One question that I noticed was being asked a lot when I attended the DiabetesSister’s conference in Raleigh this month was “How did you do it? What did you do to control your diabetes and get prepared for pregnancy? How did you get your A1c below 7 for pregnancy?” While I’m not here to give medical advice in any way, shape, or form, I will go over just a few things that helped a lot.
First, I know that many women have been able to have very healthy, successful pregnancies years ago without the use of the technology that we have now, but for me, I’m very tech-oriented and use whatever diabetes devices I have to the best of my ability… especially when I was preparing for pregnancy and all during my pregnancy. Most pumps and CGM’s (Continuous Glucose Monitors) come with software that you can upload and get a good general feel for how the past few days, weeks, or even months have gone and you can either fax or email your doctor your results.
I knew that in order to have a safe “oven”, I needed to keep my A1c below 7% per my endocrinologist’s advice. Of course, some of you may already do this, but considering I was a diabetic who hovered in the 8-10 A1c range, this was a huge step for me. The biggest thing I ever did to help make this happen was I not only uploaded and studied all of my pump charts and logbooks on a regular basis (okay, once every 2 weeks)… I also obtained a Dexcom CGM. Some of you use a Medtronic CGM that’s built into your pump.. that’s okay too. If you don’t have a CGM, I would strongly suggest looking into getting one. I know it’s not a very easily obtained piece of d-equipment, but it did make all the difference in the world for me.
There is a setting in the CGM that will alert you if you go high or low. I started out from my high threshold of 200 mg/dl and every few weeks, I lowered it by 20… so two weeks later, I lowered it to 180, then 160 and so forth. Even though I knew it would bug the absolute mess out of me, I eventually kept the high at 140 mg/dl and my low around 70 or 80 I think. I wasn’t worried about the low too much because the Dexcom defaults to alert you at 55mg/dl no matter what anyway. But by setting my high threshold at 140, I would know each and every time I hit that level and I would know to either keep an eye on it or go ahead and do something about it. I didn’t use it to think “Oh gosh, I’m high”… but more of a heads up that, “hey, you might want to watch this”. Why did I choose 140? The old “egg” (Seven Plus) system would only let you choose the high increments at 20 mg/dl steps, so I couldn’t set a 130 as I would have liked and 120 was just ridiculous, so 140 it was.
Over the next few months, I kept a very close watch on every single thing. I knew how exercise, certain types of foods, even the difference between water and a Diet Coke affected me. I literally became obsessed. I was a master of “dual wave” boluses for certain types of foods and Super Boluses for large-carb meals. I watched my numbers so closely that I had my basal rates down to the 0.025u increments, something that I never had to do before. I only ever adjusted to the 0.5u. Shortly after doing all of this, I reached and maintained that “under 7%” goal, and we were given the “green light” for pregnancy.
If I could give any advice (not medical… just “d”sister-to-“d”sister), I would tell you to honestly learn your body. Each and every one of us is made differently and what works for me may not work for you. It’s a process that takes time and patience, but it a rewarding process. I will say that I owe a big part of my preparing for and having a healthy pregnancy was having a CGM and insulin pump that I could work with and fine-tune, so use whatever d-equipment you may have to your advantage. Also, letting go of seeing your numbers as “grades” and seeing them as guides to help make a huge difference.