In the past I have written about my experience of Type 1 diabetes in pregnancy. That post really focussed on what happened for me, but everyones diabetes is different, as is every pregnancy. There is no one solution that can make being pregnant and having diabetes plain sailing. It just doesn’t work like that. But I do have some tips for what you can do to make your life easier.
I am by no means an expert. I have had one pregnancy. Just one, and I made many mistakes. I am not medically trained and I am not perfect. If you are already pregnant then do not make any drastic changes without consulting your health care professionals! However, if getting pregnant is something you hope to do soon then keep reading!
1. Write down your doses prior to trying to conceive
I did not realise I was pregnant until I was around 5 or 6 weeks. In the weeks running up to doing a test I had been constantly lowering my basal rates and changing my insulin to carb ratios to accommodate an increasing number of hypos.
I was always led to believe that pregnancy reduced your insulin sensitivity, which it does, but for me that didn’t kick in until further down the line. The energy your body is expending into turning a bunch of cells into a baby meant my blood sugars would plummet.
Once you have had your baby you will want to return to roughly your old doses, so if you make sure you have a note of them before things start to change then it is much easier!
2. Know you won’t always be perfect
My control was the tightest it has ever been while I was pregnant. My hba1c stayed at around 38 from start to finish, and I worked hard to achieve that. But I wasn’t perfect. My blood glucose was not always within the range my consultant would have liked. The reality is that it will go high sometimes, no matter how hard you try.
Obviously if its high after every meal then you need to do something about it. But the odd higher reading here really isn’t the end of the world. We all know stress increases your blood glucose, so I found that provided I stayed calm and simply made the necessary corrections and carried on with my day that things would sort themselves out. I am sure that if I had gotten stressed about it then it would have taken longer to settle.
3. Pre-bolus as often as possible….
It’s incredible what a 15 minute head start for insulin can do! I am my most insulin resistant in the mornings so personally I can bolus 30 minutes before eating. It worked wonders for stopping big spike in blood glucose levels.
4….. Unless you’re struggling with morning sickness
I made the mistake a few times of bolusing, and proceeding to see my entire meal come back up again. Seriously. So many times. I was then left with the dilemma of trying to work out how much of the meal had started to digest before I was sick.
Getting it wrong can give some pretty wicked lows, so take it easy on the pre-bolus if you’re not confident on how you’ll react to the food.
5. Make use of pump features
Obviously this only applies to pump users. Square wave and dual wave bolus are your friend! Using a wave is a great way of helping when you’re having a low GI meal, or one with high fat content. I should probably use them more even now, but it’s easy to forget. When I was pregnant I usually used at least once a day.
6. Embrace change
It is totally normal to be changing your basal rates and bolus ratios every couple of days. It is counter-intuitive at first. I was always taught to wait and see if something happens for 3 days in a row and then you know it is a trend. When you’re pregnant there’s no time for that, if there’s an unexplained high you need to act on it.
At first this made me really uneasy, particularly making changes to overnight basal. It is necessary, so the sooner you learn to embrace the changes the better!
7. Use your team
In my hospital I was pretty much left to my own devices. I was seen for a scan and meeting with the consultant once a month at the maternity hospital, and every 3 weeks my diabetes specialist nurse called me. That was it, but that suited me fine.
If you’re unsure about how to deal with something then ask for help. You don’t have to make all the decisions yourself, and they will be more than willing to come up with a plan with you. If you want to be seen more regularly then ask!
8. Make informed decisions
At the end of the day, it is your body and your baby. You cannot be made to do anything you do not want to do. I did not want a planned c-section and I made this very clear upfront. However, many diabetics opt for this.
Most diabetic mothers are scheduled for either induction or a section at 38 weeks. However, you can insist on going longer if you desire. I was given the option to go to 39 weeks due to the way my pregnancy was progressing (Piglet had other ideas and turned up at 36 weeks on his own) but I chose to refuse this as, for me, the risk was not worth it.
Do your research, ask the questions and know why it is being recommended before you make a decision.
I hope this helps you to plan for you diabetes in pregnancy. If you’re going through it yourself then leave me a comment!
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