Type 1 Diabetes and the Pregnant Mama: A Lesson From A Pregnant Perinatal RN0
I’m putting on my nurses hat and letting you all into my life as a pregnant type 1 diabetic. Any pregnancy can be tough but adding on a chronic disease just makes things even more interesting!
Lucky for us diabetic mamas, things have changed enormously over the last few decades. Generations ago we had a lot worse outcomes in pregnancy and some diabetics were told to not even try to have babies. Thank you Frederick Banting for the invention of insulin and kudos to modern technology for all the advantages it has given us diabetic mamas!
Being a pregnant type 1 diabetic automatically puts me into the high risk category of pregnancy. I’m more at risk of having complications which means I get to have a very detailed pregnancy, over seen by my very lovely obstetrician. All type 1 diabetics are encouraged to have a planned out pregnancy with high doses of folic acid taken pre conception. Our babies need to be planned out carefully under the guidance of our health care team and with a track record of excellent blood sugars.
As a perinatal RN, I am extremely aware of the consequences that having uncontrolled blood sugars can have on pregnancy. In fact, I’ve professionally seen the terrible outcomes that we all tremble at. What a unique situation I have, being a pregnant diabetic who is also a maternity nurse.
Since my pancreas is now hanging out ‘just for show’ and doesn’t secrete a drop of insulin, I’ve basically become a walking chemistry set. My job in pregnancy is to constantly control my blood sugars through diet, insulin injections and exercise.When you throw a growing fetus and placenta into the mix you’ve got a whole new level of dynamics on your hands!
You see, pregnancy hormones throw your blood sugars for a loop. The ‘on top of it’ diabetic knows this and realizes the need to increase insulin doses and increase blood sugar checks. That growing placenta challenges insulin needs and as the pregnancy progresses, you may even quadruple your insulin doses.
Pre-pregnancy I was taking two doses of long acting insulin each day. About 20 units in the morning and another 15 units at bedtime. Currently I’m 20 weeks pregnant and I take 35 units in the morning and 25 units at bedtime. Along with the boluses of fast acting insulin when I eat. As my baby grows, my insulin doses will just keep on going up!
The hardship of uncontrolled blood sugars is that they are toxic to your growing fetus. Having excess sugars soaring through your blood system is no different than having alcohol or drugs passing through to your baby. I’m saddened when I hear about poorly controlled type 1 diabetics who have had unfortunate pregnancy outcomes. Insulin dependant diabetes and pregnancy is totally doable, it just takes a bit of planning and effort.
My endocrinologist loves me as a patient so much that she gives me free rein over how I monitor my blood sugars and dose my insulin. I am my own speciality RN and my doctor knows it. I make up my own insulin doses which steadily increase through out the pregnancy as the placenta grows and grows. I test my blood sugar a ridiculous amount of times each and every day with out complaints. I poke myself with needles up to a dozen times a day while pregnant and it becomes just part of my day.
My plan of care for this pregnancy:
I’m 20 weeks pregnant right now and I’ll be having a baby in about 18 weeks at the latest. Diabetic placentas tends to age faster than a non diabetic and we are usually induced by around 38 weeks, this helps prevent stillbirth.
I have had my ‘special’ detailed ultrasound with a perinatologist standing by to check that my baby’s heart has developed properly (poor blood sugar control wrecks havoc on all of baby’s developing systems). Starting at 32 weeks I’ll be having twice weekly non stress tests at the hospital to check on the baby. At the same time I’ll also be having ultrasounds every 2 weeks to check on my fluid levels and growth.
All in all, I will go with the flow and I fully intend on enjoying each moment of this pregnancy and also having the best birth experience possible! I will keep on poking my fingers and testing my blood sugar around the clock. I will keep on titrating my insulin needs to keep this pregnancy healthy.