Managing Diabetes During Pregnancy

What happens when you're managing diabetes during pregnancy? You have to focus on taking even better care of yourself—because it's not just you you're taking care of. Here are some tips for staying the course.

Diabetes during pregnancy may sound daunting. Whether you're living with type 1 or type 2 diabetes, or you've received a gestational diabetes diagnosis, the to-do list of doctor's appointments and health checks might feel overwhelming—but, as someone who has successfully made it through two pregnancies after decades with type 1 diabetes, I'm here to tell you that you can do this.

Wait, Can I?

"So you need to keep your blood sugars as well-controlled as possible. We're aiming for a range between 80 and 110 mg/dL while you're managing diabetes during pregnancy," my endocrinologist said after I told her I was hoping to get pregnant soon.

After decades of life with type 1 diabetes, I've seen my share of literal highs and lows when it comes to blood sugar, and now I was being told to keep my numbers in such a consistently tight range? I struggled to get my A1C (average blood glucose over two to three months) under seven percent in order to safely plan a pregnancy in the first place . . . was I going to be able to do this? If you're considering a pregnancy, you might be wondering if you can do this, too.

The answer is resounding "YES," even if it feels like a whispered ". . . maybe?" at times. Diabetes and pregnancy may sound challenging, but it can be done, and the payoff is worth it. You can achieve tight diabetes control during pregnancy: it serves as a terrific motivational force. During two pregnancies, my diabetes wasn't just "my problem"; instead, it became something I shared with the tiny human being in my belly.

When you're pregnant, an out-of-range blood sugar doesn't just affect you, it also affects your growing baby. As someone touched by diabetes, it's a responsibility that you take very seriously.

Managing diabetes while pregnant is a full-time job. Both with my daughter and my son, my focus was on keeping my numbers as steady as possible while simultaneously trying to quickly correct any out-of-range numbers. Viewing blood sugar results as data points instead of a measure of my worth as a person was a constant challenge, but I leaned on my medical team and my family for help in maintaining balance.

Tips and Tricks for Managing Diabetes During Pregnancy

What helped me keep my blood sugars in line in pursuit of a healthy pregnancy and healthy baby? I had a few tricks up my sleeve.

1. Prepare

First off, it is important that your diabetes is well-controlled before pregnancy. This is the case for pregnancy with any type of diabetes. Preparing in advance helped me create the healthiest environment for my child, in addition to prepping me for the hard work it would take to control my diabetes during pregnancy. There are some terrific guidelines on the Joslin Diabetes pregnancy page that offer insight on what to expect. Some recommended pre-pregnancy medical evaluations and blood glucose goals include:

• Reviewing your diabetes and obstetrical history

• Renal, thyroid, gynecological and occasionally cardiac evaluations

• Eye assessments

• Ensuring your fasting and pre-meal blood glucose is between 80 and 110 mg/dl

• Aiming for blood glucose

• Getting your A1C under 7 percent and as close to 6 percent as possible without hypoglycemia

2. Up Your Checks

Once I confirmed that I was pregnant, I upped my blood sugar checks from 5-8 times per day to 10-15 times per day. It felt like a lot of checking, but each result confirmed that I was still on track, and my insurance company was on board with providing the extra test strips that my doctor recommended. Check in with your doctor about how often you should check your blood sugar.

3. Get the Most out of Your Insulin Pump

I also took advantage of the advanced features on my insulin pump during pregnancy. My insulin pump is able to calculate and deliver the precise insulin bolus (the dose of insulin I take for meals) I need to cover my carbohydrate intake, which made managing my post-meal blood sugars much easier. My pump also provides the ability to change my basal profile (the insulin I need to cover basic metabolic needs), which made it easier to manage my insulin needs week by week—and those needs often change during pregnancy. If you're taking insulin, talk with your medical team about whether a pump would be beneficial to you.

4. Keep Moving

Exercise did more than just help keep the "eating for two" mentality from blossoming into huge weight gain. Light exercise, like walking or swimming, helped me control my blood sugars, keep weight gain at a healthy rate, and clear my head and keep my wits about me while building a baby. Often, medical teams have exercise physiologists on staff who can help you find an exercise plan that fits your goals.

5. Lean on Your Support System

I did not shy away from asking for help. Whether it was asking for assistance with bringing down my postprandial (after meal) blood sugars or managing the emotional side of a high-risk pregnancy, I reached out to my medical team and family often. Feeling like I had support as I worked towards motherhood made the journey much easier. You don't have to go it alone; there's a whole community of people who "get it."

The Ends Justify the Means
Diabetes can present quite the to-do list, but there's nothing sweeter than the sound of your baby letting loose with their first cries after months of your dedication and determination. As I mentioned in the beginning, you can do this, and it is absolutely worth it.

By Kerri Sparling

Kerri Sparling has been living with type 1 diabetes since 1986, when she was diagnosed at the age of seven. She is an internationally recognized diabetes advocate. Kerri is the creator and author of Six Until Me, which she established in 2005 and which remains one of the most widely-read diabetes patient blogs, reaching a global audience of patients, caregivers, and others in the industry. She has been featured on NPR, US News and World Report, CBNC, Yahoo! Health, LA Times, and The Lancet, among other national outlets.

Sources:

Joslin Diabetes Center, Managing Diabetes During Pregnancy

Diabetes Forecast, Your Pregnancy Guide

JDRF, Pregnancy Toolkit

American Diabetes Association, Prenatal Care

These articles are not a substitute for medical advice, and are not intended to treat or cure any disease. Advances in medicine may cause this information to become outdated, invalid, or subject to debate. Professional opinions and interpretations of scientific literature may vary. Consult your healthcare professional before making changes to your diet, exercise, or medication regime.