The TRUTH about Pregnancy and Type One Diabetes

Hi Everyone!

I've been getting a LOT of questions about my diabetes now that I am pregnant so I thought it would be good to put the answers to the most common questions in one place. I'm so happy that people are taking such an interest in learning about what my Type One Diabetes means for our baby and me during this time. What I've noticed is that there seems to be a fair amount of anxiety about it- in large part because people just don't know these answers! So here we go :)



First of all, just to recap my first blog post: I have Type ONE Diabetes- an autoimmune disorder that caused my body to stop producing the hormone insulin, which is essentially what allows our bodies to convert the sugar in our food into usable energy. As a result, I am insulin dependent and on insulin pump therapy. (Coming up, I will write a blog post about the equipment Type One Diabetics use to monitor their diabetes). Pregnancy is a significantly different experience for Type ONE diabetics than for Type TWO diabetics (insulin resistant- they produce insulin, but do not respond to it correctly), and both are fairly different than caring for GESTATIONAL diabetes (more on this later).

It is also important to note that this blog explains MY experiences so far with Type One Diabetes and pregnancy and may be very different from another person's experiences.

Here are some of the questions I've been getting:

1) So, with your diabetes, what does that mean for your pregnancy? Does it make the sugars harder to control and the pregnancy more difficult?

Great question! So, having Type One Diabetes does make my pregnancy a high risk pregnancy. This sounds really scary to a lot of people, but honestly, all it means is lots of extra special care and attention from my doctors to make sure we are both doing well throughout this process (and about a MILLION doctor appointments to keep track of!) Seriously, being a pregnant Type One Diabetic is like adding a part-time job into your schedule! I see my regular OB every two weeks, a high risk OB (MFMP) every 6 weeks, an ophthalmologist at least once per trimester, and my endocrinologist every other month. As we get farther along, I will start to see my OB every week, then twice a week for the last month, with several non-stress tests to check baby's condition per week for the last 2 months. The pros of this? I get to hear our baby's heartbeat and see our baby a LOT during these 9 months! And, I can ALWAYS be sure to know very soon if something is not going well or we need to make some kind of adjustment. What a blessing!

The risks associated with my pregnancy are:
In the first trimester, if my sugars are not under control, it can cause serious congenital defects, such as heart malformations, brain malformations, and missing or misplaced limbs. We are DONE with the first trimester, and as my sugars were PERFECT the whole 12 weeks, baby is also perfect :)

In the second and third trimesters, the main risks are an increased chance of preeclampsia and a higher chance of a heavy baby. I see an ophthalmologist at least once a trimester because preeclampsia is first noticeable in eye changes, so he/she can determine if I am developing early signs of the complication. To prevent preeclampsia, I started taking a baby aspirin every day, and if my sugars remain under control, I should have no problem having a normal size baby. If we have a large baby, it will be because my husband is TALL, not because the baby is overweight due to my high sugars. The other risk associated with uncontrolled sugars, especially in the last trimester, is that if my blood sugar is high all the time, when baby is born and no longer receiving all that sugar from my blood and is now overloaded with insulin, his or her blood sugar could plummet and can result in death for the baby. THIS, however, is a much higher concern with Type TWO diabetics, in large part because the tendency is for their diabetes to be much less controlled. This should not be a problem for us, as long as I continue to monitor my blood sugars carefully.

Pregnancy can make blood sugars harder to control, BUT in my opinion, it really hasn't been all that different from when I wasn't pregnant. I test my sugars a lot and I am careful about counting my carbs and taking my insulin. I honestly eat pretty much the same food as I did before I was pregnant (except now I LOVE french fries and BBQ sauce, but can't stand ranch dressing- but that's because of baby, not my diabetes).



The tendency in Type One with pregnancy is for blood sugars to be low during the first trimester, then start rising steadily in second and third trimesters as baby grows and my insulin resistance increases (due to the changes going on in my body because of the pregnancy- this resistance WILL go away as soon as baby is born). I had a kind of weird experience where my sugars trended high in the first trimester and now I'm treating a fair amount of midnight lows.



However, it's also been textbook in that the amount of insulin I have to take at meals now has increased, whereas the continuous flow of insulin (basal rate) has had to decrease (largely to prevent the lows I'm waking up to several times a night). Does it make it more difficult? In a way, I guess, but as I had excellent control before getting pregnant, I think my experience has been pretty good compared to someone who isn't already in the habit of wearing a continuous glucose monitor and almost obsessively adjusting insulin levels and communicating with doctors.

