People with type 1 diabetes (T1D) are often told “no.” We hear the long list of things we shouldn’t eat, and shouldn’t do, and shouldn’t even think about trying. For things outside of managing my T1D, I subscribe to the concept of “asking forgiveness, not permission.” (Like when I pierced my belly button when I was in college—my parents weren’t consulted, or pleased, but I did tell them I was sorry.) But when it comes to my health or the health of someone I love, I am a fastidious planner. And when it came to achieving one of my biggest goals—motherhood—I started planning well in advance of the actual conception. My own health and the health of my future child hung in the delicate balance of preparedness, diligence, and a hearty dose of luck.
There’s a lot that goes into planning a pregnancy when you have T1D. (Let’s be honest—there’s a lot to pregnancy with or without T1D; pregnancy is chaos defined, only in a round, beautiful way.) For me, my hemoglobin A1C (A1C) has always been a trouble spot. I have never achieved numbers below seven percent without experiencing debilitating low blood sugars, so aiming for my Joslin Clinic–suggested goal of less than seven percent was a big goal for me to achieve. However, in pursuit of a healthy pregnancy, I made it my priority.
When I was 24 years old, after 17 years of living with T1D, I decided to ditch multiple daily insulin injections in favor of an insulin pump, in an effort to smooth the spiking blood sugars of my “dawn phenomenon,” where I’d wake up within range, but then see an 80-point jump every morning, even without eating anything. I needed the ability to bump my basal rates! Even that decision, though made well before I even met my husband, was rooted in the pursuit of parenthood. I knew that the better controlled my T1D was, the better would be my chances of being healthy and “ready” when it came time to think about starting a family. So the moment that little beeper-esque insulin pump was clipped to my hip, I knew that my brain was subconsciously in mommy mode.
A few years later, I started to develop severe hypoglycemic unawareness. This meant that my hypoglycemic symptoms of shakiness, confusion, and emotional outbursts were replaced by a dull nothingness, leaving me numb until I happened to test and would see the startling “34 mg/dL” staring back at me from my meter. After several assistance-requiring low-blood-sugar episodes (one when the paramedics were called, and a dozen or so when I wasn’t able to care for myself and needed to rely on my now-husband), I started on the Dexcom continuous glucose monitor (CGM). This device was, and remains, my T1D safety net. It helps me rein in my standard deviation, of course, but it also lets me fall asleep without that nagging fear of a symptom-free low blood sugar in the middle of the night, and aids me in catching high blood sugars faster. The security of the CGM helped me retrain my body to tune in to low and high blood-sugar symptoms. And, in the moments when my body forgot to listen, it sounded its alarm to remind me.
When my husband proposed, in March of 2007, we started talking almost immediately about having children. We weren’t in a rush to jump into parenthood, but we knew that two decades of T1D, plus unrelated fertility issues, could make for a tough journey to having a baby. My endocrinologist at the Joslin Clinic in Boston, MA, advised me to get my T1D under tight and steady control before conception, and I took her advice very seriously. So while I was planning my wedding, I was also planning my future pregnancy.
A few months before I began trying to get pregnant, in May of 2009, my endocrinologist recommended that I switch over to the diabetes and pregnancy clinic offered at Beth Israel Deaconess Hospital, also in Boston, so that I could rein in my blood-sugar levels even further in preparation for my future child. My medical team, knowing my history of struggling for an A1C lower than seven percent without excessive hypoglycemic episodes, advised me to shoot for seven percent (steady control, without excessive highs and lows), before trying to conceive. After two months of fine-tuning and hyper-obsessiveness, I finally hit my goal, and my husband and I took that leap of faith.
I worried that it would take months for us to get pregnant, but we had the blessing of a pregnancy in our first month trying. (Actually, we found out at a routine checkup at the pregnancy clinic. Those two pink lines on the pregnancy test caused me to gasp, and the certified diabetes educator [CDE] clapped excitedly and exclaimed: “We never get to tell people! They usually come in to tell us!”)
