More Than Just a Number: Early Pregnancy With Type 1 Diabetes

So, you’re pregnant!  Many who are in your shoes have worked very hard and diligently to begin this excursion.  Others have reached this milestone unintentionally.  Either way, you are about to embark on a journey that will completely challenge everything you know about your type 1 diabetes management.  These next few months will challenge your motives, your emotions, your determination, and everything that makes up who you are. So sink your heels in. Take each step one at a time.  

My daughter is currently six weeks old. Creating her and birthing her was by far the most difficult, yet rewarding, undertaking I’ve ever completed.  With this series, I will be walking you through how I managed my type 1 diabetes and my sanity while creating the most beautiful baby I’ve ever embraced.  Some of the methods I used were not recommended by any doctors.  Some of my findings may not have any tangible proof to substantiate them.  Every pregnancy is different.  Every person’s diabetes is different.  I am offering my experience for you to consider as you trudge your own path during these very pressured months.

The first thing I felt when I discovered I was pregnant wasn’t the pure joy women often talk about.  That joy came later.  It was actually a sudden overwhelming pit rolling in my stomach from all of the pressure I felt around me.  I knew that not only would my doctors expect me to be numerically perfect for nine months, but that I would also hold myself even more accountable than they.

The first eight weeks of your baby’s gestation are the most critical.  It is during those first weeks that your growing child is creating its brain, spinal cord, heart, lungs, and other vital organs.  My maternal fetal medicine high risk team stated that any A1C under 8.0% is acceptable.  Of course, we all want to be in the “normal person” range between 4.0% and 6.0%, but do not beat yourself up if you’re not there.  Continue working toward your goal.  

The exact glucose readings you receive during these weeks aren’t the decisive factors. Instead, what matters is the stability of those glucose readings.  During your baby’s major development period in those first weeks of pregnancy, your glucose numbers need to be stable, without many peaks and valleys.  This is difficult to accomplish because the first weeks of pregnancy are when your glucose levels will likely begin changing drastically.  Your insulin needs may spike while your body adjusts to new pregnancy hormones.  Your insulin needs may also dramatically drop, causing you to face glucose lows you might never even imagine possible.  

To get through those first weeks, I monitored my blood sugars every two hours, even setting my alarm a few times in the middle of the night to check.  My goal was to keep my glucose as level as possible and inside the parameters of 70 to 120 mg/dL.  There were readings outside of that range, but because I was checking so frequently, they were caught very early on and corrected.  I constantly reminded myself that as long as I was doing the best that I could, there was nothing more I could offer.

I learned my body early on.  I was making a significant number of dosage changes every single day for the entire pregnancy.  In most cases, it was impossible to ask my doctor to adjust my basal and bolus rates every time I needed to make a change because I was simply making them too often.  As long as you understand how your body reacts to insulin and slowly make these adjustments, monitoring your glucose frequently, you should be able to manage your diabetes mostly on your own.

I strongly advocate researching and considering as many diabetes treatment options as you can on your own.  If you have a supportive diabetes management team, you can filter through your findings during your office visits.  I also worked with my endocrinologist via fax when I had questions with no immediate appointment.  It is okay for you to say how you feel regarding a treatment plan.  You are no longer caring only for yourself, because inside your body is another human life.  Use this to ensure that you fully understand and fully believe in whatever treatment plan you are administered.  Gain confidence and strength in the knowledge that for the next nine months, you are creating a precious baby inside of you. You must already stand up for both your needs and your child’s needs. You are already a mother.

In the next article, I will discuss a first trimester complication of increased insulin shocks and how I protected myself from them.

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