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katie85

Getting prepared to try, but lots of questions and fears...

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katie85

Hi all,

I'm 26 years old and have been diabetic for 13 years.

I have spent a few years not looking after my diabetes but decided it was time to change and recently learned about carbohydrate counting.

My husband and I are pretty well set up to start trying, and I have always known that there would be some added difficulties because of my diabetes, but I had not anticipated quite how many more complications there would be. :eek:

 

Having visited a specialist diabetes midwife to find out all about how these things work for diabetic mothers, I came away feeling happy to know more, but also quite scared about all the things that can go wrong.....:confused:

 

I know that getting my HbA1c down is the most important thing, and having read some of the threads on here, it seems that the advice I have been given about my HbA1c is different to those of you in the USA. I have been told that 7 is a good target as if I aim below that I am likely to have too many hypos. What experience has anyone else had with HbA1c's around 7 during pregnancy - did everything go ok? Healthy baby? Not too big?

I have noticed from most of the posts I have read that pumps are very popular. I do not use a pump and I wondered how those people on the normal basal bolus system using injections have managed this during pregnancy?

I'm sure I will think of more questions as time goes on, but for now, I'm starting to take 5 miligrams of folic acid a day for three months with the hope that when I have my next HbA1c test in November, I get a result of 7 (My last one was 7.7 but I had only just started carb counting) and can then start trying!

Katie

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Steal

My doctors insisted that we not start until mine was 6.5% or less. I am now 5.6% and this feels perfect for me. I have been between 5.1% and 5.6% throughout this second pregnancy. I wanted to make sure that we are using the same scale, but I think that we are. I would certainly look into using a pump as there will be so many changes that you will encounter and it will help you to keep in control of it all. If it were me, I would switch to using a pump and get used to that. It will make you carb count, understand your body's normal basal rates (rates that are true regardless of food) and your bolus rates (Carb:Insulin Ratios). It will take some time to get the hang of it, but the key is testing and testing often. This way, nothing is a mystery. Once you have it all in control, I would say go for it! The best chance of preventing any complications with Diabetes is to put your body in the best position possible for your little one. The better your A1C and stability of blood sugars, the more stable an environment that they will have. It will also make it easier to follow and track the changes that occur during pregnancy. You will have a starting point for comparison.

 

I am happy to help you if you need to chat. Feel free to look through some of my posts or responses.

 

Good luck with your journey.

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aiah23

I was on MDI during my pregnancy and with the exception of the last month myy A1C was 6.8 or lower, got the ok to try once I got it to 6.9. Last month was the hardest w/insulin resistance & I got up to a 7.1. Beware of lows early in your 1st and 2nd trimesters, that was the most annoying part for me.

 

Fawn

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katie85

Thanks for your responses...

 

aiah23 - Congratulations on the birth of your baby!

I was confused there for a moment as I'm not familiar with the phrase MDI - but it seems like you're on a similar system to me. Thanks for the advice re the hypos - since I've been carb counting for the last 3 months I have my hypo awareness back which I'm so happy about!

Without wishing to get too personal...was everything ok with the baby? Was he/she very big?

 

Steal - I appreciate your advice...however - I can't do a pump, I have a weird phobia about things sitting permanently under the skin and being attached to stuff all the time - I don't know how I'm going to cope with drips and stuff in the hospital! And the reason it's not practical for me to go much below 7 is that the DVLA here (I think it's like your DMV?) recommend that you don't drive long journeys with a sugar lower than 6 and I drive an hour in each direction to work so I think I may have to aim for about 6.8 or something similar. I understand that i need to get it down, but I would rather have it stable around 6.8-7 than lower and have lots of hypos.

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claireadams

Hi Katie,

I also live in the Uk, in London and a lot of the advice in the US seems to be different to here, but i just take in what everyone says and adapt it to suit my personal needs. My HBa1c is 6.2 at the moment, it was 6.8 a couple of months ago and on conception is was 8 i think. My consultant doesnt want me to get it down any lower because i have so so many hypos. Ive been told lots of times by lots of different hospitals that it is better to keep your blood levels stable rather than having highs and lows... so id rather have slightly higher hba1c if it meant less highs and lows. I dont have a pump.. i couldve pushed for one if i wanted one but decided against it. Now im 28 weeks and have become a lot more resistant to my insulin and i eat carbs so the last few meals ive had to split my insulin dose in 3 or 4 different injections per meal!! Just so i dont peak too high.

