A Month-to-Month Guide to Pregnancy with T1D

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Two of my favorite T1Ds are writing a Month-to-Month Guide to Pregnancy with T1D book!  My amazing CDE, Jenny Smith, and fellow DiabetesSister and one-time personal fitness coach, Ginger Vieira have joined forces to write a much needed book for fellow T1Ds.   They are looking to publish the book in early 2016 and reached out to other T1Ds to share their pregnancy stories and dealing with diabetes. I gladly volunteered to share my stories (and was thankful I blogged a lot because my memory is crap these days).  I’m not sure if they will use all of my stories, some of my stories or none of my stories, but I hope some part of what I shared gets included and I can’t wait to get my hands on the book when it’s published!

Pregnant at Halloween Last Year!

Pregnant at Halloween Last Year!

The ladies sent me some categories to focus on so here is what I shared *warning it’s a pretty long post:

Preparing for Pregnancy/A1C Goals

I started preparing for pregnancy about a year before my husband and I decided to start trying to get pregnant. My endocrinologist wanted my A1C below 7, but ideally below 6.5.

I had never had an A1C below seven before, spending the majority of my adult life with an A1C in the 8’s, so the task seemed daunting to me. The month that I decided to stop using my birth control, I had gotten my A1C to 7.1 and my doctor told me it wouldn’t be the end of the world if I got pregnant but she wanted it lower. When I finally did get pregnant four months later, I had gotten my A1C down to 6.4!

I was able to lower my A1C by utilizing my continuous glucose monitor (CGM). When I downloaded my CGM data, I was able to see blood sugar trends and areas needing work. I found the biggest benefit of wearing a CGM to be the data, which showed how my blood sugars behaved overnight. In my 20+ years with T1D, I was always afraid of lows, especially at night. Wearing a CGM overnight reduced my fear of lows because if I started to get low, my CGM would alert me and I would wake up and treat. I believe that at least 75% of my lower A1C can be attributed to having lower blood sugars overnight, thanks to the CGM.

In the year leading up to our decision, I had also started running regularly for the first time in my life. My husband and I started off with the “Couch to 5K” program and then worked our way up to 5K’s, 10K’s and two half marathons. I was in the best shape I’ve ever been in by the time we started trying. I completed a half marathon a month before getting pregnant so I think the exercise also helped me to lower my A1C.

How you decided to pursue pregnancy and motherhood with T1

I knew it would take a lot of work and preparation. I had always wanted to have kids so it was more a matter of when I would pursue pregnancy with T1. I’ve had Type 1 diabetes for over 20 years so I knew that if/when I got pregnant, I would have a more difficult time but I didn’t let it deter me from getting pregnant.

How you decided: Pump or Injections?

I’ve been on a pump since 1997 so this wasn’t even a question for me! I would have been completely lost without my pump and I didn’t need the added stress while pregnant. I was a little worried about how my insulin needs would change later in pregnancy, thinking that I would need too much insulin for my pump to handle but luckily, I never got to that point.

Using a CGM during pregnancy (how/when most helpful? alert settings?)

I don’t think I could have had the pregnancy I did and my healthy son if it wasn’t for my CGM! The CGM aided in spotting trends so I could make adjustments and see where I needed work. When I first got my CGM (before pregnancy) my high alert was set up at 240 mg/dls and my low alert was at 100 mg/dls! I had to drastically change my alerts for the pregnancy and step-by-step I reduced my alerts to 140 mg/dls for the high and 70 mg/dls for the low. I also set my target blood sugar to 90 instead of 100 to attack the highs a little more aggressively.

However, I wouldn’t get a lot of sleep because of my CGM. Because my high and low settings were so tight, I would fall out of the target zone more often than if my alerts were higher. This was true especially overnight. At night, my blood sugar would hover around 90, but I would often dip down to the 60’s, 70’s or 80’s, so my alert would go off. Some nights, my blood sugar would be 80 (above the low alert) but my CGM would think my BG was 65 so it would alert me I was low, even though I wasn’t (normally being off by 15 wouldn’t be too big a deal but when you are walking a thin line like that, it was). I also have my low alert set to go off every 15 minutes, so if my CGM was having trouble with calibration, the low alert would go off way too often. One night, I had a low alert going off every 15 minutes for 2.5 hours before I decided to treat the “low” blood sugar that wasn’t really low.

