Editor's Note: This article is reprinted with permission from Beyond Type 2, as part of our continued alliance.
Written by T'ara Smith, MS, Nutrition Education
Ashley Leigh has been living with type 2 diabetes for over a decade. In those years, she has given birth to two healthy babies. Ashley shared her story with us about how she managed her diabetes while pregnant and advice she has for those with type 2 who are planning to start a family.
When were you diagnosed with type 2 diabetes? Did you experience any symptoms? What was your reaction and your first plan of action?
I was diagnosed about 11 years ago, around the age of 25. The path to my diagnosis was a little strange. I was diagnosed by one doctor, then I moved and saw a new doctor who said I had prediabetes. Then she formally diagnosed me when I needed to start medication. I’ve never had any symptoms or risk factors, other than family history. My diagnosis was determined through a routine blood test.
I didn’t have much of a reaction to my diagnosis because I honestly didn’t know what it would mean for me beyond taking a pill. I didn’t receive any real nutritional advice beyond “watch your sugar intake and I’ll see you back in a few months.”
Does diabetes run in your family?
Yes, I’m the third generation to have type 2, but the youngest when diagnosed.
What was your care like before and after your pregnancies? Did your doctors have to adjust your medication? What changes did they make to your diet and exercise regimen?
Prior to pregnancy, my primary care doctor managed my diabetes. When I mentioned we were thinking of starting a family, she referred me to a maternal-fetal medicine practice. They took me off Janumet and put me back on just metformin, which is safe for all stages of pregnancy.
My A1C was over 6.0, so they gave me 30 days to get it below 6.0 or I would have to start insulin. I also met a Certified Diabetes Educator for the first time and she taught me so much in that first appointment – everything from the relationship between carbs and protein to a week’s sample meal plan. I tightened up my diet to lower my A1C and was given the ok stop taking birth control.
I, with the help of some fantastic ladies at my maternal-fetal medicine practice, managed my blood sugar with diet, exercise, and metformin for the majority of my pregnancies. I had to add glimepiride about midway through both third trimesters as my blood sugar crept up.
I went back to metformin after delivering my first baby. After my second, metformin just wasn’t cutting it anymore and my OBGYN recommended seeing an endocrinologist. I got set up with one and got to work. It took a couple of years of trying different combinations, but I’m in a good spot now with Trulicity and a low dose of metformin.
Were your blood sugar and blood pressure higher, lower, or the same during your pregnancies? How were they monitored and kept in check?
My blood pressure stayed about the same throughout both pregnancies. However, I followed the path of most pregnant women – blood sugar was lower a bit in the beginning, then got higher, especially in the last several weeks. I checked my blood sugar 4-5 times a day, wrote down everything I ate, and reviewed it all with one of the Certified Diabetes Educators at each appointment.
For the first few months, appointments were every few weeks and always included an ultrasound. Around 32 weeks, I started weekly office visits with ultrasounds and non-stress tests.
My last non-stress test showed a very low fetal heart rate, so I was sent to labor and delivery at the hospital, then into an emergency c-section (my second). The cord was around the baby’s neck and I later learned my placenta had started to rupture. As my OBGYN said, “someone was looking out for you.”
What concerns did doctors express about being pregnant and post-partum with diabetes? Did you have any and did your doctors listen to your concerns?
My doctors shared all of the risks of carrying a baby while managing diabetes including birth defects, miscarriage, high birth weight, etc. They ran just about every test they could to rule out any complications early in both pregnancies.
What do you think people with type 2 who are planning families should know?
Women who are planning to become or are pregnant need to advocate for themselves and their baby. Do your own research, ask the questions, and make a plan with your care team for pregnancy and delivery. If you’re not comfortable, figure out why and what needs to change.
Don’t be surprised by a NICU stay. After living in the womb of a woman with diabetes, it may take a few days for the baby to be able to regulate his/her own blood sugar.
Diabetes can also be a contributing factor for preterm birth. Both of mine were early, one because I went into preterm labor, and the second because a routine non-stress test showed an extremely low fetal heart rate.
Diabetes or not, be flexible with your birth plan. I mentioned going into labor with my first baby, but I still ended up having both via emergency c-section – and they’re perfectly healthy today!
How do you live #BeyondPowerful with diabetes and live your best life?
I make time to be active and I’m really looking forward to warmer, longer days ahead with my kids. I ran my first half marathon last year – that was a big accomplishment for me. I’m learning how strength training is an important part of being healthy and preventing overuse injury. Getting stronger every day!