Healthy baby possible if you have type 1?

Pregnancy
1

You betcha!  It's definitely possible to have a healthy baby if you have type 1 diabetes.   But, like with most everything else in the life with type 1 - it takes some extra planning and work. 

I've always had decent A1Cs (well, once I got past my teens ;-) usually in the mid to high 6s, but before I got pregnant, my endo wanted my A1Cs to be below 6.0 and as close to 5.0 as I could get.  I did it, but it was a HUGE struggle and I had quite a few hypo episodes. 

Once I was pregant, the real fun started.  I had doctor appointments once a week for the first 30 weeks, and then twice a week for the remainder of each pregnancy.  My doctors were very strict with weight gain (undo pressure on heart with extra weight!), and wanted to keep my pregnancy weight within 25 lbs of my pre-pregnancy weight.  One positive, I got lots of ultrasounds as they wanted to ensure the baby was not getting big due to high(er) blood glucose levels.

After 38 weeks, for both pregnancies, I was induced.  Induction was not due to type 1 diabetes issues.  In both cases, I had a baby girl who was under 7lbs and considered very healthy.   One of the sad parts is both girls had low blood glucose after birth due to their pancreases overproducing insulin to cover my blood glucose levels and had to have a tube put into their stomach to put glucose in their stomachs.  After those first few hours of being checked every 30 minutes with a heal stick to get BG levels, they were fine.

By the end of my pregnancies, I was needing four times the amount of insulin I used before I got pregnant.   The minute I gave birth, I did not need insulin for just over 24 hours... but alas, try telling a nurse or doctor that a person with type 1 doesn't need insulin.  The insisted I put my pump back on and I therefor was low (less than 50mg/dl for the first 24 hours after child birth even though cramming carbs the entire time).  And of course, I couldn't convince them I didn't need the "diabetic diet". 

In the end, my girls were definitely worth all the extra work my husband and I had to put into having them.

Every person is different and they will need to figure out how their body is going to react to being pregnant.  You will definitely need to have a good relationship with your doctor(s) and be willing to go the extra five miles to get the job done.  As with all things in the life of a type 1, talk to your doctor before becoming pregnant and plan ahead.

Good luck!

2

This is great information. Its nice to know this is possible. I am  in the pre conception mode trying to get my A1c down to 6.5 it feels like it will never happen. right now i am at 7.4 but it was so hard. How did you get down to 5.0 that seems like i will be low most of the day.

3

[quote user="Gina"]How did you get down to 5.0 that seems like i will be low most of the day.[/quote]

I was low most of the day.  I felt horrible.  Constant headache.  I didn't stay at 5.0 long... I moved it closer to 6.0.

By the end of pregnancy #2, I had a 20 month old at home and had a mental breakdown in the OBs office due to continual lows.  They decided to induce at 38 weeks for sanity reasons.   Low BG doesn't bother baby, it bothers mom!

I think having the CGM during pregnancy would be a HUGE help.  I bet you will see a decent decline in your A1C after being on the CGM for a few months.

4

I 2nd the "you betcha" comment.  I have a 2 yr old son and been type 1 for over 20 yrs.  My endo just wanted "under 7" and she's pretty strict.  3 months prior to pregnancy I was 6.5, 6.4 and 6.2  Shortly after 6.5 then 5.7 and she (endo) said "too many lows" and she was right I was still exercising and hitting the 30's quickly.

We're talking #2 now and there is NO way things will be anywhere near as good.  First time around, I had an office job, sat in a cubicle and tested my blood regularly, 2hrs after eating the exact same breakfast, lunch and snacks at the same times each day.  Now I nibble and eat randomly while running around with my son.  And have consumed several bags of candy corn (3 pieces at a time) over the last few weeks!

But- 100% yes, possible.  My son is/was healthy.  Born early and in NICU for 10days, but one of the healthiest ones there and they don't know if his prematurity had to do w/my diabetes.  No problems prior to him being born early.  Whoops- did that just negate all the positives I was saying???

