My husband and I are starting to prepare for trying to conceive. We want to start trying at the end of October and we're really excited! Over the past 6 months or so my blood sugar control hasn't been the best and I'm trying to get back on track so I can have a healthy pregnancy. It's not as easy as I thought it would be, especially after I was in the habit of not taking the best control, but I'm focusing on health and a baby now, so that's helping keep me on point. I'm nervous about blood sugars and everything that comes along with T1 while pregnant, but I'm ready! Does anyone have any advice at this stage in planning and pregnancy? I'd love to hear from you!
What an exciting time for you! Good for you for taking control of your health now before you conceive.
I'll just tell you what I wish I would have done: changed my diet and gotten used to it before getting pregnant. I'm following a low-carb diet now (22 weeks pregnant with #2) on the advice of Dr. Lois Jovanovic, and it's really helping a lot, but it was hard to get used to at first. I wish I would have gotten used to it and gotten in better control before conceiving. Also I wish I had established a solid exercise habit before conceiving.
You can always start new habits at any time, of course, but I think for myself anyway, it can be easy to use pregnancy as an excuse not to do the right thing (as in, I'm too tired to exercise, or I'm too nauseated/hungry to eat right.) It's easier to keep going with a good habit once you get started.
I was in the same place last year. I am currently 19 weeks pregnant with our fist child. Here are some of my thoughts:
* I agree with what Louise said below. Establishing good eating and exercise habits beforehand is important. I felt like even though I have done those things, once I got pregnant I was so tired that it was hard to find motivation to get to the gym or cook healthy. If I didn't have these habits already, I think it would have been even harder.
* Also I recommend getting a CGM, I had decent a1cs before the CGM but was able to bring them down to 5.5-6% range once I got on it;
* The hardest part for me was the waiting part once you start trying. I am very much goal oriented and it took us a while to get pregnant, so every month we were not pregnant I kept going through my head of what I was doing wrong and how diabetes might be affecting all of this. What I have learned is that sometimes it just takes time and diabetes has nothing to do with this.
* read www.sixuntilme.com. Kerri is a t1 diabetic and she has blogged about her whole pregnancy, including bad and good times. I also recommend Balancing Pregnancy with Pre-existing Diabetes by Cheryl Alkon.
Good luck! My favorite saying from Kerri's blog: diabetics have healthy babies all the time.
I agree with all of what sweeterthanhoney says, too. Definitely, definitely get a CGM if you possibly can afford it. I guess some people like the Minimed one, but personally I had a hard time with that one but LOVE my new Dexcom G4. It is so, so helpful in seeing what's going on at night and what happens post-meal, especially. I'd recommend reading the article I posted awhile back by Dr. Jovanovic, too. And you may need to adjust your thinking of what an acceptable and what a low blood glucose is, depending on your current targets.
Also, emotionally, prepare yourself for the fact that no matter how hard you work and how awesome your control is during pregnancy, diabetes-related things may still happen (a big baby, a NICU stay, preeclampsia, etc). So try to prepare yourself for those possibilities so that you won't beat yourself up about it later (again, speaking from my own experience).
It gives some "what to expect" info with regards to diabetes and pregnancy as well as some examples of how other women with D have managed it. I found a copy at my local library. Good luck!
Coming a bit late to this thread, but popping in to say thanks for the recommendations for my book, Balancing Pregnancy With Pre-Existing Diabetes: Healthy Mom, Healthy Baby.
In addition to Amazon, you can also buy autographed copies from me via Paypal. Please email me directly if you're interested, at Lyrehca AT gmail DOT com.
Also, while it's old, my blog chronicled my efforts to get and stay pregnant with type 1 and eventually, infertility. It's Managing the Sweetness Within at www.thesweetnesswithin.blogspot.com. My kids are now 6 and almost 3, and I stopped blogging just after the youngest was born.
I thought that I would never be able to get the control that my endo wanted for pregnancy, but I did it (now I just have to try to do it again!!!).
For me, bolusing 20-30 minutes before meals (while watching for lows) helped me to avoid spikes. I also ate more frequently, but lower carb. All of my carbs came from fruit, dairy, veggies, and whole grain. I almost completely dropped junk food during pregnancy. I have to admit that it was easier to stop myself from eating too many potatoes than it is to tell myself not to finish that chocolate bar. I know that others can do things in moderation and it works for them. For me more extreme changes, eating on a schedule and limiting carbs worked.
I just wanted to pop back in and update! My sugars have been amazing and as long as my A1C is good when I get it checked in a couple weeks, they'll give me the go ahead to start trying. I'm so excited and I can't believe that I've actually been able to get control over my sugars again. The thought of having a baby to care for is motivating me beyond belief and I have something so special to look forward to! I've been getting the cart before the horse, though... I'm already pinning baby stuff on pinterest! Whoops! :)
Hello! I would recommend getting into a regular habit of eating better and taking better control of your Hba1c. Meet with your endo and let them know your pregnancy plans, so they can help you get your blood sugars on track. I would also recommend getting active on a regular basis. Finally start taking a woman's daily multi vitamin that has at least 400mg of folic acid. I did all of the above for a year. Took some time to get my Alc to where the doctors wanted, but it was well worth the wait. Hubby and I are pregnant with our first! I am only about 6 weeks along, but I couldn't be happier!
