It’s official! Baby #2 is on the way, and I am ready to tackle pregnancy with type 1 diabetes for the second time (or as ready as I will ever be). Our new baby girl is set to arrive this summer, and we are so excited to meet her. Until then, I will be micro-managing my blood sugars, attending plenty of doctors’ appointments, and chasing my toddler around from sunrise to sunset.
I’ve got to be honest— I actually wasn’t sure that I would write about this pregnancy on my blog. These past few months have felt so much busier than my first T1D pregnancy experience (i.e., having a toddler already), and it’s been difficult for me to find time to take notes, reflect, and digest this experience to the same extent that I did the first. That made me feel a bit guilty, so I chose to put it off until I felt more called to write. Thankfully, I’ve found my groove a bit and have found some energy to finally start to write at 23 weeks pregnant.
However, as the title suggests, this post will be all about the first trimester of my second pregnancy with type 1 diabetes. I’ll, of course, touch on my A1C at conception, how my diabetes management has changed this time around, and how the heck I survived the first trimester with a toddler (who knows).
How I Prepared For My Second Pregnancy With Type 1 Diabetes
In a nutshell… I didn’t. If you read my first trimester recap from my first pregnancy, you probably know that I prepared a bit more to conceive my first baby. I found my high-risk doctor, lowered my A1C, and began taking prenatals. I guess my reason for lack of prep this time around was mainly due to the fact that I still had all of my ducks in a row from my first pregnancy; I didn’t feel the need to change a whole lot when starting over this time. I never stopped taking my prenatal vitamins from my first pregnancy. I already had my care team figured out, and overall, I felt like I knew what to expect. My A1C was my main concern going into it, which ended up being the same number (6.2%) that I had when I got pregnant my first time. My doctor prefers my A1C under 6 during pregnancy, but wasn’t overly concerned with the .2%.
First Trimester Recap
Although I knew what to expect from navigating pregnancy with type 1 diabetes once already, the first trimester really does come at you fast. Before I knew it, I was back in the trenches of keeping my blood sugar within the range of 65mg/dL-140mg/dL, and feeling the extreme guilt that comes with seeing a number even slightly out of that range. Not only is the first trimester rough for the myriad of normal pregnancy symptoms it throws your way, but adding in even tighter diabetes control and the addition of taking care of a toddler full-time, it begins to feel like a whole other level.
First Symptoms, Differences, & More
I had one day of feeling extremely tired back in November, which was my signal to take a pregnancy test (I was also actively tracking my ovulation and expecting that we would know within a day or two). My first symptoms also included an increased sense of smell, slight random nausea, and slight cramping. The day before I had my positive pregnancy test, I had constant low blood sugars throughout the day — almost as if my basal rates were too high for one day. The day that I found out I was pregnant, I had sticky high blood sugars that would rise instantly and take so much insulin and time to bring them down (as if insulin resistance was starting immediately this time around). I also ended up having ketones in my urine later on that evening from the stubborn highs.
One thing they tell you about your second pregnancy is that you start to show earlier than you did your first. Not only can I attest to that statement, but I’ve also found that my insulin resistance also started much earlier in this pregnancy than in my previous one. I started seeing my first wave of insulin resistance/insulin needs changing around 7 weeks this time around, before tapering off for the next few weeks until I was out of my first trimester.
This pregnancy has also come with a bit more nausea, weight gain, and tailbone pain in this trimester than it did last time. By week 9, I had ditched my pre-pregnancy pants and was starting to show. Although I had a bit more nausea this time around (anytime I was hungry or had low blood sugar), I still managed to gain about 15lbs in the first 12 weeks of pregnancy, which is pretty similar to my first trimester last time.
How I’ve Been Managing My Diabetes This Pregnancy
My diabetes management this pregnancy has been all over the place, that’s for sure! Honestly, it’s been hard to prioritize my diabetes while also chasing a toddler around all day. There are moments when I don’t have the option to wait until my blood sugar is perfect before eating, or risk going low while I am driving both of us in the car. It’s led me to feel a significant amount of guilt surrounding my diabetes management during this pregnancy, especially when comparing my management with my last.
One thing I’ve prioritized doing this pregnancy is being overcommunicative with my diabetes counselor (my high-risk MFM who is overseeing my diabetes management during my pregnancy instead of my regular endocrinologist). I email her every Monday to review my recent Dexcom report and discuss any areas of adjustment that she recommends. This has helped me stay on top of any changes that I need to make to my basal, bolus, or carb ratio settings, which would be significantly overlooked if I were trying to juggle my T1D alone during this time.
During my last pregnancy, I obsessed over my diabetes management. I strived to achieve over 85% time in range every week on my clarity reports and tried to fine-tune everything for the health of my baby. It’s been hard to try to have the same expectation for this one while already being a mom with her hands full. My management this time around has consistently veered closer to the 70-75% time in range, and although that’s still the overall goal and what my doctor is looking for, it’s hard not to compare my data to my previous pregnancy.
How I Tackle Pregnancy Insulin Resistance
I spoke about a few focus points in my pregnancy diabetes management in my last first-trimester blog post, and those items have been essential for the management of insulin resistance this time around as well. The first being the prioritization of a “pre-bolus”. When I say pre-bolus, I’m referring to the act of allowing my insulin to start working in my body before starting to eat. This timeframe is anywhere from 15 to 25 minutes, depending on how insulin-sensitive my body has been recently. By timing my dose so that my food starts raising my blood sugar at the same time my insulin starts lowering it down, I hopefully achieve my goal of maintaining a more stable glucose graph, which is important throughout my pregnancy.
The second focus point that has helped me balance blood sugar is incorporating additional protein into my diet. My diabetes counselor suggested I eat 7g of protein for every 15g of carbohydrates to reduce spikes in blood sugar, and it has helped my overall control more than I thought it would. This looks like pairing a protein like peanut butter with a banana, a cheese stick with some grapes, or hummus with carrots.
There will always be frustrating parts of managing this chronic illness during pregnancy, especially when we are warned of all these bad things that can happen if we don’t take care of ourselves. It’s important that anytime I start to feel guilty for a bad day of blood sugars, I try to remind myself that I am doing the best I can for my baby with a time in range that my doctor is happy with.
I ended my first trimester with an updated A1C of 5.6% (I was tracking at 5.4% this time last pregnancy), which was a nice reminder that although this time around felt harder to control in a lot of ways, I still ended up with pretty similar management and blood sugar outcome as I did with my first.
Stay tuned for more updates about this pregnancy coming soon! In the meantime, follow along on Instagram.
