Having had a healthy baby and pregnancy while managing type 1 diabetes is one of my greatest sources of personal satisfaction. This exercise of discipline and determination has provided me a sense of confidence that I can handle many of life's other challenges.
That being said, I recently became extremely humbled by learning of the diabetic pregnancies of another type 1 diabetic.
The woman who trained me on both my insulin pump and continuous glucose monitor has had type 1 diabetes for over 40 years. Her three kids are at least my age (which will be 30 next January!), which means her pregnancies all took place before fast-acting analog insulin, home glucose monitoring, not to mention insulin pump and CGMS technologies!
I was floored when I heard that she managed her diabetes during pregnancy by maintaining a diet of 1,000 calories per day and only grazing on food rather than eating full meals. She delivered injections of old Regular and NPH insulin and stuck to a meal plan that kept her blood sugars under control.
All of this information came out as we were discussing Sienna's birth weight, which was 8 pounds, 5 ounces. Diabetic women tend to have larger babies due to elevated blood glucose levels. Her three kids each weighed between 7 and 8 ½ pounds, although her pregnancy was managed without any of the modern technology and education we have today.
A few thoughts occurred to me as I reflected on what it must have been like to be pregnant with type 1 diabetes thirty or more years ago.
First of all, women must have felt scared and concerned about the health of their growing baby. Hopefully one would have a supportive doctor, since diabetic women were not typically encouraged to have children. They wouldn't have their blood sugar information available on a regular basis as we do today, and must have relied on routine A1c test to evaluate their blood glucose control. Certified Diabetes Educators were rare, thus most women with diabetes during pregnancy probably didn't have access to one.
In some ways, the experience of a diabetic pregnancy thirty years ago must have been simpler. Insulin delivery was straightforward and meals were repetitive. Mothers-to-be weren't testing their blood sugar 15 plus times per day or changing infusion sites and CGMS sensors. The paraphernalia was much less. Without the constant feedback of blood sugar results, pregnant women couldn't beat themselves up over each out-of-range number.
You know the expression, "Knowledge is power." It's true, particularly when it comes to managing a diabetic pregnancy. Without the knowledge of your blood sugar level, diabetics before home glucose monitoring weren't empowered to the same degree that modern women are. Today, we can continuously monitor our blood glucose, which means that we take the responsibility and power to control it.
Thus, managing a diabetes pregnancy is both more complicated and easier than it was thirty years ago. We now have the technology and thus the responsibility to make educated decisions on a minute-by-minute basis.
I am in awe of the women who navigated this treacherous journey before they had all the tools to do it.
Published On: October 13, 2009