Hey Ladies! I just found out a week or so ago that I’m pregnant but it was a little bit of a surprise. My husband and I want to have kids, but I was still working toward better BG management. I’m really nervous because my A1c, though it has come down 1.2% in two months, is still well above where I should be for a healthy pregnancy (8.2% about a month ago). I have been doing fairly well at staying within a 70-110 range but have been experiencing some scary lows at night and have had a couple of near 200 numbers. I’ve had T1 for 12 years, eat VERY healthy, exercise regularly, wear a CGM, and am on injections. I would love any advice that you ladies could offer, especially those of you who have successfully brought down your A1c!
Congratulations! It is normal to have a lot of lows in the first trimester.
I love this book: Balancing Pregnancy with Pre-existing Diabetes: Healthy Mom, Healthy Baby by Cheryl Alkon.
Have you thought about a pump? You can be so precise, and make such small changes. My pump goes down to increments of .025. It really helps with fine tuning.
Have some grace with yourself. Be really honest about counting carbs and giving yourself insulin a few minutes before you eat. Canned pineapple is impossible to count for and give an accurate dose; don’t even try!
I worked with a high-risk OB clinic, because I was also pregnant with twins (they were a surprise!). The diabetes nurse specialist at that clinic was the best practitioner I have ever worked with. If your insurance allows it, try to work with a diabetes nurse who specializes in pregnancy.
Keep us posted on how you are doing!
@emmcgrath Thank you so much for the book suggestion! My endocrinologist has already spoken to me about referring me to a high risk OB and we are going to talk about me going back on a pump at my next appointment. I think the biggest thing I’ll be looking forward to about being on a pump again is having an adjustable basal rate. My endo had asked me to go on a low carb diet to help get my A1c down, but now I’m a little scared that if I continue that I won’t be getting all the nutrients I need for the baby, so I’ve been trying to limit my carbs to whole foods like raw fruit, sweet potatoes, milk, and brown grains.
I haven’t experienced pregnancy yet (currently trying to conceive), but one of the best things that has helped my BG is being on a pump! I was pretty steady around an A1C of 7.0-7.8 for a few years but have dropped to below 6.0 with a pump. The lowest I have been is 5.3, I’m currently at 5.8, and I’ve been below 6.0 for about a year. I’ve had my pump for about a year and a half, so I definitely think it’s helped a lot! I think Metformin (for my PCOS) has helped as well, but adjustable basal rates with a pump are a godsend. Good luck with your pregnancy! Hopefully you’ll get a pump soon 
First, don’t be too hard on yourself about A1cs. I put off pregnancy for about 2 years trying to get my A1c below 7.0. I typically hung around the low-mid 8 range before that. I made it into the low 7s, but just couldn’t get into the 6s–it was to the point where I cried at every doctor appointment knowing that I had yet another 3 months of trying to control my BG before I could even try to conceive. I eventually gave up and ended up conceiving with an A1c of 7.8. Throughout my pregnancy, I stayed in the low 7 to high 6 range. I ended up delivering at 34.5 weeks due to pre-eclampsia and HELLP syndrome, though that had nothing to do with diabetes. My son just turned 2 this month and is perfectly healthy.
Second, I agree with the above of getting on a pump and reading Balancing Pregnancy with Pre-Existing Diabetes. I also recommend reading Think Like a Pancreas–this book helped me tremendously in lowering my A1c.
Third, your high-risk OBGYN will likely be monitoring your BGs regularly (I had to send mine my CGM and pump data weekly so they could make adjustments). It really does get easier when you have a medical professional constantly reviewing your numbers and tweaking your insulin.
Congratulations and Good Luck!
I conceived at a 7.6 AIC and stayed under 8 the entire pregnancy, but I seem to have difficult management even under the best circumstances so pregnancy definitely didn’t make it any easier. Luckily I had an overall healthy pregnancy and have a healthy baby girl (but of course every mom and every pregnancy are unique!). I would also recommend the pump, especially as insulin resistance kicked in for the last trimester my rates were HUGE and I can’t imagine taking injections with those large amounts so frequently. I also followed a loosely-low-carb diet throughout pregnancy (and continue to do so now) and it had no impact on babys health. I do find she favors fruits/veg/proteins more than carbs now, but she is perfectly healthy and eats almost anything! Good luck to you with pregnancy, and delivery!
As a high risk OB nurse educator, mother of two and T1 x45 yrs, I’m so very happy to hear about your pregnancy!
As I was told and now educate other moms, this is going to be one of the best and challenging times you’ll have.
