Planning a pregnancy with T1DM and poor control

Hello everyone,

I don’t know where to begin but here goes.

My blood glucose control has been dodgy at best for years (A1c around 7-9%). I always found a reason to justify it “medical school, internship,…”. I was never compelled enough to prioritize it over a busy career but that’s what you get for choosing medicine.

I am currently in my residency at a highly demanding program and next year will be (the least consequential) of all. If I postpone it I’d have to wait until I finish my fellowship (at least three years down the road) and I don’t like my odds that way. This seems as good time as any to start planning a pregnancy.

The thing is, I’ve been negligent for so long I don’t even know how to go about controlling it again. I use an insulin pump but I’m so preoccupied I forget to bolus all the time. I use CGMs occasionally and they seem to help a lot. Though chasing highs is frustrating.

I see others having such incredible numbers and I don’t know how they do it. When do I stop birth control? Should I wait until it’s a prefect 6%? What if I have fertility issues? Do I become low carb or keto? Do I have to take a year off? (Very detrimental to my training).

Every time I struggle with my diabetes this website came through for me. What I need to hear is words of wisdom. It’d make me less anxious to jot down my plan for next year.

Well so first you have to recall that women who have diabetes have been giving birth for many years before A1C, or test strips. It is true that babies were often oversized and pregnancies more difficult, but still t1d women had children.

So can you have a successful pregnancy, I would say yes. I think however that you and the baby will have a much better time if you get your blood sugar in the tightest control possible. Notice I did not say perfect control, but the best you can do. this will improve your baby and your odds of having the most successful possible.

Use a CGM, if your not on a pump think of getting on one, test, and eat well. Lose weight, sure, exercise of course, but do not expect that your life will be better in a week or two. Get a good endocrinologist and CDE who handle diabetes pregnancies.

Finally, I am a male so do not read to much into this, but make sure you really want to do this for the rest of of your life. Once you have children it will not get easier. As a T1 father, I thought getting them there meant i could go back to treating diabetes like something I could ignore. but remember, once the child is here the real work starts.

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I know @Sally7 had one or more children, and can share her experiences, and was many years ago when many doctors told T1Ds not not have children.

Hope you can find a supportive doctor.

Thank you for your kind words. They do put things in perspective. Chasing a perfect flat line is exhausting and unattainable.

I am already on an insulin pump and occasionally a CGM. Have been for 9 years. Not sure how to up my game at this point. Utilizing them better maybe? I definitely could put my readings to better use.

A supportive doctor is vital I agree. I trust my diabetes team. When I got married they warned me not to get pregnant with my numbers. Hopefully I can get their blessing in time. What I’m missing I guess is a high risk OB?

My mom had me in 1957 with blood sugar measured with a urine fizzy tab that showed it in 0, 1, 2, 3, or 4 twice per day. If Mom had an A1C it was likely around 10 or 11. Now lets be clear that in those days we were expected to live for 30 years maximum. My mom lived until she was 48 and she was Dx’d at age 21. So her life and most of those with diabetes in 1957 was not great. We can do better. Your baby deserves the very chance. You have the tools to do that, if you control your blood sugar.

I was a PWD and I was not Dx’d until 17 years later. That is because I was in the womb of a woman who was T1 with a largely uncontrolled diabetes. Me having diabetes had nothing to do with me being in Utero of a mom with diabetes. That was determined in an instance when I was conceived.

I adore my life and so will your child. But do yourself and your baby a service by getting your blood sugar down.

One place that might help is https://diabetessisters.org/ I think they likely have the best resources for pregnancy I know many of my friends swear by them.

rick

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@Asma. I may be reading too much into this. I am retired from the health care industry (including Neonatal ICU & EMS). I wear a pump & CGM. Think of me as the old starch, combat hardened ICU nurse digesting an intern. So, if I may be so bold, in your asking for help, are you asking for someone to tell you what to do? If so:

Rx: Tandem t:Slim X2 with Control-IQ technology.
Rx: Dexcom G6 CGM

The Tandem pump has FDA presets in it. You will need basals & insulin to carb ratios. ABOUT THE PUMP: If you BG goes low, the pump decreases basal, even to zero until the CGM reports an improving BG. Conversely, if your BG is too high, the pump will gradually increase basal insulin and even give modified correction boluses.

The Dexcom G6 sensor life is 10 days (240 hours exactly). Transmitters last 90 days.

Outcome: Preoccupation is decreased. Even if you miss a meal bolus, you can catch up when you can. The pump will try to bring the BG back down. Integrating the pump & CGM should give you an A1c of about 6.5%

As far as birth control, I believe that question will best be answered by your gyne. Time off, I have seen many pregnant women actively working in the health care industry as students (medical & nursing - CCs, interns, residents, fellows, & attendings). Remember pregnancy is not an illness, it is a time to be cherished & lived.

LIke @Rphil2, I, too, am male. He has given you good, fatherly advise. I hope I was not too blunt. I wish you to receive this with the spirit of helpfulness & nursing satire only a hardened resident would understand. I do remember IDMs (Infants of diabetic mothers).

