RE: Scared

Nobody has had an infusion set slip out during the baby dance? I usually disconnect my pump and put it on the night stand. Imagine how funny it was to find out my set had come all the way out of my stomach! Found it a couple days later...TMI, but I thought it was funny.

Wow! Nope never had that happen.  Must not be doing something right lol ;)

I'm 29, T1D since 2000, 31 weeks pregnant with my first baby. A1C was 6.9 pre-pregnancy and has dropped to 6.2 (my endo says it is natural for A1Cs to drop in pregnancy, even in non-diabetic women due to increased body mass).

I use multiple injections and started on a CGM at 13 weeks. I love using the CGM. Although sometimes the readings are a bit off, it is helpful to seen how I am trending throughout the day, and nice to know an alarm will wake me up if I go low during the night. The CGM sensor is looks pretty similar to the MiniMed infusion set I used years ago (more about my pumping experience in a sec). My hubby is not great with hospital/sickness type things (although he is so amazing and supportive regarding my diabetes both pre and now during pregnancy). He is also very open and honest. When I started with the CGM he said he was a bit weirded out by the sensor and he and I were both worried about hitting it or pulling it out during our intimate time. Anyways, we are now both completely used to it and it has not disrupted our sex life at all :) He is just as attracted to me as ever, even with my now huge belly, and especially with my growing breasts ;)

Regarding Lantus... it is has not been sufficiently studied in pregnancy for it to be "approved" for pregnancy. That being said, it is thought that it should act similarly to other insulins which do not increase the risk for birth defects. I have been taking Lantus for years and throughout this pregnancy. So far everything looks great on ultrasound! An important note... every pregnancy has a 3-4% risk for birth defects (this is for all women, not diabetics)... the main risk for diabetic moms are heart defects and spina bifida, but my understanding is that with A1Cs <8 (and especially <7) the risk is not significantly higher than background, so if you are doing your best with your glucose and are in a range your docs are comfortable with, you are pretty much in the same boat as all other women on that front. Of course glucose control is important still for your own health, baby's size, fluid levels, placental function, baby's glucose after birth, etc.

Regarding insulin pumps. I used one for 2 1/2 years staring in 2002. It took me a while to get used to (a few weeks?) it because the particular infusion set I started with didn't work for some reason with my body... the catheter would get bent so I would get no insulin, and was running sugars in the 300s for days. I finally found an infusion set that worked and was pretty happy with the pump. I sometimes got sore at the infusion site after a day or two, and was annoyed with the tubing especially when trying to put on a seat belt. Also, some outfits were problematic. My pump ended up malfunctioning and while waiting for a replacement I went back to multiple daily injections. I realized that I actually didn't like having something attached to me 24/7 and have stuck with injections ever since. I don't' mind taking 7 injections (sometimes more a day) to cover snacks or correction boluses, and my endo seems happy enough with my A1C. I have heard great things from other people about pumps/omnipod, so I think it is really a personal decision.

Sorry for the long response!! I read posts all the time and don't' write often, so guess I wanted to get it all down at once!

Here's my 2 cents on everything mentioned so far...

I didn't plan to be a mom because of my diabetes but had an unexpected blessing, after having D 28 years. Had a healthy pregnancy and my non-diabetic son is a completely healthy kindergartener.  With modern technology, there's no reason a type 1 woman can't have a healthy pregnancy.  

A 6.5-7 A1c using shots is wonderful.  A pump will still help you do better.  With my pump I'll correct a blood sugar of 130, which wouldn't have happened with shots.  While pregnant I had a 5.1 with few lows... almost impossible with shots but wasn't a big deal with a pump.  

I worried about being attached to something too and didn't get a pump until I was 29.  Wish I hadn't waited so long.  Took less than a week to adjust to it.  Now after 10 years pumping I'd never go back to shots.  Main advantage with the pump is you can tailor base rate of insulin to what your body needs.  I can easily skip a meal and have fasted for 24 hours with perfect blood sugars.

During sex it's easiest to disconnect from pump and put the little cap on the infusion site, so it won't scratch your partner.  Blood sugar ususally drops anyway, so being disconnected prevents sex lows.  

Someone may have mentioned it already, but if not you should take a look at the books "Pumping Insulin" by John Walsh and "Balancing Pregnancy with Pre-Existing Diabetes: Healthy Mom, Healthy Baby" by

Cheryl Alkon.  Good information that might help you as you decide what to do.

Thanks so much to everyone who commented about their sex lives while wearing a pump- you've helped put my mind at ease. I'm still in the "honeymoon" phase, so I don't know if it's a good idea for me to consider a pump just yet, but I will keep it in mind as time goes on.

Though not FDA approved for use in pregnancy ( a very difficult and expensive approval and frequently not pursued by the drug companies), there are many cases of use of lantus during pregnancy. Its important to use what works the best to control your blood sugars. I don't believe the insulin used in the pumps are FDA approved either (but am not certain).

Switching to an insulin pump is an option that should be pursued in advance of pregnancy as there is an increased risk for DKA for patients on insulin pumps and also much greater increased risk of DKA for women who are pregnant.

