First Trimester with Type One Diabetes

All I can say is... WOW.

What a first trimester it was. As I look back at the last three and a half months, words that come to mind are "paitence, growth, and discomfort". Paitence with myself that I will not be perfect, I will go high and go low. Growth in terms of learning even more about how to stay in a tight range. Discomfort through doing things necessary to keep myself in a tight range, despite how tired I was. If you're unaware of type one diabetes management through pregnancy, I'll tell you a little about it so you can understand that this is no easy endeavor. I'll also go into personal details of changes I made with my doctor and how management has been thus far.

Type One Diabetes Management and Pregnancy

A normal, not-pregnant type one diabetic traditionally tries to stay in a blood sugar range of 70-180. If you're here 80-90% of the time, you're likely to have an A1C of 7 or lower. This is where I was for awhile and what gave me indication that I was ready to try and concieve. The reason I needed to be "ready" was because while pregnant, your range tightens to 65-140. Meaning, 141 is now considered "high" and dangerous for the baby. With consistent high blood sugars (above 140), still births, enlarged organs, big babies and miscarriages are all very common. These are all risk factors that are proved.. but being in the health and wellness space, my mind immediately jumps to other possible problems with cognition, brain and spinal cord development, or compromised anatomy. There are so many things that "could" happen, already proven risks were just icing on the cake. To achieve a blood sugar in tight range, insulin needs to be given more frequently, normally at higher doseages. Diabetics need to move more, and stress less, to increase sensitivity. Most of these things can be controlled but also, cannot. I cannot always go on a walk when my blood sugar is high nor stress less when I have a busy day. However, once you feel like you've got it under control, insulin resistance hits around week 18 (for most). This is when your normal amount of insulin - both basal and bolus - just doesn't work anymore. Weekly changes will be made with you and the doctors in charge (MFM). Some people experience insulin resistance their whole pregnancy, others hit it way later. But staying on top of changes is the most important thing for a healthy and developed baby. It's constant management with zero breaks.

Columbus Cap City Quarter Marathon at 10 Weeks

Month One (weeks 1-4)

I think everyone can agree this might be the easiest time because you don't know your pregnant half of it! I probably knew sooner than most because I was tracking ovulation and conception. I found out I was pregnant around week three. From what I can remember, I was fine during this month and didn't see much fluctuation in my numbers. I did adjust my "time in range" to 65-140 on my dexcom/glooko to ensure I was alarmed everytime I went out of range. That is when things started getting "messy". I also shared my information with MFM who started tracking my blood sugar around week 10, but they were on top of gathering the needed information to begin glucose reviews.

Month Two (weeks 5-8)

My numbers were about 65-70% in range with a lot of work to stay there. I've heard many type ones tend to decrease insulin needs during this month-- not me! So, don't feel bad if you're needs don't change. I think my needs stayed the same, but because I let myself hover 140-150 frequently, I gave myself much more insulin thorughout the day just to keep it lower than that.

My sympotoms of pregnancy began around week six when nausuea and fatigue set in. These were my only sympotoms (with occasional, very bad, headaches). Because of my nausea, I actually think I ate more food than I used to. This was the only thing that made me feel okay for a few hours. I had no cravings but aversions to anything sweet and coffee. I stopped drinking my beloved protein shakes and eating any fruit. I wanted nothing after dinner (where as before, I had a mad sweet tooth normally soothed by something with peanut butter) and I counldn't fathom the smell of coffee. It literally made me want to get sick.

I wasn't showing yet/ my body had not changed this month. Despite my workouts literally sucking because I had zero energy, I felt like I still maintained a lean strong physique. Now mind you, I was about 6lbs up from the start of taking ovulation medication. I had no intention of trying to lose that weight as I was obviously trying to get pregnant.

