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The Technology Behind a T1D Pregnancy

The bags under my eyes and the formula stains on my shirt are proof that I am a new mom, again. And the sweet chubby cheeks, striking eyes, and uncoordinated hand movements of the babe in my arms? Well, those are proof that Type 1 Diabetics can, absolutely, have successful pregnancies, no matter what Steel Magnolias depicts. Today I have decided to highlight the tech that made my two T1 Diabetic pregnancies (and subsequent, adorable children) possible!













1) Tandem t:slim X2 insulin pump

During my last pregnancy I used the Animas ping exclusively, but have since switched over to the Tandem t:slim X2. There are many-a-T1-diabetics who can pull off the multiple daily injections (MDI) course of treatment, but for me, an insulin pump is a gift from the heavens, especially during a T1D pregnancy. My insulin needs change dramatically from those first few weeks after conception, to the last few weeks of omg-am-I-ever-going-to-have-this-baby. The Tandem pump allows me to fine tune my basal rate requirements, down to the 0.001 units per hour. I can also set difference carb ratios and insulin sensitivity factors throughout the day. In a perfect world you may not need this much flexibility, but, for me, the changes are so significant and happen so rapidly that it is freeing to have complete control over all of these individual settings.

The Tandem t:slim X2 also integrates with the Dexcom G5 (and now G6!) sensor which allows me to see a real-time graph of my blood sugars right on the home screen of my insulin pump. Per FDA requirements I only need to calibrate the sensor every 12 hours (and soon, no calibrations!), so I had piece of mind with less finger pricks than my last pregnancy.

And we can't leave out the main event. I have been very lucky with both of my pregnancies to have an OBGYN that trusts my judgment and allows me to manage insulin delivery during labor and delivery. Last time, Chris was the keeper of my Dexcom receiver and kept my blood sugar steady in the 80's during the hour long pushing phase. This time the whole process went differently, and after an extremely painful (and long) stalled labor, a C-section became necessary. I was wheeled into the OR with insulin pump and CGM sensor still attached (both on my arms), and a very open and willing team of doctors perfectly content to let Chris monitor and adjust-as-necessary the Diabetes side of the house. I have heard other T1 delivery stories that are not this rosy, so the opportunity to self-monitor and self-administer is not lost on me.

2) Livongo Blood Glucose meter

Ehhh, ok, to be honest, I only use this blood glucose meter because it is free (and encouraged) with our insurance company. The program sounds great on paper - free test strips and lancets, mobile uploading to the cloud, color display, ability to input related information (i.e. just exercised, before lunch, etc). But I just haven't been impressed. The meter start up and test strip pre-check take longer than my previous meters, the free test strips are throttled based on usage and for some reason our neighborhood has poor signal for the uploading capability which I believe leads to an inaccurate test strip count. The meter itself is large, as are the test strips and lancing device - the ergonomics feel tailored for an older diabetic patient. But, all that said, the meter does test my blood sugar, so I guess I should stop complaining.

3) iPhone Apps: Dexcom, Clarity, myfitnesspal, runtastic

This time around I made full use of my phone applications to assist me in various aspects of pregnancy related care. In the diabetes department I used the Dexcom app to keep track of real time blood sugars and share them with Chris. Dexcom also has another app, called Clarity, that I used extensively to pull together trending data. The app makes it easy to run a report from the Dexcom data and save the various charts as a PDF. Then I could send that off to my Maternal Fetal Medicine doc who was assisting my OBGYN and Endo in tracking all the Diabetes schtuff. I really liked the ease of getting all of this data together via phone instead of physically plugging a device into a computer and downloading data before shipping it off - especially while I had the toddler in tow.

Beyond the obvious diabetes apps, I also used myfitnesspal daily for tracking carbohydrate intake (or looking up carbohydrate counts pre-bolus) and weight - both important numbers during a T1D pregnancy. I also used runtastic for keeping track of my daily walks, which really isn't necessary, but as an engineer, I love all.the.data.

4) Backup Plans: Paper and {insulin} Pens

Arguably, the most important T1 Diabetes technology - the backup plan. It's sort of like writing down a few important phone numbers in the off chance your phone dies at an inopportune moment. Similarly, I periodically wrote down my basal rates and other pump settings, in the off chance I had to revert to a multiple daily injection schedule. And I always carry around the proverbial "pen" - insulin pen, that is. Test strips, glucagon, and snacks are all part of my T1 Diabetes back up plan, whether pregnant or not.

5) Apple watch

So, I can't claim to have used this one during my pregnancy with little Otto, but, in an almost joke of sorts Chris gifted me one as a "push present" (which, I sort of think is ridiculous, but whatever). I have to say, I love being able to glance down at my watch to check on my blood sugar via the Dexcom app! I often have my pump (with the Dexcom graph) or phone (again, with the Dexcom graph) inaccessible, so the gentle readout on my wrist is an extremely welcome addition to my plethora of Diabetes tech. One of my favorite uses is during a workout session. I stuff my phone in a leg pocket and hit the trail - with Dexcom info being piped straight to my wrist in real time. There are even more updates coming to this technology soon that I am over the moon excited about!

As a note: I do NOT have affiliations with any of the specific companies or products listed in this post - you are getting just a pure, unfiltered, T1 Diabetic's opinion...so, take it or leave it, high or low, fast acting or slow, busted pancreas or not ;-)

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