My consultant also told me to stop reading so much on the internet because i really have terrified myself with all the complications of having type 1 whilst pregnant..and although its good to be well informed i think its also important to not get too stressed with things that arent always in your control. The best you can do is the best you can do..then after that its out of your hands!

good luck claire

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Steal

I agree with Clairdams. There are certainly different bits of advice given out, depending on where you live. It sounds like the doctors where you are really want a stable pregnancy. That is the same message for me, but I guess the overall A1C expectation is the main difference. They are fine with 6.5, but happiest a bit lower. With mine being in the 5's, it has allowed me to skip a lot of the Diabetic Protocol this pregnancy. I still have all of the same appointments, ultrasounds and checkups, but don't have to meet with the endocrinologist and just email in my numbers every so often. It is a different relationship and one that works much better for me. The message that I have always been given was to get your A1C and overall numbers lower in the first trimester during all the crucial stages of development. It doesn't mean that you should be getting low all the time, but a lower overall average is useful. Then in the third trimester, my doctors really want to make sure that I don't have lows. I am fine with a bit higher of an A1C (Higher 5's), at this point. As I had mentioned in my previous post, I too find that splitting up boluses helps. I take insulin before, during and after I eat, if it is something with a large amount of carbs. This seems to help with post eating numbers.

 

We are all working towards the same goal and I think that for the most part, we know our bodies best. Pregnancy throws a wrench in, but we can do it!

 

I stopped reading anything about complications the week after I found out I was pregnant with my first daughter. It was too much and too stressful to think about. I just had to know that I was doing my best. I stuck to this forum and asked questions and found friends and support. Non-Diabetic pregnancy books discuss numerous other complications and my mother-in-law loved bringing these "informative" texts over during every visit. While her heart was in the right place, I just had to add them to the big pile. I never wanted to stress myself out and knew I was doing my best.

 

Continued luck!

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aiah23

my son was small all throughout the pregnancy & even now, was 5 lbs 10 oz @ birth. he spent time in the nicu & it had nothing to do w/ my diabetes...our blood types were apparently incompatable which resulted in severe jaundice & low platelet count; this will be an issue w/ any children I have b/c of me & hubby's blood types.

 

mdi=multiple daily injections.

 

Fawn

 

post-25354-139628778778_thumb.jpg

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Lizzie G
Thanks for your responses...

 

aiah23 - Congratulations on the birth of your baby!

I was confused there for a moment as I'm not familiar with the phrase MDI - but it seems like you're on a similar system to me. Thanks for the advice re the hypos - since I've been carb counting for the last 3 months I have my hypo awareness back which I'm so happy about!

Without wishing to get too personal...was everything ok with the baby? Was he/she very big?

 

Steal - I appreciate your advice...however - I can't do a pump, I have a weird phobia about things sitting permanently under the skin and being attached to stuff all the time - I don't know how I'm going to cope with drips and stuff in the hospital! And the reason it's not practical for me to go much below 7 is that the DVLA here (I think it's like your DMV?) recommend that you don't drive long journeys with a sugar lower than 6 and I drive an hour in each direction to work so I think I may have to aim for about 6.8 or something similar. I understand that i need to get it down, but I would rather have it stable around 6.8-7 than lower and have lots of hypos.

 

Katie

 

I'm also in the UK. The DVLA 'recommendation' is 5mmol. Personally, I keep my blood sugars at a stable level of between 4 and 4.7mmol/L. Im not on maternity leave but my work involves a decent amount of driving, and i'm not playing russian roulette with my safety or that of others, i just know that im in control and stable and that i dont need to 'run high' to be safe. However, even if you did insist on keeping your driving BG between 5 and 6 it is still possible to achieve way better control than you currently have and still do this. An HbA1C of 6.8% equates to an average blood sugar of 7.8mmol/L, which is too high, pregnant or not. I'm not one for quoting guidelines and following official advice, but even the NICE guidelines state that someone with type 1 should keep their HbA1C below 6.5% unless there is a serious risk of hypos.

