Is it possible to have a baby with these risk factors

[jax32579]

I found out 9 months ago at 25 years old that I am type 1 diabetic, I take 2000mg per day of metformin, 45units of lantus, novalog pen on sliding scale, actos 30mg and 10mg lipitor. I have lost 3 babies in the last 12 months, 2 before I knew I was diabetic 1 after, all 3 with low progesterone. When I found out I was diabetic I brought my numbers down and tried again still lost it. I have 2 children that are 8 & 9 had them with no complications. I the second baby I lost at 15 weeks we had genetic testing done nothing could be found wrong with him. My bs is currently under control, but with the third pregnancy, as soon as I found out I was pregnant my bs started spiking to 350 and 400 and higher. Is it possible to carry a baby to term with my risk factors?

[JDRF-Team-SS]

Hello, jax32579,

First I need you to know that I am NOT a medical professional, so my advice / input is based solely on my knowledge through personal experience with my son.  My son, now almost 10 yrs. old, was diagnosed at the age of 3.  My sister also has type 1 and was diagnosed about 8-1/2 yrs. ago (2 yrs. prior to my son)...she is now 32.

Okay, now I will get to what I really want to say....
I am SO Very Sorry for your losses.  I know first hand that losing a baby no matter how many weeks pregnant can be Extremely painful and heartbreaking.  I lost my first, so this is coming from someone who understands what it is like.  (I am NOT claining to know what it feels like to be livign with type 1 diabetes, I only know it from a mother's satnd point.)

Once again, I am so sorry.  This must be very difficult for you.

Jax, to be completely honest with you, I was unfamiliar with the medications that you mentioned.  (I have heard of lipitor.)  After doing some searching, I found metformin, actos and lipitor.  What I found was that metformin and actos were primarily given to those with type 2.  I am in no way disagreeing with your treatment or your doc's instructions.  Please feel free to enlighten me about these 2 meds.  I have also found that Lipitor is used for individuals with high cholesterol.  (I am not analysing you or your doc, I just wanted to know more about these meds.)

After finding out about the low progesterone, what was the Doctor's plan of treatment?  I am almost positive that I have heard of women being given progesterone at a certain time during their pregnancy to help raise the level to what it should be.  I have a link that has an article including a Doctor's input.  It is entitled, "Recurrent Miscarriage with Low Progesterone."

http://www.ivillagehealth.com/experts/fertility/qas/0%2C11816%2C166390_459%2C00.html

please copy and paste the above url into your browser so you can read more about this.

Another thing I want to ask is, for this most recent pregnancy were you seeing a Perinatologist?  You are considered "High Risk."  After losing my first baby (my son), I saw a Perinatologist.  I obtained a referral from an OB/GYN to be treated by a Perinatologist for the duration of the pregnancy.  I saw a Perinatologist for my 2 subsequent pregnancies.  (after my loss)  A High Risk doctor has experience dealing with / treating women with difficult pregnancies or those of us who have had previous complications or problems.  (Please forgive me if because you are living with type 1 diabetes you fall into that category already and I sound ignorant.)  I just want to make sure you receive the BEST care possible.  

Sorry I cannot directly answer your question:(

As you know there are women living with type 1 diabetes that can have healthy babies.  You need to talk with a Perinatologist before you try to or become pregnant again in  regards to the low progesterone (and diabetes)and see what the treatment would be.  Also, you need to talk to your Endocrinologist about the spikes in the blood sugars during your last pregnancy and what the plan of action or treatment would be for the next pregnancy if this happens.  I do feel strongly that the low progesterone is the cause or main cause of your micarriages.  (but I am not a Doc)

My friend had a close friend who had, I believe 2 or 3 miscarriages and the docs finally realized that her level of progesterone was low and were able to give her progesterone during her subsequent pregnancy and she carried to term, however, she was not living with type 1 diabetes, so you have the issue of trying to maintain good control over your blood sugars and making sure you stay healthy during your pregnancy.

