Pregnancy With Type 1 Diabetes: Diabetes Management Updates & Insights Each Trimester
Disclaimer: This article is for general informational and educational purposes only and is not intended to provide medical advice, diagnosis, treatment, or other healthcare services. Always consult your healthcare team before making changes to your diet, medications, insulin, or diabetes management.
We are thrilled to share that we’re expecting a baby boy in early 2027!💙
I’ve been a little hesitant to share about pregnancy and type 1 diabetes because this is such a personal and vulnerable season for me and my family. I know many people with T1D have questions and concerns about a high-risk pregnancy, and I hope sharing some of my experience can help others feel a little more prepared and less alone.Â
I’ll be sharing diabetes-related insights and lessons from my own experience, while keeping many personal details about our pregnancy and family private. I’m grateful to be able to share some of this experience with you, while still keeping parts of it just for us.
Preparing for Pregnancy With Type 1 Diabetes
Over the last few years, I’ve been slowly and intentionally preparing myself for pregnancy. After managing my diabetes with multiple daily injections for well over a decade, I made the switch to an insulin pump in early 2024.
While other health factors played a role in that decision, I also knew that I wanted to become comfortable with insulin pump therapy well before pregnancy. I’m currently using the Tandem Mobi, which is the first and only insulin pump with FDA clearance for use during pregnancy in people with type 1 diabetes. Knowing that the system had been specifically cleared for pregnancy gave me additional confidence in using it as I entered this next phase of diabetes management.
Before conception, my A1C was below 6%, and after discussing my plans with my endocrinologist, I received the green light to start trying when we felt ready.
But T1D wasn’t the only consideration. I also live with rheumatoid arthritis and Ehlers-Danlos syndrome, so preparing for pregnancy meant coordinating care across multiple specialists and making sure my other conditions were as stable as possible.
In total, it took about six months to get the green light from my entire care team. A big part of that timeline was simply coordinating specialist appointments– some of which took three to six months to schedule. It was a good reminder that preparing for pregnancy with chronic health conditions can involve much more than simply getting your A1C where you want it.Â
Managing Type 1 Diabetes in the First Trimester of Pregnancy
Immediately (and I mean, immediately) after getting a positive pregnancy test at home, I sent my endocrinologist a MyChart message and scheduled an appointment with my OB-GYN. My endocrinologist asked me to send my glucose data through MyChart every two weeks so we could monitor things virtually, and we scheduled an in-person appointment for around 10 weeks.Â
My first OB-GYN appointment wasn’t until I was 8 weeks pregnant, and honestly, I think the waiting was one of the hardest parts. I had positive pregnancy tests at home, but waiting to see our baby for the first time felt like an eternity.Â
Type 1 Diabetes and Morning Sickness
Physically, weeks 5–7 were probably the toughest. And despite the name, my “morning sickness” definitely wasn’t limited to the morning. I was nauseous, hungry, and exhausted throughout the day. Thankfully, I never actually threw up, but feeling like I was simultaneously starving and nauseous was a pretty miserable combination.Â
From a diabetes perspective, this was also one of the hardest parts of the first trimester. I was suddenly navigating tighter pregnancy glucose targets of 63–140 mg/dL while also trying to listen to what my body was telling me it needed. It was a strange mental adjustment to realize that sometimes the thing that made me feel physically better wasn’t necessarily the thing that made managing my blood sugar easier.
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Carbohydrates often helped settle my nausea, but they also meant I wasn’t always able to pre-bolus the way I normally would. At times, I needed to eat every one to two hours because letting myself get too hungry made the nausea worse. I found myself constantly negotiating between feeling better physically and trying to keep my blood sugar in range.
Sometimes the choice felt like: Do I eat what I know will settle my stomach and deal with the blood sugar later, or try to manage my blood sugar more tightly and risk feeling even worse?
That was mentally difficult. I’m used to making very intentional decisions around food and insulin, but early pregnancy forced me to loosen some of that control and give myself permission to prioritize simply getting through the day.
A few things helped make the nausea more manageable. Taking my prenatal in the evening seemed to work better for me, and my OB-GYN recommended taking vitamin B6 throughout the day and Unisom at night. I also kept easy snacks on my nightstand, including prepackaged peanut butter crackers and applesauce (both of which were easy for me to carb count) so I had something within reach whenever I woke up hungry or nauseous. I also found that staying hydrated with electrolytes helped, too. LMNT Raspberry Salt is my favorite!
First-Trimester Appointments and Testing with Type 1 Diabetes
The first trimester came with a lot of appointments and testing. Some of this was simply part of routine pregnancy care– the initial ultrasound, NIPT, and other initial testing. But having type 1 diabetes also meant that my pregnancy was considered high-risk, which meant additional monitoring and appointments, including meeting with a maternal-fetal medicine (MFM) specialist.