5

I too am in the pre conception phase. I agree with Gina that bringing my A1c below 6.5 is a huge struggle. Sometimes I feel like the harder I try the worst it gets. I also keep getting different information from healthcare professionals as to where your A1c number should be. Lately, I have been quite frustrated. I feel like I am always two steps behind my body. As soon as I catch up with my numbers, my hormones seem to change everything around. 

6

Also in the pre-conception phase here! Thanks for sharing your experience. My last A1C was a 6.9 but I am hoping that the CGM will help me reduce to below a 6.0.

7

Hi!

 

I wanted to share some of my experience and knowledge.  I am still in the pre-conception phase but for the past 2 years my A1C was in the 7s and this summer I decieded to really put forth more effort and see what I could do.  In June my A1C was a 7.4 and now my latest A1C was a 6.1.  So, even though it may seem impossible it is possible with a lot of blood sugar testing or the use of a CGM.  I get low a lot more than I used to but by low I mean in the 60s probably 3-5 times a week.  as well as I have numbers in the low 200s several occasions a week as well.  I never thought I could have a day where I don't see 200 but I have had days where my highest numbers are in the 150s and 160s now and have even had a few days in a row.  My numbers rarely go over 230.  Being strict with the carb counting really really helps and just like I said testing a lot or using a CGM.  Also I had to get over my fear of being 90 or 100 as well as my body had to get used to being there which took a month of not feeling good but making myself stay at those numbers whenever possible.  Now I don't feel good when I am above 200 which used to feel fine for me.


My endo told me for conception my A1C should be below a 7.0 and one diabetes pregnancy specialist told me the same.  Another one told me below a 6.5.  I personally think a 5.0 is very unrealistic for most of us with type 1 diabettes but I do have to say I have heard many stories of women getting A1Cs in the 5s when pregnant and I know that I could probably get it lower with more deligence but for now I am definately happy with where I am right now.

8

I was told by my endo to shoot for a 7 as well and then I talked to my CDE and she said 6.5 or lower. I feel like I am not sure who to listen to so I am just trying for the lower number. My last a1c was 7.4!

I think like you Jacki I am in the phase were I am not feeling so good with 90-100 BS. Its a bit scary too because I travel on trains to get to and from work and when I am 90 i am more prone to going low really quickly while I am on a subway. Sometimes it feels like a no win situation. But, I will get through it just like anything else and i just got a CGM so hopefully it will catch me going low before it is too late.

 

 

9

My endo also says it should be 6.5 or below. The closest I've been is a 6.7. :)

10

I am also in the pre-conception stage.  It is very frustrating trying to have total control.  I am aiming for an A1C of under 7, closer to 6 or 6.5%.  I just started seeing some new doctors and it has really made a difference.  My old doctor wasn't too up-to-date with all the new technology and resources, and my A1C was 8.2% and he seemed to think that was ok.  He definitely didn't know how to use my pump to it's fullest capability.  Now my new diabetes team is fantastic!  They are great and I think that with much hard work we will get my A1C down. 

I am so excited to have kids, and can't wait to get in the range to where I can do it safely! 

How many of you are on the CGM?  My docs and I are trying to get my insurance to cover it.  :)

11

I just started with a CGM and am "working on" getting pregnant.  I hate to admit it, but my pre-conception stage diabetes-wise existed much more last time (I have a 2 year old son).  Last time there were several serious months of blood sugar control, this time, much more lax. 

Will this be first pregnancy for most of you?

12

My last A1c was 7.0. I had brought it to 6.6 during the summer and then went through a bad spell with my sugar levels. I think I just burned out and neglected my efforts. Now I am trying to get back into it. I was wondering if you all struggle with adjusting your basals during your PMS phase. About 1 to 1 1/2 weeks prior to getting my period, my BG level rises quite a bit and I have to make so many adjustments with my basals. It seems to be different every month, so I cant always use the same range. As soon as I get my period I drop and have to start at the beginning. I hope with the CGM I can get better knowledge about the different phases in the month. And yes, this would be my first pregnancy. Im looking forward to getting to that point. Hopefully soon!

