We recently had the opportunity to sit down with esteemed DiabetesSisters' faculty member, Ginger Vieira, to chat about her recent pregnancy while living with diabetes. Ginger, along with CDE Jennifer Smith, has recently released a book, Pregnancy with Type 1 Diabetes, which is available for purchase here.
Q: What challenges do you think surprises women the most during the journey?
Ginger: Specifically for women with type 1 diabetes, I think the biggest surprises are just how tightly you can manage your blood sugars with the inspiration of a bun in the oven! And secondly, just how much insulin you need in the last trimester!
But I also think diabetes magnifies some of the challenges that surprise most women (even non-diabetics) during pregnancy. For instance, you can be extremely healthy prior to pregnancy but still experience complications during pregnancy like pre-eclampsia or the slew of bizarre challenges that can occur during pregnancy! And the same goes for how your baby is born into the world: you have no control over that beyond doing the best you can to manage your diabetes well, but so many other things can happen that change the way your child is born.
Q: Ginger, what surprised you the most during your own pregnancies?
Ginger: During my first pregnancy, I was definitely surprised at just how inconsistent the timing is of when you need to increase your insulin doses in the 2nd and 3rd trimesters. Some weeks you make no changes and other weeks you might have to increase your background insulin by 2 units merely 3 days after having just increased it. During my second pregnancy, I was expecting this so I was much quicker about making those dose changes which made blood sugar goals easier because I didn’t spend as many days thinking, “Geez, what am I doing wrong?” Instead, I knew it was simply time to increase my background insulin dose again.
But I want to add that I was also very surprised at just how suddenly pregnancy makes tight diabetes management “doable.” Before pregnancy, I’d never achieved an A1C below 6.0 percent, and yet I maintained it during both pregnancies. If you are someone who has never seen their A1C get below 7.0 percent, you can absolutely bet that there’s something about being pregnant that will help you get it there. And you’ll likely take that knowledge and experience with you after your pregnancy for your everyday diabetes management.
Q: Managing diabetes on a normal day is challenging enough, how do you write a book for a woman who is adding pregnancy to that mix? Where do you even start?
Ginger: In a nutshell, we started at the beginning...not the beginning of pregnancy, but the beginning of diabetes management. The first 8 sections of the book teach good old fashioned diabetes management to ensure that every reader is starting off their pregnancy with all of the essential diabetes knowledge: how to assess your own insulin doses (basal, insulin-to-carbohydrate ratio, correction factors), how to count carbs and eat a generally “clean” diet, how to manage your blood sugar during basic exercise, etc. We truly tried to cover it all so you were set-up for success in managing diabetes before you’re even pregnant.
Then we take the reader through each month of pregnancy, what to anticipate in terms of insulin dose changes, managing symptoms that complicate diabetes, extensive tips on nutrition and your emotional well-being, and what to expect at the doctor’s office as a type 1 woman with a bun in the oven!
And then...yup: then there’s the many different paths in which your baby might be born and how to manage your diabetes during each of those paths. And then postpartum and breastfeeding...which could honestly be their own book, but we give you the nuts and bolts to help you transition from pregnancywith type 1 diabetes to motherhood with type 1 diabetes.
Q: In the doctor’s office, there’s so much pressure to do everything perfectly (blood sugars, nutrition, etc.), where do you and your book stand on A1C goals and expectations around blood sugar ranges and food, etc.?
Ginger: For example, if you were to look at Jenny’s CGM settings versus mine, you’d see that it really comes down to personal comfort levels and goals. Jenny had her high-alarm on her CGM set at 120 mg/dL. For me, that would really trigger me to over-correct and freak out and cause unnecessary lows, so a simple increase to 130 mg/dL for my high-alarm was just right...for me! For some people, that setting might need to be 140 mg/dL or 160 mg/dL because of things like lack of symptoms during hypoglycemia, a very active job, a history of severe lows that has left you personally very uncomfortable being below 100 mg/dL, etc. While we’re all aiming for the same A1C range and blood sugar goals, there still needs to be room for that personal preference and personal comfort level which really comes down to personal safety. If keep your blood sugar between X and X causes you to have a total meltdown and rollercoaster blood sugars, then that simply isn’t the right goal-range for you!
Q: How detailed and specific is your book if everyone’s insulin doses are so different?
Ginger: We all have different insulin dose needs but the way your body is impacted by the hormonal and other physical changes during pregnancy are essentially physiologically the same. In each month’s chapter of the book, we explain what you can expect in terms of the increases or decreases to your insulin doses, by approximately how many units (giving a range, of course), and why you’re experience that increase or decrease.
When you understand the bigger picture of what is going on in your body, it’s easier to grasp and manage and appreciate. If a woman didn’t know that she wasn’t experiencing so many high blood sugars in the third trimester due to rising pregnancy hormones, she might think she’s doing something wrong and “failing.” In reality, she just needs to adjust her insulin doses accordingly for that phase of her pregnancy.
(And I should point out that I only understand all of this because Jenny, my co-author, taught me when I hired her to be my diabetes & pregnancy coach for my own pregnancies!)
Q: What are a couple big takeaways you learned from your own children’s births and delivery experiences?
Ginger: Ohhh, there’s nothing like giving birth to your child to teach you (both times) that you have no control over how this little creature comes into the world! It doesn’t matter how healthy you are or how perfect your blood sugars or how even how effortless your pregnancy was--anything can happen at the finish line. It doesn’t matter if you planned on delivering naturally without an epidural...you may get to the end and suddenly need a c-section for a huge variety of reasons that are going to save the life of you and your baby. All we can do is be ready to “let go” and embrace the experience for however it unfolds! Both of my children were born via c-section but those were still two very different experiences that I could not have predicted. And they are each special and memorable and incredible in their own way.
Thank you, Ginger, for your experience and expertise. We will continue to talk about Diabetes and Pregnancy at our upcoming Weekend for Women Conference in Alexandria, VA, this October. Be sure to check out the weekend's activities and agenda - then REGISTER and join us!