 

I think you are under a bit of a mis-apprehension about what it means to have tighter control. From what I have seen, those with poorer control generally have less awareness in what is going on in their bodies, more dramatic fluctuations in blood sugar levels and experience far more unexpected highs AND lows than someone with excellent control. my current HbA1C is 5.3%. I achieve this by keeping my levels between 3.8 and 4.8 overnight (and checking several times), and during the day in a similar place and don't allow spikes above 7mmol/L if at all possible (and i eat what i want, when i want, its the insulin and it's timings i manipulate). My BG stays in the right place, most of the time. I know that Steph manages her diabetes in exactly the same way, has had an HbA1C of 5.1% at times through her pregnancy, and also, is perfectly in control. I dont think either of us have had a serious low ever because we both know a)how much insulin our bodies need in the background and respond as it changes, and b)know how much insulin we need for our carbs and tweak this as necessary.

 

Re the pump, it's your choice (I know there are big pump clinics in Berkshire or you can easily come next door to Buckinghamshire or Oxford), but you are missing out on the opportunity to control your diabetes in such a way that your body behaves like it doesnt have it, and it makes pregnancy a LOT easier as you can tweak rates and ratios on the almost daily basis that it becomes in the 3rd trimester. I would also say that the 'attachment' issue is nothing compared to having to take out a needle every time you fancy a snack in public; i have found my pump utterly liberating. i can keep my diabetes private, my body is safe from the complications of poorly controlled diabetes, my baby is developing perfectly, and i am in my mind a normal woman who doesnt have to worry about a chronic health condition, its under my control where it belongs.

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Lizzie G
I agree with Clairdams. There are certainly different bits of advice given out, depending on where you live. It sounds like the doctors where you are really want a stable pregnancy. That is the same message for me, but I guess the overall A1C expectation is the main difference. They are fine with 6.5, but happiest a bit lower. With mine being in the 5's, it has allowed me to skip a lot of the Diabetic Protocol this pregnancy. I still have all of the same appointments, ultrasounds and checkups, but don't have to meet with the endocrinologist and just email in my numbers every so often. It is a different relationship and one that works much better for me. The message that I have always been given was to get your A1C and overall numbers lower in the first trimester during all the crucial stages of development. It doesn't mean that you should be getting low all the time, but a lower overall average is useful. Then in the third trimester, my doctors really want to make sure that I don't have lows. I am fine with a bit higher of an A1C (Higher 5's), at this point. As I had mentioned in my previous post, I too find that splitting up boluses helps. I take insulin before, during and after I eat, if it is something with a large amount of carbs. This seems to help with post eating numbers.

 

We are all working towards the same goal and I think that for the most part, we know our bodies best. Pregnancy throws a wrench in, but we can do it!

 

I stopped reading anything about complications the week after I found out I was pregnant with my first daughter. It was too much and too stressful to think about. I just had to know that I was doing my best. I stuck to this forum and asked questions and found friends and support. Non-Diabetic pregnancy books discuss numerous other complications and my mother-in-law loved bringing these "informative" texts over during every visit. While her heart was in the right place, I just had to add them to the big pile. I never wanted to stress myself out and knew I was doing my best.

 

Continued luck!

 

just saw this steph. yes, im the same, i occasionally see the diabetic doctor to say 'hi' and talk about the weather but i have avoided a lot of the over-the-top appointments programme throughout pregnancy: have been seeing the midwife/obstetrician every month and now it will be every week, like any woman weeks from due date.

 

the closer you get to non diabetic (ie HbA1C less than 6%) the better job you are doing of eliminating the risks of complications. personally, i dont give a **** what the doctors recommend (they are generally happy with anything less than 6.5% in the UK as people have such shockingly bad control in general and think its miraculous to even get in the sixes), i set my own standards and in order to have a baby without the complications of diabetes, and a mummy without the complications too, i keep my control where i feel it is safest and risk free in the long AND short term.

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Steal
Katie

 

I'm also in the UK. The DVLA 'recommendation' is 5mmol. Personally, I keep my blood sugars at a stable level of between 4 and 4.7mmol/L. Im not on maternity leave but my work involves a decent amount of driving, and i'm not playing russian roulette with my safety or that of others, i just know that im in control and stable and that i dont need to 'run high' to be safe. However, even if you did insist on keeping your driving BG between 5 and 6 it is still possible to achieve way better control than you currently have and still do this. An HbA1C of 6.8% equates to an average blood sugar of 7.8mmol/L, which is too high, pregnant or not. I'm not one for quoting guidelines and following official advice, but even the NICE guidelines state that someone with type 1 should keep their HbA1C below 6.5% unless there is a serious risk of hypos.

