My story: I have a 6 months old and thinking about #2 already… about six months before I got pregnant the first time I tried really hard to get my A1C down while maintaining that (sometimes elusive) normoglycemic stability… I found that low carb and dexcom stalking worked well for me, personally. I am happy to have had a successful pregnancy. Now I am trying to get all my stuff together as I plan for the next (and maybe even one other)… unlike many, I chose not to see a giant team of specialists. I was seen by and delivered by a high-risk practice,
While managing my own diabetes throughout (You can read more at walkthedragon88.blogspot.com)
What about you? Is pregnancy daunting? How do you address it? Have you found that having kids adds motivation to be diligent about diabetes management, pregnant or not? Do you prefer to manage things yourself or have a health care team intimately involved? Why? 
Hi! Congratulations on your 6 month old and for already considering #2! I have two daughters, now ages 13 and 7. My experience with both was with a giant team of specialists. (Boston’s Beth Israel/Joslin program) There are positives and negatives to this sort of program. I am definitely the type who prefers to observe and manage on her own, requesting input from specialists as necessary. As you can imagine, this is NOT how the Joslin program worked. There were times that I had to stand my ground to go against protocol that just didn’t work for me (pump therapy just isn’t for me); I also had to involve my scientist husband to fight to continue to use Lantus (not then approved in pregnancy) vs NPH after I declined the pump. In retrospect there were “invasive” tests performed on what appeared to be (and were) two perfectly healthy pregnancies. The fetal echocardiogram resulted in a 4-6 week scare that my 2nd daughter had a heart defect. After the second scan it was perfectly resolved. So there were tests that I wouldn’t think necessary unless a specific issue within a specific pregnancy recommended them. For me, having the giant team may have resulted in more stress than going with a simple MFM option and being referred out to specialists as necessary, not just as a “diabetic risk profile” determined.
For diabetes management and motivation, my two pregnancies were slightly different. In my first, I was terrified. I was scared that a high or a low could cause lasting damage to my baby (it won’t). I had “morning” sickness throughout most of the pregnancy and was throwing up all the time. Trying to eat when my stomach was saying no way lady. Had A1cs ranging from 4.9 to the low 5s. My endo was worried about me driving b/c I was always teetering on lows. I was constantly testing and adjusting. And I had a healthy, wonderful baby. For pregnancy #2, I was just so much more confident in my own ability to manage things. I declined some of the tests and many of the monitoring appointments (especially at the end of the pregnancy – in my mind you shouldn’t wear too many belts and suspenders). It is stressful to be constantly driving to the hospital for a test that you know will come out fine. I set a higher A1c goal for myself (it is wonderful that CGM is reliable now - this must be an invaluable tool for the crazy blood sugars of pregnancy!). This time I was more relaxed, strangely didn’t have the morning sickness, and had another healthy wonderful baby.
I think when you are diabetes-educated and motivated you should feel comfortable choosing the primary members of your team. Pregnancy is intimate and wonderful and can become overwhelming, so having a loose “pregnancy plan” for yourself (that of course you can modify on the fly as necessary) can be helpful. The very best of luck to you! Jessica
I love this topic and hope to see it grow as the site does. I am amazed by the preparation required going into a pregnancy with diabetes. Since my diagnosis didn’t come until the middle of my third pregnancy, I didn’t have the level of prep work that you mamas did. Hats off to you!
And I’m thrilled to read, @walkingthedragon88, that you are considering #2! Our #s 2 and 3 came almost 13 months apart, and it has been such a delight to have them so close. Wouldn’t change a thing!
I didn’t have a CGM during the pregnancy. Wish I had, and just as a side rant, I think any mama on insulin during a gestational pregnancy should have one. I had no training whatsoever for insulin. Didn’t get to meet with a DE—just handed syringes and vials (not even pens) and sent on my merry, terrified way. Having a CGM would have taken away so much of the fear! And helped me handle the insane hormone surges with more confidence.
One of the things that I find most strange about pregnancy management with diabetes is the wide variance of bg targets issued by doctors. I’d say, YDMV, but it seems to be a top-down variance that is often out of step with tighter control. My doctor knew very little, as it turns out, about some of the other complications I experienced during pregnancy, but he did recommend really tight control with a 120 postprandial target. In retrospect, I am really, really glad he did. It set me up for being motivated by any numbers over 120 and probably set me on my course for maintaining a tight A1C post-delivery.
Resurrecting an old thread to stop hijacking another! Picking up from here: Women's Health Wiki: How Has Your T1D Been Impacted By Different Female Life Stages? - #11 by RachelMaraii
I’m still in the midst of lots of research (will I ever not be?), but my husband and I have decided we’re gonna go for it. 
For now I’m in the six month preparation period, recommended by Pregnancy with Type 1 Diabetes by Ginger Vieira and Jennifer C. Smith. It’s been a helpful book so far (~20% through), but I wish I had bought the second edition! The first edition has confusing typos. If anyone is considering reading it, I’d also highly recommend reading Think Like a Pancreas by Gary Scheiner first.
