Tuesday, September 1, 2015

Pregnancy and Diabetes FAQ

I thought I would write a little post including some frequently asked questions about my new life as a mom-to-be [with Type 1 Diabetes].

How are you feeling?!

This is definitely the most frequently asked question so far!! It's lovely to have so many people concerned about how I feel! I did experience about 6 weeks of nausea, but only once did I actually physically "get sick". While I didn't feel awesome during this time, I'm thankful my symptoms were fairly mild. The time I got sick was right after breakfast, which means I had already taken insulin for the carbohydrates I ate. This poses a slight problem when you throw up the carbohydrates you ate, with no way to "throw up" the insulin associated with them. I ended up drinking juice to avoid the low blood sugar, but it was a little nerve wracking. Like I said, thankful it was just this once!!

I'm now fully engaged in the second trimester, so most of my nausea has eased. I've found not letting myself get too hungry is the key to winning against the nausea monster!

Will your baby have Diabetes?

I have done a lot of research in this area, even years before kids were an "option". The truth is, I wouldn't wish Diabetes on my worst enemy, and I sure as heck wouldn't attempt a pregnancy if I knew the poor child was doomed to get the disease. The good news is, the research shows that our child is no more likely to get Type 1 Diabetes than a "normal" child. The statistics would be different if Chris had the disease, or if I was under 25 years old, but neither of those apply to our situation. Joslin reports the chance in our specific case is 1 in 100, equivalent to the general population.

How is a pregnancy with Type 1 Diabetes different from a "normal" pregnancy?

Ok, no one has really asked this, but I figure there are curious minds out there who may be afraid to ask. And, as a disclaimer, I'm not an expert on "normal" pregnancies (also, is there really such a thing?), so my comparisons are drawn simply from standard pregnancy knowledge bases or friends' experiences.

For starters, "pregnancy" for a Type 1 Diabetic really begins months before conception. To give everyone the best chance at health, blood sugars have to be maintained in tight control for a period of time (the recommendation is at least 6 months) before trying for a baby. Not only does this ensure mom is at peak health for baby, but it also ensures she hones her carb counting / insulin dosing skills prior to the real deal. During this time I set my CGM alerts to 80 mg/dl for "low" and 150 mg/dl for "high" (much tighter than the 70 - 180 mg/dl range my endo normally has me under).

Once the pregnancy was confirmed, my endo decreased my range even more to 80 - 130 mg/dl. This is extremely tight control, especially when you factor in the surges of hormones, pregnancy hunger, pregnancy nutrition, and exercise regimes. It really does take constant vigilance, tweaking and precise carb counting.

In the first trimester through some part of the second (it's a little different for everyone), Type 1 Diabetics experience more low blood sugars. Actually "normal" moms do too, but their body can counteract the effects almost seamlessly. This means lots of glucose tablets, and when those become too grotty (ugh, trust me they do), orange juice or yogurt or fruit or any other sort of fast acting carbs steps in to save the day. Once the placenta takes over and starts pumping out more hormones sometime in the second trimester through the end of pregnancy, blood sugars rise and the body builds up a nasty insulin resistance. This means later on I will require a LOT more insulin to cover the same amount of carbohydrates. However, once the baby is born, its likely my insulin requirements will be even less than before the pregnancy.

Other than all the fun of constant diabetes monitoring, I am seeing my Endocrinologist a lot more, on the order of once a month. As far as the OB goes, not too much different yet, except for a few extra tests, but later on it will be more frequent than a low risk pregnancy.

Have you had any cravings?

Not really, I mean I crave ice cream, but I also craved that before pregnancy, so....

Has Chris been helping with all the Diabetes-related-pregnancy fun?

I have to give Chris major props. He has come to and supported me through every.single.appointment since we found out I was pregnant. He has always helped me change my insulin pump sites, and he continues to help there. He is also getting accustomed to googling carb counts and just being more conscious about foods that may have an adverse affect on that 130 mg/dl goal.

What has been the hardest thing about pregnancy so far?

One word: guilt. Maybe this is how all mothers feel, but having a not-so-great blood sugar reading staring you in the face is just, so...quantitative. I feel like every bit of food I put in my mouth could potentially lead to a high blood sugar and in some way harm that sweet little collection of burgeoning life-cells in my belly. On the other hand, every second of exercise could lead to a dangerously low blood sugar and do just the same thing. It is such an incredible tight rope walk.

What has been the best thing about pregnancy so far?

Ohmygosh, all the things. Every moment Chris and I have spent sitting on the couch dreaming up funny answers to our child's inevitable questions, or thinking about what they will be when they grow up, or imaging family vacations to the new Star Wars Disneyland park, or anticipating them meeting our family has been the absolute best. Every mind-at-ease test result, every ultrasound with baby dancing, every successful carb count and insulin dosing....all of these have been the best. We really don't know anything about being parents, but we are excited to learn!!