My Tips for Pregnancy with Type 1 Diabetes

Even though I’m only 28 weeks in, I feel like I’ve learned a lot about type 1 and pregnancy and since there are so few resources out there, I want to share, so other women can have it slightly easier and learn from my trial and error.

  1.  Lows in the First Trimester: You are going to have tons of lows the first semester.  So many that it can be hard to do your normal job, function as a human, exercise, etc. In my first trimester my basal insulin was 75% of what it was before pregnancy.  I was taking 15 units of basal a day and sometimes wouldn’t bolus for meals.  This is a really odd pregnancy phenomena and I’m not a medical professional but I believe it is caused by your body working overdrive to create a new human (it’s like exercising 24/7 – which would cause lows).  The reason this only lasts the first trimester is because your pregnancy hormones haven’t skyrocketed yet.  The hormones are what cause insulin resistance.  Unfortunately all these lows occur at a time when you may be having a lot of nausea – not a good combo.  I was at a point where I would just look at a fruit snack and throw up.  Instead I kept whole cans of regular ginger ale everywhere – in my purse, in my desk at work, next to my bed, on the coffee table.  My stomach could handle the ginger ale and they were good at bringing up lows.
  2. Food:  I cannot stress this enough: try to eat the same amount of carbs at each meal.  It makes adjusting insulin doses 10x easier.  I eat 31g of carb for breakfast, 40 for lunch and 40-45 for dinner.  This can be challenging but try to incorporate a lot of meat and low-carb veggies into your meal plan.  The fewer carbs, the more I have been able to control my blood sugar.  When I have the same thing every day I am no longer using an insulin to carbohydrate ratio, I am bolusing a flat rate – like 5.2.  This makes it easier for both myself and my doctors to adjust dosing.
  3. Walking:  In the midst of all the lows you may get frustrated about not getting over 70 after chugging regular soda for six hours, and accidentally have too much.  Pregnancy makes coming down from highs a LONG process.  Walking increases the insulin absorption so you don’t continue to give insulin after you don’t see a blood sugar come down after 30 minutes.  I would often take a lap around the office, around my neighborhood (my dog doesn’t mind the extra walks), or even walk up and down the length of my backyard.  Walking also helped me with the stress of high blood sugars.  Every time I went above 140, I would freak out that I was hurting my baby and as the minutes passed it became increasingly stressful.  Walking not only occupies your mind, but gives endorphins to ease the stress – because we all know high risk pregnancy is stressful!

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    28 weeks pregnant – it’s very hot in Kansas right now.  This is the third shirt I wore that day

  4. Exercising:  I kept running through week 18 of my pregnancy.  It helped me maintain a little slice of normalcy in a life that was taken over by food choices, insulin, blood sugars, and crazy hormones.  I’ve written before about this, but I have been a runner my whole life so having something familiar was helpful for me to maintain a level of sanity.  My doctor said I could keep running until the day I deliver (actually several doctors said this) because I was a runner before pregnancy.  However, that was until I was put on modified bed rest for my short cervix in week 20.  I am now off modified bed rest completely and can do elliptical (but no running).
  5. TRY not to Stress about every out of range blood sugar:  I am not the poster child for this, but I would urge you to at least try.  We are only human and dealing with pregnancy while missing a functioning organ.  That’s stressful enough.  Don’t add to it by punishing yourself or feeling too guilty.  There have been days when I have had blood sugars over 200, but they are rare and came down.  The thing is that I did something about them, I gave insulin, I walked, and that’s all you can do!  And try to learn from it and do better tomorrow.  I cannot stress enough, TAKE IT ONE DAY AT A TIME.  It’s a marathon.

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    Me and my dog goofing around in the backyard

  6. Highs in the second and third trimester: Your insulin needs keep increasing because your baby growing hormones act as insulin resistors -fun! (Not)  Before pregnancy I would rather be higher if I had to guesstimate an insulin dosage or carb-count, but in pregnancy I ALWAYS over-guesstimate my insulin.  Yes- being low sucks.  I know that all too well, but in pregnancy even with walking and insulin, it takes FOREVER to come down from a high blood sugar.  You think it takes a long time to come down from a high before you’re pregnant – ha!  Try waiting 8 hours!  Lows take 15-30 minutes to treat, so I always over compensate for carb-heavy meals.
  7. Drink lots of water:  For a lot of the pregnancy I have been drinking diet caffeine free soda (my one vice right now…and cheese) but recently I have started drinking more and more water.  It has really helped keep my blood sugars regular and consistent.  I have no idea why this works.
  8. So much Insulin: I’m now taking close to double what I took pre-pregnancy and I’ve only just begun the first trimester.  In my second trimester before I filled my next 90-day prescription, I called my endocrinologist and told them I was pregnant and that I needed a larger prescription.  She not only wrote my one for 75 units a day (I’m taking only 45 now) but increased my test strip prescription from 8 times a day to 12 times a day.  Now I don’t have to worry about running out of either.  I’d highly recommend you doing the same, especially if you’ve already met your out of pocket max for the year.  Us insulin-dependent preggo girls have enough on our plates without worrying about insurance!
  9. Treat Yo Self:  This is hard.  Definitely one of the most challenging things I’ve ever done.  Making yourself feel good is something you can control.  I’ve had 3 prenatal massages this pregnancy and every time I feel amazing afterward.  I also make time to get my nails done and do spa days at home with soothing face masks.
  10. Get the help you need:  My pregnancy has been very challenging.  a) I miscarried one of the twins at 8 weeks. b) I had 8 weeks of bed rest and 2 trips to the ER  c) I have type 1 diabetes- which is a never ending challenge on it’s own.  I asked my OB/GYN if it was normal to be angry and sad all the time during pregnancy.  She said they have a special psychologist in the OB/GYN department to help women going through stressful and/or high risk pregnancy.  The psychologist also sees women postpartum.  I made an appointment because sometimes it’s just nice to talk to an unbiased third party.  As much as my husband is good at listening, he is not a professional.  My first appointment is in a couple weeks.

Update on my pregnancy:  I’m now 28 weeks in and well into the third trimester.  I am excited because all of my hard work is paying off!  At my appointment a few days ago my baby measured in the 47th percentile- no signs of macrosomia or any diabetes-related complications.  My doctor said “There is no indication your baby is even aware the mother has diabetes, you have been managing it so well”.  What a relief!  I have an A1C check coming up so am curious how that will go.  I doubt I will have maintained that 5.5 from April, but that’s ok.

I’m not sure how, but I have only gained 14 lbs this pregnancy.  I eat all the time!  I’m considering myself lucky, for now, but I expect as the baby gets much larger the next 10 weeks I’m going to be packing on the pounds.  Oh well.  I’m not that concerned because I’m sure it will come off when I am running again.

I am coming into the home stretch and weeks 28-36 are vital to maintaining good blood sugar control, because it is when the baby has the most rapid growth.  So yes, this is going to get harder before it gets easier but I am ready because I can see the finish line!

-Grace

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