Diabetes difficulties: The biggest question mark was overnight highs. With the decrease in nighttime snacking, I had less insulin on board before bed. This was helpful to keep me under 180, but to be honest I had my alarms set every night for midnight and 2 am to check my bloodsugar and give insulin. My corrections were pretty high; I'd dose sometimes 6 units without eating just to get my sugar to come to 100. I am not sure why, but my needs overnight are crazy and I was trying to manage the best I could on my own. My first MFM and endo appointment were'nt until week 9.

The challenges: I felt like I was walking all the time to keep my numbers in range. Almost every time I ate and right before bed I'd have to go on a half hour walk just to keep my numbers under 140. I was so exhausted, especially becasue I was waking up 2-3 times in the middle of the night. My quality of life was pretty low this month but I did a good job at hiding it from my clients and trying my best to keep my pregnancy a secret.

Food choices: The only thing I was consistent with across this month was breakfast. Normally, I would fast until after my workout. However, being pregnant, fasting is not a good idea. So I would have two hard boiled eggs and cream cheese. Sometimes I'd bolus for a few crackers, but I tried to keep my bolus under 15 grams. I snacked throughout the day on cashews, especially the salted ones. I ate pretty low carb as a whole; but every meal did contain a carb. Mostly because I felt like I needed the energy.

Workouts: SUCKED. I literally just did what I could most of the time. My runs were so terrible; I slowed my normal 6.5 treadmill pace to 5.5!!!! Say what!!! I am a slow poke but I have been able to run about 20 miles per week with that change. Lifting grew harder too; I changed my 5x5 program to a hypertrophy based, tempo controlled phase.

Bump at 7 weeks, time in range, typical breakfast

Our First OB Appointment (8.5 weeks)

This day was one of the most crazy, emotional days of my life. In such a good way. I'll never forget taking my husband to this appointment either. We were taken into the ultrasound room and I told him they were going to use the probe and stick it inside of me.... his face went white! The only reason I knew this was because I had gotten one done before when testing for PCOS (by the way, I am negative). When my OB came in, she congratulated me as we were truly all in this together. If you haven't read my trying to conieve post, you should! It was a journey and I give so much thanks to my OB.

As we first laid eyes on our little baby, we looked in disbelief. I could see two eyes!!! Well, that's what I thought at least. My OB, with excitement, said "do you see what I'm seeing?" Thinking that she had zoomed super close to the baby bean and I was looking at pupils, because there was two......

Yes, two.

I had two babies in there.

My husband was silent with truly the look of fear on his face. I may or may not have started crying, because, this can't be real? Right? I couldn't even get pregnant for nine months... how did I fertilize two eggs?

Well, I did. And apparently we have twins on both sides of our family, pretty distant. But none the less, I was about the be a twin mom. No wait....I am a twin mom.

After about five minutes of disbelief, God gave me some sort of peace of mind that, this is it! I am not having one... but two baby angels. This is my life, and it's a ride!

But now, the pressure is on. Two babies that need to develop appropiately and remain healthy. I can do this, I can do this, I can do this.

Two fraternal babies!

Month Three (Weeks 9-12)

This is where most the diabetes changes happened, for the better. At my endo appointment, we decided to try two things to help with the overnight highs and stop waking every few hours:

1) Switch from auto mode to manual mode

2) Split bolus dinner, despite how much fat may be there

We decided to try manual mode to allow a constant influx of insulin to stream through my body all night (basal). I've never done this before with the pump so although I was a bit nervous, I knew this would be better than my pump playing "catch up" all night. The scary thing with manual mode is the disconnect between the pump and the dexcom. If I go low, it doesn't know.. and continues to give my basal rate of insulin. So it's important to get your basal rate right and connect with your endo on your settings.

We went back and forth the first two weeks on adjusting my basal to being almost perfect. But be paitent; I had highs and many lows with this adjustment and it truly requires you to "try, try again" to find the settings that work for you.

