Sheri Barnes, Audrey Moore, and Kelli Turner have a few things in common: they live in the Raleigh, NC area, have recently become first-time mothers, and live wtih diabetes. They met at DiabetesSisters' PODS Meetups and the Weekend for Women Conference. They recently visited the DiabetesSisters' office and sat down to discuss their experiences while preparing to become pregnant, during their journey, and now, as mothers living with diabetes and taking care of their small children.
1. As women with diabetes, what concerns did you have about getting pregnant and how did being involved with DiabetesSisters help you address them?
Sheri: I was aware that chances of miscarriage and birth defects can be higher in diabetic women, and I was concerned that my blood sugar control would not be good enough to have a baby. Through DiabetesSisters, I switched to a great endocrinology practice, learned about the continuous glucose monitor (CGM), and began using one soon after. With the help of the CGM and my new medical team, I worked very hard in the months before I conceived to have my diabetes in the best control possible. As a result, my A1c dropped by almost a point and I was at my target (6.0%) within the first month of my pregnancy.
Audrey: My biggest concern was about the strict blood sugar control and the impact that pregnancy would have on my body with diabetes. When I went to a DiabetesSisters PODS Meetup and met a sister that had a child who faced my same concerns, I was immediately filled with hope that I too could have a safe pregnancy.
Kelli: My first concern was getting my A1c below 6.5% which my doctor and I felt comfortable with in order to begin to try to get pregnant. To do so, I knew I needed to get off my 6 shot-a-day regimen and get started on an insulin pump. Since I was involved with and hosting a PODS Meetup in my home, I saw women month after month using and discussing the benefits of being on a pump and I soon realized I needed to overcome my fear of starting on the pump. With the encouragement of my fellow DiabetesSisters, I purchased an insulin pump in January of 2010 and had my A1c down to 6.2% a year later!
Sheri: I knew that insulin requirements decrease in the first trimester and increase significantly later in pregnancy and was concerned about the continual adjustments that would need to be made to keep my blood sugar where it needed to be. It was great to know that I had a community of women to call on to offer advice and to give ideas when making these continual changes became difficult.
Audrey: I heard from several people that I would have to go on a very strict diet and that I could not have artificial sugars while pregnant. I learned very quickly that it is about closely monitoring blood sugar and keeping things in moderation. I was still able to have some of the things that I was used to and could eat things like white bread and my sugars were fine: I just had to adjust my life.
Kelli: I knew my biggest challenge managing my blood sugar during pregnancy was going to be the changes in insulin requirement throughout the different stages of pregnancy. Through DiabetesSisters, I was also introduced to several women using CGM's and while my first focus was learning and adjusting to the pump, after about a year using the pump I added the CGM to help manage my blood sugar even more closely. Because of this I was able to keep my A1c at 6.2% or below my entire pregnancy, even through the various insulin requirement needs due to hormonal changes in all 3 trimesters.
1. What measures did you take to manage your blood sugar during pregnancy and how did being involved with DiabetesSisters help support you in doing so?
Sheri: I used an insulin pump and CGM, tested my blood sugar at least 6 times a day, and made changes to my insulin needs as necessary with the help of my medical team. It was also great to attend monthly PODS Meetups to talk about the challenges of changing insulin requirements and to get thoughts of others. Changing insulin needs is something that all type I diabetics face, so it was easily relatable.
Audrey: I learned I had to plan a lot more and take insulin far in advance of eating. I always checked my blood sugar before eating and if they were not close to 100, I would wait to eat until they came down. I knew that eating with even a 130 would send my blood sugar on a upward spiral. It was stressful at times, especially when I felt like I couldn't eat but I learned that keeping my blood sugar at 100 was more important to me than having a higher blood sugar. Support from my DiabetesSisters eased my frustrations because I saw others be able to do it and I felt more confident in my ability to do a good job with my diet and blood sugar control.
