BG goals in pregnancy seem very aggressive!

[Marissa_C]

Hello ladies!!

I’m newly in the thick of my second pregnancy. I’ve been diabetic (T1/LADA/MODY/something like that) for about 8 years now. My first pregnancy was in 2012, and I went full-term and gave birth to a wonderful, healthy baby boy.

So my issue is, I got a positive pregnancy test back a couple weeks ago, and I’ve been talking to doctors since then. It seems like the BG goals they’re telling me are even more aggressive than they were 4 years ago, and those were bad enough!

My memory from 2012 is, 140 1 hour after a meal, and fasting in a “normal range” (100, I suppose?) When I got my positive test back a couple weeks ago, I let my endocrine practice know, and I got a call from a doc there (not my doc) who confirmed the 140 1-hour-after guideline, but also said my fasting should be 90, which started setting off my alarm bells.

Then I went to see an OB, who said I should be at 135 1 hour after a meal, and fasting “60 to 90,” with her preference being lower in the range!! What?? Is there any diabetic who feels good hanging out at 60? Am I seriously supposed to aim to wake up at 7 or 8 in the morning at 60 or 70? That is getting so close to the razor’s edge that it feels crazy to me.

Last pregnancy, I did not have a CGM, but now I have a Dexcom. I can’t even tell you all how many low alarms I’ve had over the last couple weeks. My recollection from my first pregnancy was that I would sometimes go low 2 hours after breakfast, but I wasn’t suffering from lows all through the day and overnight.

I’m not sure how I’m supposed to live like this, having my sleep interrupted almost nightly by my CGM squawking at me that I’m gonna die. I was at the gym last night and went so low that my CGM didn’t even give me a number; it bottoms out after 40.

Meanwhile, I’m also being told that I shouldn’t gain much weight during this pregnancy, since I’m already fat (with no thyroid and no pancreas, weight control isn’t exactly a picnic). Well, I’m not sure how I’m supposed to not gain much weight when I’m horfing down rescue carbs left and right.

I feel like medical professionals’ standards for me are impossible and dangerous, and that they would know that if they had ever had this experience themselves. But the last thing I need is for them to decide I’m non-compliant or that I need a C-section at 32 weeks or whatever. I don’t know if I’m looking for solidarity or comfort or a kind word or what, but I’m losing sleep over this, and I just wanted to talk to people who might understand.

[swisschocolate]

Hi there
Just some perspective. Remember that what your doctors told you is nothing but medical ADVICE.
Doctors are not here to set rules, but to give advice from what they know. You are free to follow that, but you dont have to.
now i know that is easier said than done, especially with a baby on the way and the responsibility for a new life, but all those guidelines are based on studies done with many women. Everyone is different. you know your body best. Nobody is going to fine you or put you in jail if you dont follow the new rules. you had good experiences following the old rules in the past.
Hypoglycemia is dangerous as well. If you feel that you would be better off following the old rules, there is nothing there to stop you.
If you are in the hands of good doctors, they wont decide on a c-section based upon your glucose levels, but on the health of your baby and you. You have the last word in everything, even a C-Section. They will give their opinion, and usually we follow that, as they are better trained in that field, but again, you can decide in the end.
Sometimes we forget that and see our doctors as some kind of authority. Don’t see this as me trying to persuade you not to follow any doctors rules, just know that you are free to choose.
All the best and good luck.

[Thas]

I’m not a doctor, and (obviously0 I’ve never been pregnant , but I have heard that recommendations for target BG (and resulting A1c) for pregnant women with diabetes have been lowered in recent years. From what I’ve read, those guidelines are in line with what your doctors have suggested. That said, I think you - and they - have to consider you individually. If you are not comfortable at those levels or cannot maintain numbers like that “safely” (or at least such that you feel safe), you should discuss this with your doctors and adjust accordingly.

Neither you nor your baby will be healthier if you are constantly anxious about your BG, losing sleep, and just going thru the day in fear. You have already had a safe, healthy pregnancy at moderately higher target BGs, so I think you have good cause to talk to your doctor and advocate for more attainable targets.

[busybee]

Hi @Marissa_C,

Congratulations! What joyous news! I’m so excited for you.

As much as I love babies and children, diabetic pregnancies are a mix of positive and negative emotions for me.
I’m on my last pregnancy, I’m 34 weeks now on my 4th child, 2nd T1 pregnancy.
My first one was in 2013. I have to say, even from 2013 to now, the guidelines have gotten stricter!
You are right, it used to be 140 1 hour after a meal and fastings were 100-115. Now, from what I understand, high risk obgyns want us to be 110 or lower 1 hour after a meal and for fastings 100 or under.

I totally agree with you and have commented on this to my numerous doctors. I attend a large hospital that has a specific diabetic clinic once a week. Its a flutter of residents, interns, and attendings. A lot of them are still learning and I know way more than they do. They do have attendings overseeing and popping their heads in to talk to me. My a1c for last pregnancy was 5.7-5.9 and this one has been pretty steady 5.9. As long as I’m 6.0 or under for my a1c then my doctors don’t pester me a lot. Obviously, they still analyze everything to death but its far less than if my a1c was higher.

