I am 29 and have T1D. How can I safely plan my pregnancy?

Question

Hello doctor,

I am a 29-year-old female with type 1 diabetes, and I use an automated insulin delivery system with Novolog, which requires significantly higher doses. My recent laboratory results are as follows: HbA1c 7.8 percent, fasting glucose levels ranging from 95 to 140 mg/dL, and microalbuminuria at 25 mg/24hrs. I have also experienced morning sickness, which has impacted my glucose control, and my doctor has noted a mild progression of retinopathy. My average blood pressure is 128/82 mmHg. As we are planning a pregnancy, I am concerned about how to manage my diabetes effectively during this time, especially while breastfeeding.

Could you advise on what adjustments I should anticipate and how I can prepare for safe diabetes management during both pregnancy and breastfeeding?

Kindly help.

Thank you.

Answer 1

Hello,

Welcome to icliniq.com.

I understand your concern.

You should aim for more precise glucose control, with a target HbA1c of less than 6.5 % before conception, while also taking care to avoid hypoglycemia.

It will be necessary to adjust your insulin doses as pregnancy increases insulin requirements, particularly during the second and third trimesters. You must also monitor and control your blood pressure levels and ensure regular eye examinations with medications that are suitable for pregnancy. Morning sickness may require you to have small, frequent meals to help stabilize your glucose levels.

Postpartum insulin requirements typically decrease sharply, especially while breastfeeding, which can contribute to lower glucose levels. It is important to maintain a balanced diet, closely monitor your blood sugar levels, and seek lactation support if you face challenges with breastfeeding.

I hope this information helps you.

Thank you.