Most newly-married women my age (that would be 26) spend the first year basking in the glow of newlywed life: snuggling up on the couch watching movies, traveling and exploring far-off places, establishing new routines and merging two lifestyles, and lots and lots of late nights (wink, wink).
And me? On top of all that, I’m thinking about a baby.
Even before we were married, I started plotting out a timeline for children. Many of our friends and family, contrary to popular belief, actually balked at the idea of planning for kids. “You’re so young!” “You have so much time!” “Enjoy married life!”
While my husband and I aren’t spring chickens, we also aren’t rushing to beat the fertility clock either. So why am I so wrapped up in pregnancy just three months into marriage? Well, it’s because of my diabetes.
Let me put all the cards on the table: while I’m a well-educated PWD and have zero complications, my last A1c was 8.3%. Ideal A1c percents aside, I realize that number might be extraordinarily high for some, yet a dream-of goal for others. We’re all at a different spot on this journey we call diabetes, and A1cs means different things to different people.
But not so much when it comes to a baby. I’ve done a lot of research on the topic — and even reviewed a book about the subject — and although there doesn’t seem to be a hard-and-fast consensus on the subject, in general, a woman’s A1c needs to be as low as humanly possible without excessive hypoglycemic episodes in order to get pregnant. Although Dr. Lois Jovanovic advocates an A1c of 6% or less for her female patients, that kinda freaks the crap out of me. So I tend to lean toward something a bit more moderate, like the ADA recommendation of under 7%. My own endocrinologist sets the bar at 6.5%. Which is a loooong way from where I’m at, but it’s do-able. Well, under 6% might also be do-able but I’m not sure I could handle that much cookie deprivation.
The thing with pregnancy and diabetes is there really shouldn’t be any surprises. There’s a whole host of problems that can happen to the baby if the mother’s A1c is elevated prior to conception and during pregnancy, so prep work starts early. My husband and I haven’t decided when we want to have kids. Most likely, it will be around two to three years into our marriage. But I also know that it could take that long to get my A1c where it needs to be. Breaking the 7% A1c threshold is something I have never been able to do in 18 years of having diabetes.
So what’s my plan of action?
Get on a CGM. This seems like the most obvious first step, right? You might even wonder why I’m not already on one. Well, I’ll tell you. When I was on a Medtronic Minimed CGM, I had a terrible reaction to the sensors. It wasn’t that the CGM was inaccurate (it actually worked OK for me most of the time). But my body rejected the sensors after a couple of days. Itchy redness and irritation. It was gross and painful. It just didn’t do me enough good to suffer! Now that I’m in baby-planning mode, it’s time to suck up the expenses and I’ll be joining the ranks of DexCom users. I’m very excited — and will most likely be filled with questions, so stay tuned!
Exercise! Easier said than done, of course. But exercise is one of the best ways to lower blood sugar. Plus, starting pregnancy with a few less pounds decreases the same complications that arise in overweight women without diabetes, like high blood pressure, risk of birth defects, and the risk of needing a cesarean. It’s a win-win for mommy and baby!
Eat clean. I’m not on the low-carb bandwagon by any means, but I also know that less carbs = less blood sugar fluctuations. It’s the rule of small numbers and as much as it pains me to say it, it’s true. Earlier this year, I hopped on the clean eating bandwagon, which emphasizes eating only whole, natural foods and cutting out artificial sweeteners and preservatives. Between clean eating and exercise, I managed to lower my A1c by almost a full percentage point, and I lost 15 lbs. Some of that has crept back on in recent weeks, but I’m a girl on a mission now!
I’m excited to start this journey and to share it with you all, and although I won’t have any announcements for awhile, I appreciate any and all advice in preparing and planning!
Allison,
I’m so inspired by your efforts and look forward to hearing about your journey. I have faced many of the same challenges you talk about, with the exception of trying to ready my body for a baby. Good luck – sounds like you are on your way!
