Since announcing that I’m pregnant again, I’ve had a number of blog-readers contact me with questions about pregnancy and diabetes. I’m happy to receive and respond to these emails and am honoured to be a go-to person for those of you looking for “someone who has been there”. At the same time, because I’m not a medical professional, I’m really not in a position to provide advice. What I can do, is tell you about my personal experiences, including what seems to work for me and what doesn’t seem to work for me. Your experience may be different, and what works for me might not be what is best for you. You need to do whatever it is that you and your team of medical professionals determine is right for you.
But, with that disclaimer out of the way, I am happy to tell you what is working for me. Here are a few of my personal strategies:
1. Moderating carbs. I would like to say “low-carbing”, but I’ve been told by my dietitian that the recommended minimum carb intake for a pregnant woman is 175g/day. I’m usually around there, but even a bit more sometimes, depending on how often I’ve had to correct lows. For the carbs that I do eat, I try to keep them low glycemic index as much as possible. Basically – avoiding those post-meal insulin spikes as much as possible. The added benefit is that less carbs means less insulin, and less of both tends to equal less volatility in bloodsugar (I’m not as likely to go high or low if I miscalculate my bolus by 2 units as I might by 8 units – if that makes sense). Hint 1: Quinoa is a great rice substitute that is low-carb and low GI and tastes good! Hint 2: Adding julienned zucchini to pasta dishes bulks them up without adding more carbs. Hint 3: Boiled or mashed potatoes have less carbs than baked or roasted.
2. Measuring carbs. I’m pretty good at eyeballing my food, but I’ve been trying to avoid doing that as much as possible while pregnant. I have a food scale with a database of nutritional information for most common food items, and I use it religiously. Without it, even my great “eyeballing” can be out by 5-10g of carbs, and that’s a pretty significant difference when I’m only bolusing for 30g of carbs at a meal. Reducing the room for error really helps.
3. Testing my bloodsugar often. I’m already fairly obsessive about testing, but in pregnancy my obsession is bordering on extreme. While I do try not to test if there’s no information value in doing so, if I have any suspicion that things aren’t where they should be, I test ASAP so I can correct. It also lets me run lower overall if I know I’ll be testing frequently and am less likely to run into a surprise bad low. Borderline obsessive testing may be a bit controversial as it’s easy to cross that line into testing when it’s not necessary or helpful, or making correction decisions too soon (which can lead to insulin-stacking or over-treating lows) – plus it’s expensive. I’m not saying I recommend this practice…I’m only saying that the frequency (and timing) with which I test is part of what is helping me tightly manage my diabetes while pregnant.
4. Wearing a Continuous Glucose Monitoring System (CGMS). And a pump, for that matter. Personally, I wouldn’t do a pregnancy without a pump, but that’s just me. I wear CGMS sensors all the time while pregnant, in spite of the high out-of-pocket cost. And yes, I still do test frequently. The sensors aren’t perfectly accurate, and there’s a time lag, so they don’t quite keep up with the level of management I’d like, but what they do allow is a safety net. I can run lower knowing that the alarm will let me know if I suddenly get too low. This is especially good at night, because I can be comfortable with pretty low levels at night (but not in hypo range), knowing that I’d be woken up if I dipped too low. It also helps catch those unexpected highs and gives me a chance to correct them before I’ve been high for too long. I still have highs from time to time, but generally when they happen I can catch them and correct them really quickly so that they’re very short-lived.
5. Logging results / finding trends / discussing with a Certified Diabetes Educator (CDE). This is the biggest pain in my ass of all of them, I think. (Not my CDE – just the process.) I have a spreadsheet I use to track basals, boluses, bloodsugars, carbs, and any additional relevant information (e.g. activity, stress, etc.). I log everything everyday. I hate it, but I do it. Then about once a week (or more often when things are changing), I take a step back and look for trends that need to be corrected. Every two weeks I discuss them with my CDE. These discussions don’t necessarily lead me to anything I couldn’t have come up with on my own, but they do keep me accountable and on track, so it’s definitely worth it. (I do have a “template” version of my logging/tracking spreadsheet that I’m happy to share. If you’re interested, feel free to email me. Again – your mileage may vary.)
On top of these five key (for me) strategies, the other significant factor for me is that I find that the pregnancy just gives me that extra kick of motivation to take everything one step further – to eat that much more carefully, test that much more frequently, correct highs that much sooner, etc. I may not be running an A1C of 5.9 when I’m no longer pregnant (let’s be honest – I probably won’t, especially while caring for a new baby and a young child), because it’s that added motivation that helps me get there.
So it’s a lot of work. A LOT. It’s not easy and I won’t for a minute pretend that it is. But it’s 110% worth it. 🙂
I’d also like to add another plug for Cheryl Alkon’s book here: Balancing Pregnancy With Pre-Existing Diabetes – Healthy Mom, Healthy Baby.