I wrote this post about 5 weeks ago, but hadn’t yet gone public with the pregnancy yet. Here it is:
I had my first visit with my High Risk OB Center for Advanced Fetal Care at week 8 of my pregnancy. After referring me, my regular OB/Gyn warned me, saying that this particular hospital is stricter than most. She was right. She prefaced this by saying I am doing better at diabetes management than 99% of the expectant mothers she has seen. That felt good, considering I’ve been working so hard at it for 15 months now. My A1C is currently 6.2, and she said she has seen expectant mothers with Type 1 come into their first prenatal visit with an A1C of 13.
My first experience was talking to the High Risk OB on the phone after I had emailed his nurse my CGM (Continuous Glucose Monitor) and Insulin Pump reports. He explained that he has not always worked at this particular hospital and feels they are more strict as well. He explained to me that usually most expectant mothers will be admitted to the hospital for 1-3 days when they first start High Risk Maternal/Fetal Care so that the doctors can work on setting their insulin to carbohydrate ratios, their basal rates, and food intake. After speaking with me for 40 minutes, he felt it was not necessary to admit me 1) Because I am not hypoglycemic unaware and 2) Because I seem to have a very good handle on my diabetes management.
**What is hypoglycemia unawareness?
A good definition from medicinenet.com: A complication of diabetes in which the patient is unaware of a deep drop in blood sugar because it fails to trigger the secretion of epinephrine which generates the characteristic symptoms of hypoglycemia (such as palpitations, sweating, anxiety) that serve to warn the patient of the dropping blood glucose. The patient can then take action and eat to help reverse the hypoglycemia. Hypoglycemia unawareness can result in prolonged exposure to hypoglycemia, resulting in a seizure, loss of consciousness, or brain damage.
Basically having low blood sugar more often means my body gets used to the lower blood sugar and doesn’t show symptoms of it any more.
When I spoke with my high risk OB/GYN, he told me the blood sugar goals they set for type 1 expectant mothers:
- <85 mg/dl for Fasting
- <110 mg/dl 2 hours after a meal
- Eat the same amount of carbohydrates for each meal, say 40g for breakfast every day and 25g for lunch
- Don’t use the bolus wizard feature of the pump, just give the same amount of insulin every day
It was about this time when I started to get frustrated. He just told me to move the sun. For those of you that don’t know, these guidelines are very strict, and basically better than a person that has an actual functioning pancreas. I don’t have a cape! (Although, my husband does sometimes call me Super Grace) I work my butt off every day relentlessly to achieve the blood sugars I have currently. It’s almost as though I’ve been running a marathon and someone moved the finish line 10 miles farther when I found myself at mile 25.
I asked the high-risk OB if the goals were actually realistic (they believed I can achieve them) or if they are “reach-goals” and the team hopes I end up close to them. He said a little of both. Okay, not helpful.
I then asked if there have been any studies done on the negative effects the guilt and high-stress of maintaining such strict guidelines has on the mother or fetus. He said no and that it is a very good point. He fully understands the emotional and stressful situation I have walked into – and I appreciate that.
He then explained the goals they set are based on something I like to call “correlation does not imply causation”. Women that achieved these goals had healthy babies, but there is no evidence that concludes the reason for the healthy babies was the strict blood sugars. Women with very good blood sugars (like me) also have healthy babies. Unfortunately, we are at an odd point in history. Fortunately women with type 1 diabetes are able to have healthy babies now due to advances in care and technology. Unfortunately, this has only been for the last thirty years, so there is not a lot of data available.
As a side note, I have dealt with extreme guilt over the past few weeks. Every time I have a blood sugar out of range it’s hard not to believe I am “hurting” the baby. Although, the diabetes team, my endocrinologist, my certified diabetes educator, my regular OB, and a slew of nurses have told me it’s not one blood sugar that causes negative impact, it’s a trend of them over a long period of time, it’s hard not to feel guilty. I imagine, this is something I will have to learn to cope with over the course of the pregnancy and will require a little *ahem* Grace.
The good news:
- I will continue to see my regular OB, who is wonderful.
- I have been cleared to run and have been allowed to manage my own blood sugars for this activity. (Running reduces my stress level more than any other activity and I am grateful for this.)
Type 1 Pace 