Just starting to think about getting pregnant

So all my life I have sworn I wouldn't be pregnant. Being pregnant scares the daylights out of me. I always thought I would adopt. However, after getting married last year, I'm warming up to the idea and even starting to want it. So I've started to discuss things with my doctors, and work on getting healthier in preparation. I'm trying to lose some weight and obviously get the sugars down.

Here's my challenge. My A1C's are always in the mid to upper 7's. And my blood sugars are just so freaking erratic. I don't see how anyone stays in the 80-120 range. If my blood sugar gets to 120, it only means a low is coming and it's dropping fast. There is no "holding" at 120. It seems like I'm always either going up or going down, never staying stable. Yet I feel like I work so hard at this.

I've been diabetic for 21 years, I'm 33 years old, vegan, and I've been a pump forever. I feel like I know how to manage this, but stability is never something I've ever had and while it's concerned me before, thinking about being pregnant and having huge sugar swings is even more scary. My sugars shoot up after eating, and remain high for quite awhile, even when I bolus beforehand and/or eat very few carbs (or I will overbolus and end up low an hour after eating, but more likely i am high).

yesterday is the perfect example. i started out okay, at like 140 when i woke up. i went up after breakfast but was coming down by lunchtime and was like 160 when i ate a salad. i bolused for the salad and then within an hour i was 100 and my cgm was telling me i was dropping fast, and i had 4 units of a bolus still working. i shut off my pump and ate some dried fruit. i continued to drop so i had some juice and some more fruit. then i spiked to about 300 an hour later. i went to the gym and dropped from 280 to 150 while working out. i went home and ate dinner, bolused a normal amount and expected to be in a good range, since exercise usually keeps me lower for several hours. when i went to bed i was 300. i bolused for the high and woke up a few hours later and was still 300. i bolused again, an hour later i was only 280. i bolused more (and started to wonder if something was wrong with my pump site). this morning i was 180 when i woke up. i know we all have days like this, but a day like this while being pregnant would really scare me.

some days i feel super hopeful, having seen several of my friends with diabetes have healthy pregnancies and babies, but other days i just feel like ever being healthy enough to even try is going to be impossible. the thought of having to report all of my numbers on a daily/weekly basis to someone while pregnant leaves me anxious, because i can just imagine it's going to be filled with lectures, when i already feel like so much of it is out of my control.

any advice?

Hello,

   I don't usually respond to these because usually someone always beats me to it. I am a vegetarian, would love to become vegan. I have been type 1 for almost 33 years. I have never been on a pump. I do have highs occasionally. It works with being a vegetarian.  I have a 6 month old and got pregnant at age 39, delivered him at 40. My AICs were 7 and he is just fine, brilliant. I know of another type 1 diabetic who is way, way out of control. She had a normal delivery and her son is very bright.  

    What helped a lot with my pregnancy was to do research on natural health. I learned a little too late that the reason many people get pre-eclampsia is because of a lack of vitamin D. I did get that and had high blood pressure. No one told me that type 1 diabetics are prone to this. There were few articles on this site about it.

   My blood sugars were lower the first trimester. By the second and third it was more difficult in the evening to control them.

    I don't know if you would be comfortable with it but you could go back to using injections. It really is not that bad and the syringes are so small that it is painless. A homeopathic doctor might help a lot because they have background in nutrition and might know the triggers for why you're blood sugar skyrockets. Some carbs make mine skyrocket but not all. Natural health is what helped me a lot.  

    The reason why I use natural health is because they don't seem to be solely interested in money. When I was 8 years old and diagnosed they told me that by the time I was a teen there would be a cure. I am still waiting and all of the money is focused on type II diabetics because there are so few of us.

   I hope that this helps. It has worked for me. I am not one of those people who can brag that I have a 5.3 A!C. If my sugar is below 75 I feel strange. I always think it is better to be a bit high than drop to 30.

   You will do great and I am very impressed that you are a vegan because it is tough to do but a wonderful thing!

traceystar16,

To me, your numbers sound like a typical type 1 diabetic! I am very similar to you. I have had two healthy pregnancies and babies, thank G-d. For both, it took me a good 6 months to get my A1C's down to try to conceive. For my first, I had an incredible endo who is a type 1 herself and specializes in pregnancy. she was a bit of a drill sergeant, but she got my A1C down when i didnt think it was possible! for me, keeping detailed logs of foods, blood sugars and checking a million times a day were all key. if you are in the NYC area, i can give you this doctor's info. for my second, i moved so found a new doctor and started using a CGM. dont know if you use a cgm but the cgm taught me so much about what my blood sugar is doing all the time. it helped me cut down on super frequent checking (still checked like 10 times a day but thats less than 20!). it also predicts highs and lows so you can prevent them from occurring. during pregnancy, i had plenty of highs and lows but i was on top of getting back into a normal range asap! it will never be perfect because you dont produce insulin. you can do this. it is about trying really hard, not beating yourself up over the non-perfect numbers and about finding the best support team you can.

regarding the spikes in your blood sugars post meals- by keeping logs, you will identify which foods cause spikes and either eliminate them from your diet temporarily or bolus ahead of time, etc... for me, i could not eat cereal and milk while pregnant- just didnt work- and its prob my fave food! with pregnancy #2 i could eat it but not for breakfast. also, read through the tips people write in this group. there is such great advice!

you can do it :) best of luck!

I don't think you should be having the numbers you do.  You may need to go back to the basics and ensure your pump settings are accurate.

1) Have you recently fasted for 24 hours and adjusted your basal rates?

2) Are the insulin duration time, insulin sensitivty factor, and carb factor set accurately in your pump?

3) What is your pump's target blood sugar?

4) Are you looking up carb values or just guestimating?

