This guest post is written by Kelley Ward, PhD., RN,C.

You were probably diagnosed with type 1 diabetes years ago. By now, you know how to manage your blood sugar, count your carbohydrates, and take care of your eyes and kidneys. If you are confident that you can control your diabetes and you are thinking about starting a family there are some things you should know about managing the condition during pregnancy and some things you should think about before you get pregnant.
Managing a pregnancy complicated by type 1 diabetes is a lot easier today than it was just a few years ago. Just 10 years ago, the medical community warned many women with type 1 diabetes not to get pregnant because of the risks to the mother and baby. Thankfully, today we know more about how to manage diabetes during pregnancy so women with type 1 diabetes can have healthy pregnancies and deliver healthy babies. Here are tips on how to manage type 1 diabetes during pregnancy.

1. Maintain a normal A1C. Before you get pregnant, it is very important that you get your A1C below 6.0 percent. This is because blood sugar control is extremely important in the first weeks of your baby’s life—especially in the weeks right after you get pregnant, when the cells divide and organs begin to form. High blood sugars during this time could i cause problems for your baby’s normal growth and development.

2. Prenatal vitamins. Women with type 1 diabetes have a higher risk of having babies with serious conditions called neural tube defects. These conditions can cause problems like spina bifida or other problems with your baby’s brain and spine. Your risk can be higher if your blood sugars were too high before you got pregnant and before your baby was completely formed. This is why it is important that women with type 1 diabetes take a good quality prenatal vitamin with 400 mcg of folic acid. In addition, vitamin D deficiency has also been identified in many women with type 1 diabetes. Your endocrinologist may want to test your vitamin D levels prior to pregnancy. If your vitamin D levels are tested and the results are low, you may need to take vitamin D supplements until your levels reach the normal range before you become pregnant.

3. Blood sugar highs and lows. Understand that during the first twelve weeks of your pregnancy you will experience blood sugar ups and downs as you have never experienced before. You can thank your changing hormones for it—and these changes can lead to insulin resistance. Because of the highs and lows, many women choose to switch to an insulin pump during pregnancy and some add a continuous blood sugar monitor. Continuous blood sugar monitors help women anticipate possible blood sugar fluctuations and easily correct them before they become too high or too low.

4. Insulin needs. You will experience more insulin resistance as your pregnancy progresses. This means you will need to increase the amount of insulin you take beginning early in the second trimester and continuing until the birth of your baby. Most women need fast-acting human derived insulin like Humalog® four times a day and long-acting insulin like Humulin® at bedtime and first thing in the morning. If you are using Lantus® or Levemir® to manage your blood sugars prior to pregnancy your endocrinologist and OB may want you to switch to a human derived insulin because they are considered safe to use during pregnancy.

5. Three a.m. blood sugar check. You probably do not want to hear this but during pregnancies complicated with type 1 diabetes you need to wake up around 3 a.m. to check your blood sugar level. The reason you need to check your blood sugar around 3 a.m is to prevent what is known as the dawn phenomenon, when blood sugars rise with the rise of the sun. If you can get your blood sugars normal during the early morning hours, you are more likely to have normal blood sugars throughout the rest of the day.

Hormones are a big part of maintaining a healthy pregnancy. Did you know that insulin is a hormone as well? It’s no wonder that many women experience all types of changes with their blood sugar and insulin delivery when they are pregnant. If you are, or are planning to get pregnant in the coming months, Dr. Hessel wants to see you as soon as possible. Make your appointment online today and check back next week for part 2 of our discussion on type 1 diabetes.