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Diabetes and pregnancy

Discussion in 'Adults with Type 1' started by Megnyc, Jan 14, 2013.

  1. Megnyc

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    I am hesitating to post this but hoping for some advice. I really want kids and have my whole life. Yet, I read today and have many times about the blood sugar control required for a healthy baby.

    I recently asked my doctor about this and he basically said fasting numbers between 70-90 and no spikes over 120. I spike to 200 with every meal if it has more then 15 carbs or so. He said you need an A1C as close to 6 as you can get. I can't get my A1C below 7. It is usually in the 7.5-8 range. I usually test 10+ times a day often 15-20. I wear a CGM and a pump. I constantly use temp basals and I test at 3 AM most nights. Every endo/nurse has said there is really nothing more I can do that I am not doing. I am just super sensitive to insulin and it varies greatly depending on factors I can't figure out. I can be 200 and correct with 1.6 units and one day it takes be down to 100 perfectly and the next day it brings me down to 40 and the next I go up to 300. I wake up some mornings in the 400s for literally no reason even with a CGM. The only reason I don't have an A1C in the double digits is because I also have crazy sustained lows in the 40-50 range or lower.
     
    Last edited: Jul 23, 2013
  2. obtainedmist

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    I understand your vent! I find myself worrying about this for my daughter who is your age. Then I tell myself that the world is changing quickly. There are so many things in the works that will make T1D management easier. I know that there is much research on different types of insulin that will act faster...and then there is the artificial pancreas that is getting closer and closer. There is research on encapsulated beta cells to transplant without fear of rejection.

    You have a lot on your plate now with a strenuous course and work schedule. Try not to focus on your fears and instead, applaud yourself for what you have dealt with beautifully!
     
  3. sarahspins

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    Things will probably settle down as your life does - you're only 19, and there is plenty of time for you to worry about having kids.

    That said, I honestly feel like the numbers they expect you to have before/during pregnancy are a little insane.. maybe they lead to better outcomes, maybe not, but what I can 100% assure you is that they will lead to a very stressed out pregnant lady. That isn't good for mom or baby. Being a pregnant diabetic becomes almost a full time job and there isn't much celebrating involved - at every stage all you are going to hear from every medical professional you encounter is doom and gloom, and you will need more and more tests as your pregnancy goes along even when everything is going perfectly, and it's a very frustrating and tiring process to get through.

    Having higher numbers is not a guarantee that your baby will have some kind of problem - what it does is increase the risk, but everything I've ever read suggests that at worst it doubles what is already a fairly small risk. So running high before and during conception and through the first 6 weeks does increase the risk of several birth defects, but it doesn't guarantee anything will be wrong, and lots of doctors use this scare tactic needlessly. Do the best you can, what happens will happen. Perfectly healthy women have babies with problems (my dad and my nephew [unrelated] both have congenital heart defects) - so even without D, there are never any guarantees.

    From that point forward, there is an immediate risk to the baby with very high swings in blood glucose (which can lead to fetal death), but you don't have to stress out about having every post meal # under 120 - I certainly never did, and I made it through 3 pregnancies. What you don't want are fast swings from 300+ to 30 on a regular basis. It's better to bring down any highs slowly, and try to avoid lows (which can be very difficult in the 1st trimester, as the baby starts pulling glucose from your bloodstream and the placenta hasn't started pumping out hormones that make you a bit insulin resistant).

    Later on, if you consistently run high you run the risk of having a larger baby, and if you are high during labor, you run the risk of having them develop low blood glucose after birth (since they are suddenly cut off from your supply) but what they don't tell you is that many babies are borderline hypoglycemic after birth anyways, and that a true hypo for a newborn is under 45 (some hospitals as low as 40), so you can do everything right and your child will not be clinically hypo but they will still scare you to death with talk of NICU and all kinds of things if your baby tests less than 60. Some hospitals are more or less aggressive with their protocols... but it's always important to know what to expect.

    So to sum it up, I didn't have perfect numbers before/during any of my 3 pregnancies - I did my best, but there's only so much you CAN do. I had A1C's in the upper 6's and into the 7's with all 3 of them.. with one pregnancy I actually did have one come back at 5.9 but I had been having so many hypos that it really wasn't a number to celebrate - even my endo told me to relax and run a little higher. All 3 of my kids were born perfectly healthy and at normal weights.. and all did have borderline blood glucose levels after birth (nothing severe) but so have every one of my friend's and family member's babies too - and none of them were diabetic or even had GD.
     
