1. CONSULT YOUR ENDOCRINOLOGIST
· I’ve found different endocrinologists may advise different A1Cs for different amounts of time before you try to conceive (TTC). Asking your endocrinologist about their recommendations and how to achieve those A1Cs is important and there’s no time that is “too early” to do this if you are considering pregnancy in your future. An insulin pump and a continuous glucose monitor (CGM) were a must for me and recommended by most doctors. Discussing the risks for yourself and the baby with both your endocrinologist and OBGYN are important.
2. CONSULT OBGYN
· It’s also never to early in my opinion to consult an OBGYN and ask about risks as well as expectations for the amount of additional appointments you will need with pregnancy and type 1 diabetes. My husband and I choose to do this right after we got married, 4 years before we actually had children so we could weigh pregnancy and adoption options and make an educated family planning years before we needed to decide. This was sooner than needed and then when we were going to start trying for a baby I wanted to interview potential OBGYNs prior, but we got pregnant a little sooner than expected (right after my endo said it was okay to try).
· I had a list of questions for my OBGYN and she answered most before I asked them. She avoided my “What’s your experience with type 1 diabetes?” question but otherwise was phenomenal at our initial appointment and with me in general. She clearly did not have much experience with T1D but she LISTENED to me and she talked with my Endocrinologist regularly and listened to her as well. The two doctors working together well was greatly beneficial for me especially when it came to things like wearing my own insulin pump during labor and delivery that my OB and nurses were hesitant about, but I strongly wanted and was able to do with both pregnancies.
· Mentally prepare yourself for lots of extra appointments! I was seen every few weeks at the beginning with my first baby and by full term a few times a week with him. Both pregnancies I had to sit for non stress tests for 30-45 minutes the last few weeks (well the last 10 weeks with the twins). With my twin pregnancy because of the added risk of it being twins, I was seen every two weeks the entire pregnancy by just my OBGYN, that did not include extra testing for heart (mine and the twins), extra ultrasounds, and endocrinologist/CDE visits. By the end of the twin pregnancy I basically lived at the doctor's office and was on a first name basis with EVERYONE there.
3. HEALTHY A1C
· An A1C of below 6.5% prior to conceiving and then under 6% seemed very challenging to me. Again different doctors may recommend different targets. It’s truly amazing what we will do for our babies and postpartum I’ve learned I can do it for myself as well. Do not be scared of getting that level of control, it’s hard at first if your averages have been higher but with a good team and lots of DATA (see below) it’s very possible.
· Doctors will have very strict ranges for blood sugars, I beat myself up over every high the first pregnancy and my averages were still completely fine. I didn’t do that to myself the second time! I remembered that short spikes were not going to harm either baby or me and stayed calm so I could make appropriate changes.
4. SUPPORT SYSTEM
· Spouse and family members. My husband is my assistant pancreas and seriously understanding of how hard diabetes is, he never acts like the “diabetes police” to me. He helps me problem solve. He watches my blood sugars from my Dexcom CGM on his phone as well. During my twin pregnancy I also asked family members to download it to their phones as well so I had multiple people checking on me.
· Talk to work about adjusting schedule as needed for making appointments.
· Online! The online community for type 1 is amazing and there are more then enough great Instagram accounts to follow to feel that you’re not alone as well as a Facebook Groups. This is the T1D mom group I’m in, based in the bay area but has women from all around the world. https://www.facebook.com/T1DSugarMommas/
· Attend a conference. TCOYD was one of my favorites and it’s very affordable. You can speak to different Vendors in person about products as well and this is how I initially got started with Dexcom!! https://www.tcoyd.org
5. EXERCISE
· Staying active during pregnancy will help your blood sugars, body, and mind! Talk to your talk about their recommendations if they don’t already talk to you. I used insulin, water, and exercise to “treat” highs during pregnancy and now still do! With my first we had a used treadmill we kept in the garage so I could even walk late at night or the middle of the night if I wanted to get a high down and with my second pregnancy we had a used elliptical in the bedroom. I kept it until the baby weight was gone and then decided I could do with the extra space and treat highs with squats, lunges, jumping jacks, etc. I was house sitting pregnant with my first baby once and did jumping jacks in the middle of the night!
6. DIET
· Your doctor or CDE (certified diabetes educator) may recommend a certain diet or amount of carbs. Mine advised a pretty high amount of carbs and I honestly did not bother counting them. I ate when I was hungry, which was a lot and did my best to make healthy choices and definitely choose foods that I knew were less likely to spike my blood sugar. I gave into cravings carefully when I wanted to.
7. INSULIN
· Your insulin needs may double or triple during pregnancy! Mine were triple by the end of each pregnancy and lower than my baseline rates after delivery. These rates constantly needed to be adjusted. Plan to work closely with your doctor and/or CDE to make changes as needed.
8. DATA OVERLOAD
· Take DATA! It’s your best way to SEE where things need to be changed. With my first pregnancy I was a little neurotic and spent so much time with a color coded excel sheet. For my second pregnancy I used technology to help me. I had the Clarity App for my Dexcom monitor to look at averages and patterns. For my Omnipod, I synced it with Glooko on my computer and was able to create charts easily that way! Ask your CDE for help with this or you can also call your pump or CGM company for support on how to use these websites and Apps. Glooko is free for Omnipod users and it’s charts are really useful!
9. RESOURCES
· I read and re-read this book prior to pregnancy and it seems to be the most popular in my Facebook group as well. https://www.amazon.com/Balancing-Pregnancy-Pre-existing-Diabetes-Healthy/dp/1932603328/ref=sr_1_1?ie=UTF8&qid=1540489636&sr=8-1&keywords=balancing+pregnancy+with+pre-existing+diabetes
· If you are new to using insulin or a pump there are great books for this as well. "Sugar Surfing", "Pumping Insulin", and "Think Like A Pancreas" are a few popular ones that come to mind.
· As to see a Certified Diabetes Educator! Even if you’ve had diabetes for a long time, talking to someone regularly to go over your numbers or get further resources can be so helpful!
10. CALMNESS OF MIND
· Keep calm and positive, don’t beat yourself up over little things or small spikes and reach out when you need support. Always happy healthy family planning wishes!
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