I would have to say I was pretty lucky in the way of pregnancy symptoms at first, as in I barely had any! I was really worried about morning sickness. I had read of scary scenarios where people bolused insulin to cover a meal and then couldn't eat, or they couldn't keep it down and then had spirals of hypoglycemia while trying to choke down juice or glucose tabs. Not a problem of mine! I was eating like a champ and downing more carbs than I normally would have because my body required the energy most of the time to avoid a low. My thoughtful hubby did get me a food scale for my birthday which made it much easier to count carbs and measure portions in conjunction with Calorie King. Most "normal" (non-diabetic) people would probably have been a little upset with the gift, but my type 1 self was pretty pumped about it. Around week 7 my appetite plummeted and I had a strange aversion to meat and vegetables that lasted about a week. Then it was back to eating as normal.
As far as my insulin requirements, my basals were scaled back to prevent me from going low in between meals but my bolus ratios were almost immediately increased to prevent the after meal glucose spikes. I felt like I was taking much larger boluses than I was used to, but in order to stay under 120 1 hour after eating my endo knew it was necessary. Another big difference was that my endo team said in order to keep my blood sugar that low 1 hour after eating but to avoid a hypo at 2 hours, I should eat a small snack without bolusing about an hour and half after eating my meal. In other words, we know we are overdosing you with insulin to keep the postprandial readings down so then you need to eat more to even out. After a few days it was clear that it was working well. Almost too well! I had not seen numbers this smooth in years! My next hemoglobin A1C reflected the efforts. It was in the 5's which I had never seen since managing my own diabetes.
I had biweekly meetings with my endo during this critical period of organ formation. This really helped me stay on track along with stalking and logging my blood sugars by testing upwards of 15 times a day and using my CGM data. I found that after breakfast blood sugars were the hardest to control, so I started eating the same breakfast EVERY day. Greek yogurt with fruit and almonds. This seemed to keep me pretty stable and full from the protein and fat. My overnight readings remained awesome and mostly stable according to my CGM, landing me under 100 each morning for fasting readings which is the goal during pregnancy. I did have a good number of nights during the first trimester where my CGM would alarm me that I was low, so I would wake up and have a few sips of juice or a literal bite of a granola bar. My endo loved those comments on my log sheet... he said he's never seen anyone be so specific.
All in all, we were off to a great start. No icky pregnancy symptoms, no blood sugars running rampant, nothing too bizarre aside from the frequent need to eat to avoid a low. (What's a pregnant woman to do?!) I did get some disappointing news after visiting my opthamologist in the first trimester also mandated by my endo. He nearly flipped when I said I had not scheduled an appointment yet and I was only around 9 weeks at that point. I went to my appointment expecting the usual exam of the front of the eyes, dilating drops, and then an exam of my retinas to make sure there wasn't any retinopathy present. The last year my eyes had been clean with no evidence of diabetes. My doctor examined my eyes and said she didn't want to alarm me, but she did want me to see a retinologist because she thought she saw a few microaneurysms. Nothing to freak out about, right? It's only possible bleeding in my eyes!
I made an appointment with a specialist and went in very nervous. This time they took very fancy digital pictures of my retinas using a special machine and examined my eyes like usual. The good news was that my eyes were in good shape for someone with diabetes for 27 years, but the bad news was that indeed there were a few microaneurysms in each eye. No bleeding or leaking which is good. Non-proliferative retinopathy is what he called it. I was told that because of all the hormones and extra fluids in pregnancy that sometimes it could drastically worsen, but then usually regresses after delivery. It could play a role in how my baby would be delivered. If it did progress, there was a chance that a c-section would be recommended to save my eyes from the strain of pushing and ultimately rupturing a vessel. But it could also stay at baseline. All I could do was schedule a follow up appointment during the second trimester and see.
I felt a little defeated. Did I fail myself? Was I going to fail my baby? Was it something I did or all the things I didn't do? I was scared and uncomfortable to admit that this was a complication of diabetes. Why is that uncomfortable for people in this community? Because it usually assigns blame to the person for not handling things appropriately instead of to the disease that causes it. People are judged unfairly when they say they have complications whether or not they are controlled. Control alone isn't always enough.
I went home feeling some anxiety, but still happy that the baby was healthy so far. I tried to concentrate on my small miracle and keep my blood sugars happy without letting worry interfere.
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