I talk a lot about diabetes on my blog. Mostly Type 2 diabetes and gestational diabetes. Today I want to shout out to the Type 1 diabetics who make up about 10% of diabetics in pregnancy.
Is there a difference between Type 1 diabetes and Type 2 diabetes in pregnancy?
You may ask, “what’s so special about Type 1 diabetes?” Diabetes is diabetes, right? Wrong.
Type 1 diabetes has a very different cause. And even though Type 1 and Type 2 diabetes and gestational diabetes have a lot in common (high blood sugar), the way this happens is different, and the treatment can be different.
With Type 1 diabetes, the body doesn’t make enough insulin. So glucose can’t get into your cells because insulin is required for that to happen. The only treatment for Type 1 diabetes is insulin.
By contrast, with Type 2 diabetes and gestational diabetes, the problem is not too little insulin, but too much insulin. So much insulin that the body becomes resistant to it and begins to ignore it, so it takes more and more insulin to help glucose move inside cells. In Type 2 diabetes, your cells are already overstuffed with glucose. The main treatment for Type 2 diabetes is diet.
In pregnancy, your blood sugar determines what the baby’s glucose levels are. So we want extra glucose out of your bloodstream and into your cells.
There are several important differences that Type 1 diabetics have in pregnancy, as opposed to Type 2 diabetics or gestational diabetics. One of the main differences is that if you have Type 1 diabetes and you become pregnant, there’s a good chance that you’ve been diabetic for a long time.
Most of the time, Type 1 diabetes is diagnosed in childhood, so all your education was received a while ago. Likely, you’ve had a lot of time to forget everything you learned, or you’ve been doing this for so long that you forget how important it is to have normal glucoses. After a while you get a little lax. Many of the Type 1 diabetics that I see in pregnancy have been diabetic for 10 years or more. And their glucoses have been elevated over a period of time. They may not notice this any more, because their bodies are used to operating at a higher blood glucose level. But behind the scenes, there is a lot of damage happening.
The major differences between Type 1 diabetes and Type 2 diabetes in pregnancy
Which brings me to the second difference that Type 1 diabetics have. They are more likely to have microscopic changes going on in the kidneys, the eyes, brain, stomach, and peripheral nerves that control muscle movements and sensory functions in the hands and feet.
The leading cause of blindness in the US is diabetes, and microscopic damage to the blood vessels in your eyes can get worse in pregnancy. It will be important to see the ophthalmologist to check on your eyes.
In pregnancy, Type 1 diabetics are more likely to have nausea and vomiting because of damage to the nerves that supply the stomach. The stomach doesn’t empty as quickly so everything sits there like a rock, which leads to more nausea.
If you take insulin then eat, then throw up, it can be really hard because you’ve still got insulin on board, so glucoses may drop to a low level. Glucoses can be more difficult to control in the first half of pregnancy. On top of that, there may be damage to the microscopic blood vessels that supply your kidneys. The kidneys play a role in controlling blood pressure. So when you’re pregnant and you have diabetes, you’re more likely to have problems with high blood pressure and protein in your urine.
Another major difference is the effect Type 1 diabetes has on placental cells on the microscopic level.
The placenta starts out as just a little bundle of cells that implants in the wall of the uterus. If you have changes to the blood vessels in the uterus and placenta, this can inhibit the growth and development of your baby.
One of the biggest problems that diabetics have in pregnancy is that if their glucoses are poorly controlled, the baby can grow excessively. But with Type 1 diabetes in particular, the opposite problem can happen and babies can fail to grow to their potential. That can be a big problem.
How to treat Type 1 diabetes in pregnancy
Now let’s get to how we treat Type 1 diabetes in pregnancy. The answer is simple. You need insulin.
You may already be on insulin. We look at how well your glucoses are doing on your insulin. Most of the time, we use short acting insulin for mealtimes, plus a longer acting insulin to cover you overnight. Some women are on an insulin pump, and pumps give you constant basal insulin plus extra for meals. In pregnancy, you will need larger amounts of insulin to cover you for your meals.
If you’re already on an insulin pump and you’re doing a good job with that, we’re probably not going to change a thing. Don’t be alarmed if your insulin requirement doubles or triples by the end of the pregnancy.
It’s important in Type 1 diabetes to be consistent about how many carbohydrates you eat with each meal! Whether you’re on an insulin pump or you’re on scheduled insulin injections, being consistent is very important.
Here’s where Type 1 diabetes merges with Type 2 diabetes in pregnancy
Whether you’re on medication or if you’re trying to control your diabetes with diet alone, what you eat, how you eat it, what time you eat it, what you eat it with, and what you eat first, are all very important in controlling diabetes.
So whether you have Type 1, Type 2, or gestational diabetes, if you’re going to eat more carbs at a particular mealtime, just be consistent about it.
What I mean is, if you know that you want to eat a muffin every morning for breakfast, then we will schedule your insulin or your medication to cover you for that. Just be honest about what you are eating, so we can help you be successful managing your glucoses.
We want your insulin or your medication to work for you, not the other way around.
If you have diabetes and are planning a pregnancy, it’s always best to see your doctor before you get pregnant. Your provider can help you make a plan and you’ll know a little bit more about what to expect.
If I meet with you when you are planning to get pregnant, I can send you to the ophthalmologist, check your A1c, and discuss the risks and extra work you’ll need to know about.
We can do any needed testing and diet planning, and we can help you make any tweaks to your diabetes in advance. If your glucoses are elevated in the first trimester of pregnancy, that can mean big problems for your baby. The higher your A1c, the higher the risk of birth defects for your baby.
By the time we get your glucose under control, it might be too late to prevent some of those abnormalities.
In conclusion, there are big differences between Type 1 diabetes and Type 2 diabetes in pregnancy, especially in the first trimester. Once your glucoses are in the normal range, the same important dietary and lifestyle factors that apply to Type 2 diabetics still apply to Type 1 diabetics.
This is a very general overview of the difference between Type 1 diabetes and Type 2 diabetes in pregnancy. If you have diabetes and are pregnant or want to become pregnant, reach out to your health care provider and get started with conquering your diabetes today.
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