I feel like I’m trying so hard to eat right, exercise and watch my CGM for trends (since about July last year) and I’m not making any significant changes to my A1c. In fact, in the past year I went from 7.5 down to 7.1 back to 7.4 and down to 7.1 again. I can’t seem to find the “sweet spot” (or non-sweet spot as it might be for a diabetic) to get my A1c into the 6’s like my endocrinologist recommends before I can try to get pregnant.
Anyone have any tips?
Before I was pregnant, I had the exact same issue as you did, actually we had similar a1c’s too. NOTHING I did was good enough either. I TRIED EVERYTHING! It actually put me into depression because I was trying to get into baby range for 4 years!
If it makes you feel a little better, my a1c was NOT in baby range when I found out I was pregnant 
My son was born perfectly healthy and I had NO COMPLICATIONS!
@Gina,
I just feel like I will let my endo down if I try to get pregnant at this point because I made an agreement with her that I would not try without getting in a better A1c range. I really feel like I would be relying on her during my pregnancy so I want to feel like we can trust each other. She has complained to me about other patients she has had who are “a mess” and it keeps her up at night. I would also need to come off my ACE inhibitor (to protect my kidneys) and likely go on a different blood pressure medication that is safer for pregnancy. I guess I’m an over-achiever? I keep having this nagging feeling that it isn’t going to happen. I’ve been under the impression that I couldn’t have a baby at all until last year and I’m 32 so I guess I just want to get on with it. Even if I don’t have a baby, am I ever going to be able to get my A1c down?
No offense, but you don’t have to make your endo happy. You have to make YOURSELF happy, and do what is best FOR YOU. I got pregnant for the first time at age 36. Every person is different though, and if you don’t feel comfortable with getting pregnant with an a1c of 7.1 that is your choice. My husband and I made the choice and I wouldn’t change it for the world.
Secondly, your doctor is wrong to talk to you about other patients, and use scare tactics. That is completely unfair. If you were to get pregnant your doctor wouldn’t abandon you, it is her job to help you no matter what the circumstance.
My endo never judges or makes me feel bad for things. He helps me when I need him. It is important to rely on your endo and diabetes care team during pregnancy but not if they are going to scare you the whole time, and make you feel as though you are bad, or can’t have kids?
I am curious who told you that you couldn’t have a baby? This endo? or someone else?
Before I got pregnant, my A1c ran between 6.5 and 7. I would read posts on here about people with A1c’s in the 5’s during pregnancy. I honestly thought that I could never do that. But, my A1c at conception was 6.7, and dropped to 5.4 within 2 months. I wanted a lower A1c before getting pregnant, but I don’t think I had enough motivation to do it. The growing baby gave me a ton of motivation. Testing my sugar a lot (10-15 x per day!!) and being very careful with carb counting (those 4 M&M’s actually matter?!) helped me get my numbers down.
It’s always been frequent blood sugar checking for me. Maybe try testing once every two hours. If that’s not keeping your sugars steady, then try once every hour/hour-and-a-half. My really high blood sugars usually come when I haven’t checked in a while. When I do the frequent, every-two-hours testing, I don’t usually get higher than 180. Good luck!
@Gina,
My mom went to nursing school in the late 1960’s and they were taught that diabetics (whatever type) where high risk pregnancies. I was diagnosed when I was 7 and I grew up with an older sister who always had the attitude that she was never getting married and never having kids, so I always agreed (…maybe I need a psychiatrist?). When I became old enough to discuss things with my mom she always told me not to bother, I’d probably miscarry and be disappointed. I figured I’d be the crazy cat lady with a farm with horses, sheep, goats… So I never really discussed it with doctors. When I met my husband, he was very understanding. I told him we could always adopt and he agreed (I have 2 uncles, 2 cousins and a sibling who are adopted).
My previous endo (when I first moved to the US 5 years ago) didn’t think I should even be having sex with my husband because of all the bad things that would lead to (STD’s, UTI’s, etc). I think I saw him once or twice and then switched to the endo I have now. She was definitely more understanding and very knowledgeable. I know I don’t know as much as she does. Yes, I am interested in having a child, but I’m not thrilled with the idea of pregnancy or labor and if someone is there to hold my hand with medical advice through it, I’m willing to do whatever they recommend.
I don’t think I’ve ever had an endo who hasn’t made me feel guilty for some aspect of my regime. There’s only so many times you can look at a high/risky/uncontrolled A1c and come up with something positive to say. Being put on the pump 4 years ago was probably the best thing an endo has ever recommended. (Going on Lantus insulin in college comes a close second!)
The best way to decrease A1c is to choose one target blood sugar (not a range) and to have it be as low as you and your doctor think is safe. Because you use a CGM you should be able to do this without any severe lows.
