Pregnancy with Type 1 Diabetes – Guidelines

Posted on

I didn’t know much about what I should do when pregnant going into this pregnancy.  I saw my regular OBGYN a few months before I got pregnant and her only advice to me when I said I was trying to get pregnant was to take folic acid.  My endo at the time gave me zero guidelines on what my blood sugars should be when trying to conceive and once pregnant.  Her only advice was to get my A1C below seven.

I want to grow the healthiest baby I can and I don’t want to do something wrong because I didn’t know so I have researched a ton, gone to several pregnancy classes, read a ton (books and blogs) and asked a lot of questions and I’ve gathered a list of guidelines that I try to follow during my pregnancy with Type 1 diabetes.

Of course, I am not a medical professionally so these are just guidelines that I am trying to follow and your diabetes may vary but a majority of these guidelines I have gotten from medical professionals.

Diabetes Related

  • Before conception, have A1C below 7 or below 6.5 or even below 6 (I’ve heard all three, I aimed for below 7)
  • When trying to conceive, have blood sugars before meal between 70-120 and less than 150 after meals
  • Once pregnant, A1C should be as close to “normal” as possible, meaning below 6
  • Blood sugars before meals should be between 60-99 or 60-120 (I heard both)
  • Two hours after meal, blood sugar should be below 130 (also heard 140, I also heard 1 hour after meal not 2)
  • Eat meals at least three hours apart to give insulin time to act and get blood sugars back to normal
  • Eat at least 150 carbs per day (diabetes goal although could go under nutrition as well)
  • Check ketones if you get an unexplained high
  • Change infusion set every 72 hours in the beginning, but as insulin needs increase, that will likely change to every two days
  • Aim for fewer than 3 low lows per week (lower than 60 mg/dl) and no severe lows
  • Pre-bolus by 20 minutes (at least) in the beginning, unless blood sugar is below 80 mg/dl.  Further along in pregnancy, the pre-bolus time might need to increase even more (30-45 minutes)
  • Personal tip (also recommended by my diabetes educator) I reduced my insulin on board rate from 4 hours to 3 hours to help combat highs more aggressively
  • You can still use your stomach for infusion set and CGM until your stomach gets too tight (according to my endocrinologist)

Nutrition

  • Make sure to get the following on a daily basis:
    • 60 grams of Protein
    • 1200 mg of Calcium
    • 70 mg of Vitamin C
    • 30 mg of Iron
    • 400-800 mcg of Folic Acid
  • No more than 200 mg of Caffeine per day
  • Make sure you are taking a prenatal vitamin
  • Drink at least 8-8 ounce glasses of water (some sources said even more-up to 12 glasses)
  • No more than an extra 150 calories per day in the first trimester then no more than an extra 300 calories in the second and third trimester (although some sources do say different things like 300 extra calories throughout the entire pregnancy)
  • Avoid sushi (raw fish and seafood), deli meat (unless cooked thoroughly), alcohol (some say a little is OK-my OB said to stay away all together), hot dogs, undercooked meat, cooked seafood that might contain too much mercury, soft cheeses, raw eggs (no French toast), herbal teas
  • Wash fruits and veggies really well
  • Make sure hamburger is cooked thoroughly (order at least medium well), steaks can be a little rarer but no less than medium rare
  • Buffets are bad because temperatures aren’t regulated on the food
  • Use salt moderately

Exercise

  • Keep heart below 140 bpm when running (some sources say 150 if you are already in shape)
  • Avoid exercise/sports that involve balancing like biking, horseback riding or downhill skiing and avoid contact sports or activities that require you to hold your breath
  • Try to exercise regularly and later in pregnancy try at least to get daily walks in (American College of Obstetricians and Gynecologists recommends 30 minutes of moderate exercise a day)

Body Care

  • For a person of “normal weight” before conception, weight gain should be 2-5 pounds during the first trimester, then around 0.85 pounds per week after (pregnancy calculators help a lot to track weight)
  • A person with “normal weight” before pregnancy should gain around 25-35 pounds while pregnant, if overweight prior to conception, you should gain less (11-20 pounds), if underweight prior to conception you should gain more (28-40 pounds)
  • Maintain slow, steady weight gain to avoid stretch marks
  • Stay moisturized
  • Avoid spray on sunscreen, but make sure and put regular sunscreen on if you are going out in the sun
  • Painting nails is fine, but if going to a salon for a mani/pedi make sure the salon is well ventilated
  • Wash hands often (pregnant women are more susceptible to germs because our immune system is weakened)
  • Brush and floss twice per day (gum disease can be serious when pregnant)

Sleep

  • For the most part, you can still sleep on your tummy until it gets uncomfortable (doctor told me this but I didn’t read it anywhere to confirm)
  • You can sleep on your back until around week 20 then you just need to make sure one side of your bottom is lifted (also doctor advice, not confirmed, also heard from another source that you should lie on your back after 16 weeks)
  • You can sleep on either your left or right side but some sources claim sleeping on the left side is the preferred way

Travel

  • If you are traveling a long distance or sitting for a long time, stop around every hour to walk around for a few minute
  • Air travel is typically safe up until 36 weeks, international its 35 weeks (but some airlines might have different date)

Other

  • Avoid oven cleaner; other cleaning products are typically considered safe in a well ventilated room
  • Get a tetanus shot with dTap between weeks 27 and 36, baby will get antibodies from you which will offer protection as a newborn (good for whooping cough)
  • Get a flu shot!
  • If you are taking a bath, water needs to be under 100 degrees Fahrenheit so your body (and baby) don’t get overheated (also heard 102 as the magic number)
  • Avoid hot tubs, Jacuzzis and saunas
  • Acetaminophen (Tylenol) is considered safe during pregnancy but stay away from Ibuprofen and other non steroidal anti-inflammatory drugs (aspirin)
  • Benadryl is also OK while pregnant
  • Plastics with recycle code 3 or 7 may contain BPA.  BPA has been shown to cause birth defects and miscarriage so stay away from them.  Containers marked with 1,2,4,5 or 6 are usually BPA free
  • Avoid microwaving food in plastic containers

There are probably so many more tips and guidelines to follow when you are pregnant that I’m forgetting.  My next post I plan on talking about all the resources I have used while pregnant to try and be the most informed.  I’m sure I might be going a little overboard but I felt so uneducated at first and I’m so worried about how my diabetes is going to affect my baby that I want to try and eliminate any extra causes for issues.


3 thoughts on “Pregnancy with Type 1 Diabetes – Guidelines

  1. Keep it coming! I don’t think you are going overboard at all. I’m reading up on stuff and a lot of what you wrote I’ve heard or read as well, but not all of it. I look forward to reading about the resources that you’ve dug into.

  2. My husband and I are planning on trying to get pregnant in the next year or so – – I cannot wait to read all of your posts about this. None of my diabetic friends have gone through that yet. Thanks for sharing!

  3. This is all you have to think about each day? Wow, that’s an astounding list of things to keep track of. Sounds like you’re doing great so far!

Leave a Reply