Pregnancy Tracker: 17 weeks
Size of the Baby: The size of a large avocado!
Biggest Obstacle: Making my insulin last until my new vials arrive tomorrow!
For a woman with preexisting diabetes, pregnancy requires a lot of planning. To have the healthiest and most joyful experience, special steps should be taken to get your diabetes in excellent control, and prepare yourself for the stresses of a diabetic pregnancy. Each woman will go through a personal process of preparation for pregnancy -- this was my journey:
For at least 18 months, I thought of myself as being in the process of "preparing my body for baby," and that's exactly how I described it! My first phase began in the summer of 2005. I knew I needed to step up my diabetes care, so I began seeing my very first endocrinologist and had an A1c drawn for the first time in over a year! My result came back at 7.3. Not great, but not as terrible as I had feared. Nonetheless, I had some work to do.
Through a lot of logging and more intensive diabetes management, I lowered my blood sugars pretty substantially, so that my next A1c reading, three months later, was down to 6.4.
While paying much closer attention to my blood sugars, I also began taking folic acid over a year prior to conceiving. All pregnant women require higher doses of folic acid, but it is a particularly important vitamin for diabetics.
Also, I continued to work out and watch my caloric intake during these months. I figured that I wanted to be in good shape physically before conceiving, and also maybe lose a few pounds, so that I could maintain a healthy weight throughout my pregnancy.
Other aspects of a woman's health that might be overlooked while she's preparing for pregnancy include a dilated eye exam and routine dental care, both of which are critical for diabetic women.
Although I achieved an A1c result under 6.5 (many doctors' threshold for conceiving) for several months, I was doing so with injections of Humalog and Lantus. Numerous injections, including correction doses, were required each day, and I split my Lantus dose into a morning and bedtime injection. In effect, I was mimicking the work of an insulin pump with my shots! While I had proven to myself that tight control was possible without the pump, many of my fears of the pump had subsided. I decided to give the pump a shot (pun intended).
On September 22, 2006, I began using an insulin pump. I chose the Deltec Cozmo, in part because it comes with a 300-unit reservoir, which I knew I would utilize during my pregnancy (insulin requirements can triple by the end of the third trimester!)
Insulin pumping was the missing key to my diabetes management. Now I could cater my basal rates and boluses to different times of day and particular situations. I simply love pumping now, and cannot imagine doing all the work of a diabetic pregnancy without one. That being said, it is possible to achieve excellent control with injections, it is just a whole lot more work!
Once I had over a year of sub-6.5 A1c results under my belt, while taking my folic acid faithfully and maintaining a healthy diet and exercise plan, I was ready to contact the specialists at the Diabetes and Pregnancy Group at UCSD. In mid-January, my husband I met with the CDE and OB for a "preconception consultation." At this meeting we discussed how their program worked, my health, and what to expect out of a diabetic pregnancy. Everyone was incredibly supportive and encouraging.
I left that appointment with log sheets, which were used to track all of my blood sugar readings, insulin doses, food intake, and exercise. Beginning in January, before we even began trying to conceive, I logged daily and faxed them to the CDE on a weekly basis.
There are varying opinions regarding the stoppage of birth control pills and conception. My doctor advised that we not try to get pregnant the first month after quitting birth control. At the beginning of February, I stopped taking birth control pills and Altace, the ACE inhibitor I had been taking for my kidneys. In addition, instead of taking my regular multivitamin, I began a daily prenatal vitamin which had the doses of folic acid, iron and calcium that my doctor recommended. Interestingly, before trying to get pregnant, I was taking four pills a day, as opposed to just one little prenatal vitamin once we were preparing for pregnancy! I really enjoyed the process of simplifying my healthcare.
Birth control takers beware! I was not prepared for the sudden onslaught of premenstrual symptoms that hit after I stopped taking the pill. Headaches, cramps, and generally feeling terrible hit me like a truck, after all those blissful years of no symptoms. However, just think of it as practice for the first trimester of pregnancy, which feels pretty much the same!
During the conception process, I continued to log my blood sugars, food and insulin doses and send weekly faxes to my CDE. Then, I called for an appointment with the doctor once I had a positive pregnancy test!
To read more of Kelsey's experiences with her first pregnancy, check here.
Also: more on diabetic dental care here.
Published On: July 31, 2007