Type 1 Diabetes And Pregnancy

If you are trying for a baby or are already pregnant, you might worry about how type 1 diabetes could complicate your pregnancy. Although some complications could arise, many healthcare professionals are well aware of these issues and can provide you with additional support. 

For now, the best thing you can do is find out more information on these complications so that you're prepared should they happen. However, if you suspect that something could be wrong now, do not hesitate to check in with your doctor or a support person. 

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Type 1 diabetes and pregnancy

By now, you are probably quite familiar with type 1 diabetes. Type 1 diabetes is a disease that arises from insulin deficiency because the pancreas is not making enough insulin. 

Insulin is a vital hormone that circulates throughout the body in the bloodstream when blood sugar levels are elevated. However, when this hormone is absent, blood sugar levels remain high because cells cannot absorb the excess sugar without the help of insulin.  

High blood sugar levels are sometimes called high glucose levels or hyperglycemia. Without treatment, these levels will remain elevated and secondary complications can occur. 

Understandably, many type 1 diabetics are worried about their pregnancy because there is the potential for so much to go wrong even when they are not pregnant. While that is true, there are still a lot of measures you can put in place to help ease the burden of diabetes during pregnancy. 

Scheduling an appointment with your doctor is an excellent place to start because they can offer extra support and inform you about the changes you will need to make. 

For example,¹ while you’re pregnant, consuming 175 grams of carbohydrates per day is recommended. This intake supports the growth of the fetus and ensures that your brain gets enough glucose. Based on these guidelines, you may need to adapt your current intake. 

Additionally, type 1 diabetes should not be confused with gestational diabetes.² The main difference is that type 1 diabetes is a life-long condition. If you have this, you were most likely diagnosed with it before pregnancy.

In contrast, gestational diabetes arises only when a woman is pregnant and will subside after the pregnancy. 

How does type 1 diabetes affect pregnancy?

The good news is that it is possible for women with type 1 diabetes to have a healthy pregnancy with very few complications. Taking measures to manage your diabetes during pregnancy will help with this immensely. 

These measures include staying on top of your blood sugar levels, eating healthy foods, and checking in with a support person frequently. In addition, you may find it helpful to mention your condition to your midwife or anyone else who is there to support you during your pregnancy. 

What are the risks associated with pregnancy and type 1 diabetes?

There are five major risks associated with pregnancy and type 1 diabetes. These are:

  • Hypoglycemia

  • Diabetic Ketoacidosis

  • Retinopathy

  • Nephropathy

  • Preeclampsia

Hypoglycemia 

Hypoglycemia³ is when blood sugar levels get too low. While type 1 diabetes is often associated with high blood sugar levels, it can quickly go the other way once treatment has started. 

Diabetics who are pregnant are more prone to hypoglycemia because they need to eat enough food for themselves and their growing babies. However, morning sickness, loss of appetite, or concerns about high blood sugar levels can cause blood sugar levels to drop. 

If you are unsure how many carbohydrates you should consume daily, ensure that you check your blood sugar often. If it remains consistently lower than usual, check in with a doctor for further advice. 

Symptoms of hypoglycemia include:

  • Hunger

  • Tiredness

  • Dizziness and lightheadedness

  • Confusion and irritation

  • Headaches

  • Feeling jittery or shaky

  • Being unable to speak properly

Sit down immediately to prevent falling over or fainting if you feel dizzy or lightheaded. Regardless of whether you have diabetes, pregnancy can make you more prone to feeling dizzy. Hence, pregnant women who are hypoglycemic may find this symptom noticeably worse

Diabetic Ketoacidosis

Diabetic ketoacidosis is a serious problem when left untreated. It occurs when the cells are starved for a prolonged period, and fats rapidly break down for energy. 

When stored fat is broken down, it's converted into acidic compounds known as ketones. A sudden increase in ketones circulating in the body will make the blood acidic, which can have life-threatening consequences. 