It did take some getting used to when I adjusted my alert settings but over time it provided the best motivation to keep good blood sugars because I wouldn’t want to hear the alerts going off!

I would upload my data weekly, sometimes even daily. I would share my CGM data with my CDE and she could review on a weekly (via email) and monthly (via phone call) basis how I was doing and we made adjustments accordingly. The CGM data was so helpful to my CDE and my endocrinologist to assist in making changes to my rates, but also to monitor the post-meal spikes. I did still test my blood sugar frequently (12+ times per day) but the CGM provided comfort in between those checks.

Emotional Stress & Pressure of D-Management During Pregnancy

For me, diabetes added a LOT of stress to being pregnant. I was already stressed enough about making sure I was eating correctly, or that my heart rate didn’t go too high when I was working out or that I was drinking enough water, but then having diabetes to deal with on top of that added an entirely new level of stress and pressure.

Before I found out I was pregnant, I was going through a short-term diabetes burnout (of a couple weeks) because I didn’t think I was going to be able to get pregnant (right away), so I let my blood sugars get a little higher but later on I found I was actually pregnant at the time! Once I got the big fat positive, I worried about how the higher blood sugars in those first few weeks were going to affect my son. After I found out I was pregnant, I would really stress anytime I saw a high blood sugar. If my post-meal blood sugar spiked too high I would feel guilty about not pre-bolusing sooner or I would feel guilty about my food choices and maybe I didn’t eat the right thing, causing the high.

I was also really stressed thinking about the labor and delivery of my son. I was so worried that I was going to have high blood sugars when I delivered and, as a result, he would have low blood sugars when he was born (he did have low blood sugars but they weren’t too bad and he was able to stay in the room with me, not NICU).

I felt pressure to test really often. I felt pressure to have post-meal spikes that didn’t get too high. I felt pressure and stress to have perfect blood sugars all the time. Phew, I’m stressed just remembering how stressful the pregnancy was in dealing with d-management.

Fears & Concerns 

I actually did a blog post on my fears…here is what I had to say:

Being pregnant comes with a lot of fears:

  • Am I getting enough nutrients for the baby?
  • Am I taking the right precautions to avoid listeria?
  • Did the alcohol I had before I knew I was pregnant affect the baby?
  • Am I drinking enough water?
  • Have I remembered to take my pre-natal vitamins everyday?
  • Is my heart rate below 140bpm when I exercise?

But being pregnant with diabetes, I have so many more concerns:

  • Will that high blood sugar affect my baby’s health?
  • Was my blood sugar too high for too long?
  • How are all these low blood sugars affecting the baby?
  • Is my A1C good enough?
  • Will my baby be too big or too small?
  • Will my baby make it to the full 40 weeks?
  • Will I have to have a C-section and if so will I heal properly?
  • Will my higher blood sugars before I found out I was pregnant affect my baby?
  • Do I have a good medical team to support me and do they communicate well?
  • Did I pre-bolus enough?
  • Are my insulin to carb ratios, basal rates and correction factors correct?

However, there are two things that scare/worry me the most about being pregnant with Type 1 Diabetes:

  1. What will I do when I can no longer use my stomach for my CGM and infusion set?  I’ve only ever used my tummy in 17 years with a pump and 2 years with a CGM, I don’t know anything else.  I’ve slowly ventured more into the love handle region but I’m not quire there yet.  My endo told me I could keep using my belly as long as the skin wasn’t too tight but I’m getting there quickly!  I’m absolutely dreading this day :(. (I did get to that point around the beginning of my third trimester and I moved my infusion set to my love handles and my CGM to my butt.)
  1. Will I be able to keep my insulin pump and CGM on during delivery and who will monitor my blood sugar?  I don’t know if I will have a C-section or natural birth but I want to be able to keep my CGM in and pump on during delivery.  The thought of having an insulin drip while delivering does not sound good to me.  I’ve worked (and will continue to work) to have good basal rates that I want to have confidence going into delivery that my rates are the best possible for me.  It’s still too early to have this conversation with my doctors but I hope that I am able to keep them on.  I’m also worried about having a doctor (OB) being in control of my diabetes.  I’m hoping I’ll be able to but if not, I’m going to have to start training my hubby to take over for me.