There was something emotionally strange about this part of pregnancy. On one hand, these appointments were exciting milestones: seeing our baby for the first time on ultrasound, getting confirmation that everything was developing as expected, and eventually learning that we were having a baby boy through NIPT. On the other hand, each appointment came with a sense of anticipation and uncertainty.
My appointment with MFM was particularly difficult for me mentally. They reviewed my medical history in detail and went condition by condition, explaining how my type 1 diabetes and other health conditions could potentially impact pregnancy. I understood why this information was important and appreciated having a team that was being thorough with my care. But hearing a long list of everything that could happen was difficult, even when I knew that these were possibilities– not predictions.
It was hard to separate being informed about potential risks from feeling like something was actually wrong. Our baby was still so tiny, and I was already adjusting to the emotional and physical changes of pregnancy. Hearing about everything that could happen added a layer of anxiety during an already vulnerable time.
I think this is one of the less-discussed parts of having a higher-risk pregnancy. I’m incredibly grateful for the additional monitoring and for having a care team familiar with type 1 diabetes and complex health conditions. I would much rather have something identified early than go without appropriate monitoring.
At the same time, understanding why all of the monitoring is happening doesn’t necessarily make it emotionally easy. Sometimes, simply being told that something needs to be monitored more closely can make you feel like you’re waiting for something to go wrong. On paper, I knew I was receiving the care I needed. Emotionally, it was still a lot to process.
And the additional monitoring wasn’t limited to appointments. Over the past 12 weeks, I’ve probably done more fingersticks than I have in the entire year leading up to pregnancy, largely because of Dexcom inaccuracies. Before pregnancy, a slightly inaccurate CGM reading was mostly just frustrating or inconvenient. During pregnancy, though, those discrepancies have felt much more distressing. With tighter glucose targets and so much emphasis placed on each number, it can be difficult not to second-guess a reading when your CGM and meter don’t agree. What might have been a minor annoyance before pregnancy can suddenly feel like something I need to investigate, verify, and worry about.
For me, this has been another example of how the intensity of type 1 diabetes management can increase during pregnancy in ways that aren’t always obvious. It’s not just more appointments or more testing- it can also mean more checking, more decisions, and more mental energy spent trying to keep your numbers within a tight range.
How My Insulin Needs Changed During the First Trimester
One of the biggest changes I noticed during the first trimester was an overall increase in my insulin needs. A lot of this was likely related to eating more frequently and consuming more carbohydrates throughout the day. When I wasn’t pregnant, I was used to having a fairly predictable eating pattern. During those first few weeks, that went completely out the window. I was often eating every one to two hours to keep nausea and hunger at bay, which naturally meant more insulin throughout the day.
My basal insulin also increased for a few weeks. Interestingly, though, this wasn’t a steady increase throughout the entire first trimester. My basal needs eventually started coming back down and were close to my pre-pregnancy baseline by the end of the first trimester.
This was a good reminder that insulin needs during pregnancy aren’t necessarily a straight line upward. There can be a lot of changes happening at once– hormonal changes, changes in appetite and food intake, nausea, activity levels, and the normal evolution of insulin sensitivity throughout pregnancy. I found it helpful to focus less on what I thought my insulin needs should be doing and more on responding to the patterns I was actually seeing in my glucose data.
When I met with my endocrinologist around 10 weeks, we rechecked my A1C, and it was the lowest it had ever been in my more than decade-long history of diabetes!
That was a really encouraging milestone, especially after how challenging those first few weeks had felt. It was also a good reminder that managing diabetes well doesn’t always feel like you're managing it well. I had spent weeks feeling like I was constantly adjusting, eating differently than usual, and trying to balance nausea with tighter glucose targets and yet, my overall glucose management was better than it had ever been.
Products I’m Loving in the First Trimester
A few things that have made the first trimester a little more manageable:
Nordic Naturals Prenatal: Taking my prenatal in the evening (and sometimes with applesauce) seemed to be much easier on my stomach than taking it in the morning.
Crystal Light and Electrolytes: Water suddenly tasted so metallic to me, which made staying hydrated harder than I expected. Crystal Light and LMNT have been lifesavers for making water taste good!
Spicy & Savory Foods: I haven't had any strong pregnancy cravings, but I've definitely been drawn more to spicy and savory foods. Apparently, that's an old wives' tale for a boy!
Managing Type 1 Diabetes in the Second Trimester of Pregnancy
Coming soon!
Managing Type 1 Diabetes in the Third Trimester of Pregnancy
Coming soon!
Managing Type 1 Diabetes During Postpartum
Coming soon!
