Taking care of YOU so you can take care of Baby!

Regina Shirley RD, LDN

www.ServingUpDiabetes.com

Review the various perspectives of T1D and pregnancy and how it effects all involved

Myths vs. Reality

Planned vs. unplanned pregnancy

Blood sugar management and other T1D tips

Nutrition pre and post-partum

Breastfeeding and T1D

The role of the T1D Dad

Postpartum Depression and Mood Disorders

Parenting with T1D

Supporting Your spouse with T1D

The mother of a young daughter or son with T1D worrying if they will ever be able to have a family of they’re own.

The young women with T1D wondering if all those years of not-so-perfect A1c’s will effect her ability to carry a healthy pregnancy.

The young man with T1D worrying if he will pass T1D on to his child.

For all those who are living with T1D or who love someone with T1D and can’t fathom how in the world you will be able to take care of a baby and still take care of your diabetes…

So you have gestational diabetes?

Is your baby going to be huge?

Is a c-section unavoidable?

Will the baby have diabetes?

Don’t EVER say to a diabetic mother: “Well, if your child gets diabetes, at least

you’ll know what to do and how to handle it.”

If an immediate relative (parent, brother, sister, son or daughter) has type 1

diabetes, one’s risk of developing type 1 diabetes is 10 to 20 times the risk of

the general population; your risk can go from 1 in 100 to roughly 1 in 10 or

possibly higher, depending on which family member has the diabetes and when

they developed it. (taken from the Joslin Diabetes Center website)

Will I die like Julia Roberts did in Steel Magnolias?

How important is it for men with T1D to be in good control?

Guidelines for A1C for planned pregnancy

Before pregnancy, target A1c is as close to normal (A1c <6.0%) as possible

without significant hypoglycemia

Throughout pregnancy, pre-prandial (before meals) blood-glucose levels of

60 to 99 mg/dL; two-hour postprandial (after meals) plasma blood-glucose

levels of 100 to 129 mg/dL; mean daily glucose <110 mg/dL

Pump or MDI (multiple daily injections) and use of CGM?

Unplanned? Focus on getting on track NOW!

Important things to Focus on:

physical health, nutrition

setting up doctor appointments

preparing for an increase in unexpected low blood sugars

how to manage diabetes with the symptoms of pregnancy

(nausea, insomnia, migraines, forgetfulness, hunger, etc)

What does worrying do to our blood sugars?

Miscarriage

Macrosomia

Pre-eclampsia and potential toxemia (high BP)

Bed Rest

Birth defects

Still birth (5x greater risk)

Worsening Retinopathy

Keep a positive outlook and take advantage: Emailing blood sugars to your medical team

Use of a CGMS if possible

Genetic Screening

Avoid unnecessary stress

Stay in good physical health

Get plenty of rest and stay hydrated

Control what you CAN control and DON’T beat yourself up

Keep extra pump supplies, test strips and insulin (and low blood sugar treatment) on all levels of your house, car and work.

Set reminders on your cell phone to check BG’s more (expect to be checking up to 12 times per day!)

Don’t be tempted to over-ride boluses!

Upload your pump/meter to software to keep track of patterns that change frequently when pregnant.

Take as many classes as

you can!

Keep a notebook of

symptoms of lows and

highs, as they may be

different when you are

pregnant or right after birth.

Cook and freeze meals

before the baby arrives.

Keep in mind the foods

should not be loaded with

carbs and/or dairy/spicy.

Have a list handy of high-

protein and healthy foods

to have a friend or spouse

pick up for you at the

grocery store.

Most important nutrients during pregnancy and post-partum Folic acid *start taking prenatal vitamins plus DHA three months ahead

Omega-3 fatty acids – salmon, nut butters, flax oil, omega-3 added eggs or milk

Water!!!!

Vit B6 to prevent nausea: sweet potatoes and bananas

Organic vs. Non-Organic veggies, fruits and meats

TOP 10 FOODS: Eggs –iron, choline (brain development)

Greek yogurt – protein, calcium, probiotics

Bananas - helps baby form red blood cells and antibodies, potassium for leg cramps

Salmon – (wild caught) Omega-3’s

Tomatoes – antioxidants (vit C and potassium)

Sweet Potatoes – antioxidants, Vit A, C, B6, folate and fiber

Spinach – antioxidants, vitamins, minerals and namely folic acid

Beans – fiber, protein, iron and zinc. Fiber is key for stable blood blood sugars

Lean Meats – protein, iron, zinc, and choline

Arnolds bread varieties – protein, fiber, even Omega-3’s! And whole grains

Other: avocados, nuts, berries, almond milk

***See my blog posting on ‘Top 10 Foods for Pregnancy and Diabetes’

Preparation Take classes

Be prepared with low blood sugar treatment in all rooms of the house, and foods that may effect the baby (i.e. caffeine, spices, sauces, veggies)

Look into a Doula or LC

Understand the risk infection may play with blood sugars

Skin on skin

Risk of low blood sugar to baby and use of formula

Rooming in and no pacifiers

Problems: thrush, mastitis, clogged ducts, latch issues

Milk production changes/growth spurts and blood sugar fluctuations

Formula: Hydrolyzed milk protein formula will decrease risk of allergy and other autoimmune conditions

Benefits Promotes bonding between

baby and mother

Helps mom recover better after birth (uterine contraction, decreases bleeding, etc)

Eliminates need to prepare, mix and wash feeding equipment

Saves money spent on formula

Breast milk is high in natural antibodies, probiotics

Decreases risk of breast cancer and ovarian cancer for mom

Aids in maternal weight loss

Provides immune protection for baby (breastfed babies may not get sick as often)

Prevents or decreases risk of allergies and autoimmune

Many cognitive and motional/psychological benefits

Are you at risk?

Anyone is really at risk, but if you have at least some of the following factors, you are at greater risk.

People with diabetes, especially those that have suffered with depression or anxiety

Someone who has experienced a traumatic event or change while pregnant (death/loss, major move or job change)

Family hx of depression or other mood disorders

How to recognize and cope

May not be aware it exists for many months

Symptoms vary…PP depression, mood disorder or psychosis

Family and spousal support, blood sugar mngmnt, physical health

Medication (considerations if still nursing)

Getting your doctor involved and finding a psychologist

Being the T1D Dad Your physical health and

well being needs to take precedence

Preparing your body for conceiving

Being a role model

Helping your spouse manage your diabetes (mood and energy shifts) along with the baby’s needs

Spousal support for your T1D wife Being her coach: thinking for

her when it comes to juice/water and remembering to check BG’s

Be patient!

Understand any exhaustion is coupled by blood sugar fluctuations which equals a small nightmare…hang in there, you will get your wife back someday

Be supportive…but realistic… a little sunshine or a walk isn’t always the best answer.

Listen…listen…listen

Start from the beginning telling your baby ‘NO’ when pulling on pump tubing

Always keep sugar near the bathtub and changing table

If home alone with the baby for a night make sure someone checks in on you in the morning

Wear a CGMS when possible

Create calendar reminders for reordering prescriptions

Allow your A1C some room to chill-out!

Eat when your baby eats…it benefits both of you!

When questions arise from the little one

Advocating for your diabetes during your

hospital stay

The transition of going back to work

Healthcare costs

Preparing for another baby

Dealing with unwanted weight gain

Hypoglycemia unawareness and other ways

your body changes (i.e. digestion, thyroid…)

Seeking support through breastfeeding groups

and mothers groups

THANK YOU!!