KristinW
Good luck in all the planning!! If you like to cook, I have found @TerryWalters cookbooks (I only have one) fabulous. The one I have is also separated by seasons, which makes it very convenient. Unfortunately it is still packed away, otherwise I would tell you the name of it as well.
Very excited for you and your husband! I too am not willing to “give up” carbs, but I found that limiting them to about 30 per meal worked for me…that way I fill up on healthy lower carb items like veggies and lean protein and still enjoy some carbs (which I adore!). I lost 7lbs in about 1 1/2 months too! Hope you have great success wrangling that A1C to a safe level for pregnancy…best of luck to you!!!!
Clean eating helped me out TONS with blood sugars. I just don’t eat any white foods and I’m good (aside from unexpected things like infections, stress, um, the usual, ya know) Something that also helped was to simplify my daily routine. When I don’t crowd my schedule or try to fit in too many things in a day, I find that it helps avoid times when I’m in such a hurry that I forget about my diabetes. During my pregnancy I was so loony brained (the hormones will do that to you) that I wore a watch with multiple alarms on it (the watches meant for senior citizens so they remember their medications). Every time the alarm sounded I stopped and thought about my diabetes and about when was the last time I tested. It helped me catch highs and lows before they got super high or low. I was working in a busy corporate office at the time and didn’t want to forget the most important thing-my baby’s well being. Good luck with your goal of lowering your A1c a bit more. I know you can do it.
I actually just found out that I have type 2 diabetes and I am about 11 weeks pregnant. Lil freaked out by all this new info and all these numbers and of course the new eating life style!! But glad that I finally found out what is going on with my body! The thing right now that I am trying to get use to is that sometimes I feel sick and tired from the diabetes and other times I feel sick and tired from being pregnant but I am starting to be able to tell which is which!! This def a new journey for me and I am scared out of my wits but I am trying hard to just absorb all I can at this point!! Thank you for this lets me know I am not the only one on this scary journey!!
Good luck!
I’m just four weeks away from meeting my (hopefully totally healthy) baby, and feel about ready to write my own book on the subject of diabetes and pregnancy now! What I want to say to you right now though is that although you’re absolutely right to be planning early, and to be wanting to get your A1c down for your own sake as much as a baby, don’t underestimate the difference that wanting a baby “right now”, as opposed to “sometime soon” can make to your diabetes management.
Like you, we planned ahead. We began planning before we got married and made a host of specific changes, and I was very committed to good control for the purpose of babies as well as general health. But babies and my diabetes weren’t the sole focuses in my life, and it would have been both unrealistic and stupid to make them so at that time. The month that we felt ready to actually try – the month we would have thrown the birth control out and got on with it if I weren’t diabetic – my A1c was still sitting at 7. Being told “that really wouldn’t be advised”, when I was so desperate to get going, was really hard.
And it did something to my motivation. My desire for a healthy baby gave me an amazing focus. In 2 months my A1c was down to 5.9%. I was at 5.9% at conception, and that has fallen throughout my pregnancy to my current low of 4.6%. (No bragging, pregnancy does artificially lower the numbers slightly, due to increased blood volume and red blood cell turnover.) Suddenly I was able to deal with that much cookie deprivation, willing to push everything else aside and make my life fit around diabetes rather than my usual approach of making diabetes fit around my life. Some of the changes I made are not sustainable in the longer term. I did eat much lower carb. I did eat practically the same meals at the same times to minimise the number of potential variables. I passed on certain food and activities that I would otherwise have gone for and dealt with the consequences afterwards. I didn’t mind that I was depriving myself of things and letting diabetes influence me in ways I never had before, because I was desperate enough. But doing those things over the much longer term would be so much harder (and bear in mind the actual conceiving bit can take a while too!)
I guess what I’m saying is keep your goals modest to begin with, but don’t let the idea of under 6.5% or even under 6% scare you, because it is do-able when you’re right there ready to leap off the cliff. But if you set yourself that kind of target over 2-3 years, you may well burn out before you get there.
