[sirius]

At this moment I am trying to get a better sugar results, because I want to become a mummy. I use Humalog and Landus. I have better blood sugar results and getting better I believe. The last HA1C was 7.7 (June 2005), the best result I ever had.
I am diabetic, type one for almost 7 years. The doctors told me that LANDUS is not tested for pregnancy, so from September I’ll have to change the insulin to Prophane in combination with Humalog. The doctor said that I have to be controlled up to 5.5 (HA1C), so that I won’t have risks. I changed my life habits, but one thing I did not change is to stop smoking… maybe the most important thing. I think I didn’t stop smoking because I have a stressful job – TV productions. You’ll tell me probably …”It’s an excuse - who hasn’t a stressful life? Anyway, I think I didn’t want to stop that, but know I have to. I have some worries. I will tell them to you as bad as I see them. Will I be able to accomplish 5.5 HA1C ever, since the best I did was 7.7 and should I wait and have patience to have this result and after that to have a baby? I am starting really to feel frustrated about it. My worries don’t stop. The fact that the diabetic person has to change all the time the life habits and accommodate to this crazy illness gives me a headache. I have to change again. No problem, I’ll do my best, but from the other side this is what my analytical mind is thinking: Will I have to stop to work? Will I have to just sit and lay down only, because if I do anything I’ll have hypo? If I have hypo or the opposite what should I do? I mean for 9 months I need to be careful not to have them????!!!! If I do, what happens? Will I have to measure 8 times/per day the blood sugar until my skin doesn’t feel anything? I was advised that I have to adjust the insulin units, depending on the sugar level I have at that moment. I have to stop this bad thinking of mine.
My husband and I, we are doing the same job. Our life is full of stress from the nature of our job (the company is ours and everything depends on us). Simply our life is love, stress from work, too much travel, speed…. I will try to change that, you know for which reason, but my husband can’t and I am not expecting that from him. He is supportive and doesn’t want me to feel different from others. My parents leave in another country, his parents leave in another city. I can’t expect them to help me. Until now, I was able to take care of myself and manage any condition I had (hypo & hyper). But pregnancy is something other, something unknown to me. So, we are leaving alone and my husband can’t be my babysitter and stop to work. We are living 50 km away from the city near to the sea. We rent house outside from the city to have calm. For a period of one month we stay at home from 10-15 days. I sometimes work from home, but usually travel to the office we have in the city or in other cities or countries where necessary. All the houses around are villas and some of the people are living here permanently. This is what I picture: I am home alone and I have a hypo and I can’t help myself and ……???!!! Who will take me in the hospital, if my husband is away? And the hospital is away too. Do I need to find doctor who will be 24 hours available on the phone? I have a very good discipline in the food regime and always take insulin on time. I don’t have any other health problems except for the diabetes. Maybe after all I am exaggerating in order to get ready to the fact of being pregnant. I asked these questions to my diabetes doctor who is not a specialist for pregnancy he said “everything will be fine, don’t worry too much”. He recommended to me other doctor for diabetes and pregnancy who did not have too much time and was too arrogant. I am thinking to change her. Am I having an imagination about the difficulties that are expecting me and make things worse by myself? Anyone have experience or knows anything about pregnancy and diabetics? Guys, I would like to hear and your opinion too. I think the best thing to make these fears disappear is to talk to people similar to me. I was never like this before! I NEED YOUR SUPPORT. THANK YOU ALL!!!!


“Don’t worry, be happy”

[jdstein11]

I think that with exercize you may be able to help lower your BG (if that's the effect exercize gives you) without other changes, but you should absolutely always keep tablets on-hand to control any hypos. You shouldn't have to lie down in order to manage your BG. As for the smoking, you should start planning on other ways to control stress, as smoking will definitely not help you with your diabetes or your interest in having a child. I don't think we need to get into those risks!

Have you ever had to go to the hospital due to a hypo? If not, I think you should plan more positively and believe that you should be able to handle your diabetes, pregnant or not. If you're tracking your BG levels throughout the day, I hope you've been able to handle your doses to prevent hypos as much as you can; if not, start tracking to identify causes of hypos so you can better deal with them.

As I'm a guy, I can't give you any advice on pregnancy and diabetes, but I'm sure there are plenty of others here who can. This site has PLENTY of people willing to offer helpful advice! Good luck!

[soremom]

I have two boys, 14 and 4. I had gestational diabetes with my first and then diagnosed T1 8 months after he was born. I figured with every thing I read I would never be able to have another child, didn't want to risk it and not be there for my son. We were a happy family and having one child was fine. Then my husband brother and his wife got pregnant, well that was it I wanted another one. Talked to me doctor, and she said as long as I had tight control, which I did so that was a problem, and to go on the insulin pump, there shouldn't be problems later in life, of course there is never any guarantee when you are pregnant. So that is what we did.