Pregnancy with diabetes is not a cake walk. Its important to take anecdotes about poorly controlled diabetes and healthy outcomes with a grain of salt. Every pregnancy is different and it is dangerous to assume that you'd have the same outcome.

That being said, the stress and the worrying is worth it in the end.

I am going to try Lantus again to see if it makes a difference in my control. I know that there is no evidence to say that it isn't safe, but adding another possible risk factor does worry me. I realize, though, that it would be better to be controlled on Lantus than uncontrolled on N. if I'm still having problems on Lantus, maybe I will try a pump.

I have the most trouble with my sugars overnight. Sometimes my sugar seems to creep up all night, and other times I wake up at 50 at 2am and need to have juice. My doctor said the goal is to wake up under 95 each day, which seems really difficult to me. A lot of times, I am around 120 in the morning, but is that too high? Have other people been able to consistently be under 95 in the morning?

Jenpsu2, I have been taking NPH before bed each night, and been pretty successful at having sugars between 75 and 90 every morning without having lows at night. Just have to find the right amount, and keep records so you can tell if your BGs start creeping up and you need to start taking more and more. At the beginning of my pregnancy, I was taking 10 units NPH before bed- now at 37 weeks, I'm taking 20.

Make sure to test before bed too- I usually eat about 15 carbs or so if I'm under 90 before bed just in case, and since it won't raise my BG too high. Just make sure not to take short-acting insulin right before bed, unless maybe you're really high, but then set an alarm to wake up to test just in case.

That's my 2 cents. Good luck!

I would definitely advise a pump, and if you don't like the idea of disconnecting for sex, the Omnipod (tubeless pump) is great. You can keep it on while you shower, swim, have sex, do sports...everything. I actually hated the traditional pump and was on shots until my doc suggested the Omnipod -- and now I love the control the pump gives me, particularly now during pregnancy. Whichever path you take though, pregnancy is a lot of hard work, but it is very do-able.

Pumps are definitely more convenient. However, studies have demonstrated no improvement in glycemic control for pump users as compared to those on injections. Though many of us can provide anecdotes, its not applicable to everyone.

A pump is a large expense and once you dig in, you're in  with that company for 4 years or duration of warranty.

While Omni-Pod is the first "patch" (or tubeless) pump, there are several more on the horizon that are sleeker and may be more appealing. It would be a pity to enter into a contract deal and then have to wait for 4 years for the subsequent upgrade.

There are two patch pumps in the works of FDA approval about which I'm excited. First, the Solo Micro Pump (http://www.solo4you.com)  is sleeker but seems very similar to the Omnipod.

Even more exciting is the Jewel (http://www.jewelpump.com). What is so innovative about this (aside from the sleek and colorful infusion cartridges) is that rather than the wireless controller, you can control it with your PDA or smart phone. I think this one will be the big deal given that carrying around the wireless remote AND a phone seems like too much when you can carry one.

Until then, Tandem diabetes has a sleek new tubed pump that has garnered FDA-approval.

These are just a few things to think about.

As I mentioned, pumps offer convenience but don't necessarily confer much glycemic advantage. However, continuous glucose monitoring is a different story and has been demonstrated to improve HbA1c in patients on both insulin pumps and injection therapy. Personally, I believe that all people with type 1 diabetes should be on a CGM. The information is invaluable and can reduce the amount of time spent hyperglycemic (high) as well as alert you prior to becoming hypoglycemic (low).

Lots of info but worth thinking about!

It's reassuring to hear about your successes with pregnancy and diabetes! For those of you who have had A1Cs close to 6 during pregnancy, are your sugars ever in the 200s? I have a Drs appointment in the beginning of March to see if my sugars have been good enough to start TTC. I think my A1C will be in the low 6s (hopefully) but I still have some sugars that are 250 and some that are 50. I am 50 more than I am 250. I'm not bouncing between high and low all day, but I get the occasional high reading. Is my Dr going to say this isn't good enough? Do other people have some highs or are you able to keep your sugars very tight?

Yes, I did (this was a long, long time ago in what feels like a galaxy far, far away ;-).   You will have BGs outside that 'perfect' window.  Hopefully you are checking BG more often and can fix them faster than you normally would.  That is what pregnancy is all about.    Try not to worry too much about the individual numbers - fix and move on.  Good luck at your appt!

I wanted to comment on the question about the pump- I didn't want to be attached to anything either and it was my main reason for not getting a pump, but a few years ago I started using the Omnipod pump and it's been amazing- there is no tubing, it's just an individual pod that sticks to skin and you work it with a remote control of sorts, change it every 3 days. That coupled with the CGM has been amazing and knowing that you can watch your blood sugars on the CGM and either increase or decrease your basals to adjust has been so much better for management!  My husband and I are just now starting to try for a baby and these 2 things are the reason I feel comfortable doing now .

I have a pump and dresses were an issue for me... I found that wearing spanx the ones to just above the knee (of course when I'm not pregnant) and putting the pump in the leg of the spanx with the buttons facing out for easy button access under the table... its not 100% comfortable but it is better than the bra stuffing trick i used to try!