I’m sure I have a lot of other fears about this pregnancy, but these are just what are on my mind today. For now, I just have to keep doing what I’m doing and have faith that everything will work out fine. (I was able to keep my CGM and infusion set on for delivery (c-section), so that worked out well!).

D-Management Support: did you work with a team? CDE? etc.

Yes, I worked with a great CDE (hi Jenny!). I would email her weekly and we would have monthly phone calls. With each email/phone call, we would review my CGM data and make adjustments when necessary. I also saw my endocrinologist once a month but she wouldn’t make many/if any adjustments since I was doing such a good job with my CDE.

My team also consisted of my regular OB, who I saw once a month until week 32 where the visits became weekly, and my high-risk OB who I also saw monthly until week 32 when we started the BPP test (bio physical profile). My perinatologist (high-risk OB) didn’t help me to make adjustments to my insulin rates, but he would ask detailed questions about my diabetes care at each appointment. He also provided a lot of “motivation” to have good control (really he just scared me, telling me how I could go blind, have a baby too big or too small, etc).

I also need to give a shout out to my husband, who was an integral part of my D-management support (more on him below). The Diabetes Online Community also provided a lot of encouraging words throughout my pregnancy and it was great to read other diabetics blogs who had been through the same thing.

First Trimester & D-Management

The first trimester was probably the hardest for me in terms of D-management. I had to come to terms with the fact that my blood sugars needed to be a lot lower. My “d-team” (endo, CDE, high-risk OB) really emphasized that pre-meal blood sugars needed to be between 60mg/dl and 90mg/dl and post meal should be between 110-140. Before I became pregnant, I would treat a low blood sugar at 70 or 75 so trying to be comfortable with a blood sugar as low as 60 was tough.

I found out I was pregnant pretty early on but I didn’t start working with my CDE until I was 8 weeks pregnant so I had a lot of work to do to get in good shape before the first trimester ended.   My A1C was 6.4 two months before I conceived but the two months leading up to conception and once I was pregnant, my A1C crept up to 6.8 so I needed to get serious about having lower blood sugars.

I didn’t have low blood sugars too bad in the first trimester, if anything, my blood sugars were running a little higher so I had to make adjustments. I don’t think I noticed insulin sensitivity until about week 8 or 9. Once I started working with a CDE, I did basal testing to really refine my basal and bolus rates. This proved to be a good foundation for the pregnancy so I could trust changes and tweaks I was making.

One thing that helped my d-management during the first trimester was that I didn’t have any morning sickness, so I didn’t need to worry about bolusing for a meal that wouldn’t stay with me. I did, however, have really bad food aversions! I couldn’t look at a green food (i.e. spinach-my go to food for lunch) without feeling nauseous. I also couldn’t eat any meat. Not being able to eat meat or veggies made it harder to make good food choices (I had no aversions to any carby food!). I had to get creative with meals those few weeks in the first trimester when my food aversions were at their worst.

Second Trimester & D-Management

By the second trimester, I was feeling more comfortable with lows but I was having a LOT more of them. In the beginning, I was making a lot of basal and bolus adjustments because I was becoming very insulin sensitive. As the second trimester progressed, I was making fewer changes as my blood sugars were becoming a little more stable. This was probably the best trimester for my diabetes (and in general). Then around week 24, I started to become insulin resistant. The insulin resistance hit pretty hard between weeks 24 and 28 and I was making a LOT of adjustments then, trying to prevent the high blood sugars.

