Higher A1C and Pregnancy

Pregnancy
1

Hi,

I'm 28 and have been a type 1 diabetic for 23 years.  I am currently 13 weeks pregnant with my first child.  I have always had 'uncontrolled' diabetes and have been told by every doctor I meet that I am extremely 'fragile'. When I found out I was pregnant I had an A1C of 7.2.  I was wondering if there are any women out there who can share their stories of higher blood sugar pregnancies.  Were your children born without birth defects?  Did you have a successful pregnancy? I've been told the odds are about 30% that my child will have significant birth defects.

 

Thanks for the stories.

2

I am 12 weeks today and my last A1C (1 month ago) was 6.8 The most important thing you can do at this point is to just work on getting it lower and bettering your health. Check your blood a lot and try to keep really tight control. My endo told me anything under 7 was "acceptable" but the closer you can get to a non-diabetic range, the better. I can't really give advice on the birth defects. This is my first child and I am also really worried about there being a birth defect due to my sugars. I do have really good doctors though. I stay in touch with my endo and my diabetes nurse often. My OB is also really good. I started out going to a big hospital, but found I liked the private practice so much more. They are really personal and work 1 on 1 with you. So far I have had 2 ultrasounds and I go for my big ultrasound in about 6 weeks. I am also on a pump and it has helped me a lot! Before I was on the pump my A1C was 9.7 and within just 3 months it had dropped to 6.8 If you're not already on a pump, I might would consider it. I have also heard CGMs are a lifesaver, but I have never used one. I know it is hard, but you should just try to remain positive and optimistic. The most important thing at this point (for you and your baby) is to just take care of yourself. Good luck!

3

Michelle,

I am 32 years old and been a type 1 for 21 years now.  I am on my second pregnancy (my first one I had a m/c) and I am only a little over 4 weeks along.  I have an A1C of 7.2 as well.  I am working on getting it lower.  I also had a 7% a1c with my first pregnancy but when I miscarried at 10 weeks they said that it had nothing to do with my a1c.  Yes the closer you can get to a non diabetic a1c (4.2 -4.9) the better, without lows, but in reality that is really tough especially with growing another human in our bodies.  The most important thing that I got told by other type 1 diabetics who had babies was when you reach a high, imediatlycorrect it.  That means A LOT of testing.  I got the pump too and got pregnant.  I had the CGM for 4 months before I lost it and I have another one on the way.  It is very helpful in showing when your blood sugars start to rise and drop.  I would beleive the "odds".  YOur body is MADE to have babies, we just have to do a little more tweaking to make that possible...look at all the gestational diabetics that have healthy babies...you can do it.  Don't beleive everything you hear and read...do the best you can. 

4

oh honey, stay positive and relaxed.  worrying and stressing will not fix anything. I was 30 and had had T1 for 23 years.  Never took great care of myself.   I had an unplanned pregnancy  and my A!C was 8, I found out when I was 5 weeks.  I worked my ass off testing 13 times a day and seeing my endo every 2 weeks, I got it down to 6.  Who the !#*%^*   told you there was a 30% chance of birth defects?????????   NOT TRUE, well I am not a dr but seriously I can't imagine that happening at 7.2  The complications I had were preeclampsyia (swelling and high blood pressure) and my retinas burst from the drastic change in blood sugar.  My daughter was born at 36 weeks, 7lb 12oz 19 in.  I had to have a csection because I could not push with the eye damage.  It really was not a big deal.  Her blood sugar was low when she was born, so they had to give her formula immediately and she was cold, so I could not see her for 2 hours until they stabalized her temp and sugar.  Again, not a big deal.  She was totally fine.  that was 4 years ago.  it took me over 2 years to even think about getting pregnant again cause it was sooooo much work!  I have had 2 laser surgeries on each eye.  Just saw my dr last week he said my retinas are perfect.  my A1C is 7 right now and my endo told me last week that i can try to get pregnant anytime.  I wish your doctors would not tell you that you are "fragile" that only makes you feel bad, if you live in MN i can recommend some awesome doctors.  Try to relax.  focus on happy baby, happy mommy.  freaking out about "chances" or "odds" is a waste of time.  If you are given facts and evidence, freak out but not until then.  I made a conscious choice to not worry about things that "could" happen or "might" happen.  I had many ultra sounds, bunches of tests, several level 2 ultra sounds, amnioscentices, but I never worried about them.  only worry when given a negative result.   Good luck!!  try not to get too fruterated when talking to "regular" pregnant people :) 

 

HAPPY MOMMY HAPPY BABY

5

Thanks everyone for your stories.  It's great to read real stories of what other women went through instead of the very negative generalities I'm getting from my doctors.


