Pregnancy with diabetes—any type of diabetes—is a tremendous undertaking because so much of your daily effort becomes focused on trying to be as “perfect” as possible now that another person's life is involved. Things you never thought you were capable of (like A1C results below 6.0 percent!) suddenly become achievable because blood sugar management is your ultimate priority…all day long.
This pregnancy is a bit more challenging since keeping a watchful eye on my blood sugars is competing with keeping a watchful eye on my very active 2-year-old. I just can't be as numbers obsessed with this baby. That's not to say I'm going to neglect my diabetes, it's just that my approach has changed because it's been forced to. My revised plan is outlined below:
Prior to my 1st pregnancy, maintaining an A1C at or below 6.0 percent was a very new thing to me. I’d really never tried to get it much lower than 6.5 percent. I never felt there was a reason to do so, and didn’t really know what I’d do differently in order to achieve it.
But those 9 months (and the 6 months I prepared for my 1st pregnancy) taught me so much about achieving and maintain an A1C at or below 6.0 percent that it’s now my new normal. And I don’t mean that to sound as if I’m some sort of genius—I simply changed my personal standards. It's pretty simple. I used to be content with blood sugars hovering around 140 mg/dL all day…and now I’m not. Instead, I aim for 90 mg/dL, and, sure I miss my target for at least a few hours almost every day, but I know my A1C is still going to be in that healthy pregnancy range. I know this time that the momentary high numbers are not worth stressing out over. I remind myself that I’m doing the best I can, and “100% perfect” isn’t necessary or realistic.
There are so many reasons to be grateful for a thorough and serious healthcare team as a pregnant woman with diabetes, but there are also times when I’ve needed to speak-up for myself and I didn’t. In pregnancy with diabetes, you will likely meet doctors who want to “motivate” you with fear by listing off the many things that could go wrong in your pregnancy because you have diabetes. You’ll also meet doctors who will try to shame you and scold you for having this disease—as if you purposefully picked it up at the mall and gladly carry it with you each day. This time, I won’t hesitate to speak-up when I feel I’m being scolded or shamed for something I didn’t cause. I’m working my pregnant-tail off trying to manage something my body ought to manage on its own, and the last thing that will motivate me is disrespectful fear tactics.
During my 1st pregnancy, my A1C stayed between 5.1 and 5.7 percent throughout those entire 9 months…and that is not my plan this time. During my 1st pregnancy, I was working full-time from home as a writer. I could easily catch lows as they arrived, treat minor lows just enough to hover around 70 mg/dL, and carry on with my day. This time, I’m a full-time mother to a nearly 2-year old toddler, so hovering around 70 mg/dL isn’t wise or realistic…or good parenting! This time, I will continue my “new normal” of aiming for 90 mg/dL, with an emphasis on preventing hypoglycemia as the actual #1 priority. And so far, that goal is going great—most days I have zero low blood sugars, other days I might have one low but I have glucose sources in every jacket pocket, and I check my blood sugar every 2 hours.
For me, the part of wearing a continuous glucose monitor (CGM) that back-fires is seeing the alarm that has 1 or 2 arrows pointing UP or DOWN. Especially as a mom who feels like there is limited time to take injections for oncoming highs or prevent oncoming lows, I know now that those arrows cause me to over-react. In my 1st pregnancy, I had arrows and alarms programmed up the wazoo. This time, I’m actually trying to ignore my CGM, I turned off the arrow-related alarms, and I’m checking my blood sugar every 2 hours with my meter. Instead of using the CGM to make decisions, I’m relying more on the good old-fashioned logic that has helped me stay at 6.0 percent during the last several years even when I wasn’t wearing a CGM at all. So far, that approach is working far better and is far less stressful than over-reacting to programmed alarms!
As a woman with type 1 diabetes, the worrying starts from the moment you begin contemplating pregnancy. Not that there isn't a time and place to be worried and concerned—it might be what motivates you to take care of yourself (but I think it's best when the desire comes from you, not when it's laid on you by others).
But there are also plenty of reasons not to worry and to simply hope for the best while you do the best you can. Completely healthy women experience complications in pregnancy. They have miscarriages, infertility and birth-defects. The most I can do as a type 1 woman is to do my best each day, ask for help when I need it (from my pregnancy coach CDE, Jennifer Smith at IntegratedDiabetes.com), and take a deep breath now and then. And as for Diaper Genies: they’re obnoxious, they don’t actually block out the stink of poo, and it’s far easier to just get a cute trash can with a lid…and change the bag often.
Pregnancy with diabetes is a challenge, but it can be done! Will it require a daily dose of enthusiasm, courage, and persistent diligence? You bet. But you’ll be amazed at what you can accomplish when you know it’s for the sake of that little bun in the oven!