 

I think you are under a bit of a mis-apprehension about what it means to have tighter control. From what I have seen, those with poorer control generally have less awareness in what is going on in their bodies, more dramatic fluctuations in blood sugar levels and experience far more unexpected highs AND lows than someone with excellent control. my current HbA1C is 5.3%. I achieve this by keeping my levels between 3.8 and 4.8 overnight (and checking several times), and during the day in a similar place and don't allow spikes above 7mmol/L if at all possible (and i eat what i want, when i want, its the insulin and it's timings i manipulate). My BG stays in the right place, most of the time. I know that Steph manages her diabetes in exactly the same way, has had an HbA1C of 5.1% at times through her pregnancy, and also, is perfectly in control. I dont think either of us have had a serious low ever because we both know a)how much insulin our bodies need in the background and respond as it changes, and b)know how much insulin we need for our carbs and tweak this as necessary.

 

Re the pump, it's your choice (I know there are big pump clinics in Berkshire or you can easily come next door to Buckinghamshire or Oxford), but you are missing out on the opportunity to control your diabetes in such a way that your body behaves like it doesnt have it, and it makes pregnancy a LOT easier as you can tweak rates and ratios on the almost daily basis that it becomes in the 3rd trimester. I would also say that the 'attachment' issue is nothing compared to having to take out a needle every time you fancy a snack in public; i have found my pump utterly liberating. i can keep my diabetes private, my body is safe from the complications of poorly controlled diabetes, my baby is developing perfectly, and i am in my mind a normal woman who doesnt have to worry about a chronic health condition, its under my control where it belongs.

 

I agree with Lizzie. While the pump is a personal decision, it makes control during pregnancy so, so much easier. My sister has not gotten herself on the pump and we have had Type I for the same number of years. She never wanted anything attached to her. She has managed with the insulin pen to keep her A1C to 6.3% and has always been super diligent. She is amazing, but has recently spoken with me and doctors about possibly switching to the pump. While she hates the idea of something being attached to her, she knows that this is a way that she can more easily regulate changes in her body during pregnancy. It really happens so often and slight changes are tough to do without something that helps you mechanically. It really makes all the difference. My sister HATES the idea of being tied to something, but just got married and wants to explore the possibility if it is something that will help during pregnancy.

 

It is certainly possible without, but I would highly recommend it, if it is something that you can work through. I thought it would be difficult, but as soon as I got it, I was used to it.

 

Also, as far as hypos go, I am in very stable control. Most of the time my blood sugars are in the 70s and 80s and this feels perfect. If you are on top of your testing and understanding your body and how you react, you will catch these moments before they happen.

 

Good luck with your decisions.

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katie85

Thanks all...

I'm not planning to try just yet - I'm still working on the HbA1c, however, I think I'm going to concentrate on getting it stable around the 6-7 mark rather than lower. Lizzie, I don't think I'm under any mis-apprehension, i just know that the ratio I currently use seems to be working fine for me, and when I have planned exercise I know what to do etc. I just find that if i sit around the 4-5 mark, if I even walk to the car park and back, or if anything minute happens that effects my emotions, that can make me drop off the edge into a hypo. Things may change over the next couple of months once my body gets used to me carb counting etc and I get used to calculating what I'm eating (the way i was for the last couple of years was atrocious and I think my body is still getting used to having something like a normal range again, being more stable rather than really high-really low).

I actually already go to the hospital in Buckinghamshire, as they were the only place that did the carb-counting course I wanted, and I had moved from Aylesbury so I was already on the waiting list. I will be moving over to Berkshire soon as I want to be able to get to my appointments more easily and because I know I'm going to live here for quite a while now. (Previously I have moved around a lot and not had consistant doctors/clinics which is possibly why I stopped caring for myself properly)

I am due to get the Aviva Expert meter in a few weeks. This apparently uses the same sort of intelligence and safety measures as an insulin pump in terms of not allowing you to overlap too much insulin and keeping track of your averages and logging activities or events but you still do your own injections I'm hopeful that this will help me to iron out the slight fluctuations I have now by helping me to identify what causes them.