I had a few problems with my pregnancy, I won't go into them now, but if you want to know please ask. It was alot of work, you go to the doctor constantly from the beginning, I had a different ob and endo but I didn't mind. He was a month early but perfect. He is know a very active 4 year old. We didn't realize what our family was missing till he came into it. My oldest was just shy of being 10 and was thrilled to death to becoming a big brother (that is what the youngest calls him "big brother", he dont' call him by his name, it is very funny). I can understand your fears. I have always heard that diabetics shouldn't have children and so on, well it can happen. Tight control is a definite, and it will be a challange with you bgs throughout the pregnancy. The biggest thing you can do is test constantly. I didn't have any problems with lows during the pregnancy. With the pump it helps keep you more constant and easier to correct, atleast for me.

Any other questions, please ask. Each pregnancy is different for everyone but we can shed some light for you. Good luck and if this is what you want, relax, and just take one day at a time. It makes things go much easier than worry about 9 months from now.

Kim

[sirius]

Thank you for getting back to me. Jdstein11, I never had hypos for which was necessary to be hospitalized. And, Kim I would like to know your experiences and problems during the pregnancy. Sorry but I do not understand what is ob and endo, please explain. First of all, I think we don’t have insulin pumps here in Greece, I am using injections (insulin pencil). I eat every day at the same time, take insulin at the same time, try to use same carb units for every meal and still have hypos. Maybe I should pay more attention to the energy consumption. But again I may sit all day or have a calm day and still have hypos. I also write my results in a note book, but maybe I should open agenda and do a study, write not only the BG results, but also what I eat, what I do during the day. I do the measurements myself, I have my own machine. I would like to know what were you told for hipers and hypos BG’s, during pregnancy? Did you manage to control the BG in normal levels during 9 months (5.5-6.0 HA1C)? Was it necessary to have this good results and before pregnancy? Did you plan your pregnancy? As I said I don’t have other health problems, I did a checking and I am fine. Have to stop to smoke, for sure. I went to a gynecologist and he told me that I don’t have problems, but I need to work on the BG and stabilaze it. I would like to know.....Is it better the gynecologist and endocrinologist to know each other, or work in the same hospital? Were they available for you anytime you needed them? Thanks!!!!

[ksa01]

I'm 11 weeks pregnant now, so I'll share my experiences to date as well as my planning process.

I talked to my endocrinologist and gynecologist about planning a pregnancy a year before we started trying to conceive. My endo recommended that my A1c be as close to 6.0 as possible if not just below 6. He did tell me, however, that he has had women with A1c in the 7's and 8's that have had normal pregnancies and healthy babies. My A1c were usually around 6.8 at this time.

I tested 8-10 times a day, kept a log (bs readings, carbs eaten, insulin taken, exercise) and worked with him to lower my A1c to the new goal of 6.0. For me, my bs before eating were good (70-100), but 2 hour after eating were too high (180-200) which were creating the higher A1c. I adjusted the amount of insuling I took with meals and worked on being below 140 withing 2 hours of eating. Once I did this, my A1c dropped and I was consistently between 5.8 and 6.2. It took about 6 months to reach this goals and then he wanted me to maintain them for at least 6 months before trying to conceive.

I want to stress that in order to maintain such tight control, it is essential to test frequently because you are more likely to experience hypo's. If you insulin amount is set correctly, you should be able to reach this goal without a lot of hypos. I use an insulin pump, which I believe is easier to adjust than injections, and rarely had hypos.

Now that I'm pregnant, things have changed. When I first found out I was pregnant my bs were running high (150-200), which is very normal. My endo gave me new goals to work towards: pre-meal 60-80, 1 hr post-meal <130, 2 hr post-meal<110. I had to adjust my insulin rates again to meet these goals. Now, my basal rate is lower (insulin that drips into me all day to maintain bs level - doesn't account for food eaten) but my boluses (insulin taken to cover food eaten) has doubled.

I check my bs 12-15 times per day, because I do have a tendency to have more hypo's (40's-50's) so I catch them early and eat so I don't go lower. I've found that if I eat a meal or snack every 2-2.5 hours I don't have any hypos (I don't take insulin for snacks of 20g carbs or less).

