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Question:

From Durham, North Carolina, USA:

I am 27 years old, and have had Type 1 diabetes for 9 years. My husband and I are considering trying to become pregnant in about 6 months. My last HbAc1 was 8.0. My blood sugars have been averaging 125, with a few highs (200) and a few lows (60). I am wondering what my HbAc1 level should be before we actually begin trying to get pregnant? Also, how many times a day should I plan to check my blood sugar before becoming and while pregnant? How often will I need to see an ObGyn? Are there any specific concerns I should be aware of before I begin trying to get pregnant? Thank you for any help you can offer.

Answer:

Probably one of the most significant factors contributing to successful pregnancy outcome is preconceptual glucose control. Basically the closer that fasting and postprandial blood sugar values are to normal (I use <105 mg/dl fasting, and <130 mg/dl at 1 hour postprandial as guidelines) the greater the likelihood that the risk of congenital abnormalities will be minimized. However, do not drive yourself crazy over an occasional elevated blood glucose value. Similarly, your hemoglobin A1c should also be in the normal range. Check with your doctor's office to find out what the normal values are (usually between 6 and 7% depending on the assay).

The more times you check your blood sugar the more information can be gained about your glucose control. However, you have to be practical. At a minimum I would recommend checking a fasting, before lunch, before dinner and bedtime blood sugar. If you want to check at 1 hour after meals this would also be useful but not necessary after each meal.

Depending on your blood sugar control and any other problems, you will be seeing your obstetrician once a week to maybe once every two weeks.

Your overall medical condition is important. As long as your blood pressure is normal and you have no evidence of kidney disease then the risk to a pregnancy is minimized. Therefore, it is important to assess these factors prior to conception. It is important that you work with a diabetes team (an obstetrician, an internist or endocrinologist with expertise in diabetes during pregnancy, and a dietitian). This group usually will have established contacts with other useful specialists such as an ophthalmologist.

OWJ

Additional Comments from Dr. Lebinger:

Once you become pregnant, you should anticipate major changes in insulin requirements during the pregnancy. Sometimes insulin requirements decrease during the first trimester. Insulin requirements may increase dramatically during the second and third trimesters. More frequent blood sugar monitoring may be necessary during the pregnancy to adjust the insulin dose as necessary to maintain the best control possible.

TGL

[Editor's comment: See Pregnancy Management webpages listed at the Diabetes Registry for more information. WWQ]

Original posting 4 Jul 97

  
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Last Updated: Tuesday April 06, 2010 15:08:54
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