I am writing from my personal perspective about diabetes and pregnancy for two reasons: One, because I am a mother and a type I diabetic, and two, because I am a big believer in the virtues of a diabetes and pregnancy team. I don’t think I could have had a successful pregnancy without it. I wanted the perfect baby, but, given my medical problems and diabetes, I knew I needed help.
As a patient, I found this different from any other diabetes care or self-care I’ve had. They asked for blood sugars of 60-100 before meals, and 100-130 at one hour after meals. With all the fluctuations of blood sugar we all experience they gave me a target of less than 20 percent of my blood glucose values out of this range. That was impossible, or so I thought. I worked with a nutritionist, nurse, social worker, endocrinologist, and obstetrician.
My regimen consisted of constant feedings of three meals and three snacks a day. I tried multiple injections, until I started on an insulin pump. I could never get into the target ranges until I was on the pump. I also had multiple low blood sugars, since my sugars were so tight. I learned to treat these without over-shooting the target range (most of the time).
Needless to say, this whole program required time, commitment, and an intensity in my self-care that I never planned on. I felt like my life was examined in minute detail. This was probably the hardest part for me. I didn’t like my life under a microscope. I was testing blood sugars constantly, eating, documenting, doing multiple medical tests, and even meeting with the social worker. The social worker helped since this degree of intensity is really stressful, and I still had a life I hoped to live.
Before I ever got pregnant, I had every test I think they could find to examine me. Then, after I got pregnant, there were even more tests. It took me five months to get the go-ahead to get pregnant. I wanted to be as perfect as I could to prevent birth defects. Often, by the time someone knows they are pregnant, their baby could already have defects, since most occur in the first eight weeks. That is why preconception care is so important. I panicked when I got blood sugars out of range. I would tell my husband how the baby was getting birth defects. Later in the pregnancy, I would tell him that the baby was getting huge. He was wonderfully patient with me. The pregnancy team was always reassuring when I was worried, though they also served to scare me with the next possible problem.
By 20 weeks, I had seen my daughter on sonogram and knew she was OK. By 26 weeks, I started pre-term labor and was on bed-rest. By 32 weeks, I was doing non-stress testing to prevent a stillbirth (my second major fear).
A pregnancy with diabetes requires major personal commitment, time, and work, but, at full term, I delivered vaginally a perfect 8 pound, 5 ounce baby girl named Sian Kilduff.