Symptoms of ketoacidosis include:

  • Fruity-smelling breath

  • A flushed face

  • Frequent urination

  • Increased thirst

  • Dehydration

  • Dry mouth and skin

  • Headache

  • Muscle stiffness and pain

  • Nausea, vomiting, and stomach pain 

If your blood sugar levels tend to be higher than they should be, you have an increased risk of developing diabetic acidosis. To prevent this from happening, you should stay on top of your insulin treatments and see a doctor if you cannot get your blood sugar levels under control. 

Retinopathy

Retinopathy is a diabetic eye disease affecting the retina in the eye. When you are pregnant, you are at greater risk of developing this condition if your blood sugar levels are too high. 

When blood sugar levels get too high, excess sugar circulating in the blood can cause damage to the blood vessels in the eye's retina. As a result, your vision can go blurred, and, in severe cases, you could experience blindness. 

Retinopathy arises from poorly controlled blood sugar levels. Therefore, staying on top of this is an excellent way to prevent this problem. 

Nephropathy

Nephropathy is a kidney disease that can arise from diabetes. This condition can also worsen with pregnancy. Research⁴ has not been able to uncover the exact cause of nephropathy.

However, it's believed that insulin resistance, genetics, high blood sugar levels, and the autoimmunity process involved in diabetes all play a role. 

During pregnancy, your kidneys work harder and take on an increased renal load. Hence, why you are at higher risk of developing nephropathy during pregnancy. 

Preeclampsia

Preeclampsia⁵ is the term for high blood pressure that can occur when you pass the 20-week mark of your pregnancy. Type 1 diabetes is a risk factor for preeclampsia. 

Symptoms include:

  • Constant headaches

  • Blurry vision or spots in vision

  • Stomach pain

  • Nausea and vomiting

  • Swollen face or hands

  • Unexplained sudden weight gain

  • Breathing difficulty

Severe cases of preeclampsia can result in seizures. 

Is type 1 diabetes considered a high-risk pregnancy?

Type 1 diabetes⁶ does present some risks with pregnancy. While this may sound stressful, try to have a positive outlook because many diabetics have safe and healthy pregnancies. 

Monitoring your condition and seeking help certainly helps. Do not hesitate to get medical help if you feel something is wrong, as getting treatment sooner for anything will significantly improve your outcome. 

No doubt, you already have good habits in place around treatment and monitoring your blood sugar. While you continue doing this, you lower your risk of developing complications. 

Lowering the risk of complications of type 1 diabetes in pregnancy

If you are hoping to get pregnant, now is an excellent time to plan ahead. If you have any concerns about your health, address them with your doctor to minimize stress. Besides that, some other things are worth considering too.

Before getting pregnant

Before you get pregnant, keep managing your blood sugar levels as you would normally. It may help to keep a record because you will have something to refer back to if they change during your pregnancy. 

Reviewing your medication is another good measure to take. Ask your doctor if your current medications are safe for unborn babies. 

If you are on a medication that is not suitable during pregnancy, you may need to change it. Depending on the medication you are taking, your doctor may need to lower the dose before taking you off it completely. This could take some time, so allow for that if possible. 

Also, make sure that all of your prescriptions are up to date. Running out of medication is never ideal, especially if it happens to you while you’re pregnant. 

During pregnancy

During your pregnancy, always make sure that you:

  • Continue to manage your blood sugar levels

  • Monitor complications that may worsen throughout pregnancy (high blood pressure, vision loss, kidney disease)

  • Get your blood pressure frequently checked after you reach 20 weeks to stay on top of preeclampsia

  • Ensure that you have not developed an insulin resistance

During and after delivery

You will need to stay on top of your blood sugar levels and insulin treatment when you go into labor. If you have a midwife, ensure they know this before giving birth. Or, if you are giving birth at a hospital, ask a nurse or doctor to help you with this. 

