Rossitza, from Sofia, Bulgaria, has been living with type 1 diabetes since childhood years – diagnosed over 26 years ago. Also a volunteer for the Bulgarian Diabetes Association, the dedicated advocate in January became a mother to her firstborn child, Stella. Rossi shares her experience in this DiAview:
What were your personal thoughts about pregnancy with diabetes?
“I participated as a volunteer in the making of a documentary about pregnancy with type 1 diabetes a few years ago, so I had a lot of information beforehand about it – target HBA1ac, target BGs ranges, needed additional medical checks, possible complications and risks, psychological impact etc.
When I look back, I think that having so much information beforehand could give you a lot of pressure. I knew that the advice was for the pregnancy to be planned so I was preparing myself for almost a year. I was trying to have the perfect values (hba1c lower than 7, great BG control, hormones checked haemoglobin in a good range – I had anaemia a few years ago) and at some point, it all became overwhelming. Then covid happened and my BG control became much easier because I was working from home and my routine became very predictable. So, I started to feel pretty assured finally that I have my blood sugars under control. Of course, with a global pandemic in the picture everything looked more complicated and scarier. My hba1c was 7.1 at that time but I felt like I could not wait anymore because it looked like a never-ending story – having everything under perfect control in perfect conditions.”
In Bulgaria, what kind of diabetes care is available to you? And did this have any impact on your plans for managing t1d during pregnancy?
“Well because of covid my regular diabetes check-ups were postponed (annual eye check, tests for neuropathy), so I was only checking my hba1c and labs tests for my kidney’s functions. Of course, once I got the two lines on the pregnancy test, I immediately told my endocrinologist. One of the challenges for pregnant women in Bulgaria with type 1 diabetes is that there is not an official way to have a medical team assembled to follow their pregnancy. So, I contacted my endo, then got in contact with one of the best OBs having a lot of experience with women with type 1. I am lucky enough to live in the capital.
I think it is really important to find doctors you trust who have experience with pregnant women with type 1. I felt in good hands and followed their advice entirely. This helped my mental and emotional well-being as well.
Because of my diabetes I had to undergo additional screenings and ultrasounds during my pregnancy. My kidney’s function was checked regularly so was my blood pressure – they prescribed me aspirin as prevention of preeclampsia.”
How did ‘diabetes routines’ change during your pregnancy?
“I would say that my entire pregnancy was a beautiful journey but also a big challenge – there was a constant change in my insulin needs and it felt so weird because as a type 1 for so many years, I know my body, I know how I react and now it was a completely different story every couple of months, sometimes even days. The last month was the hardest for me because I had to have a really tight control – my doctors already warned me to not have spikes, so the baby don’t gain any more weight and my OB was most concerned about the lows because they are really dangerous for the baby during the last month. I was sending every day for a month a log with my blood sugars and my pump basal and bolus rates to one of my endo and we were making updates every 2-3 days even each day at the end. She helped me so much (really very much).
The first three months were easier for me – blood sugars were in range without a lot of efforts – my body helped me to adapt. From week 26 the insulin resistance started for me. It was very unusual having to increase my basal rates all the time. Most visible as needed update were my basal rates during the nights. Hormones can be really surprising.
As I was planned for a c-section (baby was growing quicker – macrosomia) my endo prepared me a c-section diabetes plan with decrease of my basal rates the night before the c-section and the first days. It was a significant decrease like having temporal basal rates of 30% only. The aim was for me not to be in hypo or hyper during the surgery. With the placenta growing older insulin needs decrease significantly.
Once the baby was born and the lactation started I was having lows so I needed to adapt my insulin doses once again.
I would say that pregnancy is a constant change of insulin needs and doses.”
What did you learn about yourself throughout this process of being pregnant and then becoming a mum?
“I really like this question – to be honest, it is the first time I am thinking about it.
I got my last HBA1C yesterday and it is my best for some years (6.3%) and my pregnancy taught me that when I am really, really motivated I can find the ways to take good care of myself and my diabetes. I just need to be patient and to not give up when there are bad days and things are not going the way I expect them to.
I am surprised by myself – I didn’t panicked during a global pandemic, being type 1 and pregnant for the first time. I was rational and even if there were some difficult days, I was enjoying these special 9 months.”
Now as a Mother to the beautiful Stella, has this also meant a different approach for you to your diabetes management?
“I think I am more cautious with the lows when I am alone with her, this is one of my biggest fears- having a serious low when she depends on me.
I need to remind myself sometimes to take care of my diabetes – it is so easy to focus only on her and to neglect my diabetes management. For example, to forget to bolus for my meal or forget that I have bolused and I have to eat 🤣
Every time I have a series of bad numbers I remember that one of my friends (endocrinologist med. student) told me once: please look after yourself because so many moms have such bad blood sugar control once they have their babies.
Now I am wondering how to secure better my devices (pump and sensor) as these little hands of Stella are starting to pull everything on her site.”
What key message would you like to share to others living with t1 diabetes and thinking about pregnancy?
“I want to tell them that pregnancy with type 1 diabetes is a beautiful, sometimes challenging journey. It is like a marathon run – you need to prepare yourself in advance, balance your resources and continue the run even after the baby is born.
My advice is to find really good support – from family, from their partner, friends, other type 1s because there will be good days, there will be hard days and with all these crazy hormones you need to rely on the people around you. Also it is really important to feel in good hands – to have trust in your doctors – OB and endocrinologist.
Enjoy your pregnancy, keep your eyes on the prize and just don’t try to control everything.”