Looking for tips on keeping tight control during (and pre) pregnancy. I follow a low calorie/low carb regime, with a lot of exercise. I am pretty sure this will have to change when (hope) I get pregnant. I have a very hard time controlling my numbers with moderate to high carbs and no exercise.
I am a few years past pregnancy now that my girls are 9 and 6 years old.
I started eating low carb during my first pregnancy (it was the only way I could manage my sugar levels - even with insulin), and continued to eat low carb leading up to and throughout my second pregnancy. I focused mainly on protein and non-starchy vegetables, though I was partial to small amounts of dark chocolate. I was also able to exercise throughout both pregnancies.
Low carb is increasingly accepted as a valid way of eating to address fertility issues, and during pregnancy. One focuses on nutrition from non-starchy plant foods, protein, and healthy fats. Unless there are major health issues, physical activity during pregnancy is also highly recommended, though some adjustments may be required as one gets bigger.
My tips would be:-
- CGM if you don’t have one already (I didn’t and that would have been a wonderful addition to the arsenal).
- Low carb diet and exercise.
- Be prepared for insulin requirements to soar. Mine increased by 4 - 5 x prepregnancy rates. This will mean frequent adjustments.
- Know how to do corrections.
- keep sugar on hand for lows, if ever they occur.
It does take a lot of work, but it totally doable, and the resulting baby is worth all the effort.
I completely agree with JustLookin that a CGM is really helpful for achieving better control. Here are some other suggestions:
The new book by Vieira & Smith is excellent. The first few chapters have a lot of good information and tips.
Do basal testing, especially overnight. Similar to many women, I usually needed at least 10% more insulin than usual in the last week of my cycle and at least 10% less than usual in the first week. In pregnancy, my basals were high for the first few weeks (even before I really knew I was pregnant) but began dropping a lot around week 8. Your doses will change a lot in pregnancy but it’s helpful to start from a solid foundation. Surprisingly, A1c several months prior to conception has an effect on pregnancy outcomes, so it’s great that you’re serious about preparing in advance.
Test your carb ratios until you think they’re correct. It helps if you prepare your own food and eat consistent amounts at similar times every day. It’s also helpful to keep detailed records about what you ate and whether the dose worked well or not (same with the timing of any prebolus). You seem to be aware that some doctors do not recommend low-carb diets in pregnancy. Low-GI foods such as legumes or whole-grain pasta might be a good compromise. If you have a pump, experiment with dual-wave boluses for these foods and for larger meals.
I think many doctors encourage continued exercise, even running, during pregnancy. In the first trimester, it was very helpful to walk or run right after eating (to minimize post-meal highs) but exercise at other times was tricky because of my tendency to go low outside of meals. Glucose tabs became a staple for me, replacing other more-appealing candy that didn’t work as fast (but it’s important to be patient and not over-treat minor lows).
Start taking prenatal vitamins. Folic acid is very important to take beforehand, even more so for diabetics. I wish I had kept a larger stock of test strips and CGM supplies on hand because in pregnancy I ended up using more supplies than my insurance company would pay for. Ovulation kits are also helpful once you get to the TTC stage.
Good luck! With a CGM and a lot of work, you can definitely meet your pre-conception A1c goal. I won’t say that blood sugar control is easier in pregnancy (in my experience it’s harder) but at that point you’ll be really motivated to put all of your hard-earned knowledge to work.
Thank you so much @Arty for all of this detailed information!
I followed low carb during my pregnancy. Fortunately my endo was on board (although the MFM gave me trouble) and managed my diabetes. Having a good team in place makes a difference.
I agree that a CGM makes all the difference during pregnancy.