Here's the kicker: my diabetes has been more controlled since becoming pregnant than it EVER has been in the 13 years of having Type One Diabetes! A normal A1C (which is, loosely speaking, a 3-month average of your blood sugars) falls between 6-7 for diabetics. When you are pregnant, your endocrinologist wants it under 6.5. My A1C is currently 5.8!!!!! In the ENTIRE history of my diabetes, it has NEVER been that low. In fact, my endocrinologist's attending last week came into my appointment and said to me he didn't really feel like he needed to be there since he's NEVER met a pregnant Type One Diabetic with an A1C that low and I should just keep doing whatever I am doing. That A1C is such a gift given to me only by the grace of God (but more on that in another blog post).

More information about the risks associated with pregnancy and diabetes can be found here.

2) So, can you have Gestational Diabetes too, then? Do you have to take the glucose intolerance test?

NO NO NO!!! THANK HEAVENS NO! I DO NOT HAVE TO TAKE THAT TEST!!! One of the "perks" ('cause you have to find some...) to having Type One Diabetes is that you do NOT have to take the glucose intolerance test when you are pregnant.

For those of you who don't know, this is a test pregnant women take a few times in their pregnancy. They drink a certain amount of a sugary drink in an allotted time, wait a few hours, then have their blood glucose tested. This checks to see if their body is still able to respond well enough to insulin to safely sustain both themselves and baby. If they fail this test, they are diagnosed with GESTATIONAL diabetes- which is essentially Type Two diabetes, BUT only lasts the duration of the pregnancy. Most of the time, the woman's insulin resistance ends with the birth of her child.

I CAN NOT HAVE GESTATIONAL DIABETES. I'll say that again (because I actually had to explain this to one of my OB's nurses....) I CAN NOT HAVE GESTATIONAL DIABETES. That is only diagnosed in people who were not previously diabetic because it is a type of diabetes that ONLY lasts during pregnancy.

3) So, does this mean your child will have diabetes now?

Again, no. This question is sometimes asked very kindly and out of genuine interest. It is most often asked of me with a judgmental and accusatory tone. Learn this, if nothing else: regardless of whether or not you think someone should be having a baby, the ONLY appropriate response to their pregnancy is Congratulations! (more on this in another post) I have had several experiences with people who have told me it was selfish of me to get pregnant because now my child has to live with diabetes.

First of all, not true. Second of all, back off. That's not your decision, and you know what? IF our baby is diagnosed with Type One, he or she will have a very understanding mother who already knows how to care for the condition. This is still our baby and we will love him or her no matter what. He or she is OUR baby- no child is perfect. If you want a perfect baby, go to Walmart and buy a doll.

Anyway- moving on- here is what you need to know about this question:

1) Type TWO diabetes is far more genetic than type one. In twin studies conducted about diabetes, there was a significantly higher correlation between identical twins both developing type 2 than both developing type 1. This suggests that the genetic link is much higher in Type TWO diabetes than in type 1. Doctors are still unsure about the causes of type ONE diabetes, though they have some pretty solid theories, including polyglandular autoimmune syndrome. Research found here and here.

2) My child, because of my age and gender, has about a 1 in 25 chance of developing Type One Diabetes. The children I have after the age of 25 will only have about a 1 in 100 chance. Compare this to if the father is diabetic: those children have a 1 in 17 chance. Even IF BOTH my husband and I were diabetic, our child would still only have a 1 in 10 to a 1 in 4 chance. Those are honestly pretty good odds, and a far cry from saying our child WILL have diabetes. Learn about the "genetic" factors here or learn about the other theories of causes (note they only have correlations, no verifiable causal relationships as of yet) here.



4) Does this mean you have to have a C-Section?

Absolutely not! There IS a slightly higher correlation between having a high-risk pregnancy and having a C-Section, but I do have options and IF my sugars are well controlled, I don't have preeclampsia, and baby is a normal weight, there is no reason I should not be able to have a natural birth. In fact, this is mine and my husband's plan- natural birth without any pain medications at all (partly because I'm more scared of the huge needle going into my spine for an epidural than I am of birth). Of course, we have to be flexible with our birth plan, BUT so does every woman. IF I end up needing a C-Section, it will most likely be because of a complication that has nothing to do with my diabetes.

Thank you for reading and please, feel FREE to comment with any questions you have for me. I fully plan on writing more of these blog posts as my pregnancy progresses.

As always, your prayers for us- for our safety, our sanity, provision, and of course a speedy delivery when the time is right- are so appreciated.

We love you all!
Emily

I Could Die Tonight

Ok Yes. The infamous "click-bait." I may be guilty of that for this post. Let me assure you, however, that my post title is NOT hyperbolic. It is a very real thing that I have faced every day for twelve and a half years. So, what am I talking about?

