YOU Regina Shirley RD, LDN

Taking care of YOU so you can take care of Baby!
Regina Shirley RD, LDN
 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
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?
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 override 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 highprotein 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
Vit B6 to prevent nausea: sweet potatoes and bananas
Organic vs. Non-Organic veggies, fruits and meats
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’
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
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
 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
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
 Preparing your body for
 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
Start from the beginning telling your baby ‘NO’ when
pulling on pump tubing
 Always keep sugar near the bathtub and changing
 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
 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