However, I started to get stressed as the trimester continued on. By week 25, my stomach had gotten pretty big and I could no longer put my infusion set (for my insulin pump) on my stomach. With 17 years of pumping, I had never put my infusion set anywhere else besides my stomach so the thought of having to put it elsewhere was daunting. I ended up just moving more towards my love handles, still sort of considered in my stomach region though. I was able to move my CGM site to my bottom (with my husband’s help, I couldn’t reach too well!) and that actually proved to be more accurate than my stomach. I think I had a two-week period where I was very frustrated with my growing belly and my diabetes but I got more comfortable with my new CGM and infusion set sites (and the baby started kicking a lot so it was hard to be upset with my cute little fellow saying hi a lot).

Third Trimester & D-Management

The third trimester started with increasing insulin resistance. Before pregnancy, I needed about 30 units of insulin a day but by the third trimester I was up to about 50 units. I do feel lucky though because insulin resistance didn’t hit as bad as I was expecting. I had heard some people had a 1:2 or 1:1 breakfast to carb ratio and I was dreading that. I think the highest I:C ratio was 1:5.5 for my breakfast. Weeks 30-32 were tough and I was making weekly, sometimes daily (after noticing a two-day trend) adjustments to my basal and bolus rates.

However, by week 34, I actually needed less insulin. I started having a lot of lows, especially overnight. My insulin sensitivity continued to increase until I delivered at week 38. I was worried that I was having placenta failure because of my decreased insulin needs but my doctors never seemed concerned.

Hypoglycemia during 1st/2nd Trimester

I didn’t really notice insulin sensitivity until the end of the 1st trimester/beginning of 2nd trimester so I would say I had the majority of lows in the 2nd. I think the lows at the end of the 3rd trimester were the most alarming because I was expecting insulin resistance not sensitivity.When I had lows, I had to be careful not to over-treat the low. Prior to pregnancy, I would eat whatever to treat a low, often causing a roller coaster for my blood sugars (low then high then low). When I was pregnant, I didn’t want to see any highs so I made sure to correct with only 10 carbs and then check again in 15 minutes. I only did 10 carbs because I found 15 would push me a little too high. I would use a package of fruit snacks that were 19 carbs and only eat half-it took a lot of self-control!

I did have one low that sticks out in my mind from my first trimester. I was about 8 weeks pregnant and I had attended a DiabetesSisters conference over the weekend. It was a 90-mile drive from my home. The Sunday morning that I was leaving the conference, my blood sugar was running higher so I rage bolused (I had been high a lot over the weekend so I was getting upset seeing the high numbers). I then began my 90-mile drive home. My blood sugar was fine during the drive (had my CGM on) but as I was nearing my house, I noticed I started to feel kind of low (I was dropping rapidly so my CGM wasn’t keeping up too well and it said I was fine). I made it home safely but once I got into my house I broke out in the worse low sweat of my life. I tested and I was 35mg/dls. I felt awful and I kept getting lower! I think I went down to 26 before it started to rise. I definitely over-treated that low!

Exercise: managing BGs & pregnancy during

A blog post I wrote about exercise (at Week 19):

Before I got pregnant, I ran two half-marathons.  I was feeling pretty confident about my endurance and fitness level but at the same time I was burnt out from running so I took a little break.  Well, that break flowed right into my getting pregnant which turned into me being scared about running while pregnant.

I had read that your heart rate shouldn’t get about 140bpm when pregnant, or 150 if you were in shape.  Thanks to my family, I had recently gotten a heart rate monitor for Christmas so my first run after taking a mini vacation from running and after I found out I was pregnant included the use of the heart rate monitor.  My pulse quickly climbed up and stayed up while running so I started a run/walk combo.  This was around week 7 of my pregnancy.  I decided to also start going back to the gym so I went and swam some laps and I also purchased a pre-natal yoga DVD.  I was feeling pretty good about my workout routine.

My wonderful workout routine lasted all of about one week.  I think I made it to the pool twice, did my yoga twice and ran/walked maybe three times.  Then the exhaustion set in.  I couldn’t do much because all I wanted to do was sleep 24/7.  Once the exhaustion subsided (somewhat), work got really busy and I couldn’t find time to work out.