After your baby is born, your diet may need to change once you start breastfeeding. For example, your daily calorie intake may increase by an additional 330-400 calories.⁷ 

In lactating females, it’s also recommended⁸ to increase carbohydrate intake — however, this is for general reference only. For lactating females with diabetes, it’s best to have a tailored recommended carbohydrate intake with the help of a health professional. 

Also, stay on top of your blood sugar levels and treatment after your baby is born. Sometimes it can be easy to forget during this stage, and it might help to have someone else remind you. 

Diagnosis and tests for type 1 diabetes in pregnancy

Most women are diagnosed with type 1 diabetes before pregnancy because it's commonly diagnosed during childhood or adolescence. However, it is possible to develop type 1 diabetes in adulthood. So if you suspect you have this condition, ensure that you get it diagnosed before becoming pregnant. 

In some cases, diabetes can occur during pregnancy, and this is a slightly different condition known as gestational diabetes. This condition often subsides after pregnancy, although it does pay to check afterward just in case. 

If you are yet to be diagnosed with diabetes, your doctor will order some simple blood tests. 

In the past, fasting blood tests have been used. However, this may not be safe for you while you are pregnant.   

Instead, they could get you to do the random plasma glucose⁹ (RPG) blood test that measures the amount of sugar in your blood. Additionally, they may also order the A1C blood test, which can show how long your blood sugar levels have been elevated. 

How is type 1 diabetes treated during pregnancy?

Treatment for type 1 diabetes includes continuous subcutaneous insulin infusion (CSII) or multiple daily injections (MDI). Experts¹⁰ say that either delivery method of insulin is fine during pregnancy. 

Continuing your insulin treatment during pregnancy is essential because it will prevent your blood sugar levels from dropping too much. If you have any concerns about your treatment throughout your pregnancy, mention them to your doctor. 

For instance, if you suspect your treatment is no longer effective, talk to your doctor immediately. Do not adjust your insulin treatment without seeking medical help first. 

Insulin requirements can vary throughout pregnancy, and your dose may need to increase or decrease at different stages. You may find it helpful to write this information down when visiting your doctor, and you could make a treatment plan chart at home. 

How to prevent type 1 diabetes in pregnancy?

It is impossible to prevent type 1 diabetes because genetic factors largely determine it. 

Managing type 1 diabetes during pregnancy

To help manage diabetes during pregnancy, make sure that you follow these guidelines:

  1. Count carbs, stick to meal plans, and know when to make dietary adjustments if needed.

  2. Keep checking your blood sugar levels frequently. Do not hesitate to see a doctor for help if your blood sugar levels remain too low or too high.

  3. Ask your doctor for a treatment plan, especially if your insulin doses need to change.

  4. If you have a midwife, inform them of your condition so they can help manage your diabetes during your pregnancy and delivery.

  5. Be aware of the complications of your diabetes, and seek medical advice if your health declines.

  6. Relax and look after yourself. Try not to stress too much over what might happen because by following these guidelines, you are doing everything possible to reduce your risk of serious complications. 

The lowdown

Despite having type 1 diabetes, you can still maintain a healthy pregnancy. Stay on top of your treatments and blood sugar levels, and do not hesitate to seek medical advice if you are unsure about anything. 

  1. Dietary intake of carbohydrates in pregnant women with type 1 diabetes—A narrative review (2020)

  2. Diabetes and pregnancy | Centers for Disease Control and Prevention

  3. Type 1 diabetes mellitus and pregnancy (2010)

  4. Diabetic nephropathy | NIH: National Library of Medicine

  5. High blood pressure during pregnancy | Centers for Disease Control and Prevention

  6. Type 1 diabetes and pregnancy | Centers for Disease Control and Prevention

  7. Maternal diet | Centers for Disease Control and Prevention

  8. Dietary reference intakes (DRIs): Recommended dietary allowances and adequate intakes, total water and macronutrients (2011)

  9. Diabetes tests & diagnosis | NIH: National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK)

  10. Management of type 1 diabetes in pregnancy (2016)

Other sources:

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