Once becoming pregnant, I worried much more about high bs than low bs because the highs can harm the baby. My doctors all told me not to worry about the occassional highs-there is no way to avoid them completely-it being high consistently that can cause problems. When I'm high, I take extra insulin to come back to normal and don't eat anything for about an hour when I see the numbers coming down (highest so far 286). The first trimester is also the most important to keep as tight control as possible because of all the fetal development going on.

Other than changing how I take my insulin, I still take about the same amount as I did before getting pregnant. I'm told that I will need more as the pregnancy progesses. Otherwise, life has not changes too much. I still work and do all my normal things for the most part. I have been very tired, lacking energy, and decreased exercise but this is due to the fact that I'm pregnant not diabetic. Again-very normal for all pregnant women in the first trimester. I'm told this will be better by the 2nd trimester. Honestly, dealing with morning sickness all day and night is harder than dealing with being diabetic.

Anyway, my advice would be to track your bs reading and work with your doctor to see if you can decrease you A1c more (I think 5.5 is too low of a goal) before trying to conceive if you can. Also, talk to a doctor that specializes in pregnant women with diabetes if you can to find out more about the acutal risks associated with pregnancy. Most importantly, try to stop smoking. Smoking can have more of an effect on a developing fetus than an A1c in the 7's. Don't worry about what hasn't happened yet and all the what ifs -- you can only control the here and now.

[sirius]

Thank you Karen for your reply with so much useful information! As you said step by step is the best way and to concentrate on here and now. My first step is to find doctor specialized for pregnancy and diabetes, to start to get control of the blood sugar and most important stop smoking. I would like to stay in touch with you and exchange thoughts and experiencies. Good luck with your pregnancy.

[sirius]

My conversations with my endo now are like this: talks only if I had lows or highs and then he says “well try to do this or that” or I say do you think I should increase or decrease the bolus or the basal….Answer: “well, try and see what happens and call me tomorrow”. So, when I get that kind of answers I say why should I call him?! I’ll try myself and see what happens! This is one of the reasons, why I am feeling unsecured and I have fears for my future pregnancy.
I should find some endo and at the same time specialist for pregnancy to whom I can count on. I found one and I was so disappointed. Here’s the story….
My endo recommended her to me. She is working in a state hospital and on the first meeting I waited her for 3 hours to take some directions and start with the new therapy (Prophane & Humalog) vice (Landus & Humalog). She was very arrogant and her answer for the delay was that I had to mention (which I did when I asked for her) that my endo, send me to her?!!! I said to myself ….” Maybe I am exaggerating and imagining things. She didn’t give me any telephone, but gave me a new diet and some table with BG’s results and insulin units that I should stick on according with my BG’s results. For example if it is < 60 mg/dL, 0 units insulin; 60-80 BG , 2 units insulin; 80-120, 4 insulin, 121-160, 6 u insulin, 161-200, 8 u insulin …….(My opinion is that the BG’s and the insulin work different for everyone. I am telling this because when I have 80 BG and I take 4 units insulin I will have hypo. So, this may not work and for me. This is because I don’t know my “numbers”- The first is, if I take one unit of (Humalog) insulin, how far will it lower my BGL? The second number I need to know is how many grams of carbs will one unit of humalog take care of? How its possible to find out more about this “numbers”?
....We appointed the next meeting on 21 June. I couldn’t go because I had to be on work that day and out of country for hole month (Confederations Cup Germany). So because I didn’t know her telephone I called my endo first to contact her and tell her that I want to move the date for the meeting and to give me her telephone too. He gave me a telephone from the hospital on which I had to speak with two people to find her. Just to mention that I have a mobile from my endo and he is working in a state hospital too. He told me it will be better to communicate with this woman only when she is at work. So what happens when I am pregnant, have a big BG problem and she is out of work. Who will help me? At the end when I called her she was so ruthless and the first thing she told me was….” Why did I call my endo to contact her on her telephone”. I said: “because simply I don’t have your phone. I asked her when we can rearrange a meeting. She said I can’t see you in July, call me from August.” So, that’s why I haven’t start with my new therapy yet. I am thinking to change her. Maybe a private specialist can help me? They are usually more careful, but it costs. I am concerned.

[soremom]

Sorry, I tend to abberviate alot. Ob would be the baby doctor, endo my diabetes doctor, I have trouble enough saying the full word as I do typing it, endo is less of a mouthful for me, lol.

