From a young age, Sam Walsh knew she wanted to be a mom. After marrying in June 2023, she and her husband met with the diabetes care team, primary care provider, and obstetrician (OB) to discuss recommended next steps in starting a family with type 1 diabetes (T1D). 

At the time of this interview, Walsh was in her third trimester preparing for the birth of her first child, we are thrilled to announce that she has since welcomed healthy and happy “Baby W”. Here, she’ll share her experiences supporting a healthy pregnancy with type 1.   

 

What does pregnancy planning entail with T1D? 

[Sam Walsh:] Suggestions included getting started on a prenatal vitamin right away and working towards an A1C preferably 6.5 or less.  

By June 2024, my A1C had been 6.3 for about six months — or the past two times I was tested — so we started actively trying for “Baby W.” 

Pregnancy is funny because you never know if it could happen the first time trying or if it’ll take longer. Just because you’re “young and relatively healthy” doesn’t mean it’s necessarily easy to get pregnant.  

We used a few different apps to help track my ovulation cycle. There are a ton out there, but my favorites are Natural Cycles synced with my Oura Ring, Flo, and the Premom apps. While they’re all pretty similar, they have slightly different features — so it depends on what you’re looking for.  

Try not to get carried away with tracking your cycle to get pregnant. It can be helpful, but it can also add stress. 

 

How soon did you notice glucose changes after a positive pregnancy test? 

Before I even had a positive pregnancy test, I started noticing changes in my glucose levels.  

Prior to pregnancy, my glucose would rise significantly a few days before my period, and then I’d be extremely insulin sensitive throughout my cycle. So, when this pattern shifted, and I started to build more insulin resistance, I knew “something was up.”  

As my pregnancy progressed and insulin resistance became the “new normal,” I began to feel like insulin was almost like water. Meaning, insulin was so much more ineffective than it was before pregnancy. 

 

A1C talk: What have your pregnancy glucose goals been? 

There’s a lot of outdated research out there and most endos who don’t live with T1D themselves, are very strict about keeping your A1C under 6.0 and having glucose in-range between 60-140 mg/dl for 75% or more of the time.  

While I think that’s a reasonable goal, I’m personally satisfied with my A1C under 6.5 and my time-in-range staying between 80-180 mg/dl as much as possible.   

While we want to minimize highs and lows, they will still be a part of life with diabetes, even during pregnancy. If you’re having patterns, it’s important to reach out to your diabetes care team so they can help you make adjustments. 

Each week of my pregnancy has come with different insulin-resistant challenges. I have never used this much insulin in my life, and at first it was really scary. Pre-pregnancy, I was using around 40-50 units a day. Currently, I’m in my 34th week and using over 130 units a day, with a 1:1 insulin-to-carb ratio for much of the day. 

I never took insulin with my morning coffee, for example, but need 10 units to cover one cup now!  

It took me almost the entire first trimester to get comfortable using this much insulin. 

In terms of diabetes technology, I’ve been on the Omnipod 5 and Dexcom G6 CGM. The Omnipod only holds 200 units of insulin, which would normally last 72 hours, but I’m having to change my pod about every 24-36 hours now.  

Luckily, my endo changed my prescription to one pod per day during pregnancy, which was great, because I was nervous about running out of supplies.  

I think everyone is entitled to take on pregnancy in a way that is best suited to them! Trust your gut and simply try your best. 

 

Have there been any surprising things about T1D and pregnancy? 

It is crazy how much everyone loves a pregnant person! It’s so fun being in public and having strangers ask about the baby and when he’s due. I was in line at a bakery over the weekend, and there was a long line — everyone insisted that I cut in line to get my sweet treat — I’ll take it!   

Another surprising thing is the pure joy I experience every week when I check my “pregnancy tracking apps” that compare the baby to different fruits and vegetables. At 33 weeks, the baby is currently the size of a pineapple! It’s given me something fun to look forward to each week.  

 

What “special” appointments have you had because of T1D during your pregnancy, and why? 

Having T1D means my pregnancy is classified as “high-risk,” which basically means having specialized care and more testing to reduce potential complications for me and my baby.  

That said, there are so many appointments with a high-risk pregnancy!  

I see my endocrinologist in person every month, and someone reaches out each week to make management changes based on my reports. I have a maternal-fetal medicine (MFM) doctor, who is the high-risk OB. She meets with me after every ultrasound (which initially is every 6 weeks, but now is every other week) to measure the size of the baby. Plus, I meet with my regular OB, and starting at 31 weeks, I’ll have weekly non-stress tests. 

I have a great team and feel extra supported during my T1D pregnancy journey, which is extremely helpful as a first-time mom.  

 

If there was one thing that would make your pregnancy easier with T1D, what would that be? 

Being the dad, 😊 just kidding! I am so unbelievably lucky that I have the world’s best support system through my incredible husband, family, and friends. A huge shout-out to my husband, Jerry, as there is no shortage of support. He’s always there to fill my water bottle, get the heating pad, pick up Panera when I am craving mac and cheese — and he’s okay with the pregnancy pillow taking up 90% of the bed! 

Even though 9 months feels like it can drag on forever, it really is so special. Taking the time to enjoy the small moments and nest for the babies’ arrival has been one of the highlights of being pregnant.  

 

Can you share the most valuable piece of advice you’ve learned during your pregnancy that no one told you? 

My MFM assured me not to be afraid of insulin — in fact, increased insulin needs are a sign of a healthy placenta. I also try my best to stay off Google! The internet can be a scary place, so instead, I ask my healthcare providers about any pregnancy questions I have.  

Having community — other people who are going through what you are — is so valuable! When we started trying for “Baby W,” I joined a “T1D & Pregnancy” Facebook group. While there is certainly some mumbo-jumbo, there are also a lot of helpful tips and tricks from other type 1s who are planning, trying, currently pregnant, or postpartum. Take advantage of trusted community support networks and if you aren’t sure where to look, ask your care team! 

 

What’s your diabetes delivery plan? 

Women with type 1 can have a larger-sized baby, so I’ll be monitored more closely as I approach my due date. My MFM has shared with me that because of T1D, she prefers delivery before 39 weeks, so I’ll most likely have a scheduled induction around that time. 

At my 30-week ultrasound, the baby was 3 pounds, 4 ounces and measuring in the 50th percentile. So, for now, he’s not too big or too small (just too perfect 😊), but we’ll keep a close eye on the baby at my upcoming appointments! 

 

What are you expecting with breastfeeding and T1D management? 

Based on my research and what my care team has told me — breastfeeding can cause increased hunger and lower glucose levels. So, I’ll be planning on high protein snacks and keeping a close eye on my glucose levels.  

I know at first, feeding the baby is all I’ll be concerned about, so we’ll need to make sure I am eating enough, too!