How is the six month prep going? OK I guess. 
I’ve narrowed my CGM range to 70 to 140. I have about 75% time in range, with a 6.2 GMI (my last A1C was 5.5%). Highs after eating and then subsequent lows are challenging though. I’m aiming for a 1-hour postprandial target of 140 and 2-hour target of 120… and that doesn’t happen often.
I’ve got a folder full of Dexcom G7 meal screenshots to try to nail down pre-bolus timing. It is a struggle!! I can see why T1Ds would go pretty low carb for pregnancy… No matter how early I bolus so far (15-30 minutes, sometimes even 45 minutes if not already in target), if I have refined pasta or fruit or other carbs in my meal, then my 1-hour reading gets up to 180-200 and my 2-hour reading is 140. If I just drink a protein shake or something, I can easily stay in the 140/120 post-prandial range. But I love cooking and food, and that includes carbs. 
Any tips for pre-bolus timing?? I’m working on nailing the extended bolus too. Or is lower carb the easiest way to go to achieve those goals? Any recommendations for vegetarian/pescetarian low-carb recipe blogs or cookbooks? I have a friend (who I mentioned in the previous thread – now with a beautiful one-year-old!) who has tried all the keto desserts, so I have a resource for those. I know I need to do some basal, carb ratio, and correction ratio testing too.
My previous endo has retired, so I’m seeing a new endo in the same office. So far so good. I didn’t bring up pregnancy plans yet, since I’ve only had the new patient appointment. I’ll need to ask about her own guidelines in December. I’ll also plan to ask her about Gvoke.
My CDE mentioned that Tandem is supposed to offer a custom Control-IQ target BG in the next year or so, specifically because of stricter pregnancy targets. I’m hoping that update will release soon! I am so grateful for the basically straight line I get overnight with Control-IQ.
I also downloaded Sugarmate yesterday!! Finally available for Android. 
So far I like the “extended drop” and “extended rise” alerts. And I think it will comfort my husband to have the phone call feature for overnight lows once hopefully pregnant.
Any other favorite tools or methods to achieve that stricter target BG range? Thanks in advance!
Good luck to you @RachelMaraii!
Tagging @T1Allison on this, because she did it twice.
Congrats on setting your goal and taking active steps towards it!
My main advice is, “Do your best, and then let it go. It will be okay.”
Overall, my approach was having planned meals…bolusing on the high side…prebolus minimum of 15 minutes but closer to 30 minutes…and plan for a low at the two hour mark and eat my way back up to normal. That was the best I could come up with to eat enough to gain weight during pregnancy AND keep in range as much as possible.
If you have morning sickness, you’re obviously gonna have to be flexible about your goals bc your safety is #1.
My pregnancies were done with Lantus and Humalog…and only with an added Dexcom for the second pregnancy.
Your insulin sensitivity will shift throughout the pregnancy…and that may impact your personal prebolusing times. Later in the pregnancy, I needed to throw more insulin and longer prebolusing times at it to get it all to work. But you may experience it differently.
Just know that the work you’re doing now, plus how serious you are taking it, plus all of the modern resources you have will add many, many layers of protection for your pregnancy beyond what used to happen. That’s not to minimize the risks…but to encourage peace of mind that it can be done.
I’ve told people that Type 1 Pregnancy is basically like the Olympics of diabetes. It can be done with the right strategy and motivation. I’m excited for you and sending you all of the confidence and reassurance vibes that I can!
(And if you can keep it under 140: awesome. But that was never something I could routinely and safely do. I tried to stay under 160 for spikes…but there will be highs above that…frequently… and it will be okay.)
That is extremely validating! 
Maybe I need to start focusing on perfecting my “top 10 meals.” 
Try out a few low-carb meals too. Then at least I know the patterns for now… and can hopefully address the variables a little more easily.
I remember the MFM at my consultation saying, “The first trimester is a rodeo no matter what. So with diabetes you just buckle up and hold on tight!” At least I’ll know I’m normal when I’m just trying to survive.
Thank you so much, T1Allison!!
I’m glad to hear them say this! It’s nice when practitioners are realistic and not so clinical!
I think your idea of a Top Ten list of meals so that you have an idea of what to expect with them is perfect!
I remember when dinner wouldn’t go well (likely mostly bc my Lantus was running out then and it was always a battle until my 9:30pm shot), I would run downstairs to my treadmill saying, “organs are forming! Organs are forming!” I would just walk and walk until I could get the spike down.
So don’t be me. It will be fine!
I want to go back in time and hug you So much stress! I’m so glad your kiddos (and you!) were just fine in the end.
