I do not have any children but am starting to think about it. Is there anyone that has children that was on the pump during pregnancy? I have a lot of questions!!
Hi Kirstin - I wore a pump for both of my pregnancies. It really helped in managing the amount of insulin I needed by the end of the pregnancy. My daughters were both between 6 and 7 lbs when born. They are now 9 & 7. Let your questions roll and I'll do my best to answer them.
Thanks for being so open to answering questions. The first one that I will ask is about diet. Did you stick to a very bland, routined diet to keep your sugars as close to target as possible? My dr is telling me that pre-meal BS needs to be 70-90 and post-meal should be no more than 120. That is very tight control.
Ha, if you consider tacos at every meal bland, yes, I stuck to bland. ;-) Of course, my oldest wont' touch Mexican food now. Such is life.
Back to question... I did not stick to routine foods, but I did stick to meals that I was sure of the carb count of. I've always been a very good estimator on carb counts though. Your doctor's recommendations sound about what my doctor told me. You will not be able to keep your BG below 120 after a meal, so don't think that is the goal. Think of the goal being above 120 for as short amount of time as possible. You will be fighting highs and then treating lows for the entire 9 months... and will be a lot of work.
If eating the same thing makes your life easier, go for it. Do know that your moving target is going to be your basal and bolus rates. Those will change, probably a couple of times a month so just because what worked for 20 grams of saltine crackers today will not work three weeks from now. By the end of my pregnancies I was using 4 times the amount of insulin for basal and bolus rates. (bolus rate went from 1/9 grams to 1 unit/2 grams over that 8 months). I was refilling the pump reservoir daily when I can go more than the recommended three days before and even now.
Do you have a CGM? I think pregnancy would have been a lot easier with a CGM to help. I know some insurance companies who don't normally cover them will cover them for pregnant women. I dont' know your interest in that, but it might be something to check out.
You will keep hearing from your doctors about the goal being in the 70 - 120 mg/dl range, and it is a great goal, but I think everyone needs to remember that there is a person growing inside and that person decides one day to use more of mom's energy than they will tomorrow or three days before. It's near impossible to stay in that window (shoot for it, but know you won't be in it all the time). I think we set ourselves up for failure and feelings of failure/guilt if we don't go in with eyes open.
It's hard work, but it is worth it. I've been able to keep my A1Cs in the 6's since giving birth and I was almost never below 7 before deciding to get in shape for pregnancy. Pregancy and then parenthood will change how you manage your diabetes.
I am encouraged to hear from mothers that have had successful and healthy children while being on the pump. There is a lot of negative feedback about this subject as well.
I do have a CGM and I LOVE IT. It is very close to accurate about 80% of the time. The times that it is not is when my sugars are flucuating a lot. I have had low A1C's in the past but my dr at the time said that it was b/c of many lows (5.5, I think). My last A1C was 7.0 and I have been starting to pay a lot closer attention to how my body responds to different foods.
I appreciate your answers to my questions, I have a lot to learn. My next one is......did you have a lot of lows after giving birth, and if so, did they interfere with being able to care for your new baby?
[quote user="Kristin"].did you have a lot of lows after giving birth, and if so, did they interfere with being able to care for your new baby?[/quote]
I did go low after giving birth. The hospital doctors said to hook up pump right after giving birth, even though I put up a bit of a fight about it. I did it, and did end up going low quite a bit in the first 36 hours after giving birth to my first daughter. I ended up taking the pump off and required very little insulin in that first day. My insulin requirements were back to what they were before I got pregnant (write down your pre-pregnancy basal/bolus rates and put it in your hospital suitcase!!) before I left the hospital.
Breastfeeding caused me to go low too. I found that two six ounce glasses of orange juice worked to keep me level. One glass before I started. One glass while I burped in the middle. Be very careful that first week or two until you figure out what your baby does to your body.
I hate to say diabetes interfered, but you have this newborn that you have the normal first time parent jitters about and then you've got diabetes to manage. If at all possible, I'd make sure you have someone there with you to help that first week or so. Husband/dad, your mom, a friend. Someone who can bring things (i.e. fixes for low while breastfeeding) to you. You'll be slow moving for a while and will have your hands full with a newborn. You'll get the hang of it, it will just take a little extra time and work.
I did better at self-managing after giving birth to my 2nd daughter. As much as the doctors and nurses are trying to help... you know your body and diabetes better than they do. They said hook up pump two hours after giving birth, and I politely disagreed to do it until I saw a blood glucose that indicated I needed insulin.
This may be a silly question but where did you put your infusion sites while you were pregnant? I've been pumping for about six months and, in that time, I've only ever used my abdomen. However, I have a feeling this may not be the best place for an infusion site once one gets further along in pregnancy. Any insight?
(I am not currently pregnant but it is something I am working/hoping for in the near future. Thank you for sharing your experiences and positive outlook. It's very encouraging!).