Please visit the link that I mentioned.  (above)

Again, I apologize that I could not give you a straight answer.  I do know that once you lose a baby subsequent pregnancies are very difficult emotionally because the fear is there.  My first baby would have turned 11 on Jan. 10th.  He was born at 23 weeks and lived for 1 hour and 24 minutes, so when I say I know the pain of losing a baby, I really mean it.

Please make sure to see a Perinatologist if you have not already done so.  I cannot stress how important this is, as well as talking to your Endorinologist about your desire to try again, your fears, what the plan would be if your BGs spike too high AND his/her thoughts on another pregnancy in general.

Best of luck...I can assure you that you will receive comments from other volunteers who are VERY knowledgeable when it comes to the medical side of diabetes.

Please post again and keep us informed.  

    
Warmest Regards,
SS

[JDRF - Team- SS]

It is SS and I ma back because I decided that the link I posted in my response was not good enough and I am unsure I agree with part of it.  (Sorry, I should have read teh 2nd page of it before posting:(

Anyway, visit this below - regarding low progesterone levels and treatment.

http://mysite.verizon.net/res1fmz0/id13.html

[JDRF-Team-LRS]

Hello Jax,
I'm so sorry for your losses.  I can only imagine the grief adn the worries.  I've had diabetes for ~35 years, but I have chosen to not have children.  My sister has had diabetes for ~45 years and has two beautiful daughters now in their 20s.  She had had diabetes for a long time when she was pregnant.  While she doesn't use an insulin pump now, she did for both her pregnancies -- pumping 20+ years ago was a lot more cumbersome and less wonderful than it is today.

SS has good advice that your pregnancy is considered high risk.  Are you being followed by an endocrinologist for your diabetes?  Your treatment is unusual, tho' not unheard of.  Are you overweight?

Generally, Type 1s are treated with insulin using a combination of long-acting (like your Lantus) and short-acting (like your Novolog).  Insulin pumps are an excellent alternative once folks have mastered the concepts and complexities of diabetes.

There's a lot to learn about managing diabetes, adn while I'm not a physician, I would recommend that you achieve excellent control for 6-9 months PRIOR to conceiving.  Why?  Your baby will be "growing up" in your physical environment.  High & low blood sugars are extremely stressful to a developing baby and birth defects and miscarriages can result.

Diabetes is an autoimmune disease affecting our endocrine system.  It is not uncommon for us to have/develop other autoimmune problems and/or hormonal problems like you describe.  As you stabilize your blood sugars and achieve superb overall blood sugar control (usually measured by an A1c test every 3-4 months) then  seek out a team of medical professionals who are skilled & experienced working with diabetic moms.  These teams will always expect the pregnant moms to maintain extremely tight control -- which is difficult to achieve.  Best to "practice" that for 6-9 months before bringing a fetus into the picture.

Many women will choose to use an insulin pump, once they've learned the basics of insulin:carb ratios, varying basal needs, and their own insulin sensitivity factor.  Armed with these skills, and then with pump technology to best implement the principles, women have the best chances for meticulously managing their BGs, especially while pregnant.

Increasingly statin drugs like Lipitor, Zocor, etc. are advised for all diabetics and others with high risk for heart disease (diabetics are at high risk for heart disease), even when our cholesterol numbers are considered "good" otherwise.  I believe that as long as our TOTAL cholesterol is over 100, the statins are shown to be very effective in protecting our heart health.  Your doc seems to be applying this new finding in your case.  

Metformin & Actos are most often used in folks with Type 2 to reduce insulin resistance and/or increase the pancreas' ability to produce insulin.  For a type 1, eventually we produce almost zero insulin, so oral meds are useless.  When I was dx'd so long ago, a standard treatment by my endo was to give newly dx'd folks an oral med to squeeze as much out of our pancreas as possible.  Now, a more standard treatment is to give low doses of insulin to NOT stress the pancreas and to allow it sputter & spurt along for a bit more time.