I do already do stair stepping and pacing when my BG is going high… My exercise bike might be coming upstairs for post-dinner TV shows, or maybe I’ll just force my husband into building a habit of after-dinner walks 
My 2 children are now in their mid-50s and healthy. During my pregnancies, I was taking 2 shots a day of beef/pork Regular and NPH insulin, and only had urine tests to test at home, no home blood glucose monitoring at all. No quick-acting insulin. HA1c was also not available yet. I was still mostly using the ADA Exchange Diet, often carried a gram scale with me and, as others have suggested, mostly stayed with meals and foods I had an idea about, to try to keep the variables as limited as possible. Hardest part in those days for me was to keep the food intake in sync with the actions of the insulins, which did seem to vary more during pregnancy. But to keep from seriously lows, I had to tend toward higher than I have to now, so would clearly sometimes go quite high, based on the urine tests and occasional office blood tests (but, don’t really know how high or how often). And my children survived it.
So, I agree, do the best you can do while keeping yourself both physically and mentally healthy.
You asked Any recommendations for vegetarian/pescetarian low-carb recipe blogs or cookbooks?
Though I tend toward simple vegan, except some fish, foods, I got some of my ideas from Mastering Diabetes by Khambatta and Barbara, and The 30-DAY Alzheimer’s Solution by Sherzai and Sherzai.
Thank you so much, Dxin1955! It’s always reassuring to remember that many people have done the same under such varied conditions – and that things still were just fine. Thank you also for the cookbook recommendations!
I met with a diabetes educator today, specifically about T1D pregnancy. She has worked with a lot of type 1 pregnant patients, including her own daughter – I love when my care team has a personal connection! Some notes from our chat:
- Endo vs. MFM for diabetes management
- She works at both offices, so she knows that the MFM diabetes educators are usually really busy with gestational diabetes appointments, and don’t always have A1c testing onsite. She recommends that T1D patients continue to mainly see their endo for diabetes management.
- My endo will want to visit with me monthly for A1c testing. They will also be doing weekly reviews of my CGM data. Since my endo’s office works with my MFM really often, they can communicate treatment changes back and forth really well.
- Low-carb diets during pregnancy
- She mentioned that the ADA does not recommend low-carb diets for pregnancy. They recommend at least 175 g. of carbs per day for T1D pregnancies, and more if you have twins.
- Recognizing the difficulty of postprandial spikes… she recommends smaller, more frequent snacks/meals. 15-30 g. for breakfast (since insulin needs are higher in the morning), 30-45 g. for lunch, 30-45 g. for dinner, and 15-30 g. snacks.
- Gvoke for morning sickness
- She says this is a great option if needed. My endo’s office has a dosing guideline sheet that was developed by our local pediatric hospital (since they use it a lot for toddlers).
- Frequently not covered by insurance, so she recommends getting a coupon through GoodRx or the endo’s office if needed.
- Recommended reading
- There’s a 4th edition of Think Like a Pancreas! I already have an older edition on Kindle, but I think I’ll buy a hard copy to mark up and share with my husband.
- I’m gonna buy the 2nd edition of Pregnancy with Type 1 Diabetes. Fewer typos will be helpful if I assign it to my husband too!
- Pumping during pregnancy
- They like to keep the overnight BG between 70 and 100, so Control-IQ can be hard overnight since it’s aiming for 110. 110 target BG is way better than going low and not realizing it though.
- She confirmed that Tandem is expected to release an update with a lower target BG, hopefully in 2026. (Following the twiist FDA approval – thanks to all those DIY folks who made this possible!)
- She normally doesn’t recommend turning off Control-IQ, unless you very reliably wake up to your CGM low alarms.
- I showed her the Sugarmate app, and she was so excited! She had never heard of the app, let alone the phone call feature for overnight lows. (I’m hoping someday Sugarmate will be able to auto-import t:slim X2 data, since they’re both owned by Tandem. I’d love to not have to enter my insulin separately.)
- Set up a new basal profile for pregnancy. You want to be able to easily go back to your pre-pregnancy profile afterward.
- They like to keep the overnight BG between 70 and 100, so Control-IQ can be hard overnight since it’s aiming for 110. 110 target BG is way better than going low and not realizing it though.
- Check in with eye doctor
- She mentioned that eye doctors sometimes will schedule two or three appointments during pregnancy, to catch any early changes due to the increased blood flow.
- Stay curious, and stay sane
- She reiterated that I’m already set up for success, since I’m doing research and practicing ahead of time. Keep that motivation!
- Pregnancy is already hard, and diabetes is already hard… but together she knows it’s a “full time job.” And sometimes stuff just happens, as every T1D knows. It’s normal to go high sometimes, even when pregnant – we just want to be able to respond effectively.
Lot’s of good info! Thanks for sharing!
I highly recommend smaller amounts. The full dose is intended for when people are unconscious. What you are using it for is to replace carbs, so it’s a different treatment.
And also - when you take glucose from your liver, you gotta make sure you eat enough to put it back!
Make sure you get the syringe and NOT the automatic pen. The pen does not let you adjust the dosing.