I have Type 1 Diabetes. 

Many of you reading this know me personally and already know this about me, but I'd venture to say that if you keep reading this and subsequent posts, you'll learn something you didn't know.

This blog series is a project that I have been contemplating and praying about for a fairly significant amount of time, and I am writing it to lovingly promote education about Type 1 Diabetes and the struggles (both medically and socially) that I've faced in my time spent as a Type 1 Diabetic. One of my biggest roadblocks to starting this series was deciding what to write about: there are SO many topics and misconceptions I'd love to cover.

At first this started as an idea for one post, like "10 Misconceptions about Type 1 Diabetes," or something like that, but I realized that 1) that has been done to death, and 2) there is SO much more than one list of 10 things to talk about. So, I decided to create a blog series about my daily struggles and current journey with Type One Diabetes care.

Ok. I had a plan. Now, where to start? I could start with what the disease is and what causes it, or I could start by explaining the life-changing effects of insulin therapy (notice, I said life-changing not life-saving, but more on that later). Instead, let's start at the beginning...

I could die tonight.

This statement is at the back of every single Type One Diabetic's mind. Every. Single. Day. This is the first thing you need to know about me. This has been more prevalent lately as I have struggled with my doctors to develop an insulin therapy plan that works with my body and schedule. I am currently on the Flex Pens (more on that in another post), so I take a long-lasting insulin called Lantus every night. The problem is, too little Lantus will make my sugars high all day, but the high dosage of Lantus has been causing me to have low blood sugars in the middle of the night. This started shortly after Josh and I got back from our honeymoon last August.

At first, it was a slightly low sugar around 3-4 am twice  a week or so. A few weeks later, I woke up at 4:30 am feeling numb and unable to speak. I was shaking and sweaty and exhausted. All I wanted was to go back to sleep and I couldn't figure out why I couldn't make my body sleep. It took several minutes for me to become alert enough to realize that my blood sugar was low. When I stepped out of bed to find my meter, I could feel my legs caving beneath me and I felt dizzy. By the time I was able to fumble my way through my kit and test my blood sugar, it was at 37. To put that in perspective for those of you who don't know, my blood sugar as an adult should ideally be somewhere between 80-120. Severe hypoglycemia (low blood sugar) is 55 or below. At 37, most people lose consciousness or, at the very least, the ability to think their way through treating a low blood sugar. Ever since this incident, waking up with a blood sugar below 55 has been an almost nightly occurrence. I am fortunate enough that God has answered my prayers and allowed me to wake up with the ability to treat these sugars, but what I (and every Type One Diabetic) need you to understand is that this disease has the potential to kill me in my sleep.

The reason I started with this information is because of the many well-meaning but misguided comments I have received over the years, and even recently. Such comments are meant to comfort me I am sure, but in reality they diminish the pains (and victories!) I face daily and perpetuate a misunderstanding of life as a Type One Diabetic. These include:

Well, at least you don't have cancer!

You are so lucky! Diabetes is easy now with all the advancements in the medical field.

Oh, so all you have to do is stop eating sugar right?

Oh, so it's just testing your sugar and taking a few shots.

These comments are meant to make me feel better and usually come from a place of love, but here are some key things I'd like you to know as we proceed:

1) No, I do not have cancer and I do not wish that on anyone. I am NOT diminishing what it is to go through that. BUT, just because to most people my auto-immune disorder is invisible, it does NOT make it any less deadly, painful, and sometimes heartbreaking to deal with.

2) Yes, I am fortunate enough to be diabetic during a time in which we have Continuous Glucose Monitors, Insulin Pumps, and Electronic Glucometers. BUT, that does NOT make caring for this disorder EASY in ANY sense of the term.

3) Each type of diabetes is unique and Type ONE Diabetes does not have anything to do with eating less sugar (except from the standpoint of just having a healthy diet in general). Type ONE Diabetes is controlled by extensive monitoring and insulin therapy, NOT diet. 

No insulin=death. 

There are other misconceptions about Type One Diabetes that I would love to address in later posts, but I wanted to start here because this, I think, is the number one takeaway if you don't read ANY of the rest of the series: When you meet or know someone with Type One Diabetes, treat him/her with compassion and don't make assumptions. I LOVE when people ask me genuine questions, but it hurts when they make judgments or assumptions about my lifestyle, care, parents, or any number of other things. Type One Diabetes is treatable, but it isn't easy, painless, OR curable (YET!)

Please feel free to comment or email me questions or comments. If you have Type One Diabetes and want some support, DEFINITELY email me. I'm always looking for more people to talk and pray with about this daily struggle :)