Type 1 Pregnancy on MDI

[Lucy12]

Hello!
I had my first pre conception clinic appointment and to be honest I left feeling quite disappointed and unsupported.

I have good control, my a1c is 41 and from that perspective I’ve been told I’m good to go. I’m getting my folic acid prescription too. I’ve been aiming for 70% in the target range 3.9-7.8 and on some days I can achieve this fine but others it’s a real challenge. I expressed concern that my blood sugar always rises in the morning and it’s hard to get it back down quickly with a correction and was basically told there’s nothing more I can do about this. I was told that the hospital are only just rolling out hybrid closed loops for pregnant women so I wouldn’t be able to get one. I was also told that they wouldn’t want to change anything with my management because my control is good.

I feel like they have seen that my A1c is ‘good enough’ and therefore it doesn’t matter that I have concerns about my management. My control is good because I work really hard at it but my concerns were just dismissed without any helpful advice.

I know that many many women have had successful pregnancies on MDI and before better tech was available, but I’m really frustrated that the technology exists and I’m can’t get it. I don’t feel reassured by this experience and it leaves me not having a lot of confidence in the hospital. Does anyone have any helpful advice/success stories/resources about managing pregnancy on MDI please?

 

[Inka]

I can’t see that a loop will help much @Lucy12 What does help is a pump though, as it makes it easier to change basal rates. However, MDI is fine and it sounds like you’re doing well on it. Were you told to aim for 70% 3.9 to 7.8? I’ve had 3 pregnancies and only did the pregnancy targets once pregnant. Having a good HbA1C is the main thing - which you definitely have.

Because my HbA1C was very good prior to TTC, I didn’t go to any pre-conception clinics. I just got my folic acid and that was it. I was given a number to phone as soon as I was pregnant and that’s when the clinic support started. TBH, it wouldn’t have been of much use earlier.

I was told not to worry to much about the fasting blood sugar target as long as it was as close as I could get it, but my pump allowed me to deal with the rise on getting up. Do be aware that you will get spikes. It’s inevitable. Pregnancy is lots of corrections and lots of tweaks.

It honestly sounds like you’re well-prepared.

 

[Lucyr]

I have good control, my a1c is 41 and from that perspective I’ve been told I’m good to go. I’m getting my folic acid prescription too.

With an a1c of 41 I’d say your control is more than good enough as is, and the upheaval of switching to a pump wouldn’t really help unless that 41 a1c is made up of extreme lows and highs. I can’t imagine any sensible DSN would suggest you need to aim for a lower a1c than 41, it’s already really really good.

Caveat: I haven’t been pregnant or used a pump

 

[Lucy12]

I can’t see that a loop will help much @Lucy12 What does help is a pump though, as it makes it easier to change basal rates. However, MDI is fine and it sounds like you’re doing well on it. Were you told to aim for 70% 3.9 to 7.8? I’ve had 3 pregnancies and only did the pregnancy targets once pregnant. Having a good HbA1C is the main thing - which you definitely have.

Because my HbA1C was very good prior to TTC, I didn’t go to any pre-conception clinics. I just got my folic acid and that was it. I was given a number to phone as soon as I was pregnant and that’s when the clinic support started. TBH, it wouldn’t have been of much use earlier.

I was told not to worry to much about the fasting blood sugar target as long as it was as close as I could get it, but my pump allowed me to deal with the rise on getting up. Do be aware that you will get spikes. It’s inevitable. Pregnancy is lots of corrections and lots of tweaks.

It honestly sounds like you’re well-prepared.

Thank you, that’s very reassuring! I know that there are benefits that I’d get from a pump even if it wouldn’t make a huge difference in my a1c, such as changing basal rates and not having to inject as much, and more flexibility with things like exercise. It was just frustrating to explain a problem and be told well there’s nothing else you can do.

They didnt mention the 70% at 3.9-7.8, I’ve seen from my research that’s what’s recommended so that’s what I’ve been working to. They mentioned the fasting and 1 and 2 hour post eating targets which I said I’m sometimes having difficulty achieving and again, I think I’m doing everything I can there, I wasn’t told to do anything differently.

I like having lots of information and I am a bit of a control freak so perhaps I’m overthinking!
Thank you again for your help and advice!

 

[Lucy12]

With an a1c of 41 I’d say your control is more than good enough as is, and the upheaval of switching to a pump wouldn’t really help unless that 41 a1c is made up of extreme lows and highs. I can’t imagine any sensible DSN would suggest you need to aim for a lower a1c than 41, it’s already really really good.

Caveat: I haven’t been pregnant or used a pump

Thank you. I’m not necessarily aiming for a lower a1c, it’s more I feel I’m not meeting the time in range targets enough now so slightly concerned that it’ll only be more difficult in pregnancy. I think because I’ve always had good control what I perceive as a problem doesn’t always get treated as such because my a1c is fine.

 

[Leadinglights]

Thank you, that’s very reassuring! I know that there are benefits that I’d get from a pump even if it wouldn’t make a huge difference in my a1c, such as changing basal rates and not having to inject as much, and more flexibility with things like exercise. It was just frustrating to explain a problem and be told well there’s nothing else you can do.

They didnt mention the 70% at 3.9-7.8, I’ve seen from my research that’s what’s recommended so that’s what I’ve been working to. They mentioned the fasting and 1 and 2 hour post eating targets which I said I’m sometimes having difficulty achieving and again, I think I’m doing everything I can there, I wasn’t told to do anything differently.

I like having lots of information and I am a bit of a control freak so perhaps I’m overthinking!
Thank you again for your help and advice!

There is a section on the main DUK site with info about Type 1 and pregnancy which you may find helpful if you haven't already seen it.

 

[Inka]

*They didnt mention the 70% at 3.9-7.8, I’ve seen from my research that’s what’s recommended so that’s what I’ve been working to*

@Lucy12 You are indeed being too strict on yourself. Pregnancy is hard work! No way do you want to set yourself extra targets beforehand! You’ll burn out before you ever get pregnant. Concentrate on healthy eating, exercise, relaxation, etc 🙂

If it helps you at all, I didn’t have a CGM for any of my three pregnancies; in all of them I had spikes and periods of highs - but I have 3 healthy children. You really are doing very well. Most people will have a higher HBA1C than you. You’re doing enough already 🙂

Download the Toolkit from Breakthrough (formerly JDRF):

Pregnancy toolkit | Breakthrough T1D UK

This toolkit gives you information about what to expect when you’re living with type 1 diabetes and are planning a pregnancy.

breakthrought1d.org.uk

I also found the tiny chart in Think Like A Pancreas very helpful if you have that book.

 

[rebrascora]

I also think you are being too hard on yourself and I wonder if the pregnancy targets are just that ie "targets" to aim for but not necessarily need or expect to hit them every day as long as you are getting close most days.

As regards levels rising on a morning, I inject a small bolus as soon as I wake up (and always before I get out of bed) to tackle what we call "foot on the floor" syndrome or the glucose surge released by our liver. For me it is usually about 1.5-2 units depending upon my BG on waking. I don't know if this is something that might help you if you don't do it already. I usually also add my breakfast bolus at the same time if I am having breakfast ie inject my breakfast bolus before I get out of bed too, as I need quite a long pre-bolus time for breakfast, so that gives me at least half an hour to get washed and dressed before eating.

Wishing you lots of luck with your planned pregnancy and many congratulations on your excellent HbA1c. I think you might find that a pump with or without HCL might not give you as good results as you are currently getting, but I appreciate that during pregnancy with all the changing hormones, it will be much more challenging to maintain your current high standard.