx'ed(she's a year old and was dx'ed at age 4), is like us with the non-regular blood sugar pattern which is nice in a way cuz she doesn't boost 6.0 A1Cs! haha I try not to put too much pressure on my A1C results, as I know that as well..a slight change in weather causes my bloodsugar to go nuts...which in the end screws up whatever good control you had and whatever good A1C you could've had. Last winter, we had about two weeks of snow(not normal for here, maybe a day of snowfall but it melts by the AM) and my bloodsugar would NOT go down, even if I tripled my insulin! I wonder what my insulin absorption is and if that is my problem as well, as some days..it seems like my pancreas starts working again as I'll take little insulin but not go over 9, without doing anything different exercise and such wise, but most days i seem to need a lot! I'm on a 1:15 ratio for breakfast/lunch and a 1:10 for dinner, but i usually do 1:10 across the board cuz it's easier, plus 20u AM and 11u PM of lantus, which is a lot apparently for my size.

I'm on the Patch now, which I find much easier as the pill I was pretty bad with remembering to take it at the same time which doesn't help but it also hasn't caused me any sickness or weight gain since I went on it after my abortion last fall. I was on the same type of pill since I was 15 and a low dose of it, but i was always feeling a little ill and would feel better when i would take breaks between boyfriends. i haven't had that problem with the patch which is nice and i think it's due to the fact it gives me a small dose of hormones over a 24hr period rather than all at once.

If you could tell me what it was like being pregnant and dealing with the pattern was like, that would be really great! :)

6

Hi Batts!

I was experiencing a lot of insulin resistance myself and my endo just started me on Metformin in conjunction with my pump.  It has been so helpful and has definitely proven to me how resistant my body was becoming to the insulin.  The results have been amazing!

Take care and best of luck to you!

Katie

7

i went to my endo appointment yesterday and "officially" found out what my a1c was(8.3). he had a student with him, so we actually talked about my a1c and what it should ideal be at when i'm ready to start trying to conceive. surprisingly, when i said "i know i know, i have to get it down to 6.0", he said that was a little too low for me(probably due to my tenancies to have a lower A1C due to more lows..like what happened with my last A1C of 7.4 on the pump)  but to get it to preferably under 7.0 for sure.

i'm kinda happy to know he doesn't expect me to manage a 6.0 before i try to get pregnant! 7.0 is a lot easier for me to set as a goal than 6.0!

8

I am in the same boat, pretty much.  I went to a new OB-GYN today; this office has dealt with T1 pregnancies before and they were comfortable/confident that when the time comes for me, they can handle it.  The PA I saw gave me some information she got from UpToDate.com, which I guess is based on collections of hundreds of medical journals.  It had many interesting tidbits, but here were a couple of the more pertinent ones to A1C:

  • Risk of miscarriage and birth defects are highest when the A1C is over 8.
  • The test is usually done once per month during pregnancy, and the goal is for the A1C to be at or near normal (6 percent).  Attempting to be at or below 6 can cause frequent episodes of low blood sugar, so A1C goals should be determined individually.

Good news is, she forsaw no reason I couldn't have a healthy pregnancy, as long as I can get my A1C below 7 (I've tended to hover around 8), and my kidney function and blood pressure remain in the good range they're in now.  So, YAY!  When I brought up losing weight before pregnancy, she agreed that coming down a few pounds wouldn't hurt, but that they've delivered healthy babies "from much, much heavier women"... which kind of made me giggle.  I'm feeling optimistic.

9

Hi All!

My endo says 7.0 or less A1c for pregnancy. 

10

When I got pregnant my A1C was 10.4.  By my third trimester I got it down to 6.8.  However I delivered a beautiful and healthy baby boy last August at 36 weeks.  They were even going to let me deliver "normally" but Isaac got stuck after 36 hours of labor and I had a c-section.  I had a great doc who was not only a high risk ob but an endo as well.  There was actually a whole pregnant diabetic team and they were all amazing!  I did got to the doc every other week and in the beginning every week.  Yes it was a pain but the end result was so worth it.  I was but on a pump eventually during my pregnancy but by the time the insurance company approved in my endo told me that I was doing very well with shots and that I didn't "need" the pump as he had originally thought.  

This was an unplanned pregnancy for me which is why my A1C was so high to begin with.  In the future I plan to work on having my AICs lower then 8 before trying to get pregnant but everyone is different and you have to do what works for you.