Pregnancy- pump vs. no pump

Long story but here is the background: diabetic since 1993. No complications, steady control for the majority of my time with the disease (AIC hovers around 7). Last July (almost a year ago), I went to a high risk perinatologists for a pre conception appointment. I was advised to get my A1C below 7 and then we would have the green light to ttc. I easily got my A1C to 6.8 after just 2 months and was continuing down when my hubby got a job offer across the country. Needless to say, conception was put on hold. He moved ahead of me and I finally moved to join him in Feb of this year. I have new insurance and of course new doctors, and here’s where I am now: we want to conceive this summer. I have an appointment end of June to remove my IUD (this date was discussed ahead of time with doctor and CDE but they all forgot…) and start trying. I’m 32 and am uncomfortable waiting as age brings a whole new set of challenges with pregnancy! My new doctor was really pushing me to a pump. CDE has met with me multiple times all for pump (meaning, never was my day to day care looked at or helped). I now have the pump. however, the pump rep who I am required to meet with before beginning pump therapy can’t meet until July 6. I’ve been advised that it will take a minimum of 6 weeks before I am competent in using my pump and before my blood sugar is under control with the pump. Last A1C was 7 (higher because I wasn’t trying to conceive and in all honesty was a little burned out.), but I have easily gotten back to my preconception blood sugars I had last year within the first few days of trying.
Here’s my question: I KNOW I can maintain tight control using injections. I also know that pregnancy throws a ton of curve balls and makes management much harder but I am struggling to see how a pump will make management easier. I will still be the brain behind the delivery of insulin. I understand blouses can be adjusted but even then I won’t know to make an adjustment until I wake up too high or low. I have requested a CGM (which I’ve had before and got A1C to 6.2, way before pregnancy was even an idea). I feel like with a CGM I can have much tighter control and avoid lows and highs, therefore making a pump less essential.
I’m getting very little support from my doctors and CDE (but that’s another topic for another day). I’d love to hear any of your thoughts or advice!

Hi there! I totally get your concern!! I, too, was unsure about switching to the pump after being well controlled using pens but relented about 20 weeks into my first pregnancy (I was 30 at the time, 34 now). Of course do what feels best for you, but two healthy babies later I am very happy I made the switch. Managing BG during pregnancy is FAR HARDER than I ever expected and even with outstanding endocrine care, I had to make adjustments weekly to keep within my target levels. Plus the pump makes adjusting insulin delivery throughout the day much easier (pregnancy hormones cause increased insulin resistance and since these hormones vary throughout the day, so will your insulin needs). Not that everything was super rosy- I often felt more “sick” because I was now wearing a visible indicator of my diabetes (most people didn’t know I had T1D prior to going on the pump) and had to answer A LOT more questions about diabetes, basically I became an unofficial diabetes ambassador, and then there’s the at times very annoying alerts when the reservoir gets low or its time to change the device (I use the pod). But the power it gave me to have safe, healthy pregnancies with no complications for me or my kiddos was absolutely worth it. With a good support team of diabetes educators and endocrinologists who specialize in diabetes during pregnancy, I had no trouble “adjusting” to the pump and, as I said before, when I first went on I was 20 weeks pregnant. If your docs aren’t supporting you now, ditch them and find specialists who will. Not all docs, even endocrinologists, understand how to manage the insulin craziness than accompanies pregnancy so find some who can. Sometimes your insurance company (if you have one- which I hope you do) can help you with this search.
Best of luck to you!!

Thank you so much for your response. I definitely do have great health insurance, thank goodness. I am planning on finding a new educator soon too. I’ve been told by the current endo/ cde team I’m working with that I can’t start on the pump after pregnancy- must be before. So I feel like it’s kind of now or never (or at least until after I give birth, assuming I get pregnant lol). But you say you started at 20 weeks, so obviously I could start after conception if necessary. Thanks again!!!

I completely understand your concerns! I was very reluctant to go on a pump initially, but after 2 successful pregnancies I can highly recommend it. It is much more convenient, and I promise will be very quick to learn. You will never look back. I’ve been diabetic since 1992. On a pump since 2001. I used a Minimed pump for 13 years and 2 years ago switched to Omnipod. I love the Omnipod. It is much simpler to operate, waterproof and much less conspicuous to wear. No pump tubing to get caught on things. Nothing to disconnect to shower, swim or for intimate moments. My kids are 5 & 7 now and I can’t imagine life without my pump. FYI I also use a Dexcom CGM. I WISH I would have had this during the pregnancies- it would have made life so much easier and I wouldn’t have stressed so much about my sugar. I would not recommend using the Minimed compatible CGM. I tried it between the two pregnancies and it was terrible. Highly inaccurate and much more trouble than it was worth.

You’re gonna do what you’re gonna do. I, knowing this wasn’t the “way” I was supposed to do things, took my IUD out and thought ‘if I get pregnant I get pregnant and if not then it wasn’t meant to be’ (I was 39). Well we now have a beautiful 8-month old who I should have had vaginally but for whatever reason he wouldn’t come out so c-section. But back to topic - I do not know how women with T1 had kids before a CGM. Pregnancy took me for a wild ride, including 2 EMS visits before the CGM. I would suggest if you are comfortable on shots, go for it. I never did great on shots - too many lows & weird schedules & I’ve been rocking a pump since 2001 – which I don’t think most people know I am wearing unless I show or tell them. But I am old enough now to not care what most people think about me. Best of luck to you and your hubbby!