Type 1 diabetes and pregnancy

alllouise · February 2014

Is there anyone out there who has Type 1 Diabetes in any sort of stage of parenthood? I'm 25 and have had Type 1 since I was 5. I treat my diabetes with an Insulin Pump and continuous glucose monitoring system. I eat healthy, I'm active, and am at a very healthy weight. As my husband and I have been wanting to start a family, I have been so afraid. I've discussed with my doctors what I need to do in order to have a healthy pregnancy. I have been in relatively good control for a while now and should be within my suggested A1C range for conception/ pregnancy (I'll be getting my 3 month test this week). Since I have been thinking about being pregnant I feel like I have become a diabetic perfectionist, to the point where I constantly stress over an occasional blood sugar spike. I think, "what if I was pregnant right now, what harm would I be causing to a baby". I know that nobody can ever have "perfect" control over their diabetes and women with diabetes have healthy pregnancies and deliver healthy babies all the time, but I'm feeling very alone. If anyone has any experience with type 1 and conception/ pregnancy I would love to hear from you!

missnacholover · February 2014

Hi @alllouise.

I have Type 1 and am TTC as well. There is a check-in over on the high risk board and a few pregnant women over there.

Feel free to PM me if you want to chat! I know it can be overwhelming!

SLGILL1978 · February 2014

Hello! I am 35 and I am a Type 1 as well. I was diagnosed about 5 years ago right before I turned 31. I know that's rare but when I was diagnosed my doctor determined I had been a diabetic for a while (possibly years) but it went undiagnosed. I had my daughter a year ago. When I told my doctor I wanted to have a baby, we just monitored my sugars for 6 months before I conceived. She wanted me to have at least 2 good A1C's before the green light.

I never saw a high risk doctor when I was pregnant. I saw my regular doctor every 3 months, I saw my OB until 34 weeks, then I saw him weekly (for normal pregnancies I think they start seeing the doctor weekly at 36 weeks?) and I saw my diabetes educator once a month as well. My educator was a nurse specialized in diabetes. She was the one who I would email my weekly sugars to and based of those she would raise my insulin. She had the ability to raise it 5 units before my doctor had to be notified. I was the healthiest I have even been while pregnant.

You will find many OB's and practices vary on what your sugars should be after meal when you're pregnant. My OB had me test 1 hr after each meal. He wanted me to be no higher than 120. I know at first I was freaking out about it because mine were never around 95-100 an hour after my meals. My morning fastings couldn't be over 100. I have read some where their OB's wanted them strictly in the pregnant range of 65-95 for morning fasting and after meals.

I know some OB's also vary on this but my doctor would not let me go past my due date as well. I was induced before my due date. I had a healthy baby girl who weight 7lbs and 3 oz. She is not diabetic. She was monitored for 24 hours after birth and also tested. I was even able to breast feed. At first I was concerned about conceiving but we did end up conceiving naturally the first time we tried. We just started trying to conceive #2

There's a lot but hopefully I gave you a good start? Please let me know if there is anything else I left out? Good Luck!

alllouise · February 2014

Thank you! Did you deliver naturally or did you have a c section? I also worry about that too!

Danielle0311 · February 2014

I do not have type1 diabetes but my cousin does. She was diagnosed at 12yrs old and is now 32. She is 12 wks pregnant right now after a long road of getting herself healthy and is going great! Her doctor wants her a1c level under 7 but said even under 8 greatly reduces her risks of complications. She was warned that every trimester brings new battles and struggled a bit with the morning sickness messing up her sugars but they kept adjusting her regiment and is doing better than she ever expected! She was also told she will likely not be allowed to go to 40wks but likely would be induced early or c section if the need calls for it. I am not an expert but wanted to share what I know from her

SLGILL1978 · March 2014

Sorry it took me so long to reply. I actually had a c section. But it was so smooth. I have no complaints. I was actually more prepared for that than a vaginal birth. I knew I wanted an epidural and I got mine within 2 hours of being induced so I was quite relaxed and they didn't have to do much to get me ready.

wells2010 · March 2014

Hi, I'm T1 here too. Dx at 17. I have 1 daughter, who is 1yr. It's definitely do-able, as long as you stay on top of everything. It can be overwhelming. I walked everyday, which helped me keep things under control, especially after meals. It was a bit tricky for me to get KU. We tried for a few years and did all of the IF testing and I ended up finding out that I didn't ovulate. The OB put me on Clomid to make me ovulate, which worked on the second try.

The first semester I had lots of LOWS... like 40s. I dropped my insulin a ton (I use a pump and CG too). As it progressed, I had to adjust my insulin levels almost daily. By the end of my pregnancy, I was refilling my cartridge almost daily. I saw the OB and a high-risk OB throughout the pregnancy. It was very expensive with all of the co-pays. Luckily, we have good insurance and only had to pay for the high-risk visits. They closely monitor baby's size, amniotic fluid levels, your blood sugars, etc. I also had to get a fetal echocardiogram because I guess it is common for babys of mothers with diabetes to have congenital heart defects.

We have an album of ultrasound photos. SO many ultrasounds. That was probably the best part of being pregnant with diabetes. Since everything looked great with baby and my sugars stayed under control, the docs let me go to 39.5 weeks. If things weren't so good, they would have done an amniocentesis at 37 weeks to check the baby's lung development and, if everything was ok, induce me then. The docs don't really like to let a T1 pregnancy go past 39.5 weeks because there is an increased risk of the placenta going bad.

I had a balloon induction, followed by pitocin. That failed miserably. I don't think that was diabetes-related as my mom had trouble too (small hips). I decided on a c-section, which was overall fine. OB did say I had some extra fluid, which is a potential complication of DM & pregnancy and puts you at risk for hemorrhage. That was completely missed on all of the US's I had. My blood sugar was dropping by the time of the surgery so the doc put me on some fluids with dextrose. I managed my insulin pump the whole time I was in the hospital and taught my husband what to do after the birth as your insulin needs drop sharply as soon as the placenta detaches. After birth, baby's blood sugar was a little low (43). I let them give her some formula in addition to breast milk to bring it up, which worked well. The next few blood sugars of hers were also low, but I didn't want to give her any formula. It ended up dropping and she became too lethargic to latch on properly. My pedi freaked out and checked her into the NICU. She stayed there for 2 days on a dextrose IV. That was really hard. Overall, my daughter is incredibly healthy and we are now starting to try for #2.

hope that wasn't too long. I am a RN too, so please PM me if you have any questions.

alllouise · March 2014

That's comforting SLGILL1978... I always worry thinking about c sections. Thank you wells2010 ! I always wondered how it would work with an insulin pump in the hospital and during a delivery. I didn't know about the blood sugar drop after the placenta detaches; that's interesting. I would imagine it would drop from being stressed and giving birth anyways.

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