Diabetes & Pregnancy: 5 Things I’ll Do Differently During My 2nd Pregnancy
Editor’s Note: This content was originally published at OnTrack Diabetes, acquired by EndocrineWeb, and is republished with permission.
Please note: Ginger’s second pregnancy occurred from 2016 to 2017.
As I write this, I’m at the start of the second trimester of my second pregnancy. My firstborn is a healthy toddler, and I have lived and learned from the first go-round. Here are my tips for staying calm and keeping your blood sugars stable when you have Type 1 diabetes and a baby on the way, or in my case—the second baby!
Pregnancy with any form of diabetes is a tremendous undertaking because so much of your daily effort becomes focused on trying to be as “perfect” as possible now that another person’s life is involved. Things you never thought you were capable of (like A1C results below 6.0 percent) suddenly become achievable because blood sugar management is your ultimate priority…all day long.
This pregnancy is a bit more challenging since keeping a watchful eye on my blood sugar levels is competing with keeping a watchful eye on my very active 2-year-old. I just can’t be as numbers-obsessed with this baby, because I can’t make the entire day about my diabetes. That’s not to say I’m going to neglect my diabetes; it’s just that my approach has changed because it has to make room for my 2-year-old.
Here are a few ideas I’ll keep in mind during my second pregnancy.
1. I won’t get stressed over imperfect blood sugars.
Maintaining an A1C at or below 6.0 percent was a very new thing to me before my first pregnancy, back in 2014 to 2015. I’d really never tried to get it much lower than 6.5 percent—especially without having a CGM. I never felt there was a reason to do so and didn’t really know what I’d do differently to achieve it.
But those nine months (and the six months I prepared for my first pregnancy) taught me so much about achieving and maintaining an A1C at or below 6.0 percent that it’s now my new normal. (Thank you, CGM technology!) I don’t mean that to sound as if I’m some sort of genius; I simply changed my personal standards and a few tiny habits. I didn’t go crazy obsessing about every blood sugar and I didn’t eat an ultra-strict low-carb diet, either.
I used to be content with blood sugars hovering around 140 mg/dL all day, and now I’m not. Instead, I aim for a lower number, and a lower range in general—more like 80 to 130 mg/dL.
Sure, I miss my target for at least a few hours almost every day, but I know my A1C will still be in that “healthy pregnancy range.” I understand that the momentary high numbers are not worth stressing out over this time. Keep an eye on your blood sugars, take a deep breath, take action, make adjustments, and move on.
I remind myself that I’m doing the best I can, and “100% perfect” isn’t necessary or realistic.
2. I will speak up quickly when my healthcare team isn’t respectful.
There are so many reasons to be grateful for a thorough and diligent healthcare team as a pregnant woman with diabetes, but there are also times when I’ve needed to speak up for myself, and I didn’t.
In pregnancy with diabetes, you will likely meet doctors who want to “motivate” you with fear by listing off the many things that could go wrong in your pregnancy because you have diabetes. Their statistics are also based on very old data in people with diabetes who did not have today’s CGM or insulin pump technology, or even rapid-acting insulin. Take those statistics with a grain of salt.
You’ll also meet doctors who will try to shame you and scold you for having this disease as if you purposefully picked it up at the mall and gladly carry it with you each day. This time, I won’t hesitate to speak up when I feel I’m being scolded or shamed for something I couldn’t prevent. I’m working my pregnant tail off trying to manage something my body ought to execute on its own, and the last thing that will motivate me is disrespectful shaming tactics.
Remember, though, to stay calm — especially on delivery day. You can speak firmly and clearly, but the moment you start yelling, they’re going to stop listening. Firm but calm.
3. I will adjust my A1C expectations and goals.
My A1C stayed between 5.1 and 5.7 percent during my first pregnancy throughout those nine months, which is not my plan this time. During my first pregnancy, I worked full-time from home as a writer. I could easily catch lows as they arrived, treat minor lows just enough to hover around 70 mg/dL and carry on with my day.
This time, I’m a full-time mother to a nearly two-year-old toddler, so hovering around 70 mg/dL isn’t wise, realistic, or good parenting! This time, I will continue my “new normal” of aiming for 90 mg/dL, emphasizing preventing hypoglycemia as the actual number one priority. So far, that goal is going well.
Most days, I have zero low blood sugars, other days, I might have one low, but I have glucose sources in every jacket pocket, and I check my blood sugar frequently.
4. I will turn off the alarm that alerts me to increasing blood sugar levels on my CGM.
For me, the part of wearing a CGM that backfires is seeing the alarm that has one or two arrows pointing UP or DOWN. Especially as a mom who feels there is limited time to take injections for oncoming highs or prevent oncoming lows, I know now that those arrows cause me to panic and over-react. It’s a major anxiety trigger for me.
I had arrows and alarms programmed up the wazoo during my first pregnancy. This time, I’m trying to ignore my CGM. Yes, I look at it a lot but I’m not letting it hoot and holler at me. I’m relying more on the good old-fashioned logic that had helped me stay at 6.0 percent during the last several years, even when I wasn’t wearing a CGM at all: thoughtful decisions around insulin, food, and physical activity.
So far, that approach is working far better and is far less stressful than over-reacting to programmed alarms!
5. I will worry less and never purchase another Diaper Genie.
As a woman with T1D, the worrying starts when you begin contemplating pregnancy. It’s not a light undertaking. It’s a very serious decision because the task of managing your blood sugar throughout your pregnancy is immense.
But there are also plenty of reasons not to worry and to simply hope for the best while you do the best you can. No pregnancy is simple—without or without diabetes. Ultimately, even “normally” healthy women experience complications in pregnancy. They have miscarriages, infertility, and congenital disabilities.
The most I can do as a woman with T1D is to do my best each day, ask for help when I need it (from my pregnancy coach CDE, Jennifer Smith at IntegratedDiabetes.com), and take a deep breath now and then.
And as for Diaper Genies—they’re obnoxious, they don’t actually block out the stink of poo, and it’s far easier just to get a cute trash can with a lid and change the bag often with regular ol’ trash bags. Very often!
The bottom line…
Pregnancy with diabetes is a challenge, but you can do it! Will it require a daily dose of enthusiasm, courage, and persistent diligence? You bet. But you’ll be amazed at what you can accomplish when you know it’s for the sake of that little bun in the oven!
You can do anything you set your mind to with diabetes. Having a great support system is an added (special) bonus to the process.
Ginger is also the co-author of the book, “Pregnancy with Type 1 Diabetes”.