Type 1 Diabetes and Pregnancy


Type 1 Diabetes and Pregnancy

Kelly SchmidtAbout a year ago, a fellow type 1 female asked me several questions about my pregnancy, and we turned this into an interview to share. Please note, the way I did things in my pregnancy isn't gospel nor medical advice, it's just an idea of how I went about the 40 weeks.

Pregnancy can be such an emotional time, but then you add the extra emotions of being high risk and the complicated task of managing type 1 diabetes. How do you encourage expecting moms to succeed this time of both joy and anxiety?

I am grinning as I write my response as I so easily remember the moment I found out I was pregnant. I first told my husband and then ran for my phone and called my mom with fear. I was scared to eat, exercise, or cause any movement in my blood sugars with a growing fetus inside me. But then I realized there are many babies born to mothers with diabetes, and I was going to be okay.

Embrace each moment and believe there is a higher plan. Try to tap into your inner strength and intuition to do the best you can to take care of yourself. Round up your medical team and even social media support. I found extreme value in connecting with other women who were in the same stage I was during the initial weeks of pregnancy. While my CDE (Certified Diabetes Educator) was rather awesome, I really benefited from connecting to other type 1s, and I even made a pen pal from across the country. We had our first babies just weeks apart, and it was so beneficial to exchange notes. We discussed what foods were working for stable management and noted when unusual increases happened with our basal/long-acting insulin. Type 1 diabetes allowed us to have an automatic connection with one another. Don’t hesitate to seek a tribe. In the least, I’d be happy to connect.

How can meal timing and consistency play an important role in managing blood sugar levels?
I approach a client who is newly diagnosed with diabetes and a woman who is newly pregnant with diabetes in a similar fashion. Consistency is one of the most important things to implement to feel good, and also to learn what works and doesn’t work for blood sugar management. There is an incredible value in eating at the same times and with consistent portions of fat, protein, and carbohydrates. One strategy that worked for me was to have batch-cooked meals ready for the week, and by no means, did they need to be fancy.

Insulin need to manage type 1 diabetes can significantly increase, especially in the second half of pregnancy. Some days I feel like I am just pumping myself full of insulin, and I don’t love that feeling. What is your encouragement to women who don’t like that feeling but know that balanced blood sugar is best for both mom and baby?

Do whatever you need to do to keep your blood sugars in range. If you are worried that the excess insulin will cause you to gain weight, understand that the wellbeing of both you and your baby is most important, and the weight will come off. IT, Will. Come. Off. Cross that bridge when you get there, and put your best health first.

Also know, as the weeks go on the amount of time needed for a pre-bolus goes up as does basal/long-acting needs. For example, in the first trimester, you may find a 15-minute pre-bolus is needed before eating, in the second trimester it may move towards 30 minutes, and in the third, it indeed may need to be 45 minutes. By third trimester it’s also common to be on 3x as much basa. The amount of insulin isn’t the worry, keeping blood sugars in range is.

How can hydration have a negative affect your blood sugar?
A 2011 study from Diabetes Care found that adults who drank less than two glasses of water each day were more likely to develop blood sugar levels in the pre-diabetes range. Although we already have diabetes, this study is important.  It highlights how other hormones, such as vasopressin, increase with dehydration, telling our kidneys to hold onto water - which can influence higher blood sugars. Also, hydration helps insulin do its job. Lastly, for those who wear a CGM, being adequately hydrated can help with accuracy.

Beyond water, those of us with diabetes are at risk of losing our electrolyte balance as our blood sugars move up and down. Sea salt, mineral water, and a diet abundant in vegetables can help counteract this. Please note, the use of table salt (iodized salt) is not recommended. It can stress our thyroid, and have other negative effects in the body. Pure, unrefined sea salt, pink Himalayan salt, and Celtic salt, are all great options. Last note on salt, if you are eating mainly a whole food diet, low in dairy and grains, you will need to salt your food more. If you are craving salt, listen to that as a sign you need to sprinkle a little more on your food, as well as making sure you are getting enough rest. When our adrenals are working hard, they can also stimulate salt cravings. Proper hydration can take effort, and it’s handy to always have a water bottle on you (preferably glass or stainless steel).

How can hormones, blood sugar, and insulin need change postpartum - both immediately after delivery and in the months that follow?
I had an insulin pump for both of my deliveries. Towards the end of my third trimester, I knew I needed to plan new basal rates. My CDE and I determined a total post-delivery basal that was about 10% lower than my pre-pregnancy insulin needs. Everyone is different, and it’s common for post-delivery basal to be even lower than mine was. I changed my insulin immediately, right after holding and bonding with my child.

In the following months, there were some jumps in my insulin needs, but insulin needs vary from one mom to the next. A few of my friends with type 1 found that when they nursed, they needed to eat something simultaneously to prevent low glucose. That wasn't the case for me, but my rates were very low for the first three months, and they went up as my baby's milk needs lowered. When I started the baby on solids (which I did at 10 or 11 months), my insulin needs went up dramatically.

I feel like I have been taught that only food influences my blood sugar, but I notice that stress - both physical and emotional - significantly affects my blood sugar. What are some great ways to minimize stress, and what are some calming activities you enjoy?

