With good blood sugar management and the right therapy settings, it is absolutely possible to have a successful pregnancy with type 1 diabetes. For me, this has been one of the most wonderful periods of my life!
My name is Marlis. I am 37 years old and have been living with type 1 diabetes for over 19 years now. My first 6 years with diabetes were one catastrophe after another, but after that, I was able to manage my blood sugar levels relatively well. My HbA1c was always steady between 6-7% and overall I hardly felt restricted by my condition. In fact, I often saw diabetes as an opportunity and that’s how I got my job at mySugr.
Despite this positive outlook, however, I still saw no way to keep my blood sugar consistently between 60-140 mg/dl during a pregnancy. The range seemed too restrictive and challenging. I tried to stay in this target area as long as possible but could barely reach it for 7 days...much less 9 months! ‘
Pregnant with type 1 diabetes? I can never do that,’ became my attitude for many years. ‘Besides, not every woman has to have children, does she?’
First a little background about me.
My career and being financially independent has always been a priority. I could not imagine having a child and juggling pregnancy along with managing my diabetes.
I have been working at mySugr for 8 years. At that time, I was the first official employee, in addition to the 4 founders and 2 freelancers. In the early days, I took on every task from customer support, user interviews, and errands to the post office or copy shop. I even made coffee for our guests. Over time, my responsibilities grew until I became the Head of Product Management. This made me responsible for all products that mySugr developed.
I love this role and the responsibility that this position brings me and I have always been extremely proud of my career. But I knew, pregnancy and child-bearing would not easily fit into such a busy day-to-day work schedule, and certainly while trying to manage blood sugar levels too. It took a long time before I dared to take on the responsibility that pregnancy with type 1 diabetes entails... including reprioritizing my career.
What I did pre-pregnancy.
Before I really tried to get pregnant, I took 6 months to get my diabetes as tightly controlled as possible. That means that my basal rate, carbohydrate factors, and correction factors were tested, adjusted, and rigorously monitored. My goal was to get my HbA1c at/below 6%.
In addition, I studied my menstrual cycles carefully to know which hormones affect my blood sugar during ovulation. My doctor explained to me the importance of having my blood sugar levels in range as early as possible during ovulation.
It was during this time I discovered that simply walking around had an incredibly positive impact on my blood sugar levels. So, as soon as my CGM warned me that my glucose reading would reach the upper limits of my target range, I would put on my sneakers and start walking.
Consequently, I have consistently followed this routine since to intercept a lot of blood sugar spikes before they happened. Walking is not always feasible, especially when you go to work, but for me, it is still the most effective tool for keeping blood sugars below 140 mg/dl.
All my efforts paid off and I reached an HbA1c of 5.8%! Not only was that the lowest value that I have ever measured, but shortly afterward I got pregnant!
Hooray, I'm pregnant! Now what?!?
After the initial joy of our big news, the hardest phase of the pregnancy began. The first trimester with type 1 diabetes was incredibly challenging. The hormones at the beginning of pregnancy led to many hypoglycemia phases. For me, this increased significantly, especially in the 9th week of pregnancy.
During the night my blood sugars plummeted. Fortunately, I had an insulin pump + CGM system which reacted to the sensor glucose and stopped the insulin supply automatically. This function became absolutely essential for me in this phase and there were some times when my pump turned off practically all night!
Thankfully my boyfriend was there and could feed me glucose during times when I needed extra help. It was a scary time though, and sometimes I was really afraid to go to bed alone because I didn't know if I would wake up the next day.
As if the nights weren’t rough enough, my blood sugars increased substantially during the day. I sometimes injected insane amounts of insulin to keep my blood sugar in the target range and that was even with walking as much as 20 km a day!
The sweet spot.
With the help of my endocrinologist, I was able to adjust my insulin requirement perfectly. I went for a walk after every meal to improve insulin sensitivity and thereby keep postprandial levels flat, but apart from that, there were no major problems.
From the 16th week and on, I was sent on early maternity leave. During this time, the work stress ceased, my blood sugar levels stabilized and my energy was finally back. I enjoyed this phase to the fullest and everything has gone wonderfully. I am fortunate to have had none of the usual pregnancy problems so far.
Pregnancy in type 1 diabetes can be considered high-risk. In some cases, the child's growth is strictly monitored in order to be able to intervene early if necessary, as above target blood glucose levels can cause the baby to become too large. The mother is also closely monitored. Blood sugar levels, HbA1c, blood pressure, weight gain and protein excretion all checked regularly to identify any complications in a timely matter.
For me, the mySugr app has been invaluable. It lets me track all the health data from home and share it online with my doctors. The estimated HbA1c gives me a lot of security that I have my values under control and that my child's growth is not being negatively affected.
I have now reached the incredible HbA1c value of 4.7%! This seemed absolutely unattainable to me before. Does that mean my blood sugar values always between 60 and 140 mg/dL? No, definitely not! But I do my best every day.
So far our child has developed well and there are no signs of any complications. I know that the third trimester still has some challenges ahead such as more increases in insulin but I’m prepared.
So we’ll have constant dose adjustments, constant blood sugar checks, lots of sensor alarms and possibly some sleepless nights. I'm excited! Sure it might be nerve-wracking sometimes since nobody can tell you exactly how the insulin requirements will change. But I will try to keep calm, check my blood sugar regularly and go for walks to stay in my target range as much as possible.
But while yes, I have type 1 diabetes and yes it has its challenges… I feel absolutely great and have never had so much confidence regarding my own body in my life! Perhaps meditating and practicing yoga has helped, or perhaps it is just the incredible joy that our unborn child has brought about creating this mental change. I don’t know.
Diabetes in pregnancy is unpredictable and it can sometimes feel unfair. But nothing and nobody can take away the incredible joy my boyfriend and I feel every time we sit together on the couch in the evening and we feel the kicks of our little one. We are so excited to meet our child and definitely have no regrets about this process!
Pregnancy with diabetes CAN work!
If other people with type 1 diabetes are wondering how to manage blood glucose levels during pregnancy, I am here to encourage you. It is absolutely possible to have a healthy pregnancy AND manage your diabetes! You don't have to be perfect, you just have to try to do your best every day.
Here are a few tips that have helped me during this entire phase. Perhaps they will be useful for other pregnant women with diabetes:
- Know your body! Developing accurate therapy settings and an understanding of the female cycle before trying to conceive helped me a lot.
- USE A CGM*! It doesn't matter which CGM you buy, but continuous glucose measurements are an enormous help when trying to stay in the target area.
- Movement, movement, movement! No matter if you walk, do yoga, or go swimming. Just MOVE! Walking helped me to get my time in range to 90%.
- Split meals*! For me, I always give myself the full bolus, but only eat half the meal. I eat the rest about 1 hour later. It's annoying, but it helps to flatten the postprandial increase in blood sugar.
- Avoid hypos! My many hypoglycemia episodes contributed to the blood sugar roller coaster in the first trimester. If you can avoid the hypos, the blood sugar generally remains more stable.
- Use a Blood Sugar App! Especially in situations in which physical contact with doctors is restricted, an online log is absolutely essential to be able to share data with the doctor. My diary app helped me tremendously in keeping an overview of my day so that I could make better therapy decisions.
- Get more hugs! I have to mention that a loving partner is one of the most important things. Pregnancy is one of the most emotional phases of a life even without the added stressors of managing diabetes. A loving hug can sometimes offer more support than 1000 words!
*Check with your doctor to see if this might help you.