Katie

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katie85

I also wanted to ask - have you all found that with having so many checks throughout pregnancy that it has been impossible to keep the sex of the baby a surprise? I wanted to try and keep it a surprise if possible as I figured that everything is so closely monitored there won't be much that's a surprise - especially if you end up planning the delivery! But from poking around in these forums it seems that everyone knows what they're going to have. Not sure if that's choice or necessity!

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Steal

It is impossible to know what you are looking at during those appointments. If you want a surprise, just tell the technician and they won't say anything, they will just check that all the parts are there.

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Jenny250

Hi everyone!

 

I am 25yrs old and diabetic type 1. I have been with husband for 10years, married for 1 :)

 

I want to get pregnant so badly but know that i have to get my Hba1c down first. It is currently 8.4.

My consultant obviously says this is too high and i should be down at 7 at least.

 

I am trying so hard but cant seem to regulate my blood sugars. I went to see him today and came out feeling completely deflated :( I write down every reading i get and take my blood at least 6times per day! I am so fed up guys.

 

Has anyone been in this situation?? Any tips on what to do? x

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aiah23
Hi everyone!

 

I am 25yrs old and diabetic type 1. I have been with husband for 10years, married for 1 :)

 

I want to get pregnant so badly but know that i have to get my Hba1c down first. It is currently 8.4.

My consultant obviously says this is too high and i should be down at 7 at least.

 

I am trying so hard but cant seem to regulate my blood sugars. I went to see him today and came out feeling completely deflated :( I write down every reading i get and take my blood at least 6times per day! I am so fed up guys.

 

Has anyone been in this situation?? Any tips on what to do? x

 

Get Using Insulin by John Walsh or Thinking Like a Pancreas (Gary Scheiner). These books will help you identify/trouble-shoot your problem times, etc. When pregnant, you'll be testing a minimum of 10X/day so I recommend testing around that number now. Why do you feel deflated? When are you having highs? What are your eating habits like and exercise? What about some of the basics like folic acid/vitamins/etc?

 

Fawn

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Steal
Hi everyone!

 

I am 25yrs old and diabetic type 1. I have been with husband for 10years, married for 1 :)

 

I want to get pregnant so badly but know that i have to get my Hba1c down first. It is currently 8.4.

My consultant obviously says this is too high and i should be down at 7 at least.

 

I am trying so hard but cant seem to regulate my blood sugars. I went to see him today and came out feeling completely deflated :( I write down every reading i get and take my blood at least 6times per day! I am so fed up guys.

 

Has anyone been in this situation?? Any tips on what to do? x

 

I needed to test around 15 times per day and that included a lot post meals and in the nights. Those are the numbers that we can't see and they really influence your overall control numbers. My doctor always said to wait until I am 6.5% and I was there at conception and then stayed very strict after that and it kept going down to 5.1% at one point! I am currently 5.5% and that felt perfect. Are you using a pump? That helped me more than anything else and with all the changes pregnancy brings, it really is a help. I lowered my carbs during pregnancy to help with overall insulin and regulation. I also lost weight and this helped me lower my numbers overall, too. We are here if you need more help. It will help your ability to get pregnant and have a healthy pregnancy if you can get yourself in as great a range as possible. I always thought these numbers were impossible, but when I tested often and gave insulin as needed and really tested and tested, it happened. You can do it.

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Jenny250

Thankyou for your reply Fawn.

 

I have been taking folic acid for a month or so now. I eat very well, no 'fatty' foods plenty of fruit and vegetables. I exercise a lot, im a keen walker. Climbing a mountain next weekend!! :)

I feel deflated because im getting no encouragement, they just tell me what im doing wrong which makes me upset.

 

i will definitly look for them books, thanks

 

Jenny

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Jenny250

Steph, this is exactly the encouragement i need! thankyou ever so much.

I have been on the pump for 2years now, its great and has helped alot. It seems i need to check my bloods even more and definitly through the night because thats when i think i might be going high, and as you say we cant see these numbers. My bloods are nearly always below 9 or 10 so they arn't 'that bad' i just need the consistency.

just reading yours and Fawns messages has given me a boost.

 

Thanks guys im glad i came on here :)

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Hannah.sniderm

Jenny, don't be deflated! I got my Hba1c to 7.4 from 9.0 in just 3 months!! Purely from the motivation of getting ready to conceive :).

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