Hi Laura - not silly at all. I actually kept my infusion sets in my stomach for the entire pregnancy. There is plenty of space on the side to put in the sites. This was 10 years ago, and I truthfully don't remember seeing any people or documentation about putting sites anywhere else. :-) I have put CGM sites on my thigh (in fact, I don;t use the my stomach for CGM), and have put pump sites on my daughters upper behind too.
I hope this helps.
Does your daughters have diabetes? This worries me so much :(
Thanks for sharing.
I also have had 2 healthy pregnancies while being on the pump. I have had type 1 for 21 years now (I was 12). My oldest is 2 and I have a 12 weeks old, and both are perfect and healthy. Of course the pregnancies were high risk, and I spent a lot of time at my OB's office... my daughter was born at 35 weeks (but she was perfect, almost 7 lbs) and my son was a scheduled c-sect at 38 weeks and he was 8lbs. Quite a miracle considering when I was diagnosed they told me I would not be able to have kids!!
You may want to move your infusion sites out, I found it worked well to have them higher up or in love handle area. My daughter is in a research study because she is at high rick for developing type 1 (The TEDDY study), so far all her tests have come back negative. I worry that she may become diabetic as well, but bottom line is, what a gift to her to grow up with a mom who completely understands how hard it is. Good luck!!
[quote user="Enza"]Does your daughters have diabetes?[/quote]
Yes, my oldest daughter does have type 1. She was diagnosed at the age of four (five years ago). It was quite a shock. These days, we know that a child with a parent with type 1 has about a 5% chance of developing type 1. There is a clinical trial called TrialNet that you can enroll your child in to see if they have an increased risk. We have done this for my youngest daughter. More details are here: http://www.diabetestrialnet.org/index.htm
Everything Katie Clark said about pregnancies was the exact same for me. I had a pump and still put the infusion site on tummy but more to the side and had no problem.
All the info about breastfeeding and waiting to put the pump on after the birth because of lows was true too.
I had three super healthy pregnancies and c-section deliveries. Just alot of monitoring and doctor visits, but it is ALL worth it.
I almost hesitated in replying because I did not want to make you more nervous about having children, but do need to tell you one of my kids developed type I 3 years ago at age 5. I am like Katie in that way too- BUT I am sharing this to tell you that although Katie and I both have T1 children the percentage is REALLY still low at that 5% she mentioned- Katie and I just happen to be part of the lucky few that make up that percentage. Even with Julia having diabetes (which is not fun!) I still could not imagine our life without her and she is a super healthy girl who plays soccer, etc...
Lastly, I even had Julia at age 36 and my OB ( a high risk one) still encouraged me to have more babies!! but that was enough for me.
Make sure you have a really good high risk OB and feel free to ask as much questions on this site as you want.
I am not pregnant yet but I use many different spots for my infusion sites. I actually don't like to put them on my abdomen b/c that is the area that I used to inject a lot before I got on the pump. I use the sides of my abdomen (love handles as someone else called them!!!) I also use the upper area of my butt, the sides of my thighs and have even tried the fronts of my thighs. One thing that I noticed with putting it on the front of my thigh was that I was much more sensitive to the insulin than when I have it on my abdomen. I am sure this is mostly b/c I am up moving around most of the day and the insulin gets distributed faster. My dr even said that I could put infusion sets on my upper arm but I am not comfortable having it there, especially with the tubing.
Just some ideas for you, hope all is going well. I plan on getting really tight control of my sugars in the next 6 months or so and then start trying to get pregnant.
That is an interesting thought. I only do my infusions and my Sensor in my tummy.
Can you do this when you are pregnant?
My Story: We are wanting to start trying in about a year. I have to have my A1C below 7.0 for my doctor to approve me a having a baby. I was 9 before the pump, one month later I was down to 8, 3 months later I was at 6.9, then could not use the Sensors anymore due to money and now my A1C is back up to 8.8. I am back on sensors again!!!!
Oh I cannot imagine upper arm! I wore a pump for two pregnancies, have 2 healthy boys, 1 of which tested positive for the higher risk gene only. Children of mothers with Type 1 diabetes have a 3% increased risk of developing the disease whereas children of fathers have a 7% chance. At least those were the statistics cited in medical school.
The first stage of every pregnancy is typically characterized by the addition of padding. There is plenty of room on the abdomen for both CGMS and infusion set. The abdomen is taut in the third trimester but by that time, the padding is such that you have an adequate supply of subcutaneous tissue on your flanks and sides (think love handles) to still insert in your midsection.
A word on pregnancy in diabetes - my first was with a pump but no sensor and it was difficult to control the glucose levels. I wore the Dexcom CGM throughout the last pregnancy and it dramatically improved my glycemic control. DRAMATICALLY. And it worked much better when pregnant (increased interstitial fluid and blood volume with pregnancy). Most insurance companies will cover it because noone wants to screw up the control of a pregnant woman with diabetes and your risk for hypoglycemia is indeed greater due to the need for tight glycemic control.
Sensors and pumps are fine throughout pregnancy if not superior. In fact, I would even predict that the increased number of healthy pregnancies in women with diabetes is due to the pumps and frequent glucose monitoring.