Because a non-diabetic’s blood sugar is typically between 60-80, when I found out I was pregnant I aimed for blood sugars of 80 at all times. This wouldn’t have been possible without a pump. I wasn’t perfect, because my A1c was 5.1, which averages out to a 104 blood sugar. But I also didn’t have any bad lows and was rarely below 70. I looked up carb counts and would test an hour after eating to see if I needed a correction bolus.
Try this and see if you can get your numbers down. Also, as much as I hate logging, keep a paper log for a couple weeks and see where basal rates may need to be tweaked.
Like others have said, once you have a baby on board, you will instantly be healthier and A1c will drop. Do not avoid being a mom because you have diabetes. Your pregnancy will be considered high risk no matter how healthy you are, but you can have a completely healthy pregnancy and baby. After going through it, I wish I hadn’t avoided motherhood until so late in life so I could have had 5 kids.
Wow…Well your mom is partly right, we are high risk pregnancies but, you CAN have a HEALTHY BABY with type 1 diabetes! I know its sooooo scary. Trust me I can attest to it, as I am sure many of the women on this site could as well!
I think adoption is a WONDERFUL alternative, and you don’t have to give birth to a child to be a mother. What a gift you would give to a child if that was the way you were to choose!
@Jennagrant
My biggest problem with trying to keep my BG’s at or below 80 (at the moment at least) is that it does not take much for it to drop suddenly. A few extra minutes working before eating lunch or shoveling snow or something and I’m at 60 before I know it. It does sound like a strategy that might work though! What kind of foods are you/were you eating? Any indulging?
It’s a lot of trial and error at first but, once you get yourself together it’s a piece of cake! NO PUN INTENDED! lol You can try using the temp basal in your pump to help you with lows especially if you are going to go out and shovel. Ask the doc how much they think you should lower it by before a big shovel. You can do it by percentages.
For me checking every hour worked. I know it sounds extreme but, I had to get my a1c down really fast! Within two months of pregnancy I was down to 6.1. I pretty much stayed in that range throughout the entire pregnancy till the last trimester. Eating a clean diet and walking, and CLEANING! I couldn’t stop LOL I re-arranged my closests and organized everything in my house till up to the week I gave birth! Exercise and doing chores is the best medicine and I think it also kept me sane the entire 9 months!
Also, my husband checking me a couple of times over night and in the morning before work helped too, he would wake me if I was above 120 or if I dropped overnight. Having your husband take some of the burden off is a great stress relief.
I’m only about 6 weeks along, just found out (yay!!) and am worrying about my averages over the last few weeks. My a1c is in the 6’s (just had another test last week before I knew pregnant and results not back from doc yet). I’m on the omnipod and it’s telling me my 7/14 day averages are around 155. Since I found out last Saturday, I’ve had a bad cold and my numbers are higher, or sticking around 145 despite a bunch of corrections. They finally fall after lunch so I think my morning basal needs to adjust. Last night with no explanation (normal dinner, plenty iob, lower at bedtime) had 292 at 2:17 am! I was 52 just before bed so I had ~20 grams carbs to get back up and help with the iob. So confusing and annoying. I’ve read all of your tips and encouragement to the others but it’s so hard knowing these damn numbers could effect the baby. Hopefully my endo will have some ideas on tweaking my basal and correction doses. I’m not sure it’s the pregnancy or fighting this cold, but it’s frustrating.
Oh and I do have the dexcom CGM. I realize I need to make the high alarm louder to wake me up to catch those highs earlier. It didn’t wake me or husbAnd last night, but it usually wakes him up.
80 might be too low of a target. Work with your doctor to figure out what’s reasonable. Maybe 90 or 100.
I haven’t had a 5.1 since I was pregnant, which was many years ago. I’m usually around a 6.5 because it’s a lot of work to constantly be carb counting and bolusing.
When pregnant I didn’t restrict my eating, other than that I ate the same thing for breakfast every day and in the last trimester I avoided high fat and high carb food at dinner because it too so long to digest and would cause a middle of the night high. I had a thing for mint chocolate chip ice cream and mexican food and ate both often. =)
That’s cool that you’re insulin sensitive from activity. You might try just suspending your pump so your blood sugar doesn’t drop when shoveling snow or whatever.
Sounds like you are doing a really good job. As diabetics we pressure ourselves a lot, but as long as you have a decent A1c with few highs and lows you are doing great.
@HarmonyM,
Congrats on your pregnancy! Your BG’s sound similar to mine. 1 tiny thing makes drastic fluctuations. Your 52 to 292 sounds like a rebound (your body trying to compensate for the low, but really over-compensating). I tend to get those inconsistently, and usually several hours or more later, which my doctor blames on my having diabetes for so long. My body tends to be more resistant to insulin during that time.
