No couple planning to start a family should have their desire to have children left unfulfilled. But getting pregnant and having a healthy pregnancy can be more challenging for women with type 1 diabetes. Advanced technologies such as automated insulin delivery systems (AID) can help make the wish to have children come true.
The main focus is on keeping blood glucose levels as close as possible to those of healthy people. What is most important is a long-term value – medically referred to as “HbA1c” – of less than 6.5 percent and a fasting blood glucose on waking of less than 5.3 millimoles per litre (95mg/dL). A woman should keep these values as constant as possible during the six months prior to pregnancy. Pump therapy supplemented with an AID is helpful here, as it encourages a flat blood glucose curve. You should start using it at least six months in advance – the earlier the better.
Pay attention to the minima and maxima when selecting AIDs
The wish to have children is a great motivator for many women and they are happy to go the extra mile to keep their glucose levels constant. The automated insulin delivery systems, also known as Hybrid Closed Loop, should allow a target value of 5.3 mmol/L (95 mg/dL) or lower, because some devices do not let you enter a target value below 5.6 mmol/L (100 mg/dL). They are therefore not approved for use when preparing for pregnancy or during pregnancy itself.
What to watch out for when getting pregnant
The following points, among others, are particularly important to reduce the risks for the mother and child:
- Continuous diabetological support
- The ability to assess and screen out carbohydrates correctly
- Knowledge of how to respond to ketoacidosis and how to avoid it
- The ability to control and manage blood glucose yourself
- Avoiding stress
A structured daily routine helps to maintain an optimal blood sugar level. In addition, you should favour foods that keep blood sugar levels low or that are easy to control with the right amount of insulin. If you cannot control your cravings for fast carbohydrates, it is advisable to divide them into several rations.
Smart systems help pregnant women with special programmes
The basal insulin requirement of pregnant women can change every three days. Smart systems store the values retrospectively for up to 14 days and may not be able to make the adjustment fast enough. Such fluctuations can be smoothed out with the boost function, for example. AID systems in particular can make it easier to prepare for and manage pregnancy and bring blood glucose levels closer to those of healthy women – but those affected must have the knowledge and the will to do so.