  4. DsMom

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    Although I can't vouch for their BG numbers or A1cs...I can tell you that I have two adult nieces with D...one has had D since the age of two, and she has two healthy, happy young kids right now. She wore a CGM throughout the first pregnancy, not sure about the second. She did have a bit of a health issue in her second pregnancy...but I forget what it was or if it was D related (don't think so). But her kids are beautiful...and she is complication free.

    My second niece is expecting her first child any day now!:) She had a lot of problems with lows...she had to get up at night to eat, and even with no basal. She is an extremely active person...even though pregnancy...so I'm sure that was part of it. However, she did great...and we're all anxiously awaiting the birth of her little boy!

    You will have to keep a closer eye on things than the average pregnant woman, but you have every reason to expect to have healthy, happy babies one day. I'm obviously not an endo...but no spikes over 120 sounds unreasonable to me. I would do some more research on this if I were you...and get more docs' opinions when the time comes that you are ready to start a family. Perhaps by then, your BGs may stabilize a little bit too...and it will be easier on you.

    Best wishes...and keep dreaming of those babies!!:):)
     
  5. MomofSweetOne

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    Jenny Smith of Integrative Diabetes (Gary Scheiner's group) could be valuable help for you, both now and in the future. Her own little Oskar was born in December.
     
  6. Ali

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    Ahh sorry but you need to work with some more experienced endos. I had two kids 28 and 25 years ago. Healthy kids healthy pregnancy and I was not anywhere near that control. In my experience a wake up BG under 120 is good and his spike numbers are crazy. I have A1cs of 6 regularly and spike above 150 almost always. Maybe he is basing it on newly diagnosed T2s. T1 women have been having healthy kids for years, way before the type of testing now available. The critical issues are your health before getting pregnant and then as stable control as possible and more checkswith the endo and ob/gyn as things progress. For what it's worth my A1c at conception was around 8 with both kids. For me my A1cs reduced during the pregnancy. I think my best number was maybe a 6.8? And my Docs were thrilled. My advice find a really experienced high risk endo. The integrated diabetes team may have a suggestion for a good Doc. Your Doc has either freaked u out for not a good reason or he has not explained stuff well. ali
     
  7. MHoskins2179

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    Hi Meg: I'm sorry your going through all that and it's so stressful... hope it does calm down eventually. Aside from what everyone has mentioned above, you might also find it helpful to connect with some other ladies in the Diabetes Online Community who've gone through all that -and have had successful pregnancies. Kerri Sparling is one of those over at Six Until Me had her daughter a couple years ago, along with Sarah Knotts from Sugabetic who had her son about a year ago. There's also Kim Vlasnik at Texting My Pancreas who just recently found out she's pregnant, and is going through all that process now. They're in there early 30s, but might be a few to reach out to - as they have gone through the same concerns you have now.

    Best your way.
     
  8. Tanikit

    Tanikit New Member

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    Hi, like you I always wanted children - have been diabetic since 1991 and now have two beautiful daughters. Neither of my pregnancies started with the hba1cs your doctor wants. Neither of them did I manage to get the readings he wanted either. The pregnancies were probably the hardest I have ever had to work at the diabetes in my life. They were difficult, really difficult. But despite that I want to do it again and have the third baby I told my husband I would want when I first married him. This time however I am trying to get a pump to have a slightly easier time of things (don't want to get into why now, I just think it will be best for me and a third pregnancy).

    You can do this. I was thinking today about having the third - never in my life have I allowed my diabetes to stop me from doing something I want to do. I will not allow it to now when it comes to the next pregnancy. You can do this when you get there - many many diabetic mothers have managed.
     
  9. Connie(BC)Type 1

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    I have a friend with Type 1, who has had 3 successful pregnancies, 1 was a set of twins, all pregnancies to term, all natural births, ALL HEALTHY, as is Mom, Kids are all older now~
     
  10. mocha

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    JDRF has a pregnancy tool kit. I highly recommend it. I would also see about reading some other dblogs out there of T1 Moms and their pregnancies. Kerri at sixuntilme.com has some great info, and I think she actually helped write the pregnancy tool kit.

    I think one of the greatest take aways from the FFL conference for me was during the baby session, where is was pretty much agreed upon that most doctors know jack about diabetes. Sure, getting your a1c as low as you can is great, but don't kill yourself trying to get to a place that's not okay for you. And sometimes, you have to find new doctors.
     

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