Lowering/maintaining a1c for pregnancy

Type 1 and LADA
1

I am 31 years old. My last 3 a1cs were 7,7 and 6.9 despite being on a pump and CGM. My endo said I should be at 6.5 before starting to try. I know I have to improve my eating habits, but it just seems impossible that my post-meal blood sugar should be 150 or below. At least 1 a day my BGs get up to 200 at some point. How do people with good control do it? Both before and during pregnancy? Are you eating the same foods consistently? Maybe I need to go back to basics and learn to count carbs and eat again. My best a1c was right after my T1 diagnosis and it's never been that low since.

I have this fear that I won't be able to achieve a good a1c (i.e. what I call diabetic "infertility") or I'll do it but not be able to keep good control for months and months required to have a healthy pregancy.

2

I think that it is always good to go back to basics. If you haven't studied things closely since diagnosis it would be really worthwhile to do some homework. One good book is "Pumping Insulin" by Walsh. Another good resource is "Diabetes Solutions" by Bernstein. Although you say that postprandial numbers are a problem, it would probably be good to start at the beginning and make sure your basal is set properly and then make sure your ratios are all tuned up. But more importantly, many people find that lowering the amount of carbs in their diets can dramatically reduce their blood sugar swings form meals. I have also found maintaining "consistency" in my meals helps. It doesn't have to be the same meal, but keeping meals with similar amounts of macronutrients and total volume helps. With consistency, it is easier to make adjustments to fine tune your postprandial numbers.

3

Eating the same thing is a useful idea. One thing that helps me immensely is to use a scale to check serving sizes. If I'm going to eat some sort of garbagy junk food, being able to weigh it and know precisely what I'm eating can help me make decisions. Chips are horrible however a bowl (28G) of chips is better than say 1/2 the bag, both on your glucometer and your pantsometer and anything else you might measure.

I also use Lose It, a food app, that will count carbs (along w/ protein and a bunch of other stuff...) and seems to help me tighten up. It's a bit of a chore for a week or so until you have filled it up with your "usual suspects" and then you can put things in. If it comes in a box w/ a UPC code, you can scan the nutrition info in with your phone.

That being said, I totally attribute part of my success to eating pretty conservatively and often the same thing for much of the week. It's almost gotten worse as my daughter brings her dinner to school several nights/ week for poms/ dance team so I just eat on my own, low carb, high veg, flat BG. Good luck!!

4

Prior to an unexpected pregnancy, I was on MDI and switched to a pump. I did not use a scale to measure my food. I used measuring cups, packaging cues, and a lot of eyeballing. So measuring my food more accurately with a scale helped. I also started to eat throughout the day instead of big meals. This inadvertently created a ton of overlapping doses and it helped me keep my BG down. Doing all of this, I managed to get my A1c down from 7.2 to 5.8.

By the way, it's really important to have your BG no higher than 120 during delivery to avoid your child needing glucose to treat a hypo after delivery. I managed to nail that and my daughter needed no treatment. My younger sister, however, who is also a type 1 diabetic was not told by her healthcare team about this. I had to tell her. But she never had her BG under good enough control to get it and keep it there during her delivery. So my nephew did require treatment. I just wanted to mention it because it really bothered me that my sister was never told anything about it despite receiving care from Joslin Clinic.

Best of luck to you!

5

I would try go lower carb, if you can do that. Good luck!

6

+1 Brian

I obviously can't discuss pregnancy with any credibility, but counting carbs is a basic technique that pays off for any diabetic in any situation. If you know what exactly what you're eating, you can figure out exactly (or awfully close) how to match insulin to food -- which is the bedrock foundation of good control anytime, anywhere.

7

Hi Yu Shing,

I'm so glad you bring this up!

I had my first baby last February 2013. I can remember all the same fears you're experiencing. I had a lot of anxiety.

I conceived with an A1C of 7.2% and was told to work for an A1C around 7.0% or lower. My doctor was happy with 7.2% though.

Today I have a healthy baby boy and he was worth every ounce of work.

One tip I can offer is to test, test and test. I've never been a great carb counter but I do test frequently to catch post meal highs. If I catch them early enough then I can act quick and prevent long hyperglycemia periods.

I do not eat the same foods everyday, boring. I get more concise with carb counting when pregnancy planning but like I said I test frequently, like 1 hour after each meal and snack.

A quick refresher with a dietitian won't hurt. I also found it helpful to have carb counting tools on my phone to help estimate.

One final tip is that I balance each meal i.e. carb, protein, veg. This way the spike in my sugars is not too dramatic as it would be if I just had a big bowl of rice. Protein, fat and fibre slow down how fast sugar goes into our bloodstream.

Oh and I look for delicious but low carb treats, I'm human after all. I tended to eat chocolate when planning my pregnancy because it doesn't make for a post snack high. I'd also treat myself to a sugar free and caffeine free latte at my favorite coffee joint.

Don't be too hard on yourself, you are doing an awesome job. You are your pancreas and that's freakin' hard. You can do this.

I'm in pregnancy planning mode now too for baby # 2, so I'm right there with you trying to achieve a great A1C and trying not to freak out too much since this disease does not give us a break!

If you're interested in following my journey check out my type 1 diabetes pregnancy blog.