I’ve had type 1 diabetes for 14 years. I have been trying hard to get my A1c down because I wanted to minimize complications, and help with the complications that I already have. I saw my doctor yesterday and was told that my A1c was 5.5. I was thrilled, but my doctor said that this is too low.

I have had several lows, generally running in the 40s to 50s mg/dl [2.2 to 3.2 mmol/L], but I have always been able to catch them and treat them. Why would this be considered too low? I want to get pregnant soon, and I thought that the lower the A1c was the better it was for me and the baby.

I think you are both correct in your own way. First, you are correct that you want to have a normal A1c at the time of conception to minimize the risk of the teratogenic effects of hyperglycemia. However, we also know that the lower the A1c, the higher the rate of low glucose reactions. This might be acceptable for a short-term period like pregnancy, but frequent lows is not something to tolerate indefinitely. You see, the more lows you get, the more likely it is you will lose your early warning symptoms for hypoglycemia. If you lose your symptoms, your first manifestation of a low glucose could be a seizure or loss of consciousness. You will have to reach a compromise with your physician. More frequent lows during pregnancy may be tolerable during pregnancy, but not long-term.

JTL