Monday, October 29, 2012

Diabetes and Pregnancy

So back when I was first diagnosed with diabetes one of the most difficult things for me to hear the doctors say was that I couldn't have any more children for an extended period of time (several many years) because of the difficulty women have managing diabetes and pregnancy.  As HB and I had previously been hoping to begin trying for baby #2 around that time, the doctors took their time to explain the complicating factors my new disease has on the creation of fragile little embryos and maintenance of a healthy fetus. The white coats used big, scary medical terminology to indicate that abnormal blood sugars cause significant birth defects, that babies of diabetics are HUGE, that I'd likely wind up more sick because of the strenuous nature of pregnancy on my already damaged body and that there was no way a freshly diagnosed diabetic could understand the nuances of either the disease or the combo of the disease & pregnancy without several many years of diabetes management under the belt.

I remember feeling emotionally crushed.  I had been so looking forward to the feeling of a baby in the womb again, to holding another sweet little angel in my arms and to adding to the completeness my life newly feels because of my kid(s).  Having spent so much of my life prior to GW searching for a true form of self-expression and the key to my passion, I whole heartedly embraced the gift he gave me by honoring me in being my son... nothing replaces or ever could replace what he - and my future children - give me by simply being who they are.  So when the doctors pushed the "stop" button and placed my entire dream of a large family on hold, it hurt and I resented the failure of my pancreas all the more.

But now that the two year anniversary of my diagnosis (1/24/2011) is within counting distance and that I am close to finishing a difficult, but successful pregnancy with diabetes I understand what the doctors were saying back then.  Managing a pregnancy with pre-existing diabetes is tough and not something to be entered into lightly without serious preparation or comprehensive disease understanding.  I mean the consequences of diabetes alone on the health of a diabetic are serious enough, but adding the responsibility for another person - especially a little person - to the mix has a lifetime's worth of impact... indulge me with a quick explain:

With diabetes, by itself, there is a basic level of disease maintenance that is necessary to be considered healthy.  In the medical community, unfortunately, that is measured by the "low" bar of a HgA1C of 7% - which although it is better than the average diabetic (8% or higher) it is still considerably higher than a normal, non-diabetic's A1C (between 4% - 6%).  Whether on multiple daily injections of insulin or on an insulin pump, a diabetic must actively work to maintain some degree of glucose control to be a functioning person with limited knock on issues (such as blindness, amputation, heart disease, stroke - you get the point).  And - to speak generically on behalf of insulin dependent diabetics - that control can be extremely tough in even the most basic situation.

But when you throw pregnancy in on top of that (in all fairness, probably any other medical complication), diabetes gets more complicated and that's not a good thing.  Unexplainable changes, sharp spikes and dips in bg readings and larger than me implications for the baby make the juggling act of insulin, carbs and hormones all the more sensitive and important.  If I didn't know how to handle low blood sugars, how to prevent DKA, how to calculate a bolus or understand what a bolus rate is, I wouldn't know how to do what the fetus NEEDS me to do to keep it safe.  And since the placenta is constantly throwing in changing variables it's frustrating enough to be fine tuning my insulin needs without the overwhelming feeling that inevitably would result if I didn't "get it."  Especially since my bgs drop overnight (I've been in the 40s and 50s the last couple times I've checked at 3 AM), I need to literally know what to do with my eyes closed and in my sleep because the reality is that is life with diabetes and there is no down time!

Long story short, I was fortunate that my doctors had enough confidence in my self-care to grant me the "go-ahead" on this pregnancy as soon as they did.  But in retrospect I must admit that those doctors at Georgetown University Hospital had a point when they said that it isn't wise to mix the two until really ready.  I mean, I wouldn't forgive myself if something happened to my baby because I failed to take care of my disease or didn't understand it enough to be a good mother before birth.

Even now, at eight and a half months, diabetes and pregnancy is a scary mixture to me, but I'm grateful that there are materials available that helped prepare me for what my body would going through.  For those of you who are diabetic and thinking about becoming pregnant, or if you know and love someone who is, these are some great paperback (I like what I can hold rather than surf) resources worth checking out:

- Balancing Pregnancy with Pre-Existing Diabetes: Healthy Mom, Healthy Baby by Cheryl Alkon (click here) ** Most helpful to me **

- Diabetes and Pregnancy: A Guide to a Healthy Pregnancy for Women with Type 1, Type 2 or Gestational Diabetes by David A. Sacks, MD (click here)

- Diabetes Pregnancy: What to Expect by the American Diabetes Association (click here)


  1. Hi--just found your blog and your link to my book. Thanks! So glad you found it helpful, and good luck with everything!

    All best,
    Cheryl Alkon

    1. Thanks for the message, Cheryl! You've made my day. Your book has been amazingly helpful -- you did an great job with it and, even with how difficult this pregnancy has been, I feel I've managed my diabetes better because of it. Thank you for writing it.