I’m now at week 19 and I’ve been incredibly lazy for the last 12 weeks.  I now get winded just walking up stairs or going to my mailbox.  It’s actually pretty embarrassing so starting this week, I have tasked myself with some goals to try and get back in the swing of things (plus, I do well when I have goals to achieve). (left goals out of this story but they were swimming and yoga regularly).

One thing that is more difficult now than at week 7 is my blood sugars.  At week 7, I still hadn’t seen too many changes (highs or lows) with the pregnancy.  Now 19 weeks in, every week I am making adjustments to my basal rates or I:C ratios and I have no idea how my body is going to respond to exercise.

I did make it to the pool last Friday and swam about 20 laps and my BG before was 105, I ate a small snack (~10 carbs) and disconnected from my pump for 30 minutes and after my swim I was a perfect 100 but then an hour later I climbed up to 200 so I’m not sure I have mastered that yet.

Update to the blog post: I did end up swimming regularly 3 times per week in the second trimester. I did eventually figure out how to handle swimming with my blood sugars. I would bolus a small amount before I disconnected for the swim and that seemed to handle the post-swim spike.

Once third trimester hit, the neighborhood pool closed so I stopped swimming but I started to use my prenatal yoga DVD. I would say I did the pre-natal yoga about 2-3 times per week in the third trimester. I was having really bad back pain by then so the yoga helped some with the back pain. I didn’t disconnect my pump when I did the yoga, but I would get low immediately following the workout (and it wasn’t a difficult workout by any means), so I would make sure and have a snack on hand to treat a low.

Your Personal Strategies on Nutrition during pregnancy

When I was pregnant, I had several nutrition goals. The first one was to eat less than 50 carbs per meal (breakfast, lunch and dinner) and less than 15 carbs for a snack.

Other goals were to eat the following per day, based on advice from a pregnancy class at my local hospital:

  • 60 grams of protein
  • 1200mg of calcium
  • 70m of Vitamin C
  • 30mg of iron
  • 400-800mg of folic acid

I also took a pre-natal vitamin everyday. During the first trimester, I was told I only needed an extra 150 calories per day and in the second and third trimester, I needed an extra 300 calories.

I used my Fitness Pal to track everything that I ate, so I could see if I was getting enough of my nutrients, but this also helped to remember what I ate for a meal when I was reviewing my blood sugars. I also weighed a lot of my food, like grapes, so I would have an accurate carb count. It was a pain to do at first, but then I got used to weighing everything and now I still do!

I struggled to drink enough water so a strategy I implemented was putting 6 water bottles (16.9 fl oz. each) in the door of my fridge and I would make sure I drank all 6 bottles before I was done for the day. I am a self-proclaimed Diet Coke addict so I still drank caffeine while pregnant, but I limited myself to one 16.9 fl. oz. bottle per day.

During the first trimester, I had some crazy food aversions-I couldn’t eat green food, like spinach, or meat except for bacon (I didn’t even like bacon before) so I had to get creative with food to get the required nutrients like protein, like eating peanut butter or eggs.

I also craved carbs really badly, especially during the third trimester. I gave in to my donut cravings way more than I probably should have, but I just made sure to pre-bolus and carb count correctly and I would be able to avoid the post-meal spikes.

Your Personal Insulin Dosing Strategies & Techniques 

I was wearing an insulin pump and a CGM so I would make changes pretty often to my basal and bolus rates throughout the pregnancy, reviewing my CGM data on a weekly basis, if not more. I would try to pre-bolus for each meal, especially breakfast. I had to change my insulin pump infusion set more often (every 2-3 days versus every 3-4 when I’m not pregnant). I, luckily, never had to give myself a shot while I was pregnant. If I had a high blood sugar, I would bolus and wait to eat until my blood sugar came down although sometimes I would rage bolus (where I put in more insulin than I needed so I would come down faster) but that wasn’t too often. I also changed my target blood sugar to 90 so when I used my bolus wizard to correct for a high, it would attack the high a little more aggressively.