Review John Walsh's "Pumping Insulin" book.  Great resource and always helps me fine tune.

Definitely wouldn't try to get pregnant until you have more settled numbers, especially avoiding lows since they can affect your baby's development.  

It will also make life after the baby is born easier if you get into better control now.   For the first few months with a new baby you eat weird, get no sleep, and barely any time to use the bathroom, much less do a pump site change.  

thanks for the responses everyone.

carrier, thanks for the vegan encouragement. i've been vegan for over 6 years and actually went vegan after i saw an article that it was the best diet for Type 2s. Though i'm T1, i thought i'd give it a shot. I was a vegetarian for 13 years before going vegan, i know it can be a difficult transition. but now i look at dairy and eggs the same way i looked at meat beforehand.

i'm also very into natural health. i've been wanting to find a more naturopathic primary care doctor, but i have a naturo chiropractor who is great on things like supplements, etc. i'm also more like you in the sense that i'd much rather be 150 than 75, so i tend to run myself higher in general, because like i said, once i get below 130 it's just a short matter of time before i'm low if i don't eat something first. and i know it shouldn't be that way.

Fraida, I appreciate the support. i do have a CGM although i have a love/hate relationship with it. i'm wearing it now for the first time in probably 3 months. and ironically it does make me test more i think (when i already normally test 12-15 times a day). obsessively testing isn't my issue, i do that. i just feel like i never quite get the balance.

jenna, i agree that looking back at some basics could help, though i've done that many times over my T1 life. it's just so frustrating.

I picked up two books when I first started to think about getting pregnant: "Balancing Pregnancy with Pre-Existing Diabetes" and "Think Like a Pancreas". I was in the same boat as you when I started to think about pregnancy, and both books helped a lot. For getting control, Think Like a Pancreas takes you back to ground zero -- and it offers a ton of useful info, even for a 20 year veteran of T1D. Once you're under control, Balancing Pregnancy helps you feel like pregnancy is do-able and takes you step by step through what to expect.

Beyond the books, though, I can see a couple things in your case that I also had to learn. First, way back when I was diagnosed, I was taught to correct low blood sugars incorrectly. You have to correct with 10 to 15 grams of sugar (Think Like a Pancreas gives you the proper amount for your weight and BG level) and then wait a full 20 minutes to test again. It feels like forever. Honestly. But It takes that long to kick in. Now, here's the kicker: once you wait that 20 minutes and test, don't correct your blood sugar again if it's raised even slightly. Like if you tested at 59 the first time and test again at 65 after the 20 minutes, don't eat any more. Your BG's on the rise at this point; you will be normal soon. Oh, and the lows feel so low right now because your BGs are on a roller coaster. Once they stabilize, your lows won't feel so terrible.  

The other thing I learned is that I had to bolus 20 minutes before eating anything. Even a salad. I had to measure everything and count the carbs in the veggies, dressing, croutons, etc. (and I was eating way more carbs in a salad than I thought!). Also, protein goes a long way toward keeping sugars stable, so add nuts or chickpeas or something if you don't already.  

If you want to re-set your pump basal and bolus amounts to your current weight, that helps a lot too. Your doctor can run you through how to re-set everything. You might even wish to take the pump class again; it helped me to pick up on pumping things that I missed the first time I took the class.

Good luck!! I just had my first daughter, and I can tell you it's totally worth the hassle. A ton of hard work, but worth it in the end :-))

thanks Christa. that's helpful. i actually did get the pregnancy book awhile ago, but the Think Like a Pancreas sounds interesting.

i actually think the CGM is bad for me in the sense of which way the sugars are going. like yesterday i know i ate way too many carbs when i was low but it just kept giving me the double arrows down and i knew i had 4 units still working from lunch.

the overtreating lows thing is big for me, i will admit. but i'm terrified of crashing too low and passing out or something (especially when i'm alone, or going to bed). so i do whatever i can to avoid that, which usually means keeping myself too high because as i said once i'm in the "normal zone" i end up dropping too fast.

I know how you feel! It took me a while to become friends with my CGM, mostly because I was overcorrecting lows and eating too soon. Both of those things can completely mess with the CGM. Both make it think you're increasing or decreasing faster than you actually are.

So then you have to remember in the moment of a high or low blood sugar (which is really hard to do!) that you have either food or insulin on board that the CGM doesn't know about. In the case of double arrows down, that can be scary. But say you ate 30 carbs. if you estimated and took insulin for 40, you really only need 10 carbs to bring you back to normal. The hard part is not knowing how much extra insulin you took, but correcting in the slow 15 carb/20 minute increments gets you there safely, as long as you're not 40 or something to start.

Can you start slow? What I mean is aim for blood sugars of 150. If you can get stable in the 130 to 170 range, then you could slowly move down to normal. It'll take your body time to adjust so that the lows don't feel so low anyway, and then you'll feel more confident about trying out the lower range later. Think Like a Pancreas explains why the lows feel so low, and I think it talks about dropping low fast, since you have that issue. Seriously would marry that book if my husband wasn't so great!  

Think Like a Pancreas is a great book.  The author, Gary Scheiner, also does online diabetes classes at www.type1university.com

He has type 1 diabetes and is an exercise physiologist.  Super knowledgeable and you can ask questions during the live online trainings.  They're usually about $30 each.  

When pregnant I would bolus, eat, then test an hour later to see if I needed a correction.  You might try that if you're still struggling after you make sure your pump settings and carb counting are on track.  

I got pregnant when I was 32, after having type 1 for 28 years.  I was surprised at how possible it was to be a type 1 mom.  Nothing like "Steele Magnolias"  =).  There's no reason you can't have a healthy pregnancy and a healthy baby.