I'm not on a pump, I've always been told I cannot be by many different endos (the 'fragile' thing).  I take Levemir and Novolog now, but the most frustrating part was that in the first 2 months of my pregnancy, my insulin types were changed 3 times.  I like the Levemir and Novolog and have made it clear I'm not changing anymore. Changing insulin was hard enough before I was pregnant, it took me more than 6 months to get used to a new insulin.  I think it's crazy they had me change 3 times in 2 months while pregnant.

I do test all the time, but I'm unsure of what to do with the numbers.  Before I was pregnant, I was happy with any blood sugar under 250.  Now things have changed.  There are times I'm 200 after a meal, take 1 unit of Novolog and drop to 30 in less than an hour after that.  Then there are times that I take that 1 unit of Novolog at 200 and am 300 in less than an hour, without eating or exercising.  My doctors tell me they're puzzled by what my sugars do and always want to change the amounts of insulin and even the times I take it.   I don't feel comfortable changing it around so much.  I'd rather stay on 4 shots and day and tweak the amount at each time than change to 5 shots and all different amounts.  I know must of you said you're on a pump, but did anyone else have such large, constant changes in insulin amounts and times taken?

6

Michelle,

The pump and CGM is perfect for "brittle" or "fragile" diabetics.  It tells you when your blood sugar starts to climb or drop.  It even predicts lows and highs.  I wasn't sold on it at all until my miscarriage and once I got on it i liked it.  It takes you blood sugar every 10-20 minutes and you can look at your pump and see a graph of what it is doing in the past 3 hours, 6hours, 12 hours and 24 hours!  I had a lot of unpredictable blood sugars ( the calculations that should have worked did not).  I found out that it depended on my stress level and my carbohydrates.  The ADA preaches that all carbs are the same no matter what, THAT IS NOT True!.  Some carbs start to break down the moment you chew them (the saliva works and breaks them into sugar).  Since we are missing phase 1 of digestion (the phase that handles carbs) it is harder for us to keep those lower.  I started keeping my carbs at under 7 for breakfast and under 13 for lunch and dinner.  It did wonders.  I felt better too (after I got over the bowl adjustments).  Your body requires 300 more calories a day not more carbohydrates a day.  I have done better this past month than I have done in years.  You are also probably now at 13 weeks in a different phase of insulin resistance too.  YOu have a lot hormones pumping through you too (think about what your body and blood sugars do when you PMS) the body is working hard at balancing the baby and the hormones so your blood sugars will be a little "crazy".  Try to relax and test a lot to see your trends.  Try two days of testing like every 1-2 hours (except when your sleeping) and write down what you eat.  See if you can figure out any trends that your doctor can't figure.  You know your body better than ANY doctor :)

7

Also, I would have to say that having a lower A1C does not guarantee there will no problems either. I am 27 weeks pregnant and my A1C is 5.4 but I am experiencing many complications myself. So far, the baby has been fine, but I have very high blood pressure, extremely high protein spillage, and now need more laser eye surgery. My A1C has been very good for a couple of years now, but my earlier complications in my kidneys and retinopathy are returning and getting worse, just because pregnancy is such a strain on the human body. I don't think having a higher or lower A1C will necessarily lead to certain outcomes, everyone's body is different and it is impossible to predict from the outset what will happen. Someone could have a higher A1C than me and have no problems, while someone like me with a low one can still be having trouble.  You just have to try your best to stay in a good range, and the rest is really out of your hands, so I wouldn't stress out about it more than you have to. (This being said, I am paranoid about everything and can't wait to deliver, which is less than 10 weeks away at most for me!)