I had different insulin to carb ratios for each meal and I also had about 7 different basal rates throughout the day. I would make adjustments to these rates as needed. Throughout the entire pregnancy, I made a LOT of changes to my rates.

Dosing strategies to prevent spikes after meals

I had the WORST spikes after breakfast. I ended up bolusing 45 minutes prior to eating. When I would wake up in the morning, first thing I did was test my blood sugar then bolus for breakfast. Then, I would get ready for the day and by the time I was dressed and ready to get to work, it was time to eat breakfast. I ate two waffles with 20 carbs and Danon Light and Fit Greek yogurt with 9 carbs for breakfast. Per the advice of my CDE, I would eat my waffles 45 minutes after bolusing and then I would eat my yogurt an hour after I ate the waffles. It seemed to work out well for me. Other meals didn’t seem to create as big a spike as breakfast did but I still tried to pre-bolus by 10 minutes for each meal.

How Your Husband/Wife Supported You

My husband was great during my pregnancy. He went to every OB appointment with me (regular OB and the high-risk OB). He also reviewed my blood sugars with me on a regular basis and attended the monthly phone calls with my CDE. He also took me to Dunkin Donuts a few times to satisfy my donut cravings (I couldn’t get enough donuts when I was pregnant!!). Personally, I don’t think I was too bad hormonally when I was pregnant but when I would freak out about something, like not being able to put my infusion set in my stomach, he was there to calm me down and/or vent. And once my belly got too big for my CGM, he would help me to put it in my butt/bottom/rear ☺ since I couldn’t reach back there too well.

Your Child’s Birth Story

My son’s birth story was a bit of a roller coaster! He was born at 38 weeks and 4 days via C-section. He was scheduled to be delivered via C-section at 39+2 weeks (C-section due to his size) but the week before we hit a few bumps in the pregnancy.

At 37 weeks and 6 days, we went in for our weekly BPP test (biophysical profile) and he didn’t pass. Of course, that day both my high-risk OB and my regular OB were on vacation. The substitute high-risk OB didn’t know my history so he wanted to err on the side of caution and since I failed the BPP, he wanted to take my son that day. My husband and I freaked out a little bit because we weren’t expecting to deliver him then (it was also Halloween!). We hadn’t even packed our hospital bag. Luckily, the doctor gave us the option to come back in the afternoon and try the BPP again. To our relief, my son passed that afternoon so we went home.

Over the weekend, I thought I noticed decreased movement (probably overly cautious after our scare the day before) so we went into the hospital (with our bags packed this time!). However, he ended up passing the non-stress test when we got there so they sent us home.

The following Wednesday at 38+4 weeks, I had my regular OB appointment. Given all that had transpired the previous 5 days, my doctor decided she wanted to go ahead and deliver my son that day versus waiting until the following Monday (at 39+2 weeks) when I was originally planned to deliver. Of course my husband and I hadn’t learned our lesson and we again didn’t have our hospital bag with us! My husband rushed home and I headed towards Labor and Delivery.

My OB appointment was at 11AM, so I had eaten breakfast that morning. At the time, I had been struggling with post-breakfast lows but I thought I had a few more days to get my rates corrected. When she told me we were going to deliver my son that day, she said that I couldn’t eat or drink anything anymore. So off I went to Labor and Delivery (around 11:30AM) and by noon, my blood sugar had dropped to 60mg/dls and was still dropping. They hadn’t admitted me back yet so I was waiting in the lobby to be admitted, while my blood sugar continued its drop. My husband was still gone to get our bags so I was alone, stressing out the birth and my blood sugars.

I was getting really nervous but they finally took me back and set up an IV. By this point, I was breaking out in a bad sweat because I was getting so low. But the IV drip finally started to work and by 2:30PM, my blood sugar had climbed to 187mg/dls.

Once my blood sugar rose, I began to get nervous about being high because I had read that having high blood sugar when you deliver is bad for the baby because he will overcompensate for the extra sugar in the placenta and will have low blood sugar when he is born. I bolused for the high blood sugar and hoped I would come down before delivery. I think some of the high was from adrenaline (I was so nervous!) because I dropped faster than I think the insulin could act. Around 3:30PM, they took me back to the operating room to deliver and my blood sugar had dropped to 86mg/dls.