I had a test done between 14-16 weeks to test for down syndrome or other possible problems with the baby. I was 32 at the time and felt with my age and health I wanted to know. I would rather find out in the beginning and deal with it and get the best possible care when the baby was born, then finding out after he was born that there was a problem then dealing with it. That is just me though. I believe it is called an alpha maternal fetal test or something very close to that. The first one came back abnormal, had to wait 10 days to take another. Same results, this was signifying that the baby could have spina bifida (spinal abnormatilty). We were sent to a specialist. After all the tests were done, we were told he was perfect (plus we were having another boy). The checked his heart valves, internal organs, fingers and toes, brain. We were told there was still a slight chance of a hole in his spinal column, but doubtful.

Towards the end (33 weeks), I went back to the specialist for one last examine. My amniotic fluid was very low, but in the hospital with fluids, raised it and was sent home on bed rest. Checked a week later to see if he could come out (have an amino) and the fluid was worse, put back in the hospital with fluids and had him the next day. He was born at 36 weeks, which they say is premature, but he was fine.

It is worrisome the whole time, wondering if I did the right thing, but I did that with my first and didn't have prblems with him till the end, gestational diabetes with the first.

A good doctor is crucial, I would definitely find one first so you are comfortable with the doctor. Good luck and any more questions, please ask.

Kim

[sirius]

Hi all of you,
I have some questions.........
1. What type of insulin do you or did you use during the pregnancy? I was told that Landus is not tested on pregnant women and his effects are unknown. I use Landus & Humalog now and was told to use Humalog & Prophane (NPH) if I say it correctly.
2. When you say normal level of BS what do you mean? I know that normal is from 80-120 mg/dL, lower then <80 I am feeling the effects of hypo. The hypos I had until now are from 26 to 76.
3.Kim/Karen is/was your endo for pregnancy available for you on the phone 24 hours?
4.The meetings with the endo for the pregnancy, do they depend on the condition of each pregnancy case? How often do/did you have to see your endo during the pregnancy?

[soremom]

I actually saw my endo about the same as normal. The baby doctor sent my reports from every other week visits to her. If she saw something that didn't agree, then I was in to see her.

I was on humalog because of the pump. I went on lantus after my son was born. I had problems with the pump the last month of my pregnancy, shots actually helped control me better. I don't like going over 120 if I can help it any ways, so she left me alone. I didn't have problems with lows until I went on the lantus.

My endo was available 24 hours, either her or someone covering. We have answering services you call, and they have the doctor can't back in touch with you. I never had to call during my pregnancy, but another time (can't even remember for what). They are good at getting me in quickly if I am having problems. The baby doctor is the same, call the service and they call back. I had to do this once because of migraines that wouldn't go away. They were also good about getting me in immediately if I was having problems, which I had to do a couple times. It seems that because of the diabetes they don't like to mess around. Which was nice for me.

Hope I got everything, again any more questions fire away.

Kim

[sirius]

I am trying to get rid of these stupid fears I have. The more I know, the fears will go away. I think only by talking with someone and sharing your thoughts for what you feel you are one step ahead to resolve something which you think is problem.
Actually, I have a lot of questions….. if you don’t mind. I’ll ask them one by one. What about the birth of the child? Natural way or c-section?

Only you seem to be interested to reply to my questions.
Thanks Kim for your support. You're a real friend.

[ksa01]

To answer some of your questions:

I'm on an insulin pump so I use humalog. I started using an insulin pump within 6 months of being diagnosed with type 1 so I don't really remember what it was like to use injections. I know I used humalog and NPH and didn't really have good control until I went on the pump. For me in control or normal bs readings are between 60-110 now that I'm pregnant, with the exception being 1 hour after eating where I can be as high as 130 and still be good. Prior to being pregnant, normal bs was the 80-120 range and less than 140 within 2 hours of eating. As you can see, the range is tighter during pregnancy in an effort to mimick non-diabetic women's responses to pregnancy and therefore minimize potential risks to the developing baby.
I'm telling you these goal so you know what to expect when you become pregnant, but don't try to attain the tighter goals before getting pregnant. Tighter control leads to more hypos. Pregnancy and all the hormones involved will make it fairly easy to reach the tighter goals as you blood sugar drops pretty easily.


Currently, I see my endo every three weeks. Prior to becoming pregnant, I saw him every three months. I also see the high risk pregnancy doctors every three weeks. As I progress, I will see them more often. By the third tri-mester, I'll have weekly appoinment and possible twice a week when I get close to my delivery date. In the third trimester, the monitor the baby's development very closely for problems and make sure it's not getting too big that would cause other complications for delivery. Besides the frequency of the visits, they said my care is the same as any other pregnant women's. The only test that is routine for diabetic mothers and not for non-diabetic women is a fetal echocardiogram at 20 weeks. This is because our babies can be more likely to develop heart problems.

