Q & A: TYPE 1 DIABETES AND PREGNANCY

This was originally posted on my type 1 friend’s site, Caroline Potter, when she was pregnant and going through the changes in diabetes for each trimester. Enjoy.

Please welcome Kelly Schmidt to the Flourish blog today for an encouraging and informative Q & A about Type 1 Diabetes and pregnancy!

From Caroline: One of the most beautiful parts of my very difficult pregnancy has been connecting with so many of YOU—I can’t tell you how encouraging your comments, prayers and emails have been to me and the saying “it takes a village” has come true to life!

Managing not only a difficult pregnancy but also the effects of Type 1 diabetes has been exhausting and most days far too draining to want to talk online  I wanted to bring on my beautiful friend and fellow Type 1 mom, Kelly Schmidt, RD, LDN, to chat all things Type 1 pregnancy.  She is a beauty inside and out and such a wealth of knowledge! Kelly has been such an encouragement to me and I know you will love her!

**Please note, this information can also be helpful to those with gestational diabetes or blood sugar issues in pregnancy.  This is not medical advice.**

Type 1 Diabetes and Pregnancy Q & A with Kelly Schmidt, RD, LDN & Caroline Potter, NTP

Type 1 Diabetes and Pregnancy Q & A

Pregnancy can be such an emotional time, but then you add the extra emotions of being high risk and managing the ever so changing and complicated task of having Type 1 diabetes.  What is your encouragement to expecting moms to manage this time of both joy and anxiety?

I am grinning as I write my response as I so easily remember the moment I found out I was pregnant. I first told my husband and then ran for my phone and called my mom with fear. I was scared to eat, exercise or cause any movement in my blood sugars with a growing fetus inside me. But then I realized there are many babies born to mothers with diabetes and I was going to be okay.

Embrace each moment and know there is a higher plan, and to tap into that inner strength and intuition and do the best you can in taking care of yourself. Round up your medical team and even social media support. I found extreme value in connecting with other women who were in the same stage I was during the initial weeks of pregnancy. While my CDE (Certified Diabetes Educator) was rather awesome, I really benefited from connecting to other type 1s and I even made a Pen Pal from across the country. We had our first baby just weeks apart, but it was very beneficial to exchange notes of what foods were working for stable control and noting when crazy increases happened with our basal/long-acting. To say the least, Type 1 Diabetes allows us to have an automatic connection with one another. Don’t hesitate to seek a tribe. In the least, I’d be happy to connect.

How can meal timing and consistency play an important role in managing blood sugar levels?

I approach a client who is newly diagnosed with diabetes and a woman who is newly pregnant with diabetes in a similar fashion, and with this, consistency is one of the most important things to implement to feel good and to learn what works and doesn’t work for blood sugar control. There is an incredible value to eat at the same times and with consistent portions of fat, protein, and carbohydrates. It was key to have a soft plan of batch-cooked meals for the week, and by no means, did they need to be fancy.

Especially in the second half of pregnancy, insulin need to manage Type 1 diabetes can greatly increase.  Some days I feel like I am just pumping myself full of insulin and I don’t love that feeling.  What is your encouragement to women who also don’t like that feeling but also know that balanced blood sugar is best for both mom and baby?

Do whatever you need to do to keep blood sugars in range. If you are worried the excess insulin will put on weight, understand your wellbeing and baby’s well-being is most important, and the weight will come off.  IT, Will. Come. Off. Cross that bridge when you get there, and put your best health first.

Also know, as the weeks go on the amount of time needed for a pre-bolus goes up as does basal/long-acting needs. For example on pre-bolusing, first trimester you may find 15 minutes is needed before eating, 2nd trimester moves towards 30 minutes, and 3rd trimester it indeed may need to be 45 minutes. By third trimester it’s common to be on 3x as much basal as well. The amount of insulin isn’t the worry, keeping blood sugars in range is.

How can hydration affect your blood sugar in a negative way?

A 2011 study from Diabetes Care, found when adults who drank only half a liter of water (~two glasses) or less each day, they were more likely to develop blood sugar levels in the pre-diabetes range, versus people who drank more water. While we already have diabetes, this study is important, because it highlights how other hormones, such a vasopressin increases with dehydration, telling our kidneys to hold onto water, and this can influence higher blood sugars. As well, water/hydration, helps insulin do its job. And lastly, if wearing a CGM, being properly hydrated can help our it work be more accurate.

Beyond water, those of us with diabetes, are at risk of losing our electrolyte balance as our blood sugars move up and down. Sea salt, mineral water, and a diet abundant in vegetables can help counteract this. Please note, the use of table salt/iodized salt is not recommended. It can stress our thyroid, among other negatives in the body. Pure, unrefined sea salt, pink Himalayan salt, and Celtic salt, are all great options. Last note on salt, if you are eating mainly a whole food diet, low in dairy and grains as well, you will need to salt your food more. If you are craving salt, listen to that as a sign you need to sprinkle a little more on your food, as well as, making sure you are getting enough rest. When our adrenals are working hard, they can also stimulate salt cravings. Proper hydration can take effort, and it’s handy to always have a water bottle on you (preferably glass or stainless steel).

How can hormones, blood sugar and insulin need change postpartum—both immediately after delivery and in the months that follow?

I had a pump on both times I delivered, and I knew coming to the end of my third trimester, I needed to plan new rates. With my CDE we agreed on a total basal for after delivery and it was about 10% lower than my pre-pregnancy insulin needs. Everyone is different, but it’s common for that basal to be even lower than that, and I had to change my insulin immediately, right after holding and bonding with my child.

