Taking care of YOU so you can take care of Baby! Regina Shirley RD, LDN www.ServingUpDiabetes.com  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 pregnancy. 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? Miscarriage Macrosomia 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 Water!!!! Vit B6 to prevent nausea: sweet potatoes and bananas Organic vs. Non-Organic veggies, fruits and meats TOP 10 FOODS:           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’  Preparation           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 Benefits           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 change)  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 health 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 precedence  Preparing your body for conceiving  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 answer. Listen…listen…listen Start from the beginning telling your baby ‘NO’ when pulling on pump tubing  Always keep sugar near the bathtub and changing table  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 prescriptions  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 THANK YOU!!