When we decided to have a baby, my HbA1C (a long-term measure of blood sugar control) was 7.2. Not too bad for a type 1 diabetic (T1D), but it should be closer to 6 for a healthy pregnancy.
For about 4 months we reduced alcohol, eating out and stress. We exercised and slept more. We saw less of our friends. I tested my blood sugar more often so I could catch highs early. We ate sandwiches for dinner every night, and woke up at 6am every morning, even on weekends.
On Christmas day 2016 the pee stick said we’re pregnant. With our strict, boring routine, my HbA1C was down to 6.4.
If a poorly-controlled T1D falls pregnant with a high HbA1C and doesn’t bring the number down, she may put her baby’s normal development at risk during those crucial first 12 weeks.
I WhatsApped my endocrinologist with the news, in a panic about blood sugars that were all over the place. You see, early-pregnancy hormones cause all sorts of haywire with insulin sensitivity, so I felt out of control despite my best efforts. I was pricking my finger around 15 times a day to test and correct, test and correct, test and correct.
Even before Maya was conceived, I was used to getting up several times at night to attend to my diabetes. I already felt more than prepared for a newborn.
My endo said I should come in every two weeks of my pregnancy. The anxiety of thinking several times a day that this spike or that dip is harming my baby was exhausting, and it was another stressor that played havoc with blood sugar levels.
But she assured me I was doing well and she arranged for a continuous glucose monitor (CGM) specialist to talk to me.
A CGM is a biosensor that is inserted into fatty tissue to measure a patient’s glucose every 5 minutes. Using bluetooth, it gives me a live reading on a mobile app, and it alerts me when glucose readings are rising or falling.
Even better than that, it allows me to see trends of how exactly a meal affects my blood sugar. For instance, I could now see that a bowl of oats would dump sugar into my bloodstream within 15 minutes of eating, long before the insulin I injected for it could start acting. To me this meant my “healthy” breakfast every morning was harming my baby with a glucose spike, so we started eating eggs, dairy and salad for breakfast instead.
I also realised that in trying to avoid high glucose levels, I would often over inject insulin, resulting in regular and severe lows. A low essentially feels like being very drunk, starving and weak. It’s of course dangerous while driving, gets in the way of work and can lead to loss of consciousness, especially while sleeping.
The CGM helped me to catch lows early too, but unfortunately its alarm is too soft to wake me up at night, so I still had (and have) many sleepless nights or prolonged lows.
But the CGM helped us realise that carbohydrates in any shape or form would make our journey more difficult: the more carbs I eat, the more insulin I have to take, the higher the chance of the roller coaster highs and lows. Also, the more insulin one takes, the more fat is stored, and an increase in body weight means an even higher insulin requirement.
We thus started eating meals with loads of veggies, fat and protein to make sure I got enough calories and fibre without too many carbs. No more sarmies for dinner.
My HbA1C went down to 5.5. A record at my endo’s clinic, pregnant or no. At 12 weeks and at 20 weeks we had to have fancy scans for a high-risk pregnancy, and they all showed Maya was developing perfectly.
Even when insulin resistance kicked in later in my pregnancy, my HbA1C only crept up to 5.8, and it stayed there even after Maya was born.
These constant glucose data updates were exactly what I needed. My new cyborg abilities and low carb diet allowed me to exercise without the fear of lows, so I could keep using crossfit and dog walks to maintain my insulin sensitivity. And it made work less stressful because I could attend meetings and conduct workshops without going high in response to cortisol, a stress hormone.
That said, besides messing with blood sugars, stress during pregnancy can have a profound effect on the developing baby itself. It is important for all mothers to pay attention to their mental health during pregnancy. I tried to do everything possible to reduce stress and anxiety (our village – family, friends, colleagues and my incredible medical team – carried me as much as I carried her), but I think exercise, healthy gut bacteria and plenty of sleep and water played a big role too.
Even so, there were many tears, many dark days of frustration. Many doubts about whether we should have undertaken the journey in the first place. I keep saying “we” because Stephan helped me through it mentally, emotionally and practically, in solidarity throughout.
Today is World Diabetes Day.
A diabetic pregnancy is playing life on hard mode. Sadly, most T1D mothers don’t have access to a CGM, which is currently at best partially paid from savings on certain medical aids. Each sensor only lasts for about 6 days, and at R300 a pop it’s unaffordable for most. And that’s in addition to the R12K start-up cost for the transmitter (I did not pay for the transmitter during my pregnancy – Medtronic loaned one to me as the first pregnant South African T1D to have a CGM).
Most T1D mothers-to-be in South Africa also don’t have access to a good diet, time for exercise, a medical team or a strong support system.
In fact, most mothers-to-be in general in South Africa don’t have access to the these things, and in a country where 70% of women are overweight or obese, prediabetes and type 2 diabetes is becoming more common in women of childbearing age. Type 2 diabetes is much, much more common than type 1 diabetes, but both diseases lead to high blood sugars that are harmful to the growing fetus.
I no longer see a CGM as a luxury; I use it more than a car or a phone or a laptop, and it makes life pretty normal for me.
Luckily most mothers don’t need an expensive cyborg technology to protect their baby; veggies and dog walks go a long way towards preventing or managing diabetes, whether pregnant or not.