Other women describe how friends don’t understand why they are going to so many doctor appointments—especially during the third trimester when women with diabetes are monitored several times a week with a fetal nonstress test to make sure the baby’s activity level is normal. It’s frustrating when your friends can’t relate to your experience (in spite of your explanations), but what’s ultimately most important is that you respect that a pregnancy with diabetes really is different and that you attend to your needs.
If you’re not getting the support you need from your established social circle, you may want to seek out or even create a local support group for women with diabetes who are pregnant or go online to www.DiabeticMommy.com to become part of that cyber-support network.
Trimester by trimester
For women with diabetes, each trimester truly contains its own challenges. Because the first trimester is the time of much of the fetus’s major organ development, it is critical to maintain blood glucose in the recommended range during this time. However, women may not find out right away that they are pregnant, and even when they do, their blood glucose levels can fluctuate wildly because of the introduction of pregnancy hormones into their systems. This is the time when women need frequent contact with a physician or C.D.E. who can help them to make insulin adjustments as needed. During my second pregnancy, my endocrinologist had me wear a continuous glucose monitoring system in my first trimester for three days so that we could see what was going on with my glucose levels 24 hours a day and then make adjustments to my insulin doses from there.
Morning sickness can also disrupt some women’s blood glucose control during the first trimester. How do you know how much rapid-acting insulin to take when you’re not sure how much of your meal you’ll be able to eat or keep down? I discovered that insulin pump therapy allowed me to easily take part of my premeal bolus before I ate, then take more during the meal as needed. On days I felt nauseated, being able to do this made all of the difference in my blood glucose control.
The second trimester is when most women see their insulin needs increasing each week, as pregnancy hormones cause them to become more and more insulin resistant. Some women describe this time as “chasing their blood sugars”—needing to add more insulin just when they thought they’d found the dosage they needed. Insulin pump therapy, which mimics the human pancreas by secreting small amounts of insulin into the bloodstream in an ongoing manner, makes it easier for a woman to make adjustments in her basal rates at this stage in pregnancy. In fact, many women with Type 1 diabetes go on the pump before conception with the specific purpose in mind of making pregnancy management simpler and better.
This pattern of increasing insulin needs usually continues into the third trimester, which is often a challenging time because it’s when the woman is at her largest. She may feel more tired and less able to exercise. For me, swimming helped to keep me in shape during the last few months when walking more than a few blocks felt like running a marathon.
Planning for delivery
It is during the third trimester that women need to sit down with their obstetrician and talk through a birth plan. For women with diabetes, a baby’s due date is somewhat flexible. Because we are at a higher risk for stillborn babies, many physicians routinely schedule babies to be delivered at week 38 or 39, which can be done by induction or Caesarean section (C-section), depending on factors including the size of the baby (estimated by an ultrasound report).