T1D and blood sugar spikes, fearing it's harmful to baby?

Hi all! I apologize if something like this has been brought up in the past but I haven’t really seen any topics on it. I’ve had T1 for the past 21 years and I’m now 28 weeks pregnant with my first baby! Despite not having an ideal A1C when conceiving (7.3%), so far my MFM docs are pleased with how everything is going via growth scan ultrasounds, bloodwork and doc visits. I managed to get the A1C down to 6.0% and then 5.4% (although my endo was skeptical of this for some reason based on my actual sugars). I’m supposed to go for another A1C tomorrow and fear it will be back to 6.4ish range. While I know they’d like it to be 6.5 or lower, I’d rather not be at the higher end of the scale.
I use an Animas Vibe with the CGM and have been super obsessed with making sure my numbers are in target range! I keep in contact with my Endo/NP on a weekly basis by uploading my pump/glucose monitor to Diasend. Regardless of how hard I’m trying and constantly fixing my basal rate, ISF, carb ratios (which seem to change every single week), I keep getting spikes after I eat breakfast! My target range is to be 140 an hour or two after eating and lately I’ve been in the 170 - 200 range! I can’t correct for this because there’s tons of insulin on board. I’ve tried everything from eating less carbs, combo bolus, temp basals and finally when it seems to be the right calculation, the next week it changes. My numbers throughout the rest of the day are always good but I am constantly fearing that the 2-4 hour spike in the morning is going to do harm to my baby. It’s not every morning but even 3 days out of the week is really stressing me out.
I know that having consistant high numbers over a long period of time is usually what causes the baby to have birth defects, be larger, miscarriages, stillborn etc but what about the little spikes here or there? I think I’m just looking for others who’ve had similar experiences. I know your numbers can’t be perfect 24/7 no matter how hard you try.

In addition, can someone tell me what I can look forward to in terms of MFM care from here on. My doctor scared me a bit and said typically we see stillborn babies in Diabetic woman starting at 32 weeks so there will be different things to monitor from that point on. I assume there will be non-stress tests and more frequent growth scan ultrasounds?

Many thanks! It’s always nice to hear from others who are going through the same thing you are!

As for the morning spikes, personally I don’t think you have anything to worry about. I only have one son (currently 10 months old), but I made it through the pregnancy with A1cs anywhere from 7.8 (at conception) to 6.5ish through the pregnancy. Much like you, I was using my pump, CGM, and meter to the point of obsession and just doing the best I could. You’re probably worse off for the stress you’re causing yourself than those brief spikes after breakfast. And, let’s face it–170-200 isn’t all that high. It’s not like you’re spiking into the 300-400 range or anything like that. So just take a deep breath and keep pushing on–your basals, ratios, etc will continue to change weekly and it’s hard to keep tabs on it all. You’re doing a great job so far!

As for MFM care, try not to let them scare you with talk of defects and stillbirths. That is by no means the norm, just something they continue to check for. Beginning at week 25 or so, I had ultrasounds every 4 weeks (yay for more baby pics!). I forget if it was around week 30 or 32, the non-stress tests started being twice a week. Once after an NST they sent me to have an ultrasound just to be sure of something that wasn’t reading right (it was only a precaution and everything was fine). Even with all of the extra monitoring, I still delivered 5.5 weeks early via c-section due to a nasty case of preeclampsia that literally developed over night. (seriously–I had just been in for an NST the afternoon before and everything was fine. At 5am I was checking into the ER, only to later learn it was time to deliver) There was no indication that this was caused by diabetes or anything else I did or didn’t do. Sometimes things just happen. My son spent 2 weeks in the NICU, but ultimately is perfectly healthy (and starting to crawl–Lord help us all LOL).

Hang in there Mama–you’ve got this, and more importantly you’ve got an awesome little snugly bundle on the way! Keep your eyes on the prize and try not to sweat the rest!

I think the biggest thing you need to keep in mind is that it’s the big picture that counts, not each individual spike. If overall you’re doing well, your baby should be just fine! I had spikes throughout my pregnancy because everything changes so often. I would change my insulin dosing weekly, or sometimes daily. There are a lot more horror stories out there than good stories!

I started twice weekly non-stress tests at 30 weeks. I was triaged once around 32 weeks because of increasing contractions, but I just seemed to have a lot of contractions throughout my 3rd trimester and my baby was just fine (heart rate was great). I was induced at 38 weeks because they were estimating his weight to be around 9 pounds, and since they grow about 1/2 lb per week towards the end, there was a risk of him getting too big. I was in labor for 27 hours, but it was a relatively smooth delivery and he weighed in at 9 lb 2.9oz! My son spent 4 days in the NICU. He initially went in with low blood sugar (it kept dropping to the 30’s/40’s because I had been on an insulin drip throughout my labor) - this is totally normal for a diabetic baby and he’s perfectly fine now! The extra 3 days in the NICU were for jaundice which cleared up after light therapy.

Now I feel like the luckiest person in the world to have such an amazing baby and the one million doctor appointments seem light years away. I agree with KSmerk12 - you’ve got this! Accept the anxiety because it’s all new; you’d have different anxieties as a non-diabetic mom, it just comes with the territory. You’re almost there - it will be the best day of your life and the most amazing feeling to have that baby in your arms!! :slight_smile:

Thank you, ladies! Such kind responses and it definitely made me feel a bit better!

I had a very similar experience right around the same time frame. For about 3 to 4 weeks I was making changes to my basal rate, ISF, carb ratios almost daily. Then things leveled out at which point my total daily dose was double pre-pregnancy. I use an animus ping and dexcom CGM. I was concerned when my bloodsugars would get into the high 100s or low 200s and it would take me several hours to battle them down. Both my Endo and OB said that that was typical around this point of pregnancy. I was almost certain I would have a higher A1 C because of this, but I just had it tested Monday and it came back as 5.7. I’m so thankful that is behind us and things are more stable now. I’m currently 35 weeks 5 days and things are going well. I see my Endo every eight weeks and call or email if I have a question in between. I’m comfortable managing and changing my settings on my own for the most part. I have had A1 C’s consistently in the fives pre-pregnancy and all during this pregnancy with one exception of 6.1. I personally struggle with the issue of stillbirth. In September 2014 my son was stillborn at 27 weeks. He checked out perfect at every appointment and growth scan and my A1cs were great the entire pregnancy. We had no previous issues. It was a total shock and they did not find any explanation or cause, diabetes related or otherwise. Despite my excellent control, I also had a miscarriage at five weeks before him and a miscarriage at seven weeks right before this pregnancy. As far as testing, we started growth scans every four weeks at 24 weeks. We have been doing once weekly biophysical profiles since week 32. We also had a NST at 32 weeks because she did not pass the BPP that day. She did well with the NST. We had a scare last week during the night in which I did not feel her move for almost 2 hours. As we are about to pull in the hospital parking lot, she starts moving. They did an NST for an hour and a half and she checked out fine. I have only been to MFM twice during this pregnancy, for her level 2 ultrasound at 19 weeks and for her echocardiogram at 22 weeks. They told me I am good to continue with my high-risk OB docs as long as there are no issues. I am scheduled for a C-section at 38 weeks because my daughter is breech. She has been in this position since week 18 that I know of and has not moved out of it. Only 2 more weeks to go for us! Hang in there. I know its tough but you are doing great!