My endo and pregnancy doctors are both with the same hospital, but they don't really work together. The send each other summaries of my visits with them, but don't really communicate otherwise. The pregnancy doctors told me they could help me adjust my insulin as needed and also make adjustment to my thyroid medicine (I have hypothryoidism too), but I prefer my endocrinologist to work with me on this. After all, these are his areas of expertise. They're ok with that.

Both my endo and pregnancy doctors are available all the time - just as Kim (soremom) described. Whenever I've called either office, either a nurse or doctor has returned my call by the end of the day. So far I've been happy with this, but I haven't really had an urgent situation occur. The high risk pregnancy doctors have emphasized that they want to be called if I have any problems, illnesses, or start experiencing many high bs readings for extended periods, etc. Hopefully, I'll never have to call them.

I'll try to answer any questions you have and hopefully ease your fears a bit. I was terrified of being pregnant with diabetes too, until I talked to others and my doctors. For me, it's reassuring that many diabetic women have had babies and I'm not the first. Most of these babies have been perfectly normal and healthy despite their mother's diabetes -- so the odds are on you side. Sometimes it's hard and frustrating, but all you can do is you best and try again the next day and next.

[ksa01]

Originally Posted by sirius

My opinion is that the BG’s and the insulin work different for everyone. I am telling this because when I have 80 BG and I take 4 units insulin I will have hypo. So, this may not work and for me. This is because I don’t know my “numbers”- The first is, if I take one unit of (Humalog) insulin, how far will it lower my BGL? The second number I need to know is how many grams of carbs will one unit of humalog take care of? How its possible to find out more about this “numbers”?

You're right-everyone is different and your insulin needs must be adjusted to best suit you. Unfortunately, I don't know how you figure out this information for non-pump users. I'm not sure if it's different but I don't want to give you wrong advice since I'm clueless about insulin via injections. I would suggest posting this question elsewhere on the forum where others are more likely to respond. In addition to finding out the answers to you questions above, you also need to know how to check to see if your long lasting insulin (Lantus) is set at the correct dosage for you.

Once you figure out this information, you should be able to experience much more stable bs readings without a lot of hypos.

On the same subject, you doctor may be able to help you figure this out or at least offer you a starting point. From your previous posts, it seems to me that you are, however, expecting too much from your doctor. The doctors can only offer you general suggestions/guidelines based on their experiences and knowledge of their fields. But ultimately, you know your body and it's reactions to food and insulin and therefore are the only one truly capable of perfecting your own care. When I see my endo, he can never tell me what will definately work to control my bs. Like you doctor, he says try making this change and see what happens. What I do then is follow his lead by making slight changes, charting my results for a few days and making more changes if necessary. The important thing is to write down results and the changes made so you can see a pattern and never make more than one change at a times. If you're not comfortable making the changes yourself, this is where your doctor can offer you guidance.

Good luck. With patience, persistence, and good record keeping you should be able to figure this out.

[soremom]

I had c-sections both times. The first I was induced and after two days, I made no progess, I didn't diatlate at all (sorry for spelling). With the second, they gave me the choice. Frankly, natural childbirth scared me. I know what to expect with a section, so I opted for that. The doctors also said there was a good chance that the same thing would happen with the first.

If your baby becomes too big, they may decide to do a section just to make it easier on you and not have the baby get stuck coming out. This is really something the doctor will have to go over with you, each one is different on how they handle this.

The doctor helped me figure out my carb ratio, which I may change depending on what I eat, but that was by trail and error like ksa said. This did change the further along in my pregnancy, you need more insulin the further along, but after giving birth it starts going back to normal very quickly. I did all my own insulin adjustments, I would go over this with the endo and she usually agreed with me. I know my body better than her and she understands this, which is so nice. I was just surprised by how much insulin I need versus what I would normally take.

Again asky away. I love talking about this, I loved being pregnant. I didn't have anyone to talk to that had gone through this and had first hand experience so I love being able to give someone advice. Just remember what worked for me may not work for you. Unfortunately it is all trial and error.

Kim

[sirius]

Can somebody tell me more about the insulin pump? As I said I use pencil to inject insulin. No insulin pumps here in Greece. Maybe I can order it or buy it.
As far as for the basal insulin (NPH) I should take during the pregnancy, I was told that has similar effects like Insulatard. Is this true? I used to take Insulatard and changed my insulin therapy with Landus, because my bs was not so good. Will I have to go back to bad bs again?
Can you tell me where can I find answer for the "numbers" here or somewhere else? If you don't have an idea I don't mind I'll try to do my own search too.
Very good! I learned so much and have to learn more. "Life is learning all the time". Don't mind that.