The reasoning behind all of this stricter mess, is that your baby isn’t diabetic and its normal for a nondiabetic to be at 60 for a fasting and 100 or under for 1 hour after meal. The idea is to make things as “normal” or nondiabetic as possible for that nondiabetic baby. Although, we don’t live in a bubble and we make mistakes and hello, the vessel is diabetic!!
Even though it was difficult for me to hear all of this, I have learned from experience that your body will get used to a lower level of blood sugar level. I used to get shaky at 90, now I don’t shake and tweek out until I’m at 60. You have give your body time to acclimate to this change, but it will happen. My doctors told me the same thing and I thought they were on the moon, but they were right. Have a lot of glucose tabs, juice and snacks with you.
I also found this pushed me to eat smaller meals throughout the day, which is really what we should be doing anyway, pregnant or not.

I’m on a pump and CGM too, I was for my previous pregnancy and this one. And yes, my alarms were going off all the time. I had to adjust mine to ring off at a lower number so they wouldn’t go off so much. Nights were particularly nasty for me as well. I was in the 40s a lot too. Keep juice by the bed. For most of the 1st and 2nd trimester I run lower, now I’m in the 3rd, i run more high which is frustrating.

All this said, I do have to agree with @swisschocolate. Its just advice, guidance, guidelines. If you are in the range, you are not harming your baby. heck, I still have 8/8.5 lb babies. Its not big, big is 9 lbs+.
I still get cooperative doctors. Right now, my baby is measuring at 5.4lbs at 34 weeks. That is a little big but I have specifically requested that I wait to go into labor. My doctors have agreed up until 40 weeks. Now, I have agreed to have my membranes stripped before 40 weeks to “help the process along.” Their cooperation with your birth plan shouldn’t be contingent on you following the guidelines to the letter. There is some wiggle room.
I’ve never had a C-section, I have been induced once though. Not fun and do not ever recommend it at all, unless you decide on an epidural. I’m staunchly against pain meds so thats why I did it that way.

Personally, my BG goals during pregnancy are 115 or under 1 hour after a meal and 100 or under for fastings.
I think this is reasonable and safe for baby too. Every doctor is different. My docs know I’m compliant so they let a lot slide. They also know I know more than them about diabetes management. I have needed help from them but for the most part I don’t.

I wouldn’t worry so much about the weight. The BG management is way more important. I have no thyroid as well (Hashimotos) and I could care less about the weight thing. By the way, I haven’t had to adjust my thyroid meds at all with this pregnancy which is awesome!
I breastfeed after and I give myself time to work off the weight. It takes 9 months to pack it on, it takes a year and half or more for a diabetic to take it off. We do have priorities here!

I wish you the best. You are going to do awesome. Please don’t stress. Seriously, from one mom to another who has been exactly where you are, you are going to be more than okay. You are compliant and a good diabetic. Don’t let those docs tell you differently!

Busybee

[yourhanner]

My goal ranges are similar in this pregnancy. Fasting below 90 (they didn’t give me a bottom number, but I’ve been in the 70 - 80 range and felt ok). Pre-meal below 100. 2 hours post meal below 120. I’ve been able to stick within that range pretty well!

Definitely be careful of lows - I had to really adjust medication because I kept waking up in the middle of the night with BG of 30. Scary stuff! You’ll probably have to be in close contact with your endo, as you will probably find your needs changing throughout, due to hormone changes.

I am also a fat lady, and my doctor said that while there are target weight gain goals (I think they said for me 20 pounds or so), the only number I have to pay attention to is BG numbers. I am 13 weeks and haven’t gained anything yet.

My biggest advice - find a doctor who is willing to listen to you and really work with you. You don’t have to accept the first doctor you see. I shopped around a little bit, and found a practice that has been really excellent to work with.

[LauraCBower]

The goals are super aggressive! I’m at 24 weeks and I have my dexcom set to alert at 80 and 140. I definitely do not always nail the targets but overall the Endo is extremely pleased with my numbers. My last A1C was a 6.0, my best since the post-diagnosis “honeymoon.”

I mean, I still live in constant terror.

[MariaM2]

My recommended goals are 60-90 overnight/ and less than 120 2hr pp. I am a bit more lax in that I accept 60-120 overnight (according to my dexcom I am in double-digits for most of the night but I rise a bit in the am) and 60-140 during the day (I try hard to avoid spiking past 120 though and do correct at 2 hrs pp if over 130). Just got my A1C back and it’s 5.7 a my lowest ever

[rgcainmd]

Great job on a difficult task, Maria! When is your baby due?

[MariaM2]

Thank you so much! My due date is very close to Thanksgiving, I am between 11-12 weeks now