Overwhelmed at the thought

Pregnancy
1

My husband and I are discussing pregnancy.  A little about me, I'm 32, Type 1 since I was 18.  I was on the pump from ages 19 until last summer, when I decided to take a pump vacation for my wedding and related events (honeymoon, etc.).  I've done well on MDIs and my A1c levels have come down from 8.7 to 7.8, so headed in the right direction.  My doctor, however has requested that I get my A1c down to 6.0 or lower before conceiving and this just seems so un-attainable to me.  I'm trying really hard to keep my numbers in check, lose weight, etc.  It is just TOUGH.  I'm putting a lot of pressure on myself and I'm not even pregnant yet (not planning on trying until the end of this year, assuming my numbers are in the right spot.)

I've never been pregnant before and quite honestly I am freaked out about it.  I'm nervous that my numbers won't be good enough, that I'll be stressed with work, etc.  Just how I'm going to handle it all.  I know women with diabetes have healthy babies all the time and I hope that with some hard work, i will be one of them.

Any tips on dealing with this anxiety?  

I am going on a CGM in the next few weeks to help and will be re-starting pump therapy in a month or so (want to get used to the CGM first).  I hope these help get my numbers in an acceptable range for my doctor, but still, I feel like 6.0 is just so far out of reach.  :(

2

You are not a statistic.  You are a person who has your own unique experience with diabetes and will have a unique pregnancy.  The reality is that  moms with diabetes have been having healthy pregnancies for a long time, with and without textbook A1cs. Try not to stress.  I think the most important thing a woman can do to get pregnant and have a healthy pregnancy is to be happy and content with life.

Below is a giant list of things that helped me have a healthy pregnancy, but it's purely informational, not a list of things you must do or else you're a terrible mother.  Sometimes doctors forget that we're real people, not robots that live to fill out our glucose log books and check our feet daily. =)  I am a fairly relaxed diabetic and only do the diabetes management things that are worth the trouble to me.  When I was pregnant, I found books like "What to Expect When You're Expecting" way to demanding and stressful.  So I did the basics (keep blood sugars as normal as possible, eat some vegetables, enjoy my pregnancy) and everything was just fine.  

Because of my diabetes I didn't think I should have kids.  Thankfully we had an "unexpected blessing"  at age 32 with an A1c just below 7.  Having a baby on board was the biggest motivator... my A1c quickly dropped to a 5.1 and stayed there for the duration of my pregnancy.  My son was born healthy and had a normal blood sugar.

I wish I had known earlier how possible it is to have a healthy pregnancy with diabetes.  I would have had 5 kids!  

It takes extra work but it doesn't feel like a burden when you're doing it for your child.  The things that helped me:

* A pump.  Think it's smart that you're giving it another try since pumps dose insulin so much more accurately and give 24/7 coverage.

* Test blood sugar and take correction doses often.  Highs happen but you can minimize their impact.  During pregnancy I also would bolus, eat, then test and give a correction bolus an hour later.  It pretty much eliminated big post meal spikes.

* Target blood sugar of 80 with frequent testing to make sure I didn't have lows.  Lows can damage your baby's neurological development.  My usualy target is 100, but my goal in pregnancy was to have non-diabetic blood sugar levels as much as possible.  

* Refresh on carb counting.  When pregnant I ate whatever I wanted (until 3rd trimester when I would avoid high fat or high carb meals at dinner because delayed stomach emptying caused middle of the night highs), but I looked up carbs and bolused accurately for what I ate.  If you have a smart phone the Calorie King or LoseIt! apps are great.  The Calorie King book is good if you don't have a smart phone.

* Exercise helped with insulin resistance and helped me feel so much better.  In first trimester I was too tired to exercise, but by 2nd I signed up for an expectant moms exercise class at the hospital and did water aerobics and yoga.  It felt great and was wonderful to meet other moms.

After pregnancy my A1c went back to their normal 6.5 - 6.9 levels and I can't imagine having a 5.1.  But when you have a baby affected by your choices, it's easy to be in tighter control.  As a mom you'll do all sorts of things you never knew you were capable of.  

3

Thank you SO much for the thoughtful post.  I really appreciate it and love your pieces of advice.  I do sometimes feel like a number when at the Endo, especially when they don't realize just how hard it is to attain these perfect numbers.  But, for the most part I like my medical team.  