8

Kelly,

Very good point.  Yes I have also heard of women whose a1c have been "perfect" and they still have minor complications.  Nicely put

9

Michelle, I absolutely know how you feel about regulating your blood sugars! I am on the pump and yes it has helped. Like I said, my A1C went from a 9.7 to a 6.8 but I still am struggling with keeping my numbers perfectly under control. I actually get the feeling that my diabetes nurse is getting frustrated with me. Everytime I report my numbers to her she seems so confused about what I am doing to cause it. LOL The poor woman, I am probably going to make her quit her job before it's over. It's really nothing I'm doing that's causing it though. I guess it's just pregnancy. I test religiously. The other day I spiked up to 500 and took my usual correction dose. 2 hours later I had only came down about 100 points. I was thinking maybe I should take more insulin, but I was also hesitant to because I had come down 100 points so obviously the insulin was working some. So I ended up just waiting it out a bit. Another hour later I am down about a bit more. Another hour passes I am down a bit more. Then that evening (without taking anymore insulin) I drop to 57! Before pregnancy I ALWAYS had high early morning readings. My fasting number would always be the highest number. The complete opposite has happened now. I have to do temp basal at night to lower my insulin dosage because I will drop into the 40's at night if not. I normally also have a small snack before bed just to keep my sugars up a bit. Something like a juice box. It's very hard to keep your numbers in a perfect range while your pregnant. It's really a lot of work, and it requires a LOT of patience. I feel so frustrated with myself when I see a number that is too low or too high. These numbers are not only effecting me, but also effecting my baby so I get so upset when I know they aren't right in a perfect range. But I guess the best we can do is just try our hardest. I test A LOT. Before and after meals. And sometimes I even test during the night if I wake up to use the bathroom! LOL I always take correction doses, even if I am just a wee bit high. We are never really going to have perfect sugars all the time, but I guess trying to get them as best under control is what's important.

10

RachelEmily and Michelle,

I am in the same boat as both of you guys.  Shortly after pregnancy my A1C was 6.9.  My doctor was fine with that, but wanted me to watch the highs   We struggled a little bit with insulin resistance, but I am now coming back down  I am struggling on a daily basis.  I test everytime I think about it.  i have a feelign that I am goign to have to buy extra strips because I test so much.  I have the same problem with my diabetic nurse  The only problem is, she wants me to keep my readings between 60-80.  (I have been a diabetic for 35 years.  I was diagnosed at 1 year old)  My entire life, that number has been too low  I usually run around 130-140.   Now, it is a constant argument as to where I should be.  I feel like I am low more than anything, and go around in a daze.  I did finally talk to my doctor this week, and he said that as long as I don't keep the average above 150, I will be OK  He seems to be more forgiving than my nurse.  I am so very glad to hear from everyone about their experiences.  It takes some of the fear away.  I can't wait to hear more!!

11

Hello all,

I am not pregnant (yet), but we are trying and I hope to be soon :)  I wanted to weigh in on the high blood sugar thing.  I hear a lot about 'perfect range' and keeping your sugars at non-diabetic levels.  The truth is we are diabetic, it is virtually impossible to keep our sugars in the normal, non-diabetic range.  We are going to have highs, it happens, but if we deal with it as soon as possible we cam mitigate many of the complications.  The complications come from sustained high blood sugars over longer periods of time, more than a couple minutes/hours. 

People (even Nurses) who don't have diabetes don't understand.  They just think you must be doing something to make the blood sugar get that high.  I have times where I eat the exact same thing and did the exact same insulin dosage as the day before, but my sugars react differently.  There is so much going on in your body (even before pregnancy - like one of the other posts said, think about when you get your period, how wonky sugars go because of the hormones swimming around) that it is IMPOSSIBLE to predict what your body is going to do.  Yes, you can get a good idea and most of the time you can manage effectively and predict, but there will ALWAYS be those times that your sugar jumps, many times for no apparent reason.  I get angry when I read some of the posts and hear from people that doctors/nurses are making them feel bad because their numbers aren't perfect - anyone who thinks that a diabetic isn't going to have some BS in the upper 100s, or 200-300 range sometimes is ridiculous and unrealistic.

I agree with Kimmy on numbers.  I have heard other posts of ladies saying their doctor wanted them in the 60-80 range - for me that is too low.  Sorry, at 60 - I am having a granola bar to bring it up.  I refuse to go around feeling weak and low all the time - I think that is far worse on your body than having it run a little higher.  I am happy running 130-150, and I recently read that A1C below 7.0 (like 6-7), actually relate to an average of about 150-170 I think.  And if you are in the 6's as a diabetic, you are doing awesome.  And if you hitting lows a lot, you are more likely to have jumps as you try to bring it back up - isn't having a more level sugar (even if it is a little higher than 'normal') better than having your body jumping between numbers all the time? (and it seems to me that being low all the time while pregnant would be bad for you and baby).