I appreciate all feedback regardless so thank you for pitching in. And you’re spot on, I’m asking what I should do next.

I’m currently on:
Pump: Medtronic Minimed Veo
Sensor: Enlite sensor /Libre on-and-off

The tandem sounds great but Medtronic is the only one available where I live so my options are limited (to one). And maybe the omnipod. Not sure if there is wiggle room for an update. Maybe they can update me to the 670G.

I’m setting up appointments to consult my diabetes team and subsequently an OBGYN.

Thanks again for weighing in.

You are welcome gracious lady. Best to all of your endeavors.

I am currently 30 weeks pregnant and before conceiving I actually forced myself to do a trial run of what pregnancy would be like with my pump and CGM. I actually just got my pump in October 2019 and started with an a1c of 7 but after 3 months of being on my pump and “practicing” for pregnancy my a1c was down into the 5’s and thats when I knew it was safe to start trying for a baby. Sometimes you just need a reason to try harder and for me wanting a baby was that reason. Once you actually get pregnant it just escalates and you work even harder because you know the CGM numbers you are seeing aren’t just for you anymore! The CGM is the biggest life saver though and I doubt I would have had my a1c in the 4’s and 5s throughout pregnancy if I didn’t have it because things change so much from week to week… my endo actually has me upload all of my information from my pump and dexcom every week so she can look at the numbers and help me change them if needed. Its a lot of work but its definitely worth it! Also for reference I have the tandem t:slim x2 and dexcom g6 (the control IQ is life changing)

Sorry it has taken me so long to give some thoughts here. I am trying to reduce news intake so I don’t turn on my tablet as much as I use to and of course my Starbucks is not open to sitting down🙁
I for most of my first 20+ years never had an A1C under 9. Even using a pump, I couldn’t make it happen. Much of it was how much time I wanted to put into it and my job just wasn’t great for diabetes management. Fast food restaurant manager and Starbucks manager.
But when my husband and I finally decided that the time was now, I went to my doctor and we talked about genetics (I didn’t want my kids to have diabetes), and how difficult it was going to be.
So I was using a pump but no CGMS at the time, so it was relearning meal planning, insulin timing, logging everything. A lot of work. But my team Endo, CDE, high risk OB, eye doctor, a whole team helped me get my numbers to a good place and I was given the go ahead to try and get pregnant. My A1C’s were in the mid to upper 6’s. Which I was pretty excited about because as I said I was never that low. And I fortunately for us, it took almost a year to get pregnant. So I was running pretty good numbers for well over 1 1/2 years. Exhausting!
But we did it! And we had a beautiful baby girl who weighed 7 lbs 3 oz and yes was 3 weeks early, so she would have been bigger but completely healthy!
It was exhausting and exhilarating at the same time. And wow, did I test my blood sugars all the time. I think with my Dexcom I could have done much better with numbers but I think of the women who did it with urine testing so each era has its struggles.
Is this the time? Only you and you husband can answer that. Can you get numbers to a place where your team thinks it’s ok, only you and your team can answer that.
You all need to agree on the numbers you need for a successful pregnancy. What numbers I needed are going to be completely different that what you might need.
I will say now with the new insulin pumps and CGM systems out there, this is so much easier. There are some great ones on the market right now. I mean, I think less about my diabetes now, than I did when I was a teenager and never thought about it!
You can do this. It will take some work and maybe some training with a CDE to fine tune things. I did come away with a better understanding of insulin timing and carb counting which has helped me now 28 years later.
So we did try it again. 3 years later we tried again. And unfortunately we lost the second one. I was told by everyone that it was just something that happens. My A1C was better with the second and still a neural tube defect and no hope. It took us another 2 years to try again and happily we had our second child.
It is very doable, no matter where you are currently at. This is a disease that with a little attention you can make some big changes.
So maybe a new CGM/pump system that does things automatically could make things much easier for you. But remember a person with diabetes can have children! If numbers aren’t “perfect”, you can still have a baby. Sure it might be harder on you and the baby and your husband but it can be done. Don’t keep waiting for the perfect number. If we had, I would never have had a child. I don’t think even with my new technology I could get my A1C under a 6. So shoot for the number you and your team seem as safe enough. You got this girl!

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I highly recommend listening to the Juice Box Podcast. I am currently preparing for pregnancy. Using a Dexcom and Omnipod and using the principals of Intuitive Eating, I got my a1c down to 6.2. My doc gave me the go ahead to try to convince, but I’m going to take a prenatal for a month and try to get my average down a little lower first. I also don’t use carb ratios :stuck_out_tongue_closed_eyes: So it’s totally possible without keto or “low carb.” When I tried to use diets to control my numbers, I would always end up bingeing and getting really high blood sugar.

You can do it! It’s really a matter of paying more attention and learning how to “surf” your blood sugar. I highly recommend the book Sugar Surfing.