Kelli: I used my insulin pump and relied heavily on my CGM, but also tested my blood sugar at least 8 times, if not more, per day. When my blood sugar was high 1-2 hours after a meal, I quickly corrected and in some cases over-corrected to bring it back down to 100. I also tried to get my blood sugar down to 80 or lower before meals. Being involved with DiabetesSisters by hosting PODS Meetups at my home was extremely helpful to me. The Meetups allowed me to express my frustrations with my changing insulin needs as well as "bounce" my scenario off other women like Audrey, Sheri and others who had children and had the same struggles throughout pregnancy.
Sheri: The most challenging part of managing my diabetes during pregnancy were high blood sugars without a predictable pattern on which to make insulin changes, so there was a lot of guesswork. This was mostly in the second trimester, but the second and third trimesters were equally difficult for me. In the third trimester, I expected my requirements to continue increasing like I had read and researched, but they actually decreased, so I was often low multiple times a day. My lows were mostly overnight, and I would have to wake to treat them 2-3 times a night. We joked that it was getting me ready to care for a newborn!
Audrey: The most difficult challenge was keeping my blood sugars from spiking after a meal. This is a very natural thing that happens when you are a diabetic, but the doctors wanted me to have my blood sugar back to 100 1-2 hrs after a meal. This took lots of planning and focus. I also had to learn not to beat myself up when my blood sugar did go high. It was doing more damage fretting over a 180 than the actual blood sugar was going to do to me or my baby.
Kelli: The most difficult challenge for me was managing my lows overnight. Wearing the CGM was helpful; however I had to eat frequent snacks every 3 hours or so throughout the night to keep my blood sugar from getting too low. This was most difficult in my first and third trimesters due to the normal pregnancy side effects, like nausea, bloating and gas which made eating large or even normal sized meals difficult for me. In turn, I had to eat very small portions more often to get all my calories and nutrients but had a tough time regulating my insulin delivery through my pump at first. Once I got the patterns, down the management was a bit easier.
3. How did being pregnant change the way you manage your diabetes?
Sheri: I have always been very well informed about the importance of good blood sugar control and have done my best to take care of myself. However, this was raised by a notch when I considered that it was no longer just about me, but about the health of my baby. Because of this, I was much more proactive and had monthly visits with my CDE and endocrinologist throughout my pregnancy to ensure good blood sugar management.
Audrey: Pregnancy taught me how to keep my blood sugar stable. Small meals and focusing on blood sugar was my life!
Kelli: Being pregnant made me more diligent in my diabetes management. During pregnancy, keeping my blood sugar in control was the most important thing I focused on for the health of my baby. I continue to wear my CGM now and although I am not managing my blood sugar quite as well as I did while I was pregnant, I am still much more dedicated to my diabetes management than before trying to conceive. I am also breastfeeding so eating healthy and maintaining good blood sugar control is essential for both my milk production & my health. It's not always possible but next to taking care of my daughter, I try to make my diabetes management a top priority.
Sheri: My biggest concern was not being able to wear my pump and CGM during labor and being able to manage my diabetes while in the hospital. I spoke with my obstetrician regarding this well in advance of my delivery and we agreed that I know my body best, so I was able to manage it myself and simply keep the medical team updated.
Audrey: My biggest concern was whether I would be able to use my insulin pump and if my blood sugar would remain stable. I was also concerned about having a c-section. My baby was big and some doctors would hint to me that I would need a c-section. Turned out that I did not need a c-section and I was able to control my insulin delivery through my pump the whole time in the hospital. The medical staff did want me to use their meter to check my blood sugar which was fine, I just requested that I use my own lancing device and they obliged.
