September 24, 2001
Question from Catania, Sicily, Italy:
I am a 31 year old woman with type�1 diabetes, and my husband and I would like to try for children, but I have been told that I should lose about 10 kilos and also get my blood sugars under control first. The problem is my morning blood sugars are 250-350 mg/dl [13.9-19.4 mmol/L]. Exercise in the evening after dinner has helped recently with readings down to 120-140 mg/dl [6.7-7.8 mmol/L] the following morning, but sometimes, exercise and low-carb dinners notwithstanding, I still get a high reading in the morning (too much Exercise sends me into a night hypo, and then I always go high the following morning). How dangerous is the occasional high reading in a pregnancy? My doctor has told me to keep control extra tight if and when I get pregnant and that hypos will be inevitable. This worries me as after a hypo, I always go hyper. Can you give any advice on how this swing up can be avoided or at least reduced?
The time that tight glucose control is most important is the during the preconceptual period and during the first 10 weeks of pregnancy. This is when the developing fetus is most sensitive to the effects of hyperglycemia. However, an occasional elevated blood sugar is probably not of major consequence, particularly if you treat it when you detect the high value. You will have to check your blood sugars frequently (before and after each meal) and be aggressive in your glucose management with insulin. Adhering to a proper diet with regular meals is important. If you have access to a dietitian, you may want to review your daily calorie intake and how it is distributed among carbohydrates, protein and fats.