Dr. Nat Strand Talks Second Pregnancy

Dr. Nat Strand has already had one successful pregnancy as a mom with type 1 diabetes, but we wanted to know if and how pregnancy was different the second time around. Does it get easier? What wisdom could she impart on us, now that she’s been there and back again? Beyond Type 1 got to chat with Dr. Strand about anxiety, sharing her diabetes management and having that cupcake every now and then.

BT1: How has this pregnancy differed or been consistent with your last pregnancy?

NS: Overall this pregnancy has been a lot less stressful. I learned a lot in my first pregnancy that I was able to apply to  my second. With my first pregnancy, I had a lot of anxiety about whether or not I would be able to keep my blood sugars tight enough. My husband and I actually went to surrogate agencies because I didn’t think I could do it. Then I talked to other women with type 1 who had kids, and I told myself to stop psyching myself out. I know now that I can do it. My first child didn’t have low blood sugars after birth and he was born perfectly healthy. I’ve been much more confident and relaxed the second time around. I guess everyone probably feels that way. I definitely have enjoyed letting go of some of that worry and anxiety.

Being seen just once a month isn’t enough. There are so many changes that need to be made to my insulin regimen as pregnancy progresses. During my first pregnancy, I kind of fine tuned my team. I worked with a diabetes educator, high risk OB/GYN and endocrinologist. You don’t have to wait between visits to address highs and lows, and you should be able to get ahold of someone to help you make adjustments quickly. Not every office is like that, so ask how they handle in-between visits with blood glucose monitoring. It’s important to find someone who will look at your data and make adjustments even between face to face visits.

With my first pregnancy I went low-carb the third trimester. And this pregnancy, I didn’t feel like I had to do that. I found that pre-bolus has helped 15 to 30 minutes prior to eating carbohydrates, and I have been fine. If I really am craving a treat, I use my Dexcom to tell me when my insulin is active by waiting until I see my blood glucose trending down.  It’s called “Blood sugar surfing” or “Dexcom surfing.” You wait until you see that wave coming down and then you get away with a little treat because you know you are trending down (in my case, the occasional Sprinkles cupcake!).

It can be scary how much insulin needs go up when you’re pregnant. In the first pregnancy, I was a little hesitant with delivering larger insulin doses because the increase seemed so dramatic. But, as you learn, for a pregnant person, it isn’t too much. I’m not afraid to do the insulin adjustments now, and I know that my body will handle it differently. My usual insulin to carbohydrate ration is 1:15, and towards the end of pregnancy it is 1:6.

I was actually inspired by the Apple watch that Mary Lucas was wearing, and I started using one to link up to the Dexcom so I could see my blood sugar at a glance. The disease burden of diabetes is already so great, especially while pregnant, so the little things can make a big difference.

The other thing that I’ve done differently is that I have Dexcom Share and I have shared my continuous glucose monitor (CGM) data with my husband. Sometimes he calls and says, “Looks like you’re trending up.” It’s helpful to have that little extra reminder if I happen to be distracted with my one-year-old or work.  My husband also has the job of getting a juice box if I am low and stuck on the couch (hey, it happens when you get bigger!).  I recommend trying any little things that can help you take a break from some of the tasks of diabetes. I think everybody does it differently, too. I have a friend who gave her husband “control” of monitoring blood sugars, counting carb and insulin ratios for the weekend. I wouldn’t do that, but I like the idea of it.

A type 1 pregnancy group (like on Facebook) is nice to be a part of. People are always asking questions and are able to vent to a group who really understands. Having that strong connection to the community is helpful, and I would recommend that for other woman. It’s good to hear other people’s success stories—of women who had healthy babies while managing type 1 diabetes. Also, if anyone did have difficult experiences, you can learn how they dealt with that and also see all the support type 1 mommas have for each other.

BT1: What’s the worst thing other people do or tell you when you’re pregnant?

NS:  Everyone wants to share their horror story with you! [She laughs.] “My C-section anesthesia didn’t work.” I think people think they are trying to be helpful though.

What’s really frustrating is when people try to relate to you with things that aren’t as difficult as managing diabetes. Like, “I had to take a glucose tolerance test.” If you only knew what I had to do with this pregnancy! Venting online helps. I have found that people sometimes have a need to downplay what type 1 diabetes is to make themselves feel better about it. People say, “At least it’s not cancer,” or “You obviously have it under control.” To be honest, there are certain cancers that are curable; Type 1 is not. A better response is, “I’m sorry. Let me know if I can do anything to help.”

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