Who recognizes the name Lyrehca from the blog Managing the Sweetness Within, chronicling one woman's efforts to get and stay pregnant while dealing with her lifelong type 1 diabetes? Yes, you guessed it: Lyrehca is coming out of the closet as herself, Cheryl Alkon, now-author of the forthcoming book Balancing Pregnancy With Pre-Existing Diabetes: Healthy Mom, Healthy Baby. Today, Lyrehca (er, Cheryl) shares a brief version of her story, and some don't-miss tips on diabetes and pregnancy.
A Guest Post by Cheryl Alkon, D-blogger and Author
When I first thought about trying to get pregnant, almost five years ago, I did everything I was supposed to do:
- I stepped up visits to my endocrinologist for pre-pregnancy consults
- I worked to get my blood sugar numbers into the tight ranges recommended for pregnancy
- I saw my eye doctor to check my eyes for any longterm damage from diabetes and learned how pregnancy might affect them
- I ate better and took prenatal vitamins
I also looked everywhere for books and websites about the subject and I soon met with the maternal-fetal medicine specialist who worked with my endocrinologist at my hospital's diabetes and pregnancy program.
Despite excellent blood sugars, an overall good bill of health, and extensive knowledge about the topic, I left the specialist's office in tears.
The doc, also known as a high-risk obstetrician, spent our appointment telling me all the terrible things that could happen in a pregnancy complicated by diabetes. Yes, tight blood sugars were necessary. Without them, the chances of having a pregnancy colored by complications, both for me and for the unborn baby, were high. The visit was a long list of all the potential things that could go wrong, from the pregnancy itself, to actually giving birth, to the health of my future child: birth defects. Potential miscarriage. Pre-ecclampsia. Vision issues. Kidney complications.
And yet, I had a handful of friends, longtime type 1 women like me, who were in our 30's and had had their own healthy beautiful children. They were not hobbled by illness or problems throughout. They may have had an issue here or there, but they managed things and got through them. And they were able to do it with the tight blood sugar control recommended for women with pre-existing diabetes. The truth is, with average hemoglobin A1C numbers in the 4-7 percent range, women with diabetes are no more likely to have pregnancy complications than are women without diabetes. This was recently proven by research in the journal Diabetes Care that found women diabetes who had A1C numbers 6.9 percent or lower had no more risk of "serious adverse outcome" than the non-diabetics did.
I knew I could try to do it, too.
Soon, I started blogging about my efforts to get and stay pregnant, while managing my type 1 diabetes. I liked the support I received from commenters. Plus, I wanted to connect with others who were pregnant, had given birth, or who were trying to conceive, all with type 1 diabetes.
At the same time, I found that there were no insider's guides to pregnancy with pre-existing diabetes that were told from an actual woman with diabetes' perspective. The books sanctioned by official diabetes organizations were written by health care professionals, and not by people with diabetes (as far as I could tell). I found Kathryn Gregorio Palmer's excellent book, When You're A Parent With Diabetes, which touches on pregnancy, hadn't been published yet. And while I found an out-of-print Australian book that interviewed women with type 1, but it was actually pretty dry and clinical.
I began slowly finding other bloggers writing about pregnancy and diabetes. I found the great website DiabeticMommy.com, which is a sprawling bulletin board devoted to all things pre-pregnancy, pregnancy, and parenthood, with type 1, type 2 and gestational diabetes. There are some excellent Yahoo Groups devoted to these issues as well, particularly PositiveDiabeticPregnancies and PregnantPumpers.
Super-tight control for pre-pregnancy, as defined by my docs in my hospital's diabetes and pregnancy program at the Joslin Diabetes Center, is having blood sugars of about 70-100 mg/dl before meals, about 120-140 mg/dl one hour after meals, and 100-140 mg/dl before bed. Once pregnant, those numbers dip even more, to 60-90 mg/dl before meals, with 120 mg/dl an hour after meals and 100-140 mg/dl before bed.
It took a lot of trial and error, along with constant blood sugar testing (sometimes once an hour, up to 15 times a day), but I was able to figure out which foods I could eat that wouldn't spike me too high after a meal (hello, oatmeal and whole grains, particularly mixed with some low-fat protein; goodbye, white bread). Exercise—even a stroll after a meal or a walk to my local train station—always helped smooth things out. And this was in the days before I had a continuous glucose monitor. I recently started using one and it's sometimes really surprising to see how some meals show a nice slow and unpronounced rise in numbers after a meal, and how some meals really sent things flying high (oy, French fries, what did I ever do to you?)
Of course, everyone is different, and what works well for me, food-wise, might send another person's numbers soaring. SO much about diabetes is trial and error, and figuring out what works for you, pre-pregnancy, can make actual pregnancy and its inevitable changes and challenges (hello, hormones and insulin resistance) easier to handle.
I'm pleased that after many long months, I finally got pregnant and knock on wood, had a pretty healthy and normal pregnancy (the details are all on my blog.) Our healthy son, known online as Toddler L, was born two years ago without any problems and thrives today as his chatty and mischievous self.
I'm also facing another kind of birth. After an equally long process, the guide I wished I had back in the day will be published in early 2010. My book, "Balancing Pregnancy with Pre-Existing Diabetes: Healthy Mom, Healthy Baby," (see above link) will be published by Demos Medical Publishing in early 2010. It gives the insider details of pregnancy and type 1 or type 2 diabetes, using both my own experience and insights from dozens of other women who have been there. I hope it will give future readers the kind of information I was so hungry for and that it will give them the sense that a pregnancy with diabetes doesn't have to be the horror show some doctors (or the technically accurate but extremely dated film Steel Magnolias) would lead you to believe.
Instead, pregnancy with pre-existing diabetes is a challenge and a boatload of work, no doubt, but it can be a pregnancy where the end result is a fantastically healthy and happy new mother and baby.