Remember too, that if you try one thing and it isn’t working, you need to try something else. Believe that it really is hard work, but if you’re willing to do the work it is also possible. Totally possible. Good Luck!
Great Post! So meaningful to get such great information. Keep up the good work.
BTW, everybody sign the JDRF Petition to Draft FDA guidelines if you haven’t gotten the chance yet! Here is the link!!
‘Sign the Artificial Pancreas petition and help those living with diabetes at http://bit.ly/nQY3QM!’
Best, Natalie
This is a great post and I applaud you for getting ready now for pregnancy. I too have type 1 diabetes and have never been able to get my A1c below 7. But my husband and I decided that it was time to start this journey of parenthood earlier this year. I am now 4 months pregnant and let me tell you, no matter what you do to prepare yourself and your diabetes control, it all becomes a roller coaster ride because of all of the hormones and changes of pregnancy.
I had been working on getting my A1c below 7 so that my doctor would approve getting pregnant. It was exactly 7 when we did find out I was pregnant. I am pleased to say that it is now 6.3 and dropping. I never thought that it would happen and it scared the living daylights out of me when my OBGYN said that I needed to get it down below 6 for the health of my baby. But with the help of my medical team and very strict testing and adjusting I can now see that it is possible.
The best advice that I can give is to do your research before and leading up to your conception, but then you just have to be kind of flexible and adjust with your body as it changes.
@Natalie – Yup, we’ve been promoting the JDRF petition too. Thx!
First of all, good for you for getting prepared early. I too have been terrified of the unknown of a diabetic pregnancy. And I too, have never been able to get my A1c below 7. But earlier this year my husband and I decided it was time to embrace the many uncertanties of parenthood.
I am now 4 months pregnant and let me tell you this, no matter how prepared you are how in control your diabetes is, it all becomes a roller coaster ride of diabetes and pregnancy. I had an A1c of exactly 7 when we found out we were pregnant and with the help of my medical team and very strict testing and adjusting it is now 6.3 and dropping. I never thought it was possible, and I was scared out of my mind when my OBGYN told me I needed to try to get it to 5.5 for the health of my baby. But I am starting to see that it is possible, and really not that scary.
The best advice that I could give is to do your homework and be prepared, but when it comes down to conception time you really just have to be flexible and adjust with the changes of your body.
-Jeanette (Jralphs)
Hi! That is very exciting that your planning on having children! It’s alot of work but such a blessing! I’m a type 1 diabetic age 34 & have had diabetes for 29 yrs. Also, I’m a mother of 5 healthy children…yes 5:) My A1C has always been 6% or below (normally 5.6-5.8%) 5.6 was my last one a month ago,( except in my early childhood years of diabetes it was more like 7-8%.) Please let me know if you have any questions! I would be happy to help you through this journey. I’m currrently working on setting up a blog of my own …I feel like I have so much info to share with others!
I should add that I have no diabetic complications thankfully. I’m so thankful for the new control methods now a days, when I was 6yrs old things were alot different then they are now! I could go on and on with given you advice but would rather you write any questions you may have so I’m not repeating things you already know:) Take Care! And I’m glad I came across your blog!
Having a pregnancy-friendly A1C does not have to mean cookie deprivation. I am T1, 27 weeks pregnant, A1C before pregnancy 5.6%, currently 4.9%. And I never say no to a good cookie. It’s all about portion control. The maximum amount of cookie carb I will ever ingest in one sitting is 10g; 5g is even better though. Yeah it’s not a lot of cookie but you enjoy it more if you make it last. And 2 hours later, you can have another small morsel.
This eating-like-a-mouse approach even works with pizza. I had a pizza blowout sometime around week 16. One small piece of thin-crust pizza (20g carb) every 2 hours. It took me two days to finish a medium pizza but throughout those two days, my blood sugars ranged from 3.8 to 7.5 mm/ol (multiply by 18 for American equivalent), which is a pretty nice flatline for pizza!
The point being, yes it’s bloody hard work but it’s doable and well worth it in the end. Good luck!