I had my son via C-section. My son was born 10 pounds, 14 ounces(!), a big boy but perfectly healthy. He received an 8 and a 9 on the APGAR test. He had low blood sugar the first 36 hours but he was able to stay with me, not in NICU. I breastfed him but also gave him formula to help bring his blood sugar up.

I was able to keep my infusion set (insulin pump) and CGM on. I was also able to manage my diabetes myself when I was in the hospital. I didn’t immediately adjust my basal and bolus rates (to pre-pregnancy rates) like I should have so I spent the majority of my hospital stay drinking OJ and eating graham crackers to treat low blood sugars. We didn’t get more than about an hour of sleep the three days we were at the hospital so when I finally got home, I was able to think a little clearer (after catching up a little on sleep) and make the changes to my rates. I also was very nauseous and vomited so that complicated things a little bit when I was trying to treat my low blood sugars.

It wasn’t quite the birth story I was planning on. I definitely wasn’t planning to deliver that day and I hadn’t had a chance to properly prepare my blood sugars, but in the end I had a healthy baby boy and that’s all that matters!

Breastfeeding & D-Management

I feel pretty lucky. My son latched well from the beginning and has not had a problem gaining weight. Surprisingly, when I was pregnant, I was more worried about being able to breastfeed than I was giving birth. I really wanted to be able to breastfeed for a year and I was worried that having diabetes might inhibit my ability to produce milk. We are going on 8 months (!!) of breastfeeding exclusively (and introduced solids at month 6) and I feel really blessed (I wrote this back in July so I’m actually now almost at 1 year breastfeeding!).

The one surprising thing though about breastfeeding with diabetes is that I didn’t really notice a change in my blood sugars from breastfeeding. I had heard that breastfeeding can cause you to go lower, but that hasn’t been my experience (I wish it was so my a1c would be better!). *Update (I wrote this originally back in July) Since I have decreased breastfeeding down to 4 times a day, I did notice high blood sugars so I think breastfeeding did help to keep my blood sugars lower.

In the beginning, I worried about how my blood sugars would affect my son when I breastfed but I was reassured that if I was high, the extra sugar in my blood wouldn’t get into my milk supply.

I think the hardest part of breastfeeding with diabetes is that breastfeeding becomes the priority over my diabetes management, especially in the beginning when I was breastfeeding really often. If my son was formula-fed, my husband could help out more with the feedings but because we are exclusively breastfeeding, the responsibility lies solely with me. So I spend majority of my time stressing about his feeding schedule and less about my feeding schedule or my blood sugars. I love my time with my son while I’m breastfeeding though and I wouldn’t have it any other way!

Diabetes Management…with a baby to care for!

I have actually found this to be the most difficult part of having a baby (more difficult than the pregnancy!). My son isn’t a great sleeper. The nights I don’t get much sleep, I am exhausted the next day and my blood sugars are usually elevated. Also, my priority lies in making sure my son is fed when he needs to be, put down for sleep on time and is stimulated enough so he is learning and hitting his milestones on time. Because of all the energy focused on my son, I often let the focus on my health lapse. I don’t upload my CGM data nearly as often as I should. I don’t make adjustments when they are needed and as a result, my blood sugars have been climbing higher and higher and I’m becoming more comfortable higher than lower. I also forget to put my CGM on some days and I haven’t been changing my insulin pump infusion set sites as often as I should. I also grab prepackaged snack food for convenience instead of eating something healthier that I would have to weigh. It isn’t all bad though! Because I am on a pretty structured schedule for my son (who is 8 months old), I find myself on a pretty structured schedule too so I’m able to test my blood sugars often.

Post-Partum Depression

I wrote about this last week so check out the blog post.

Having Type 1 diabetes while pregnant was tough and had it’s ups (tons of ultrasounds!) and downs (where to put infusion set, carb counting, insulin resistance) but I got a beautiful baby boy out of it so it was all worth it. Holding my son


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