I have had T1 for 22 years, my A1C has always been in the usually low 6s (except an occasional low 7).  I have not had any diabetes related complications to date.  I have high blood sugars, it happens.  I have had other doctors (not endocrinologist) say something about my sugar being high on one blood draw, and be condescending, and I take it with grain of salt - come step into my shoes for the last 22 years and then see what your tune is.

So that was my rant, thanks for listening, I just think it is important for others, including doctors, to realize that perfect isn't going to happen.  We do our best, and as long as we get the high blood sugars down quick (and try to keep them from being too frequent), we will be alright.   If you have a doctor that is pushing too hard, or makes you feel bad - FIND ANOTHER! There are plenty out there that will be better for you mentally and physically - and that will translate into healthier T1 and their babies (when that time comes).

Do your best, and try not to worry.  Everyone is different and will have different BS that they are more comfortable with, everyone's body reacts differently - you know your body better than anyone else - even your doctor - trust it and trust yourself and you will be a happier, healthier diabetic.

Cindy

ps - about the changing insulin - that is crazy to make you change 2-3 times in a couple months - if certain types are working - stick with them, just adjust dosages until you find the balance - changing types so much is going to mess with your body for sure, and not get you to the numbers you want!

 

12

Hello ladies,

Ok I am not pregnant yet, we are planning on trying starting in September. I have not been in great control for the past 19 years with diabetes. Recently my A1C was a 8.9. My endo has given us the "go" once my A1C drops below a 7.0, but my regular OB was very pessimistic about my decision to get pregnant, telling me all the complications I could/would run into. So I saught a second opinion, love the new OB. She is worried becuase I have Stage 2 retinopathy. She says that that is considered a Class R pregnancy. She says that if I am already having pulminary issues that places me at greater risk to complications during pregnancy. My retinas could burst and I could go blind? I thought you could have the laser surgery if needed. This weekend I have to do a 24 hour urine test to see if I am spilling any protein I suppose.

You all make it seem like your Dr's didn't seem very worried about complications like mine are. I walked away from my appointment in tears, assuming I would not be able to have a baby. I am also forbidden from having kids after 30, due to me having diabetes for almost 20 years and being 25 now. What the heck?? Some of you are over 30 and have had diabetes that same amount of time and are able to have babies. Its really frustrating.

13

Hi Nikki,

My doctors said the same thing about not having kids after 30 (I'm 28 now have had diabetes for 23 years and am pregnant).  Most of my childhood doctors told my parents I would never be able to have children, every doctor has different opinions and times change. My current doctors were also worried about me having a few complications because of the pregnancy like kidney failure and retinopathy, but I did not have any complications before hand (and still don't, knock on wood) so the risk was less.  I have been told and read that if you already have complications before you're pregnant, they are likely to get worse during and sometimes after the pregnancy.  

About the retinopathy, the doctors told me they could do laser surgery while you're pregnant and my endo. didn't seem too concerned about the possibility.  My eye doctor, however, was not as calm and did not give the same good outlook.  Both my aunt and uncle are/were blind from diabetic retinopathy, so I take the possibilities very seriously. I don't want to be blind. From what I've read and discussed with my OB, if you have any retinopathy, you'll most likely have a C-section.  I'm probably more worried about complications from the diabetes than my doctors, except the eye doctor who my endo thinks is too old fashioned and out of touch with current practices.

I'm also very concerned about complications for the baby.  So far I'm 16 weeks pregnant and everything looks normal.  I'll find out at 20 weeks if there are any visible complications in my little one.  

All the different opinions and levels of concern from various doctors is really frustrating.  All I can say is that you know yourself.  I thought I'd be able to have a baby even though I've been 'uncontrolled' for 23 years because I function normally on a daily basis, have no complications, and don't think of diabetes as soul crushing or horrible.  Being pregnant is more strain than I expected, but I've been doing fine.  My blood sugars are NOT perfect and will never be. You know what will work for you.

14

I am 24 and I am 18 weeks pregnant and had an A1C of 9 when I conceived. So far everything is looking good on my labs and u/s they did the preliminary anotomy screen this week (we are having a boy!) and it looks like all the heart chambers are in tact and everything looks good as far as they can tell. I have gotten my A1C down to a 6.7 as of right now and working harder at it everyday. Good luck <3

15

Nice Work Chelseaw86.  It is hard work but my doctor told me that she loves type 1 pregnant women because they are the HEALTHIEST eaters LOL...yeah cuz we really don't have a choice lol