What's the reality?

Pregnancy
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Hey all. I’ve been a type one diabetic since I was 8, so 12 years going with this battle. At first it wasn’t a battle, but when I hit the age of 13 it went downhill. It’s been a struggle since. My a1c is crazy high and I’m working on controlling that with exercise, a better diet, and by paying more attention to my diabetes but it’s still rough.

I’ve always wanted kids. I remember being heartbroken when I was a teenager as it truly dawned on me what having kids as a diabetic would be like. Now that I’m 20 years old and married I still want nothing more than a family.

Mainly I’m terrified. We plan on trying in two years once my husband is finished with his degree, so I know I have time. But still I’m plagued by these thoughts. What if my blood sugar accidentally goes above 200 while I’m pregnant? What if I cause my child to have disabilities or complications? I’m just so terrified that I’ll never be able to do this.

I guess I want to know the reality of it all. I’ve tried talking to my doctors but I only ever get the professional talk of get your a1c down to 6, stay as low as possible, etc. I never know the reality. What is the harm if my blood sugar goes above 200 once during my pregnancy? Is it an automatic death sentence? I’ve heard it’s easier after the age of 25, is that true? Do I need to forget about ever eating carbs again? Am I stressing about this way too much?

Thanks, I appreciate any support/advice/personal experiences.

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Hi Becca,

I’m glad to see that you’re trying to get informed and in the best health you can before you get pregnant. It will help everything else be easier.

First, understanding that it’s not a simple thing, getting yourself fit and getting your A1C down is important. Without trying to be harsh, I’m going to be straight with you, since you’re seeking information. High glucose levels in early pregnancy increase the chance of birth defects and of miscarriage. This is of greatest concern during the first trimester.

Second, elevated glucose levels in your blood mean elevated glucose in the baby. This leads to the baby’s pancreas generating more insulin, which is an anabolic hormone (increased growth), so the baby may get bigger than it otherwise would. Depending on how much bigger, it may mean a C-section rather than a traditional delivery.

Whatever else you do, be sure you’re keeping in touch with your OBGYN and your endocrinologist throughout the pregnancy.

You’re already getting a good start by planning ahead. Best wishes and feel free to ask questions. -Joel, RN

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I want to clarify what I’ve said here Becca. A _single _ blood sugar over 200 probably won’t have any negative effects. It’s when they’re continually elevated that it becomes problematic. Your most likely “complication” is that the baby will be larger than average.

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Hi Becca! I was as nervous as you sound. Diagnosed at age 13 and finally ready for kids at age 29, I had plenty of time to worry.

I saw Florence Brown at Joslin in Boston. She was fantastic. I checked my glucose 12-14 times per day. I got my A1C down to a 5.1. I obsessed, also afraid of one high reading. While pregnant with my first, I saw 200 mg/dL and sobbed.

Not to worry! It turns out that an occasional excursion does absolutely no harm AND seems completely unavoidable! Your hormones will be going nuts, weight changing… perfection is impossible. At first, your insulin needs may decrease slightly. By the end however, my insulin needs were more than 5 times higher. I drained my pump reservoir with my basal rate alone in one day and used syringes for boluses. I needed to take insulin 30 minutes before eating, then “enjoy” my low-carb meal. My doc recommended a high protein snack before bed and check for ketones in the morning. I had to take insulin to cover the dawn phenomenon when I woke then eat breakfast a little later.

Large babies are normal for my family. My grandmother had 6 kids and no diabetes; none were under 9 pounds.

First baby induced at 38 weeks:
8 lbs. 1 oz., 64 mg/dL, no NICU
Twins at 35 weeks 5 days:
8 lbs 1 oz, NICU 8 days for apnea due to age
6 lbs 13 oz, NICU 24 hours to monitor glucose
Fourth baby, 39 weeks:
9 pounds 13 ounces, 49 mg/dL, no NICU but glucose checked for 24 hours

Now, baby #4 is a post-tubal-ligation miracle. I was 35, unprepared for pregnancy in every way and was a completely overwhelmed primary caregiver for 3 young kids throughout. (Two thumbs down. Don’t try that at home.) When I found out I was pregnant, my A1C was 6.8 (I got it down to 6.1), I was at least 30 pounds overweight, and my lifestyle was… just survival. Very stressful. (Twins babies/toddlers are intense.)

So far, all my kids are completely healthy. You get extra OB visits, tests, etc… It IS a lot of extra work, but not to worry! You can have T1D and healthy babies (twins! Surprises! You never know!). No point in worrying anyway: it just messes up your blood sugar. :wink:

My average non-pregnant A1C is around 7 (6.5-7.2 maybe). I am not motivated to make glucose control top priority unless my child’s well-being is at stake, evidently. Sure, 40 weeks seems like a long time to engage in extreme behavior (e.g. no dessert?!?), but when you see the little flickering heartbeat, it really is inspiring. It is easy to do anything, give up anything, to keep your child safe. Gestation is less than a year. When faced with a lifetime, (up to) 40 weeks of pregnancy is nothing.

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A beautiful testimony Lauren to what you have achieved! Inspirational.

You have done what you wanted and managed diabetes to allow that.

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If you are able get an insulin pump and CGM stat. I was not on an insulin pump until I turned 25 and it was a real life saver for me. My A1C’s were always in the 7’s and 8’s until I got a pump. Prior to pregnancy, it was 6.2 and during pregnancy has been below 6 (never in my life did I ever think I would have an A1C below 6). But when you know there is more involved than yourself, you get the job done.

In terms of diet, remember that sugary foods and high-processed foods will make your blood sugar rise dramatically (even my Bran Flakes I have for breakfast) and high-fat foods will make your blood sugar rise hours after you have eaten. This is still something I struggle with even though I can count carbs well, not all carbs are created equal.