Newly Pregnant (long)

Hey everyone,
It's been a long time since I've visited tudiabetes, but I recently found out I'm pregnant (it was unexpected) and I figured it would be good to talk to other women in the same boat. Some recent history for me:(A LOT has happened recently, feel free to skip the next paragraph.)

My fiance got a job offer in my hometown in late September, with a start date of October 1st. We had about a week to pack up and transfer our classes (we're both students) for a 12 hour move. We stayed with my family for a little over a month, while purchasing our first home. About 2 weeks after we got here, I fell down and dislocated my kneecap (I'm clumsy). My insurance was a state-run program for Oregon, so it covered the hospital visit, but none of the MRI or orthopedic requirements. My fiance & I decided to get married so I could be seen in California under his new insurance. We had a sweet little 5-minute ceremony on October 7th in the backyard of the house we were purchasing, with plans to do a bigger ceremony with family and friends in May.
(We weren't scheduled to get our keys until the 30th, but the realtor let us in. She's a sweetheart.)

We were very busy, but things were going well. I took weekly pregnancy tests to be on the safe side, since I have really irregular periods (last period was in January). On October 24th, it came back positive. I freaked out, because I hadn't been taking great care of myself and my last A1c was 7.7. Since then I have been juggling doctor appointments, school, a new home, training our puppy, and all the paperwork of relocating to another state while being pregnant and diabetic.
We had to establish care with new doctors in the area (which was far more difficult than it should have been), get referrals and update prescriptions. My new Endo is great and helped me get back on the pump, which I started last week (Minimed 530G with Enlite). We had an ultrasound and found out that I'm currently 10 weeks along, and due June 29th. My A1c was down to 7.3 as of 10/28/2014, which is still not great, and I worry about it constantly. Hopefully the pump will help me pull it down quickly. We are now in our new house, which is amazing but has almost no furniture. We have a couch and an air mattress, plus all the appliances needed. It has been a rough start, but fingers are crossed that it gets easier and the baby is healthy.

Sorry for the book I just wrote, but I haven't had a chance to really talk to anyone about it all yet. It's only been a little over 2 months since we got a phone call with a job offer that changed everything. Are there any others out there currently managing pregnancy and diabetes? I feel rotten that this was unplanned (though not at all unwelcome) and that my sugars have argued so much during the critical early weeks.

Hi Amanda. First- congratulations! And second, phew! That is a lot to deal with. I'm not currently pregnant with diabetes, but I just had a baby 2.5 months ago, so it hasn't been long. I will just say that a) I know of lots of people who started their pregnancies with high A1c's (and in the 7's isn't really SO high) and had totally healthy babies, and b) no diabetic pregnancy is without high bloodsugars. Every time my BG went high I would freak out and be convinced I was hurting the baby, but she is perfect and gorgeous and healthy, and your baby most likely will be too. All you can do every day is try your best, correct what needs to be corrected, and move on. I know that might sound trite, but remembering it really helped me. 9 months is a long time, and stressing out about diabetes every day is no way to spend a pregnancy. Try to enjoy it, even with all the work it takes. Good luck!

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Congratulations on your little girl! Thank you for your response, it has helped a lot to get back on here and see that I'm not alone with a not-so-perfect start. Reading all the goals and expectations from doctors and medical journals made me feel really overwhelmed and under-achieving. It's reassuring to know I'm more normal. It has been a very busy and stressful couple of months, but I'm starting to relax a little and come to terms with letting my best effort be good enough (if that makes sense). I've been so lucky in that I haven't had a lot of morning sickness, so definitely counting my blessings!

Congrats on baby and all of the aforementioned life changes!! You have been busy!!

I have T1D and a 22 month old daughter. She was born healthy, stayed a day and a half in the NICU for hypoglycemia as a precaution, and has been perfect ever since! I'm currently about 5 weeks with #2.

Just take every day one step at a time. You can't change the past, but you have control over the present. Be prepared to use A LOT of insulin once you hit the 3rd tri. Drink lots of water and go on walks after meals. That helped me keep things in control last time.

You will need a lot more prenatal appointments since you are automatically high-risk. For me, this included seeing a MFM specialist in addition to my OB and having a fetal echocardiogram done. It's a big time commitment.

And don't worry too much about furniture. Just make sure baby has a place to sleep and s/he will be happy!! Your home will come together. Enjoy the time you have building your new family!