During the course of the next eight months (yes, eight … more on that in a minute), T1D management was the focus of the majority of my life. I have never stalked my blood sugars with more rapt attention than I did when I was carrying my baby. Every fasting blood sugar was logged and analyzed, and I wore my Dexcom CGM every day. There were dozens of ultrasounds, two fetal echocardiograms, bi-monthly lab work sessions, and countless appointments with CDEs, my endocrinologist, and the high-risk obstetrician-gynecologist (ob-gyn) team at the pregnancy clinic. The only blessing in these constant appointments was seeing, with regularity, that our child was growing well, and right on schedule. And the morning of our 18-weeks ultrasound, we learned we were having a girl. A girl! Nothing mattered more than keeping myself healthy so that my daughter would be healthy.
Like all parents-to-be, my husband and I worried incessantly, prayed consistently, and loved our child-to-be intrinsically.
There were moments that I don’t like to replay in my head. Like when I was seven and a half weeks along, and there was an afternoon of bright red bleeding. I spent the day in the emergency room, praying for my baby’s safety while they scanned me with the ultrasound machine, but I was ultimately reassured to see the strong and steady heartbeat of our baby. Every high or low blood sugar gave me pause as I frantically worked to correct the numbers and protect my growing child. And when my medical team advised me that a Caesarian-section delivery was best—due to my preexisting diabetic retinopathy, which was exacerbated by pregnancy hormones—I felt defeated, like I had somehow not worked hard enough.
The last few weeks of my pregnancy were very stressful. In addition to managing preexisting T1D, I ended up with preeclampsia (a disorder that occurs only during pregnancy and postpartum, defined by high blood pressure and protein in the urine, and “cured” only by delivering the baby) and spent the last month of my pregnancy on bed rest in the antepartum suites of Beth Israel Hospital in Boston.
“We’re going to do our best to keep your baby inside of you until you hit 37 weeks, OK? That’s the best chance for a healthy baby and a healthy mom. We’re going to work together to keep you both OK,” my ob-gyn said, holding my hand the morning after I was admitted.
The hospital stay was very taxing, both emotionally and physically. I wanted to be an example of a healthy T1D pregnancy, and I felt like I was failing with every passing day. I wanted to have my baby without surgical assistance, full-term, and without complications. I was furious at T1D for making my pregnancy feel less magical and more clinical, and I was upset with my body for creating a difficult environment for my growing baby. Although it was very challenging, I worked hard to “keep my eyes on the prize.”
It’s funny, though, what things you end up remembering more clearly than the difficulties. April 15, 2010, dawned sunny and bright. My husband and I were brought to the operating room, and in what seemed like just moments later, the sound of my daughter’s cry pierced the air. The medical team cleaned and swaddled my child, and then brought her over to me.
“Oh, my baby. It’s you. I’m your mommy. I love you.” I murmured the same sentences to her, over and over again, marveling at the fact that this tiny baby was just tucked inside of my body, and now she was breathing the same air as me, nestled between her mother and father for the first time in all of our lives. I thought about how hard I had worked to make my baby healthy and strong. How hard I would continue to work to ensure that she and I, and her daddy, would have a long, healthy life together.
T1D may have impacted much of my pregnancy, but it didn’t touch my daughter. She is silly, healthy, and the greatest joy I have ever known. The years of planning and the months of worrying all gave way to the victory of motherhood. T1D just wasn’t part of the moment she arrived into our lives. My heart didn’t have room for anything other than love for my daughter.
Women with T1D have healthy babies all the time; it’s possible, it’s happening, and it’s an amazing testament to how far we’ve come in managing the disease. Despite the challenges of my own pregnancy, I’m proud to have joined the ranks of motherhood through nothing short of a hard-earned, well-planned miracle.
Kerri Morrone Sparling has been living with T1D since 1986, and is the creator of SixUntilMe.com. She is a freelance writer and global public speaker, and lends her voice to many diabetes-related publications, conferences, and causes. Her diabetes-related disclosures can be found here: SUM Disclosures. Kerri lives in Rhode Island with her husband and their daughter.