13

It's definitely possible to have a healthy pregnancy with type 1--it just takes a lot of work. My son is now 19 months and was and is totally healthy. I maintained tighter blood sugars for a good two years before actually conceiving (we had assorted health and infertility issues). I tested my blood sugar *constantly*--probably every two hours or so at least, and would correct highs before they got too high and yes, had a lot of lows. I don't often feel my lows, so it got to be that I could be 60 and feel fine, or be at the gym on the ellipitical machine and test and--look at that!--be 37. I ended up treating reactions a lot, and put on a good ten pounds before I actually got pregnant, but my A1cs were always good--5.9 when I conceived and I think I got down to 5.4 during pregnancy itself.

I'm working on a book about type 1 and pregnancy--sort of a Girlfriend's Guide to Pregnancy with Type 1--so this topic really interests me.

I blogged extensively about my whole experience at Managing the Sweetness Within and the archives (recently organized!) are pretty easy to follow if you want to check it out. It's at www.thesweetnesswithin.blogspot.com.

Good luck, everyone!

--Lyrehca

14

Hey Ladies!  How long was your A1C in the 6's before you conceived? 

15

I've consistently heard "good control for 3 months prior."  It's the "good control" part that is up for interpretation! :)

16

I don't think you will ever find it documented "how long before" to be in good control.  Obviously, you want to be in good control from the moment of conception.

And remember, just because you get yourself in good control for a month or two, does not mean you will get pregnant right away.  ;-)  I got myself in the low 6s and kept my BGs in good range for two months before we decided to start trying.  12 months later, we were finally pregnant.  So, 14 months of good control to get pregnant, then 9 more months of vigilant control.  Girls - it's a lot of work!  Prepare yourselves.

I think anything under 6% is not good. That means WAY too many lows.  Even with CGMs, one little growth spurt of the baby and you'll be low faster than you've ever been before.   And, getting close to 7 is too high.  If you can get yourself between 6 and 6.5 you are doing really well.  This is just my opinion.  If you can shoot for low 6s and keep yourself there for a month or two, you are probably in good shape to start trying.  (and know that it might not happen right away and you have to keep yourself in good control)

Oh, also, A1Cs are a measure of the last three months.  There was another blood test they did on me when I was pregnant that was a 6 week gage of control.  So I would have A1C every 3 months and this other test in the middle of those.  I cannot remember what the test was called, or if they still do it, but it might be something to ask about when you see your endo (if you are thinking of getting pregnant).

17

To answer Katie's question, that test is a fructosamine level.

And to echo what Katie said; I met with my endo for two years before I
actually got pregnant. For a year, my husband was ill and for a year,
we were dealing with infertility issues. I kept my A1cs in the low
sixes and low fives (5.9 when I conceived). I ate a lot of the same
breakfasts and lunches, and tested before and after meals frequently
and gave a lot of correction boluses.

--Lyrehca

Managing the Sweetness Within

18

Does anyone know about Type 1 with early CKD, and pregnancy? So far I have heard we could have a baby within the next two years and be okay (kidney wise) but, my husband is so freaked out by the idea of being high risk the whole time!

Beth

19

I don't know if this is better or worse for your husband to hear, but just having Type 1 makes you high risk!

20

You, I and most of the rest of the world get that! For some reaseon he thinks that High Risk is the end of the world! I'm thinking that I will find a Diabetes Pregnancy specialist to just meet with....maybe he will humor me and go with. I am struggling with how to help him understand how many diabetics out their are having healthy babies!!! I have my A1C down in the sixes and am continuing to work on it, and my Kidney Dr. specifically said that she clears me for pregnancy on the kidney side...... I am hoping in Feb. he will go to the dr with me and see for himself how hard I am working to make this possible and safe!!!! I think he just gets scared thinking about what if's.......