First, try to get your A1c down to at least under 7. I was 7 at the start of my first pregnancy. My OB said I needed to be under that so I started to journal all my bg nos, what I ate, how much insulin, activities, how I felt. Everything to establish a pattern. Within a couple of mos I was 6.5.
Most important, I started having rescue lows- paramedics are called to revive you. I always ran high and never passed out. It would happening without warning. Luckily babies are very resilient and she was fine but not so good for me. Always have a Glucagon kit ready and make sure family, and friends know how to use it Never skip meals even if you’re nausus. Eat what you’re craving. Just adjust your insulin if needed. Into the second trimester things should get better.
Into your third trimester a condition called preeclampsia may develop. T1 women seem to have it more than non diabetic moms. I had it with both pregnancies but, because my doctor delt with high risk pregnancies, he diagnosed it early. The treatment bed rest until delivery. Annoying but very doable.
It’s important for you and your baby’s outcome to have a team of OBs specializing in high risk patients, endocrinologist, and if you see an internist for nondiabetic concerns.
I would like to know how you’re doing in the up coming mos and when you delivery. Its a challenge but so worth the outcome.
Congrats! I just had a baby boy about 4 months ago. I wasn’t at the level I wanted to be at when I got pregnant but quickly got it under control. A few things that helped me have a successful pregnancy:
- being on a pump and CGM. It’s easier to correct highs and manage to varying insulin needs throughout the day. This could help with your lows too because maybe you need a little less insulin at certain parts of the day and the pump allows you to adjust for that. I wouldn’t necessarily say it’s normal to have serious lows during pregnancy.
- Having an amazing medical team. 1) endocrinologist / nurse practitioner - she looked at my numbers twice a week and made tweaks and adjustments as necessary. She also helped me after I delivered to get my dosing back to the new normal.
- nutritionist - there is one at my endocrine practice and she was immensely helpful in helping me understand what were the best foods for for me to eat
- high risk OB. Sounds like you already have one. You’ll be monitored a lot. For me this was a silver lining because I got constant reassurance that the baby was doing well and got to see him on lots of scans.
- wait 20 mins after bonus to eat then the insulin is kicking in and you are coordinating with the peak better
- eat 100% whole grains and pair them with fats or proteins to slow the spike
- if you are high before you eat, correct then once you are starting to come down, give yourself the food bolus. If you’re starving, eat protein while you wait.
- my team told me I had to eat carbs (175g at least towards the end) so I had to find the right carbs and what to pair them with. Can share more if you want. Let me know!
Someone else mentioned preeclampsia. My doc told me not to gain too much weight and to take baby aspirin every day after 12wks to try and prevent this. Perhaps your doc will encourage this too.
It’s a lot of work but you can do it! Just keep thinking about the precious baby you will be rewarded with in the end. Good luck!
Congratulations! I went in to my pregnancy without diabetes and came out as a T1D. I was in ketosis when diagnosed at 25 weeks- but got on my insulin and did fine :)! I was very stressed about my baby’s health. Baby weighed 6 lbs 15 oz at my scheduled section at 39 weeks (breech baby). He did great! He was a little jaundiced but the bili light sorted him out quickly, no NICU time(they freaked me out about diabetes/insulin during pregnancy) My A1C was well controlled after they sorted me out. My endo wanted very tight control of my numbers so consequently I would dip frequently to the 40s/50s. I couldn’t really feel my lows always; the baby would kick me to let me know- no joke. My only advice would be to not worry so much! A plus about being an insulin dependent diabetic during pregnancy— you and baby are watched closer. Hope all goes well with you and baby
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Be extra careful around the 13th week, when you’re shifting from the first to second trimester. You can expect lows during that week. When I had children (1994-95 and 98-99) I had to meet with the endocrinologist every 2 weeks to review my food diaries and blood sugar tests. That was really helpful. And then every week for the last 10 weeks. Don’t beat yourself up for the high numbers, correct them carefully, and talk to your endo about the night time lows. Consider adding more fiber and healthy fats to your diet to slow down your blood glucose surges (I’m also a RD). When I was pregnant I had strong cravings for fresh fruit, and I would make a bowl of cut-up fruit for lunch everyday - enough for 4 people - and mix it with a container of sugar free yogurt. At night all I wanted was a big piece of grilled meat and a salad. That was a great alternative to carb-heavy dinners and the results were good. I hope you have a dietitian to work with who isn’t judgy. It’s hard enough being pregnant without health care providers getting up in your grill. Good luck! I’m very excited for you.