If you are not being treated by an up-to-date endocrinologist, I encourage you to find one.  Read all you can about diabetes, and work with your doctor to stay current on treatments and ways to prevent complications.  I am not a physician, but based on my own experiences learning (and STILL learning) about diabetes, I also encourage you to allow a year or two more for you to really develop deep knowledge of your body's detailed responses to diabetes and your treatment before adding the complexities of managing a successful pregnancy.  Perhaps some of the emotional trauma can heal during that time, too.

And then there's adoption.

[jax32579]

That you for your responces, Yes actos and metformin are generally used for people with type 2. I am taking it b/c the doc thought it would help with the little bit of insulin my body is making. I feel lost sometimes with the level of care I am getting, many peoplr say I should see an endo doc, my ne wprimary seems to feel it is under control. I take the lipitor b/c my cholesterol is 123. I am overweight, had lost 50lbs, very fast but now it is creaping back on, gained 5 lbs. I love the kinds words you guys had and hope to keep my new found support system. any other thoughts are very welcome.

[JDRF-Team-LRS]

Glad you checked in again, Jax.

Primary care docs know a bit about many things and are a great resource to help us coordinate our care from them and from needed specialists.  If you can possibly afford it, I'd encourage you to see an endo who will have very deep knowledge about the many nuances of diabetes management and the latest research results on diabetes care.

I hvae been cared for by a "regular" primary care doc and I have been cared for by an endo.  It was easier to work with a primary care doc -- but the reason was a bad one for me!  I was in denial about both the quality of professional care I was getting and, more importantly, I was in denial about my own self-care and my level of knowledge.  It's easy to think we've mastered this disease, and yet after 35 years, I'm still humbled by what I don't know.

For yourself, for your hubby, for your children and for any children-to-be do get a referral to an endo ... and while you're at it ... to a Certified Diabetes Educator (CDE).  Working with all you know already, these folks will help you get the most positive results from all your hard work, help you learn to recognize patterns and to troubleshoot problem patterns.

Okay, I'm off my soapbox now <wink>,

All the best,
LRS

[JDRF Team SGG]

I must agree with the good advice the others have given here. I wanted to add a bit from the point of view of a type 1 diabetic who has had children while diabetic. While the hormone imbalance that you wrote that you have is probably the cause of your miscarriages, it is known that the first few weeks and months of a pregnancy are the times that are most likely for the child of a type 1 diabetic to suffer from birth defects if the glucose levels are not under extremely good control. Whether this caused your latter miscarriages or not, this is something to be aware of. This is one of the reasons that doctors do like for diabetic women to have extremely good control long before getting pregnant. Also, the last weeks of pregnancy are considered a dangerous time for pregnancy since high glucose levels can damage the uterus in the same way they can damage kidneys, heart, or eyes. At this time, any damage to uterus can cause the baby to lose the nutrition he or she needs to grow and the mom can lose the baby after successfully carrying it nearly to term.

So the best advice that you can be given concerning the diabetes in pregnancy is to keep the glucose levels as much within the normal range as possible. This protects both you and baby. And if you need treatments to balance those hormones in order to keep from losing babies, ask your doctor what kind of treatment can be done to normalize the progesterone levels.

The fact that you are being treated for insulin resistance is worth noting, for this problem tends to become worse after pregnancy as hormones shift, for some female hormones act as insulin-blockers and can cause insulin resistance. Since you mentioned that you are overweight, I need to add that losing weight may be one of the best things you can do to protect yourself and any future baby, for fat cells naturally act as insulin-blockers and increase insulin resistance. So losing fat cells may lower your insulin requirements and help you control your diabetes without as much insulin being required. Some lean diabetics require only minimal amounts of Lantus insulin (I am a thin one, and I need only a total of about 10 units of Lantus per day) to keep good control over those glucose numbers. There are no guarantees, but the weight could be a real health issue in your case.

We wish you the very best of health and hopefully a healthy baby if you wish to have one. Start with the weight loss and tight control over the glucose numbers and then work on the progesterone levels and see what happens.