Before becoming pregnant, I'd heard a lot about the need for increased insulin during pregnancy so I was somewhat mentally prepared for this. While it took a while for this to become a reality for me (insulin needs didn't increase until ~20 weeks) I'm now at 33 weeks and am feeling surprised by the continuing need to increase both my basal and bolus doses! I'm at 5 times what I was taking before becoming pregnant, but may have still been honeymooning when I conceived. The diabetes clinic has been closed for the holiday season, but in my last visit the endo said triple or quadruple a total daily dose isn't abnormal in pregnancy but I'm curious to see what they'll say about where I'm at when I go in next. I exercise a minimum of 60 minutes (walking, swimming, yoga) a day and am told I'm fairly light with the carbs (125-150g per day). I just bought a new box of humalog as I was becoming paranoid that the insulin just wasn't working and it was only my lantus pulling down my blood glucose - apparently not the issue. I'm starting to feel like even the small amounts of fruit I do eat cause too much of a spike to be worth it. I'm curious if anyone could please share numbers with me about how much your insulin increased by the end of your pregnancies and how many g of carbs you ate? I would like to be eating more carbs, but it feels crazy to me to keep adding insulin - my total daily dose is around 50 units! Everything is checking out with the baby's health (non-stress tests, ultrasounds, etc.) and my numbers are mostly in range, A1C at 6 -- I think I'm just looking for reassurance that this dramatic increase in insulin needs is still normal (and hopefully will drop-off after the baby is born)!

I'm still pretty early on (15 weeks tomorrow), but I haven't seen a significant change in my requirements yet. Everything's been pretty minor. I had pretty aggressive I:C ratios pre pregnancy though, probably due to a not-so-fabulous diet and the weight gain that goes along with it. But I average about 60 units on about 170 carbs per day. My exercise is fairly low since my knee is still recovering, but I manage about 30 mins a few times a week. Working on increasing it. Walks after meals help to prevent spikes. I'm eating more carbs than I had planned, but my numbers are staying in a pretty decent range and according to the averages from carelink and my meter, I expect my next A1C to fall into the low 6's. I'm seeing a perinatal center (MFM) in addition to my OB, and there was mention at my last appointment of possibly adding some metformin to my regimen later in pregnancy when my needs increase, since we don't have a lot of room to increase my I:C ratios (1:4 before noon, 1:6 after). I was told to expect around triple my normal intake toward the end, and everything I've read so far says that your needs will get back to normal after baby is born.

Thanks for your response! We have been quite busy, but things are starting to settle a bit. I am seeing a perinatal center in addition to my OB, which includes the MFM and a dietician every couple of weeks, and according to data from carelink and my meter, I expect my next A1C to be in the low 6's. I am trying not to focus too much on my mistakes and increase my exercise. It's hard, and some days I just feel helpless. But it is getting better. I drink tons of water, and try to pack healthy foods in. I have an appointment at the end of the month for hemodynamic testing to check my heart and blood vessels, since my blood pressure tends to run high.
We have our 16 week ultrasound scheduled in 10 days, and our tech told us she expects to tell us gender at that appointment so we're very excited!

Thanks very much for this response! It's comforting to hear from you as someone else on 50+ units a day - it's probably not helpful to compare to my pre-pregnancy needs and it's certainly helpful to remember that insulin regimens are expected get back to normal after baby is born (hard to imagine, but this is what I've read, too). Super interesting to me to hear about your potentially adding metformin later in pregnancy. I've only a month to go, so I doubt I'll go this route but I've been reading about metformin + type 1 and metformin + type 1 pregnancy this morning - makes a lot of sense! Good luck with your exciting upcoming 16 week ultrasound. I've been very fortunate to not be working for the second half of my pregnancy because the appointments sure do pile up - I have 3-4 appointments every week (starting after 32 weeks). I think I would find this more difficult if I was working but as it is, I find the checks (non-stress tests, ultrasounds, clinic visits) really reassuring.

I'm glad you're feeling a little better. It really isn't fair to compare your use now to that of pre-pregnancy. No matter what there is going to be a large difference and it's only going to stress you out. We have enough to worry about right now without adding to it. ;)
Yeah, the metformin idea came as a surprise to me but made total sense since I'm already taking a large amount of insulin daily. I have fabulous doctors and trust their judgement on how to proceed since this is all new territory to me. I'm doing pretty well on what we've got right now, so we'll see how long it lasts. Luckily our new insurance is great!
I'm not working either, but I am a full-time student. All my classes are online since the move, so my schedule is very flexible. Handling all of this while working just sounds so stressful, I have a lot of respect for the women who do! I'm doing bi-weekly visits, but they don't always line up between the different offices so I end up making a trip somewhere every week. Since I can't drive myself due to my knee, we still have to make appointments around my husband's work schedule but he works 12.5 hour shifts, so he frequently has a few weekdays off. I always feel better after my appointments!

Yes, like you, I'm finding a flexible schedule and trust in a solid medical team are pretty key in managing all the elements of diabetes that become new territory again with pregnancy. Well, and also good insurance -- our extended medical ended last March and so I'm negotiating with the provincial medical plan folks about deductibles and have to wonder if metformin + insulin might have been cheaper as another reason to go that route.. Anyways, I really empathize with people who work (I've heard often the case is a need to take a medical leave and then a mat leave just to fit in all the monitoring and appointments!) and also the women with gestational diabetes. All the other women at the prenatal diabetes clinic I go to have gestational diabetes and I think in many ways that it would be harder to manage! At least I had a couple of years of learning about carb counting and insulin dosing and injections, etc. etc. before everything changed with the pregnancy. It would be completely overwhelming for me to feel like I had to get up to speed ASAP with all that you need to learn to be taking insulin safely/effectively! How long did you have your T1 diagnoses before becoming pregnant?