That's really interesting that you are bolusing 20-30 mins before meals. My docs have never mentioned that approach and I normally wait 5. Even then sometimes I'll go low 15 mins after I bolus, while I'm eating (I only really know that from my CGM). Do you have a problem going low to early?
Right now I'm eating pretty much just as you describe - though with a bit more chocolate thrown in ;) - and having annoying 150s/60s after lunch and dinner that just sort of linger... Doesn't appear to be basal related.
Also do you do the same thing if you're doing a combo bolus?
I'm not pregnant yet but we're trying! Very timely discussion!
In case this helps: when I'm not pregnant, I can only bolus 10-15 min before a meal without going low, especially if it's a big bolus and/or I'm eating a lot of fiber or protein along with the carbs. When I'm pregnant, I need to wait at least 20-30 min and should probably wait longer to avoid spiking. It's crazy how things change once you have all the pregnancy hormones taking over your body!
Hi Laura, I found that bolusing 20 minutes before I ate would also send me low too quickly when I was using Novolog insulin. However, my insurance changed and now I'm on Humalog, and I find that bolusing 20 minutes ahead works perfectly now. It might depend on which fast-acting insulin you're using!
I am 13 weeks pregnant now, and I'm paying very close attention to the timing of my boluses to try to minimize post-meal peaks! Unless my blood sugar is below 70 or 80, I try to wait 15-20 minutes before I eat. If my carb counting is accurate, I have rarely been above 110-120 an hour after eating, so this method seems to be working so far!
Oh my doctor didn't tell me this either. I think that I learned it here on TuD too :) In fact my doctor begs me NOT to do this. It is true that it can be dangerous if I wait even just 5 minutes too long.
We are all different. If I was under 90, then I only waited 10-15 minutes. If I was over 90, then 20-25. Above 150, then 30.
Try this, but only when you are sure that you will catch the possible lows, as it can be dangerous. It will be helpful that you have a CGM. I was really just guessing things as I don't use one.
I almost never use a combo bolus, as I never found how they could work with me. The only time that I do it is with pizza. Then I wait too (if I have the self control).
I never thought that I could do this, but my 1 hour spikes were almost never above 140. Still somehow I never managed to get that A1c under 6. I was having very few lows most of the pregnancy because my endo always adjusted to stop them. I know that others have/had much better control.
This is interesting Jenn! My endo switched me to Novolog because she said that it acts more quickly. (I was using Humalog when I first told her that I was bolusing early and she did not like that!) I didn't really notice a difference.
Congrats on the pregnancy and way to go with the awesome post meal numbers!
Of course the day after I posted my comment, I decided to treat myself to cereal for breakfast. I carefully measured out my portion, bolused 20 minutes in advance, the whole nine yards. And of course I was 200 an hour later. No more cereal until after the baby comes!! :)
Thanks for the great feedback, everyone! I'll be trying it out to see how it can work for me.
As for combo bolusing - I use it for meals that are either carby & fatty (like pizza) but I also find it really useful for meals that are the total opposite - low carb and high in fiber/protein. I find that really low glycemic meals digest more slowly but also for a longer period of time. I do like a 70/30 split for 1 hr on those types of meals (like say a massive salad with beans) and it really does the trick.
Hi, I am a little late to this but just wanted to share my experience. I am using the Pregnancy program at Joslin and started it about 4 months prior to conception and also started an insulin pump prior. I would highly suggest getting an insulin pump if you don't have one already. I was super hesitant but with all the adjustments I have had to make in pregnancy I am so happy I did it. I did not get a CGM because my insurance wouldn't cover it but I think that would be incredibly helpful as well.
I am just over 31 weeks now and the baby is measuring right on schedule. My last A1C was 6.2. It has been challenging managing blood sugars throughout pregnancy but I have a great Dr that I can email whenever I have a couple of days of off numbers and make adjustments quickly. Like others I have found that I need to bolus about 30 minutes prior to eating. Which is hard because I am so hungry sometimes! But it does help. I also found that there were certain foods I could eat pre-pregnancy that really spike my blood sugar now and other foods that I used to avoid that somehow seem to be ok now. For instance milk or cereal really raises my BG but I can eat Mexican food now? I'll take it but it is a weird one. So just be ready for some curveballs.
My best advice is make sure you have a good Dr that will be responsive so you can make adjustments quickly. Also a Dr that is supportive and understands the struggles we have. When I had a week of highs and my baby was measuring ahead I felt horrible about myself, like I already failed as a mother. My Dr was great at helping me understand that this just happens and I did everything right. My next appt baby was right on track again.
Good luck with TTC. I was very lucky to get pregnant in our first month trying. Part luck but also part knowing my body and tracking BBT's using www.fertilityfriend.com. I highly recommend it!