In the following months, there were some jumps in my insulin needs but insulin needs vary from one mom to the next. I know a few friends with type 1 – and when they nursed they needed to eat something simultaneously to prevent a low. I didn’t have that so much, but my rates were very low for the first 3 months, and went up, as my baby’s milk needs grew less. When I introduced solids (which I did at 10/11 months), my insulin needs dramatically went up.

I feel like we as Type 1 diabetics have been taught that only food influences our blood sugar, but I personally notice that stress—both physical and emotional—greatly influences my blood sugar.  What are some great ways to minimize the stress and some calming activities you enjoy?

  1. Walking is magical. A fast-paced walk can lower blood sugar 1-2 mg/dl per minute, and I took advantage of this when I knew I didn’t take my insulin early enough before eating. I still utilize walking even not pregnant. It can help catch a high, pick up the pace of insulin or mobilize a carb immediately. I remember when we lived in Chicago and all I wanted when pregnant was a little gluten-free pizza, and just 1 triangle slice sent my sugars up. So on that Friday night, I just walked up and down my stairs for 10 minutes. Also don’t be scared of highs, just work to correct them quickly. A high BG won’t hurt baby, a constant high is where the risk comes in.
  2. Hydrate, hydrate, deep breaths and then hydrate. Both water and breathing (plus prayer or meditation) make everything better.
  3. Flip the script. I delivered both of my kids in Chicago and especially with Teagan, the care was horrific (sorry for the transparency NorthWestern). I was informed falsely I had ovarian cancer, then I was provided the wrong genetic results, then given results scaled against a non-high risk female, and was tossed around 10 different doctors. I wanted to go bonkers and leave the practice when I was 20/30 weeks but was nervous no one would want my high-risk case. But to say the least, I treaded through the stress and remained as calm as possible because baby feels it all. Every challenge is an opportunity and our response is more important than the circumstance. 

How can you balance knowing your own body and trusting your “gut” with also trusting your medical team in a high risk pregnancy?

Be your best advocate in labor. I controlled all my insulin/CGM/Blood sugars during labor, which was not preferred by the doctor or nurse staff, but they honored my interest and my blood sugars were steady through each. Declan was even a 36-hour labor! All of us with diabetes have a different case— the solution to blood sugar control is not the same for one person to the next.

If you want to focus on labor without thinking of blood sugar control, pass the responsibility to your team.

Exercise is a fabulous way to help naturally lower blood sugar.  Both in pregnancy and not, I have noticed walking greatly lowers my blood sugar! What are some great pregnancy safe exercises that will help balance blood sugar and not spike it?

As mentioned, I loved walking, but I also incorporated other exercises into my care. I fell in love with water aerobics and got certified as an instructor when I was 27 weeks pregnant, but I also really enjoyed yoga. I always informed the instructor I was pregnant and asked if they were aware of modifications.

Yes, some higher intensity exercise do raise blood sugar—for me barre classes, HIIT training, and heavy lifting all required and still require taking insulin before a workout.

What are your favorite real-food sources of carbohydrates?

Right now I could have fresh raspberries all day long. Overall the foods I am listing are chosen, not 100% on flavor, but on flavor and easy on my blood sugars. I have a gentle gut and some carbs spike me far more than others. For example, sweet potatoes spike me far more than white potatoes. Usually, it’s the opposite for others. My favorites include lentils (love lentil pasta), berries, cooked onions (odd, yes), Brussel sprouts, green beans, and plantains.

Do you have any supplements or vitamins you find helpful for managing Type 1 Diabetes during pregnancy?

  • Diabetic or not, a good probiotic is so important to take care of our gut while our hormones transition, but also to prevent a positive Strep B test, which is found in 1/3 of pregnant women. If we are positive for this test in the USA, we must put on antibiotics at labor. This isn’t the worse thing, but it’s beneficial to do what you can to avoid it.
  • Additionally, a high-quality fish oil is great for the baby’s brain, but also supportive of preventing postpartum depression.
  • Methylated B vitamins—type 1 pregnancy’s have higher folate needs, and methylated folate is far better than folic acid. Folic acid can even be harmful.
  • Magnesium can help with insulin sensitivity, muscle comfort, bowel movements and more.

*I always make recommendations specific to client needs and please consult your medical professional before taking anything.*

What is your best encouragement to managing Type 1 diabetes and pregnancy?

  1. Test like it’s a part-time job. This is obvious, but the pre/postprandial checks are crucial, and with my second child, I went on a CGM around week 16. It was amazing, and once I did it, it proved to kickoff a good streak of optimal A1Cs. With the CGM I realized my hormones went nutty as I went to bed at night. I remember my line graph on my CGM climbing from 9pm-11pm. I eventually got aggressive with my insulin and prevented this high from happening.
  2. Be bold with insulin. Use your diabetic intuition of when to dose more insulin than what is calculated to bring a number down or cover a food. Once the baby comes, you will have a motherly instinct and I tell my mom diabetic clients to use that instinct with their diabetes too. I understand my diabetes better than ever after having kids.
  3. Calculate insulin needs for protein. The way I do this (and I am sure you have heard of this): add the protein in a meal and divide it in half and finally add in the carbs. That number is what you use for measuring your insulin needs. Example meal: a 3 egg, veg omelet. An egg has 6g of protein, so 6 x 3 = 18. Take that 18/2 and you get 9. So 9g plus whatever carbs are in the veg, so we can pretend it’s 5. So total “carbs” to calculate insulin needs is 14 grams.
  4. Don’t read too far into the “no-no’s” for pregnancy ie. no shellfish, wine, soft cheeses, etc. Every country, as I am sure you know, has different suggestions. Practice using your instincts here. Full transparency, I enjoyed a few glasses of wine with each pregnancy as it was thoroughly enjoyed and gentle on my blood sugars.

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