Advice needed re: pre-conception care for diabetics

[VAJ1985]

Hello, I am a 27 year old female and have had T1 for 26 years, and my last HbA1C was 6.9. My husband I have decided to try for a baby next year (the reason we're forward planning is partly due to my diabetes and also because once I finish my current prescription of the contraceptive pill, we are assuming it will take a few months for my cycle to return to normal).

Anyway, I was wondering if anyone could tell me what pre-conception care (if any) is given to T1 diabetics? Would I have to see a midwife/nurse before we start/while we are trying? My next consultant appointment is in December so I will tell him our plans then. Would I usually be put on folic acid as soon as I come off the Pill?

Am a bit concerned about what the doctor will say because my Hba1C has been excellent for about five years now but for the last few weeks, I have needed more insulin than usual. I think this is down to a change in routine, which always affects me (as a teacher, I have been off work over the summer). But I hope this hasn't affected my Hba1C to the extent that he says we can't try for a baby.

 

[Elc1112]

Hiya, I am in a very similar position. I'm 28 and am hoping to start trying for kids in the next year or so. I spoke to my DSN about it and she was about as much use as a choc ate teapot. Told me to come back when I am actually trying. I explained to her that I want to make sure I am in the best possible health eyc before trying to that I can have a safe and uncomplicated pregnancy.

Anyway, spoke to my GP instead. She told me that, ideally, my hba1c needs to be below 6.5. The lower the better, within reason of course. She also advised that any problems with my eyes could get worse because of the pregnancy so to be aware of that. Blood pressure and cholesterol were all normal but told to keep them that way. She told me to come back when we are actually trying and she would give further advice. Folic acid wise, I was told to start taking as and when we were ready to try.

Hope this helps. Good luck with everything and have fun practicing

Emma

 

[VAJ1985]

That's interesting, as my consultant was a bit more helpful and realistic. He didn't tell me I had to be under 6.5, he just told me to stay in the good range I have been. He said my GP should prescribe an extra high dose of folic acid as soon as we're trying, so really you shouldn't be having the same dosage off the shelf as non-diabetics (although, of course, it's much better than nothing). I was also told that I need to demonstrate good control (as I have been) before we start trying, not just during, so it doesn't sound like we got the same advice. Perhaps you could request to speak to a diabetes-specialist midwife if you're concerned?

 

[VAJ1985]

Oh, and as for cholesterol, I have been on medication for mine for a while (although I want it re-tested, as I now exercise much more than I used to) and my consultant didn't say anything about it, although he did say he wouldn't like to see any changes in my blood pressure if I want to have a baby. I don't think a high cholesterol level is especially dangerous if you're pregnant, but obviously it must be easier on the ol' diabetes if everything is as normal as possible

 

[Elc1112]

I'm sure the cholesterol was more to do with my diabetes than anything else. It's normal anyway, but they always like to remind me to keep it that way lol.

My GP was lovely about it all and was certainly a lot more helpful than my DSN. When we're ready we'll go back to see the GP and possibly a diabetes midwife, as you suggested.

Good to know that we have been given broadly the same advice!

 

[hails]

I am also going through this. My HBA1C last year was 8.1 for the entire year. Then I managed to get it down to 7.7 but they are still considering it to be too high. I am now going through the process of getting a pump as they have run out of ideas of how to get it down furthur as I have no pattern to my levels at all. They think if they can get the basal rate pinned down then we can figure whats going wrong. They have said if I can get it to 7 then they would be happy that the risk to the baby would be lowered but I am more worried about them rising when I actually get pregnant

I have been on folic acid for 6 months (you can go on it at any point, I am also on the pill) so go on it as soon as you can so when you decide to go for it you will be full of folic acid! I think its 5grams and I have it on repeat for as long as I want.

Unfortunately for me I have been waiting for the go ahead for a year and a half but I am hoping in the next 6 months I will be able to start trying.

I am off to an appointment today to discuss it a bit furthur as I just want mini mes now! :lol:

 

[cml79]

I'm in the pre-conception state as well it is more than slightly scary... but this is what I'm up to:

- I'm taking 5mg folic acid (started 3 months before trying to conceive) and my consultant has also advised 75mg of aspirin too
- eyes checked before and through pregnancy is important, especially if like me you have some background retinopathy
- i got a referral from my gp to the best local diabetic obstetric clinic. I had to fight for this as it wasn't my closest hospital, and they usually only refer you after conception. 
- i'm aiming for blood tests less than 7 within 1 hour of eating, especially during conception and first trimester. I read somewhere that a pregnant diabetic spends on average 15% of her day hypoglycaemic! I have a diabetic friend who is pregnant - her HbA1c is 5.2... she is basically bumping along at near hypo levels all day, with a stash of apples near by to keep topping herself up. I don't think a consultant would recommend this! but frankly my feeling is that as long as you aren't having massive unrecognised hypos (especially overnight) then lower is better.

Having a pregnant diabetic friend to talk to helped so much. she is going through everything 6 months   before I do - which really helps me realise that this isn't impossible. So keep checking in here x