When I read Gina's post regarding planning for a diabetic pregnancy, it was a trip down memory lane for me. Very timely as well, since I'm starting to think about my next pregnancy Obviously, having already traversed the challenges of a pregnancy complicated by type 1 diabetes, I'm feeling confident that I can do it again.
There were several practices that I had to master during my preconception and pregnancy phases, which I believed helped me to keep my blood sugars stable and my A1C below 6%.
First of all, restricting my carbohydrate intake was key, especially during the morning hours. We all have dawn phenomenon going on to one degree or another, and pregnancy hormones make the morning insulin resistance worse. Thus, restricting my carbohydrates to 15 grams at both breakfast and my morning snack helped tremendously. Also, during my pregnancy, I discovered how much better I felt when I ate eggs for breakfast, rather than cereal or other high-carb foods. Not only did my blood sugar not spike from the refined grains in cereal, but I felt full and satisfied for much longer. Eating eggs every morning is a habit I've continued since Sienna was born and it's helped me maintain a lower weight too!
The pregnant or soon-to-be pregnant diabetic's best friend is their glucose meter. Testing often, 15 or more times per day, is the best way to catch highs and lows before they become problematic. In order to achieve a low A1c, you have to eliminate the swinging sugars. By knowing your blood sugar level consistently (either via multiple tests or a CGMS) you can head-off problems and keep your blood sugar from straying too far off course.
Once you know your current blood sugar, you must use that information to help make good decisions going forward. For me, that meant that if my blood sugar was high (above 90 mg/dl) before a meal, I'd bolus for my meal and test my blood sugar until it was at 90 mg/dl, then I could eat. When our blood sugar is high and we start our meal, the insulin doesn't have time to effect the blood sugar before the carbs start raising it again. Waiting to eat until my blood sugar was at that target number is probably the single best tip for achieving a lower A1c. For that matter, bolusing several minutes before eating is a great way to minimize postprandial spikes. Unfortunately, our synthetic insulin options simply don't work fast enough when they're delivered just before consuming carbohydrates. During the early months of pregnancy, I'd bolus 30 minutes before eating. By the end of my pregnancy, I would often bolus 60 minutes before eating, even when my blood sugar was already close to target, because those pregnancy hormones made my body so resistant to insulin.
My lowest A1c during pregnancy was 5%. It was weird to think that my blood sugar control was almost better than non-diabetics! But, I think that bolusing early was a big part of that success. For non-diabetics, their blood sugar rises slightly after eating, before the insulin brings their blood sugar back to normal. By bolusing early, I could largely avoid those postprandial spikes and thus maintain pretty stable blood sugar.