PREGNANT T1 WOULD LIKE TO ASK SOME QUESTIONS

Dear Nicklenocky,

Congratulations!

I've had type 1 for 20 years next week and have two children, one nearly 3 and one 4 months. I started on a pump in between and deifinitely found getting my sugars within pregnancy targets (pre-meal 3.5-5.9 and <7.8 post meal I think) much easier second time around although still very hard work.

Both times I found I was quite prone to hypos in the first trimester. Difficult because I was especially aware how important tight control was in the first 12 weeks for preventing abnormailites in the baby, so it was tempting to try and run on the low side. Only thing I can suggest which may sound completely obvious is to test in-between meals to check you're not running low as even if you've tested after a meal and it's 7-8, it could be much lower only an hour later. Also make use of the temporary basal rate function on your pump to reduce your rate prior to and during exercise ( I would sometimes forget that walking to the shops is still exercise). Other than that stock up on the lucozade-especially make sure it's handy at work ( assuming you work), and although people often don't like telling people until they are 12 weeks, it's worth telling at least someone at work that you'll be more prone to hypos in the first few weeks and tell them your hypo symptoms/signs so they can help you out if needs be.

I was seen fairly regularly at the clinic and as far as I can remember increased basal rates and CHO ratios fairly gradually-I don't remeber there being a massive jump. I stayed pretty active during pregnancy though which may be why I didn't have to increase insulin quite as much as some people. Make a note of what your rates and ratios are now though for when the baby is born, as they will have changed so much that you might not remeber what to put them back to. The target I found hardest-especially in late pregnancy was to be in range pre and post breakfast and I know of other diabetic Mums who found the same thing. The massive advantage of the pump is that you can increase your basal rates for early morning if you need to. Even though I did this I really struggled to keep my post-breakfast sugars within range without taking such a big bolus that I'd be really hypo before lunch. The only thing I found I could do was to eat a smaller breakfast and have some more food later in the morning (with another small bolus) or to give my breakfast bolus a while before I actually ate it.

Hope that's helpful. It's really hard work and I think my fingers are still recovering from all the testing but it's definitely worth it.

Good luck!