What I Learned From Managing T2D While Pregnant
Planning a family is a major milestone in anyone’s life—whether someone has diabetes or not. However, when a person does have diabetes, extra precautions are needed when planning a pregnancy. Those precautions can include being prepared to be put on insulin and monitoring glucose levels more than usual to ensure a safe pregnancy and healthy child. What’s not always helpful in preparing individuals to manage diabetes while expecting, is focusing on the possible adverse events that can happen.
Winnipeg, Manitoba resident, Erin Lebar, who at the time of the publishing of this article had just welcomed a newborn son, shares her experiences of managing type 2 diabetes (T2D), what she did to plan her pregnancy, and the concern about fear-mongering around the subject.
BT2: Hi Erin, when were you diagnosed with type 2 diabetes? What information did you receive at the time of your diagnosis?
Erin: I was diagnosed in June of 2020. My father is a type 1 diabetic and I have a lot of diabetes in my family. But despite knowing of signs and symptoms, I think I had been experiencing stuff for close to a year before, such as UTIs that were debilitating. Then I was getting recurring yeast infections for the first part of 2020 and had crazy fatigue and was falling asleep at five o’clock after work.
But it was also during the pandemic so I thought that was having an impact on my wellbeing. It got to the point where my doctor did blood work and my A1C was 9.9 percent and we knew I was diabetic. I started metformin that week.
What changes did you have to make to begin managing diabetes effectively? Did you have any support?
I’m actually very active and eat well. I play soccer and all these other sports, so my doctor said I didn’t need to change that much.
She recommended that I monitor my portions and watch my carbs. It was nice to receive that information, because when I was diagnosed I thought everything had to change—I can’t eat anything like fruit or bread. Initially, I had an all-or-nothing mentality. But my doctor helped me realize it didn’t have to be that way.
My father has type 1 diabetes (T1D)—a late onset diagnosis in his mid-30s, called LADA. He wasn’t happy that I got diagnosed, but he’s my “diabuddy”. He was the first person I called. He took me to the pharmacy to get things I could do right away to keep my blood sugars in check until I could get my prescriptions and get my glucose monitor.
He’s been an excellent resource. We manage things in different ways but it’s nice to have someone who understands the mental exhaustion of dealing with it every day.
When did you begin to start planning for your pregnancy? What steps did you take with your healthcare team?
That was my one really big stipulation with my partner. I didn’t want this to be a surprise pregnancy because I wanted to be as healthy as possible going into it, knowing that there was an increased risk of different complications. So we had decided that we would kind of officially start trying around the fall of last year.
I made an appointment with my general practitioner (GP) and my endocrinologist to get all my blood work done and make sure that they sign off to say that it’s safe for us to try. My A1C was 6.1 percent, so we got the all-clear. However, I’m 34, so they said, if you don’t get pregnant within six months, call us back and then we’ll send you for a fertility test as they would for any sort of older pregnancy.
But we were lucky enough to be able to conceive within three months and so I tested positive on New Year’s Eve. Then, I was able to get in with my endocrinologist in less than a week and then my GP in less than two weeks.
Did you have to take any medications to manage your glucose levels?
I needed to take insulin. This wasn’t a surprise because my doctor told me there was a pretty high likelihood of me being put on insulin. She’d even actually talked about putting me on it a little bit early so that I could get used to taking it and dosing it just in case I had a rough first trimester. She said I didn’t want to be learning how to take medication while you’re also barfing all the time.
Still, I started taking it at five weeks pregnant. The way she explained it, even though I was managing my diabetes with just the metformin and monitoring my carb intake, the baby requires more carbohydrates to develop properly. The only way for me to intake as many carbs as I need and manage my sugars is to use insulin.
I stayed on my metformin for the first 16 weeks and then only used insulin.
What tools, other than insulin, did you use to ensure you had a safe pregnancy?
I have the continuous glucose monitor (CGM) from Dexcom, but I can only use it during pregnancy because our insurance, or at least the one that my husband has, will only cover it as an insulin-dependent diabetic. As soon as I’m not on insulin anymore, it’s not covered anymore and it’s way too expensive for me to maintain.
So I’ve been stockpiling sensors to get me through to probably the end of November, and by then I feel like I should be okay to just go back to doing my finger pricks. It has been great to have this device during pregnancy.
At first, I thought I’d be a chronic over-checker and wasn’t sure if it’d be good for my mental health. But I’ve released that anxiety and embraced having that information, especially for overnight glucose levels because fastings were a big problem for me.
Having that information of what’s happening overnight has been life-changing. This has been such an amazing tool to have.
Fear-mongering is already an issue in the ways type 2 diabetes is generally discussed. Can you describe what fear-based information you saw?
I saw a lot of that kind of information. Some of the info I saw mentioned that you’re going to have a ginormous baby, and have such a higher risk of stillborn pregnancy or get preeclampsia.
These were mentioned as if they are definitely going to happen to you just because you’re dealing with a diabetic pregnancy. It was like, “Oh my god, this is terrifying”.
Other information mentioned was keeping your blood sugar tightly monitored to the point of, I would almost say disordered eating. It was just so intense and so scary. I’m lucky that I have another friend who has T1D and was going through a pregnancy right before me, so I talked to her a lot about these experiences.
There were not a lot of examples of a complication-free pregnancy, which I’ve actually had.
Did you have a conversation with your healthcare team about this kind of information?
I did and they were really great about saying yes, some of those things can happen and it’s good to be aware of the possibility of them happening, but because I am pretty diligent about my sugar management they didn’t have concerns.
It was important to hear your medical team, who have delivered a lot more babies than I have, to say they weren’t concerned, everything is fine and please don’t worry. But even still, if I spike or if I haven’t dosed my insulin correctly and I’m sitting high for a couple of hours, I’m still like, “Oh my God, am I hurting this baby? Am I doing a bad job?” The anxiety is already there, naturally.
I’m fortunate that my care team was very available. I had at least an appointment a month with all three doctors for the first four or five months, and then the last two months I’ve had appointments every single week. So they’re very available to answer my questions or hear my concerns.
What advice did your pregnant friend with T1D give you about managing your pregnancy?
She was ahead of me by about six or eight months, so she kind of was flagging things that might happen down the road.
For example, she’s breastfeeding now and she said something that she didn’t realize was that your blood sugar just tanks when you’re breastfeeding. Lows have been a problem for her and it’s really hard to keep it up. She was able to flag that for me to have juice or have cookies in the house to catch lows.
It’s nice to have that personal experience from someone who’s the same age as me, in the same situation. It’s invaluable, just knowing you aren’t alone.
What can others with type 2 diabetes, who are also planning their own families, take away from your experience?
That it’s absolutely possible to have a complication-free pregnancy as a diabetic. Do what you think is best, follow the advice of your care team and try to just drown out everything else. Because as we all know the internet is full of misinformation and it’s not just about diabetes.
Know what websites you’re looking at and make sure that they’re medically accurate, legitimate websites. If you have concerns about what you’re reading online, talk to your doctors. That’s what I did. It’s the best thing you can do because they know your situation.
Also, embrace this special time. When we go to scans, I know a lot of people get very emotional seeing their baby, but it’s made me a lot more of a feminist in a weird way because it’s so incredible what our bodies can do. I was sitting in bed and I could see him moving pretty vigorously inside. I looked at my husband and said “I grew this from nothing.” I feel incredibly lucky, and that doesn’t encompass the love I already have for my child.
Having a community of women with type 2 diabetes who understand the ups and downs of pregnancy is invaluable. Join our Beyond Type 2 app for additional support!