Split bolusing has also been a big question mark for me; I've never understood the science of it. I wanted to try this becasue I had taken corrections before bed before going "high" and it landed me a perfect blood sugar. I don't normally eat crazy high fat meals, but for some reason I think the sedentary nature of my evenings makes my body need an extra 15 grams of bolus before bed, even when I'm not eating. I'll tell you now, this works about 60% of the time. The remainder of the time, I go low. The amount of lows I was experiencing was way more than I ever imagined; again, not because my sensitivity was high, more because I'd split bolus too much and had manual mode turned on.

Diabetes difficulties: Understanding my overnight basal rate to keep my blood sugar under 140 without going low

Things I loved: I got my first prenatal massage this month and although it wasn't anything like what I usually like, it was so incredibly needed. I went to Paloma for a 90 minute pre-natal massage, and was so pampered. I ended up purchasing Hatch Belly Oil and Down Girl Cooling Foot Lotion.

Symptoms: I felt pretty nauseous until 13 weeks. Although I didn't get sick, the constant sick feeling was constant. The biggest symptom was my fatigue; I felt like I never got enough sleep. My workouts slacked and I definetly did not feel like myself. I still cringed thinking about coffee and sweet foods.

Food Choices: I changed my carb-free (boring) breakfast to more substance. I would make either sourdough toast or low carb toast, two eggs, and cream cheese or guacamole. This breakfast tends to land me a solid morning bloodsugar and I seem to not go low during my workout or run. This is new to me being a diabetic; before pregnany, any insulin on board would cause me to go low. Now, I try to have 300-400 calories as my first meal and I feel pretty satisfied. Most breakfasts are either salads with a protein or cauliflower rice with a protein. I'll always bolus 30-45 grams of carbs because I'll add in crackers or tortilla chips. Sometimes I have an afternoon snack, but try to do a carb-free snack like pickles or cottage cheese. Dinner is always later than I'd like it to be, but I have been trying to do less than 45 grams of carbs before bed. This is helpful for keeping my numbers in range over night. I am also mindful of the amount of fat I use, because that can cause a delayed spike. Dinner is all over the board, but always high protein, with vegetables.

Workouts: Running got easier because I learned to run with fatigue! LOL! I still suffered from lack of energy, but I did the damn thing and it had a physical and mental benefit of pushing through the hard. I am still lifting weights 3 times a week and very much enjoying it. As my body started changing around this time, running and lifting both began to feel harder. Running just felt like I was out of shape and lifting felt like I needed to go do some core, HAHA! But I am maintaining movement every single day and I am grateful to be doing so.

Week 10, Week 12, Week 14

Month 4 (weeks 13-16)

I am currently at week 15 writing this; and I am so satisfied with where my care is at. I feel confident in making changes myself in terms of my basal and bolus. MFM and I communicate every Monday to review my numbers the week prior and make changes, too. The care on their end has been exceptional, but always remember that YOU know your body best. They once gave me recommendations based on a weekend I was extremely sick with noro-virus. I decided on my own to not make the recommended changes because I knew the situation was based on my numbers while sick, not my new needs of insulin. Be your own advocate, even when doctors make recommendations.

Management: I currently don't need to walk after every meal and sleep through the night (kind of). This is a result from not resting until understanding what my blood sugar needs were all throughout the day, what works for me and what does not. I am getting more rest without fearing of a spike or crash.

Symptoms: Almost all of my symptoms have passed! I am getting my energy back and feel less nauseous. Although I am still getting sick occasionally, I do indeed feel better. As of today, I've gained about 7lbs since conception, 13lbs since trying to get pregnant (back in Oct of last year). It baffles me that some people don't show at all in first trimester; but I have to remember I am growing two humans, not one. I'm so used to being light on my feet while running and having a strong core while exercising... so it's weird doing these activites in a bigger body. But, I am embracing it!

I have achieved an A1C of 5.7 for the first trimester. I am so happy with this result as I truly hoped for under 6.5. It goes to show that the hard work does indeed pay off. I have not really hit insulin resistance yet, outside of random days of insulin just not working. My hope is that diabetes can go easy on me for longer; but I know second trimester will bring many ups and downs. Bring. It. On!!!