  • Walking is magical. A fast-paced walk can lower blood sugar 1-2 mg/dl per minute. I took advantage of this when I knew I didn’t take my insulin early enough before eating. I still utilize walking even after pregnancy. It can help fight high blood sugar and can pick up the pace of insulin. I remember when we lived in Chicago, and all I wanted when pregnant was a little gluten-free pizza. Just one triangle slice sent my sugars up, so after indulging, I just walked up and down my stairs for 10 minutes.  Don’t be scared of highs; just work to correct them quickly. One high blood sugar won’t hurt the baby; a constant high is where the risk comes in.
  • Hydrate, hydrate, deep breaths and then hydrate. Both water and breathing (plus prayer or meditation) make everything better.
  • Flip the script. I delivered both of my kids in Chicago, and especially with Teagan, the care was horrific (sorry for the transparency). I was falsely informed that I had ovarian cancer,  was provided incorrect genetic results, was given results scaled against a non-high risk female, and was tossed around between ten different doctors. I wanted to go bonkers and leave the practice when I was 20 to 30 weeks but was nervous no one would want my high-risk case. To say the least, I treaded through the stress and remained as calm as possible because the baby feels it all. Every challenge is an opportunity, and our response is more important than the circumstance.

How can you balance knowing your own body and trusting your “gut” while also trusting your medical team in a high-risk pregnancy?
Be your own best advocate in labor. I controlled all my insulin, CGM, and blood sugars during labor, which was not preferred by the doctor or nursing staff, but they honored my preference. My blood sugars were steady each time, even with Declan's  36-hour labor! Diabetes is different for each of us, and the solution to blood sugar management is not the same from one person to the next.

If you want to focus on labor without thinking of blood sugar control, pass the responsibility to your team.

Exercise is a fabulous way to help naturally lower blood sugar. Both in pregnancy and not, I have noticed walking greatly lowers my blood sugar! What are some other pregnancy safe exercises that will help balance blood sugar and not spike it?
As mentioned, I loved walking, but I also incorporated other exercises into my care. I fell in love with water aerobics and got certified as an instructor when I was 27 weeks pregnant. I also really enjoyed yoga. I always informed the instructor I was pregnant and asked if they were aware of modifications.

Yes, some higher intensity exercise does raise blood sugar. For me, barre classes, HIIT training, and heavy lifting all required (and still require) taking insulin before a workout.

What are your favorite real-food sources of carbohydrates?
Right now I could have fresh raspberries all day long. Overall the foods I am listing are chosen not just on flavor, but on flavor and low impact to my blood sugars. I have a gentle gut, and some carbs spike me far more than others. For example, sweet potatoes spike me more than white potatoes. (Others with diabetes sually find the opposite.) My favorites include lentils (I love lentil pasta), berries, cooked onions, Brussel sprouts, green beans, and plantains.

Do you have any supplements or vitamins you find helpful for managing type 1 diabetes during pregnancy?

  • Whether you live with diabetes or not, a good probiotic is important to take care of our gut while our hormones transition, and also to prevent a positive Strep B test, which is found in 1/3 of pregnant women. If we are positive for this test in the USA, we must be given antibiotics at labor. This isn’t the worse thing, but it’s beneficial to do what you can to avoid it.
  • Additionally, high-quality fish oil is great for the baby’s brain, and also supportive of preventing postpartum depression.
  • Methylated B vitamins, as type 1 pregnancies have higher folate needs, and methylated folate is far better than folic acid. Folic acid can even be harmful.
  • Magnesium can help with insulin sensitivity, muscle comfort, bowel movements and more.

*Please consult your medical professional before taking anything. I always make recommendations specific to client needs. *

What is your best encouragement in managing rype 1 diabetes and pregnancy?

  • Check your bloood sugar like it’s a part-time job. This is obvious, but the pre- and post-prandial checks are crucial.  With my second child, I went on a CGM around week 16. It was amazing, and once I did it, it proved to kick off a good streak of in-target A1Cs. With the CGM I realized my hormones went nutty as I went to bed each night. I remember my graph on my CGM climbing from 9pm-11pm. I eventually got aggressive with my insulin and prevented this high from happening.
  • Be bold with insulin. Use your diabetes intuition to guide taking more insulin than calculated to bring a blood sugar down or cover a portion of food. Once the baby comes, you will have a motherly instinct, and I tell my moms with diabetes to use that instinct on their diabetes too. I understand my diabetes better than ever after having kids.
  • Calculate insulin needs for protein. The way I do this is by adding the grams of protein in a meal, dividing that number in half, and adding in the carbs. That number is what you use for measuring your insulin needs. Here is an example meal: A 3 egg and vegetable omelet. An egg has 6g of protein, so 6 x 3 = 18. Divide in half to get 9. So 9g plus whatever carbs are in the vegetables (let's pretend it's 5). So total "carbs" for calculating insulin needs is 14 grams.
  • Don't read too far into the "no-no's" for pregnancy, i.e., no shellfish, wine, soft cheeses, etc. Every country has different suggestions. Practice using your instincts here. Full transparency, I indulged in a few glasses of wine with each pregnancy as it was thoroughly enjoyed and gentle on my blood sugars. (Be sure to consult with your healthcare team first.)