Ivf and pregnancy for type 1 diabetic at 43

Hello, I’m 43 years old and have been type 1 since age 12. I’ve been controlling my blood sugar to prepare for conception, we will be using an egg donor through ivf. I’ve been on the pump for 6 months and have gotten my A1c down to 6.3. This has been a huge struggle. My bg seem to fluctuate and sometimes I can’t eat when I’m hungry because I’m trying not to eat when my bg is over 130. It can take an hour or 2 to lower my bg is it’s above 180. Working very closely with my dr. I want to know if anybody can help me learn about how they have maintained control through an ivf cycle, and what I can do to keep a healthy pregnancy for a full term. I’m especially interested in any type 1, juvenile onset women who have gone through this later in life. I’ve read that target bg for pregnancy is between 100-130 post meal, not sure how that even works without going low. Any help is great. Thanks!

I did one round of IVF (successfully) when I was 38, two years ago. Have been on the pump for the whole duration of my T1D, which at that point was 10 years. It’s great that you have been bringing down your A1c and you can certainly continue to do so as you only get more comfortable with using and fine-tuning the pump by yourself. (Of course until then it’s good that you have a doctor you’re working closely with. Is this an endo or what kind of doctor? How familiar are they with pumping? What is their philosophy on recommended ranges? I am asking because you want to get your BG to be as stable as possible, which the functionality of a pump helps with tremendously, but you need to know how to do it. If that doctor is not fully capable of helping you, seek other resources, such a your pump manufacturer’s trainers or even a company like Integrated Diabetes.)

As far as the IVF procedures and medications – in my case I didn’t notice any difference in my insulin needs until conception and implantation happened. I am sure this differs from person to person however. My personal (even pre-pregnancy) target range is actually fairly tight (70-100 pre-prandial and 80-140 post) and so I only experienced a minor shift in what I was aiming for while pregnant. I did read a lot to figure out what to expect during the pregnancy, as those 40 weeks are indeed a bit of a rollercoaster with all the hormonal changes that happen in the body. But it’s totally doable!

I am happy to talk more here, but am not sure what specific questions you have. Good luck whether you write more or not!

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Seeing an endocrinologist and diabetic nurse practitioner at Kaiser. Right now my target is 90. I hope they will lower my target soon, as I plan on going through ivf w an egg donor in May. I’m struggling because my bg are still a bit high despite changing my diet. This morning I had a spinach omelet, very low carb, started w/a 100 bg, yet went up to 140. It took an hour for my bg to go down. That’s fine for right now, I’m just having a hard time seeing how I can have a range from 80-140 all the time. I’ve been lowering my carbs and eat pretty healthy. Can you let me know how you got tighter bg? What changes happened w/your insulin at implantation, first month of pregnancy, 1st trimester, 2nd, and 3rd? What resources helped?

An endo and diabetes nurse sounds like a good combo. I imagine a target of 90 is what you have set in your pump and that sounds like a great number to aim for as well. That’s slightly different from what I meant when I wrote about my target ranges. I don’t believe a lower pump target is actually advisable, but of course discuss with your team. Instead you might need to change (in small increments of 0.1 until you hit the right for you numbers) your I:C ratio if you consistently find your current rate leaves you with a post-prandial that’s higher than you aim for. But you should also make sure your basals are set right throughout the day. One great feature of the pump is that you can have different rates depending on how BG might fluctuate. For example, I used to have just one rate for the longest time, but once I notices I was waking up higher than I wanted to be, I raised the midnight-6am rate to deal with that issue.

Aside from fine-tuning pump rates, I would suggest you consider whether exercise is a part of your regimen you can optimize too. In my case working out after dinner is hugely beneficial. I know that’s not for everybody, but as a more general case, working out after any one meal you have the time for seems to work great to help keep the post-prandials good (while of course taking a smaller bolus so that you do not go low, depending on the intensity of the exercise).

I don’t do low-carb, but I do have some carb limits that I know help me. I naturally eat about 100g a day; if I consistently go over that for days, I absolutely notice a difference. Also if I have over 45g at any one meal, I have to use dual bolus and sometimes also raise my basal a touch for several hours after the meal to have a better chance of staying in range.

These are all ideas from pre-pregnancy that I have gleaned from this forum (the Flat-liners discussion in particular), as well as two books I read when I was first diagnosed and went on the pump, Thinking Like a Pancreas and Sugarsurfing. Not sure if you are familiar with them, but I would recommend those as a start.

For diabetic pregnancy resources, I have to dig out some of my own older posts here (in the Pregnancy discussion) to remember the exact titles. Maybe in my next reply.

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I am a 39 yr old T1d (diagnosed 30 yrs ago) and am currently 13 weeks pregnant with my first via IVF. This book was a game changer for me: https://www.amazon.com/Pregnancy-Type-Diabetes-Month-Month/dp/1544267347

Just using the prebolusing and GI concepts alone makes a huge difference with lowering post-prandrials!

Happy to answer any questions about my experience!