Kelli: Like Audrey and Sheri, my biggest concern about the birthing process was being able to wear my insulin pump & CGM before, during and after the birth of my daughter. However, I knew beforehand that I would be having a planned C-section due to prior uterine surgery. I spoke with my OBGYN discuss how the hospital planned to proceed. Although my daughter came early, I had a few hours preparation to discuss my birth plan with my doctors, and together we decided I would wear my insulin pump right up to 5 minutes before my spinal tap and would reunited with it within 2.5 hours of surgery. I also wore my CGM the entire time and my husband carried it into the operating room and kept a close eye on it during the C-section. My blood sugar remained in the 120-130 range the whole time and after recovery, I was allowed to test my blood sugar with my meter whenever the nursed tested me with the hospital's and they allowed me to use my own lancing device.
1. Was the birth and hospital experience better than you expected, worse or about the same?
Sheri: My birth and hospital experience as far as diabetes is concerned was exactly what I expected. With all of the unknowns of labor and delivery, it was a comfort to know that my diabetes management would be in my control.
Audrey: The whole experience was better than I expected as far as my diabetes goes. My blood sugar remained stable and I had a healthy baby boy. My nurses were great and made my experience much less stressful than I anticipated. Having a baby is a miracle in itself and going through that with other concerns was even a bigger miracle for me. God was watching over me, that’s for sure!
Kelli: I was truly blessed with a wonderful medical team that handled my emergency c-section with grace! I was admitted due to preeclampsia & decreased kidney function with major swelling and third spacing thoughout my body. The medical team worked together to make a plan that was best for both me and my baby, I could not have asked for a more dedicated group of men and women. Once my daughter was born and transferred to the NICU, she was truly in the most amazing hands and the nurses taking care of her and me were top notch. So all in all, my hospital experience was better than expected and the birth was challenging but the medical team was amazing.
Sheri: It is great to touch base/vent about hormones, breastfeeding, blood sugar, baby gear, etc. with other moms that “get it.” Caring for a newborn is challenging, but adding the diabetes layer on top of it introduces complexity that few fully understand. Having the other Sisters available for a quick text or phone call is a real comfort and encouragement.
Audrey: We have encouraged each other just by being there for one another and sharing in the joys of being new moms. We also talk about our diabetes and how we have to take care of that part of our lives or we won't be able to be as good of a mother. We also help each other laugh and get through so we know we are not alone and it is worth all the effort to take care of ourselves!
Kelli: It's been wonderful as new moms to be able to reach out to one another via text, phone or lunch to talk, not only about being a new mom and how our little ones are adjusting to life on the outside, but also how our blood sugar management is going during this challenging time. I get so much comfort being able to speak to one of my DiabetesSisters about how my management is going while breastfeeding and get ideas on how to adjust my eating to help maintain my sugars better.
Sheri: Definitely! Although I’m only nine weeks into this motherhood journey, I have learned a lot about myself through being pregnant and now through being a mom with diabetes. There are a few external resources, but nothing that compares to being able to lean on other moms that have successfully managed diabetes and pregnancy. I can’t wait to share my experience and to be an encouragement to other women with diabetes who are pregnant or who are trying to become pregnant.
Audrey: I think my experience can help others by sharing that it is not only possible but it can be a joyful experience. If I could tell someone who had diabetes one thing, it would be to take as good care of yourself as you can and leave the rest to God and the doctors. Also, do not let the doctors worry you to death about your blood sugar. You do the best you can and don’t let them give you a hard time or feel guilty about ANYTHING! You know your body and how you take care of your diabetes better than anyone and you can’t be perfect. Relax and enjoy the process of bringing life into this world!
Kelli: Without a doubt! I myself found it extremely helpful to listen to as many stories of other women who had successful pregnancy prior to getting pregnant. Now having gone through a pregnancy with diabetes, I know my experience would not only be helpful but encouraging for other women thinking about or trying to get pregnant. The entire experience from preconception to post delivery was challenging but with hard work, support and encouragement from other women with diabetes, good doctors and God's grace you can have a successful pregnancy and bring your child into this world. I am blessed beyond words and so thankful for my DiabetesSisters and the support I receive from them.