Saturday, Sunday and Monday I exercised for 15-20 minutes and ate the best I could and I kept bouncing back and forth between 55 and 130. My CGM kept me awake (every 30 to 60 minutes) most of Sunday and last night with mostly false lows, but 1 or 2 real lows.
Today I decided to rest (orders from my physical therapist for my ankle tendonitis) and spent most of the day feeling sleepy (catching up on sleep!) and my BG’s were between 125 and 214. Ugh.
@Jennagrant,
I have tried disconnecting during activity and that doesn’t seem to work. My endo wants me to do a temporary basal for 2 hours but I think I’ll have to lower it more than she recommended.
It feels like when I find something that works, it works for a few days and then something happens and everything goes crazy. I’m just so nervous about keeping it working for 9 months!
Over the course of about 6-9 months (not pregnant, just trying to get in range for one) I managed to lower my A1C from 8.3 to 6.8. Here’s a few tips I can offer:
Exercise regularly–it may cause lows at the time, but will keep your overall BG steadier and lower for 1-2 days afterwards
Test more frequently (every 2-3 hours for me) and correct as needed. For example, I may think 125 is a good reading but according to my insulin ratios on my pump it requires a correction bolus of 0.2 units. It’s not much, but bringing that 125 down to 80 or 90 makes a difference.
Change your idea of what a “good blood sugar” really is. Of course you should discuss this with your doctor first, but I used to think anything under 200 was acceptable. I now have my CGM set to alert me to anything over 165–which makes a huge difference.
Treat lows very carefully–try to stick to 15g of carbs and wait for your BG to rise rather than over-treating.
One of the biggest things that helped me was reading this book called Think Like a Pancreas by Gary Scheiner. You can find it on Amazon or most major bookstores like Barnes and Noble.
Good Luck!
Temporary basals can be really effective. It sounds like you’re on the right track, so keep tweaking it until you have improvement with exercise lows. How long has it been since you’ve fasted for 24 hours to test your basal rates? It might be worth doing so that your pump settings have a solid foundation.
You made me laugh with
"It feels like when I find something that works, it works for a few days and then something happens and everything goes crazy."
That’s the definition of diabetes! And it’s what makes us into quick and creative problem solvers. I always feel kind of bad when I see newbies post on here, wondering when blood sugars will finally be in normal range and they can stop worrying about it, because the answer is diabetes is always changing. I may be biased, but it seems like only extra cool, intelligent people get diabetes so we are up to the challenge. =)
Do not stress about maintaining perfection for 9 months. You just take it one day at a time in pregnancy. Your body will go through the most miraculous, and sometimes comical, changes. Being a mom is a blessing and if it is something you want I am completely confident you can do it as a woman with type 1 diabetes.
@jennagrant: You almost made me want to cry! Thank you for the inspiring words. I have tried, but never made it through the 8 hour fast to check 1 segment of my basal rate(s) because my life is so hectic. Now that I am on a leave of absence from work (possibly permanently) I really should take the time to do that. My doctor realized I couldn’t do more than 8 hours at a time so that is all we have discussed. I had no idea that the standard is to do a 24 hour fast! Are you checking your BG every hour? That’s a lot of test strips. Thanks again!
Hello everyone,
I need to share my relief with you. I had an A1c taken last week. 6.2! The lowest I ever was before was 6.6 in October. I am so relieved and while my husband was happy, I know you ladies will understand how I feel. I’ve read that A1c often drops under 6 once a few weeks/months pregnant due to increased blood volume so who knows. I’m counting this as a win either way.
@HarmonyM,
Congrats! So exciting! As long as you are correcting right away and not staying high for too long you should have no issues, and everything should run completely amazingly boring for you LOL Just like mine was lol Just be sure to keep in contact with your doctor, especially if you are noticing a pattern. They will help to adjust your levels quickly and get you back on track.
@MaggieJo,
You sound like me with exercise. I have to lower my basal about 1.5 hours before exercise and then put a temp of zero during and then again 1.5hours after. Just when I think I got it all together? Nope, I have to make it higher another day? Such a pain right???
During pregnancy everything for me would change every couple of days! By the end of my pregnancy I was on 1:3 carb ratio and triple the amount of insulin I took before pregnancy.
As soon as they took out the placenta out, after the baby born, I was getting glucose straight into my IV because I went low immediately. Nothing with pregnancy and after is what you expect. You gotta just go with the flow or you will make yourself crazy. Prepare yourself now and you will be better mentally with everything, once you are pregnant!
Maggie another thing, you should ask your doctor to give you a pregnancy guideline, maybe that can help you to get your a1c down too. Do everything as though you were pregnant and then you will already be in that routine and then when you become pregnant, you won’t have to change much!