I agree, finding out about diabetes while pregnant has got to feel terrifying and so overwhelming! although I have to admit I'm a tad jealous that they get to be dome with it after baby's born.
I will have had T1 for 12 years in February, so I have a pretty good handle on how to manage it nowadays. I went through a "screw it all" kind of phase over the last 2 years or so and got up to 7.9% earlier in 2014, which was the highest A1C I've ever had. I've been really lucky in that I've never had too bad a time keeping control, even when I'm not taking care of myself. Have had no complications in my time with diabetes so far, I'm hoping that I can continue with that track record.
I saw my dietician and perinatal specialist this afternoon, and we did one of the finger stick A1C tests to gauge my progress. I was so happy to find out that I'm now sitting steadily at 6.2%! I'm so pleased, it feels like a weight has been lifted off my shoulders. I'm still unhappy about some of my spikes after meals, but we've altered our gameplan a little and I go back next week after my ultrasound to see how I'm doing with it.

Glad you can feel good about this super A1C - yay! - you came down a lot in a short time, that's really hard work! And YES - I get frustrated about spikes after meals and pretty panicky about seeing any double digits post meals although because I'm back in range by the two hour mark my med team tells me not to worry so much about the few out of range one hour after meals. But they've worked with me to avoid even these through aggressive bolus for the meal and frequent testing (1 hour, 2 hours plus often 3 and 4 hours post meal) and well timed snacks in between meals. I thought with this approach I could revert to what I did when I was first diagnosed and trying to get a handle on everything - just eat roughly the same thing at roughly the same time everyday. This somewhat boring strategy worked well back then when my schedule as a phys ed teacher was pretty set and I was only on a basal dose, but this really isn't a trick that's worked with pregnancy for me -- seems there's no rhyme or reason to when my body becomes insulin resistant. Eating the same carbs as usual, I've been chasing lows all day today and haven't had a day like that in ages! Felt bizarre to grab dex tabs - it's been so long since I've had to correct a 3.0 low!


I have had 2 diabetic pregnancies. My oldest is now 6 and my youngest is nearly 3. Both were born at term and just over 7 lbs in weight. They were perfect. My a1c at the end of my first pregnancy was about 4.9. At the end of my second 5.6. I ate low carb the whole pregnancy.... and no carbs at breakfast (when I was most insulin resistant).

My insulin needs during pregnancy increased about 5x. I was up just over 100 units a day by the end of my second pregnancy... compared to about 20 before....

I may be pregnant again - with my 3rd.... will know in a few weeks....

Wow, those are stellar numbers! What did you typically eat at breakfast time? breakfast is my biggest struggle, but I really don't like most of my no-carb options. I typically eat a few eggs with spinach and a slice of toast, but I haven't been liking eggs enough to eat them on their own. The toast is really what has been making them bearable for me. I'm similar to @A above, where eating roughly the same thing at the same time can give me quite a range of different results, so it's frustrating. Did you plan your third, or will it be a surprise? I'm just over 19 weeks now and showing, but really haven't put on much weight. Maybe a few pounds. Anatomy scan is next week and we'll confirm that the tech saw girl parts at the last one.

Hi Amanda,

My breakfast was always eggs of some sort with some vegetable or cheese or meat (omlete, no base quiche, scrambled with veges), a handful of nuts or some cheese if I didn't feel like eating cooked breakfast, or I made almond flour pancakes and ate them with cream. I basically couldn't eat any carbs with breakfast as I could not avoid going high.

I did lots of reading and then I really followed a strict low carb diet. I read Lois Jovanovich, and she said the baby doesn't know if you eat carbs or not, all it knows is if the blood sugar is high.

I believe that it is important to get great nutrition in pregnancy - but that can come from low carb foods (I avoided grains and fruits - there is nothing in either of those that cannot be gotten from vegetables, nuts, and animal-sourced foods.

Almond flour pancakes have the following ingredients:
Almond flour, eggs, vanilla, maybe a touch of unsweetened almond milk if I wanted the texture wetter. This mixes up to a thick batter. Have to lightly brown before turning, else it will break.

Boring, but that was my standby and I was very determined to have a healthy baby.

My third is very much planned and wanted. I have been trying (using IUI) for more than a year now. No success last year - and quite a few cycles were cancelled as I didn't respond well to injectable meds at all - which is what my RE wanted to try or then my partner was not in town. Then I took a few months break for the end of last year.

This is my first cycle this year - back on oral meds at my insistence (clomid-femara combo supported with estrogen for lining, and trigger then IUI). I had 4 mature follicles - 2 each side, which they consider is ok and not a big risk for multiples higher than twins at my age.

Today is DPO5. Way too early to know anything - but my insulin requirements have significantly and noticeably increased (which is what happened with my second - who was also IUI), and my blood sugar response to foods has also increased. Who knows, I might be about to go through it all again!