Did you use a CGM while pregnant? I just received the call (literally about 30 minutes ago!) that mine is on it's way to me.  YAY!  I think it will help tremendously.  I'm trying to almost live as if I am pregnant just to get into good habits now before it actually happens.  

4

I'd tried CGMs in the past and between that and my pump felt like a cyborg. To me CGMs aren't worth the trouble... accuracy isn't 100% and you still have to test blood sugar, plus they use up valuable pump infusion sites.  A lot of people like them and find them useful.  It's smart to try it and see what works for you.

Instead I tested about 6-8 times a day when pregnant.  

Can't remember what it's called, but after learning I was pregnant a diabetes educator wanted to verify my pump basal rates and had me use a CGM type device that recorded my blood sugar for several days.  It was more accurate than a CGM, but I couldn't see the results as it was testing and it had a nasty needle the diabetes educator had to insert.  The information was great though and worth the hassle for a few days.

Hope your experience with the pump is better this time.  Have you ever read John Walsh's book "Pumping Insulin"?  It's a good resource.

Take care. -Jenna

5

My A1C's have been very high. It was around 8.9 when I first found out I was pregnant. My body is very touchy when it comes to my blood sugar levels and insulin. If I'm not watching and measuring EXACTLY how much I'm eating and writing down every number, they go crazy. So now that I'm pregnant, I'm really trying to watch everything I do. I'm at 23 weeks tomorrow and so far baby is looking healthy.

However, complications can arise if your levels are consistently high and high levels can cause your baby to measure larger. But work with your doctor and stay diligent. It's alot more work being pregnant with diabetes, but definately possible to have a healthy baby!

Good luck :)

6

Jess,

I found out I was pregnant with an a1c of 8.9 also. Mine go crazy if I don't watch exact either. That is so funny that we are so alike. I just had my boy this past November and I had the best pregnancy...The end was a little more let's say interesting with insulin resistance but for the most part I had myself in pretty good control.

All I can say to you ladies is do your best, check, correct, check correct. Don't stress... and try to relax as much as you can. Oh and don't read TOO much because that will definitely make you crazy!!!

7

Hi, I’m a pretty new type 1, will be a year in June, so this forum is really helpful - I’ve learned more here than any session with my endo. When u day test and correct, do you mean correct a high BS on the spot? Do u immediately give yourself more insulin to correct a high reading? I’m not on the pump and have only been injecting prior meals. If I have a high post meal in the future I just give myself more insulin if I find the carb ratio high in my next meal. Should I be correcting on the spot? I feel at an endo appt I was told not to do this, but I’m currently in the middle of switching endos and don’t see my new one until this coming Monday. So just curious to see if I should have been correcting sooner!

8

Jessicamanning - I am currently on MDI and what I do is test 2 hours after a meal.  If I'm a little high, I'll wait 30-60 minutes and test again.  if I'm still high, I'll give myself a little injection (like 1-3 units, depending on what my BS is).

If I'm really high (like 250-300+) 2 hours after a meal, I won't wait and will give myself an injection and text in an hour to make sure I'm coming down.

I am excited for the CGM to tell me how my sugar is trending so I can better predict what will happen and treat in a better way!

9

[quote user="Jessicamanning"]Hi, I'm a pretty new type 1, will be a year in June, so this forum is really helpful - I've learned more here than any session with my endo. When u day test and correct, do you mean correct a high BS on the spot? Do u immediately give yourself more insulin to correct a high reading? I'm not on the pump and have only been injecting prior meals. If I have a high post meal in the future I just give myself more insulin if I find the carb ratio high in my next meal. Should I be correcting on the spot? I feel at an endo appt I was told not to do this, but I'm currently in the middle of switching endos and don't see my new one until this coming Monday. So just curious to see if I should have been correcting sooner![/quote]

Your doctor should have given you a correction factor, which is a formula that tells how much insulin to take to correct a high.  Ask him about this if you don't know what yours is.

With a pump it's easy to give correction doses at any time because it can calculate insulin on board,  plus pumps only use short acting insulin so it's less complicated.  You can calculate your own insulin on board with shots.  Look at John Walsh's book "Using Insulin" for a good explanation and the formulas.  

Feel like I should be getting a kickback from John Walsh for recommending his books. =)  But they're just good and sometimes available at the public library.