Pregnancy is already a time when you can feel like your body isn't entirely your own.
You have appointments. You have tests. You have ultrasounds. People are watching your blood pressure, measuring your belly and asking how you're feeling.
Add diabetes to the picture and suddenly there can be a whole lot more to keep track of.
More appointments. More blood sugar checks. More monitoring. More ultrasounds. More conversations about risk.
Before getting into what pregnancy with diabetes can feel like, I think it is important to acknowledge something that often gets lost when we talk about “diabetes in pregnancy”: diabetes is not one single condition, and pregnancy with diabetes is not one single experience.
Gestational diabetes, Type 1 diabetes and Type 2 diabetes are very different diagnoses. They develop for different reasons, are managed differently and can affect pregnancy in different ways.
Someone diagnosed with gestational diabetes may have never had to think about blood sugar before pregnancy. Suddenly they are being asked to monitor glucose, change how they eat and learn a whole new set of numbers and targets, often while also being told that their diagnosis could affect their pregnancy and their baby's health.
Someone with Type 1 diabetes, on the other hand, may have spent years or even decades managing blood sugar before becoming pregnant. I have had Type 1 diabetes since I was eight, so I know what it is like to already understand insulin, carbohydrates, blood sugar patterns and all of the little variables that can affect a number.
Pregnancy adds another layer to that management. Blood sugar targets become tighter, and the numbers you may be used to seeing outside of pregnancy can suddenly be considered too high. For example, pregnancy guidelines commonly recommend fasting blood sugar below 5.3 mmol/L (95 mg/dL) and a reading below 7.8 mmol/L (140 mg/dL) one hour after eating. Those numbers might look straightforward on paper, but actually achieving them while avoiding low blood sugars is a whole different challenge.
Insulin needs can change throughout pregnancy. Hormones can affect blood sugar. Foods that were once predictable may suddenly produce different results. Stress, sleep, activity and countless other factors can change a number. You can have years of experience managing your diabetes and still find yourself adjusting, troubleshooting and wondering why your blood sugar is doing something completely unexpected.
The emotional side of this can look very different depending on where you are in your journey with diabetes.
If you have been diagnosed with Type 1 diabetes recently, the thought of managing it through pregnancy can feel intimidating and even frightening. You may still be learning how your body responds to food, insulin, activity and everyday life. Now you are being asked to manage all of that while also thinking about your baby's health and navigating a pregnancy that may be labelled high risk.
If you have lived with Type 1 diabetes for years, you may already know your body and your diabetes incredibly well. You may understand how different foods affect you, how your insulin works, what tends to throw your numbers off and how to make adjustments when things don't go as expected. In many ways, you may be the person with the most detailed knowledge of your day-to-day diabetes management.
That doesn't mean your medical team isn't important. Pregnancy with Type 1 diabetes requires appropriate medical care, and your providers bring expertise in pregnancy, diabetes and the risks that need to be considered, but guidelines are built around broader groups of people. They cannot predict exactly how one person's blood sugar will respond to a particular meal, how much insulin she will need on a given day or why a number has suddenly changed.
Type 1 diabetes is incredibly individual. What works well for one person may not work for another, even if they use the same insulin, eat similar foods or are at the same stage of pregnancy. A recommendation that looks straightforward in a guideline can be much more complicated to put into practice in real life.
This is why the experience of the person living with Type 1 diabetes matters so much. Your knowledge of your own body is valuable, and it deserves to be part of the conversation with your care team. You should be able to ask questions, explain what you are experiencing and work together to find an approach that considers both the medical recommendations and the reality of managing your diabetes every day.
Type 2 diabetes can bring another set of circumstances, with treatment and management looking very different from one person to another. Sometimes it can be controlled with diet alone and sometimes medications are used, including insulin.
These experiences aren't interchangeable. Even within each type of diabetes, two people can have completely different pregnancies and completely different experiences managing their blood sugar.
There is a tendency to talk about diabetes management as though there is one universal formula. There isn't. I have seen women with diet-controlled gestational diabetes being given advice that sounds perfectly healthy on the surface but doesn't necessarily translate into good blood sugar control for everyone. “Have oatmeal for breakfast” is one example I've come across.
Now, if oatmeal works well for someone's blood sugar, I am genuinely happy for them, but oatmeal is also a relatively high-carbohydrate food, and even after more than 25 years with Type 1 diabetes, it is a food that I still find challenging to dose for.
That doesn't mean you should avoid oatmeal. It means that individual responses to food matter when you are managing blood sugar.
The same is true of carbohydrate recommendations. Women with gestational diabetes may be encouraged to eat a certain number of carbohydrate servings throughout the day, and a recommendation of 15 servings would work out to 225 grams of carbohydrate. That may be an appropriate amount for some people, but if someone is specifically trying to manage blood sugar through diet alone, simply hitting a carbohydrate target doesn't guarantee that their blood sugar will respond well.
The point isn't that there is one correct way to eat during pregnancy with diabetes.
The point is that diabetes management is individual.
When pregnancy is added to the equation, things can become even more complicated.
For someone with gestational diabetes, this may be the first time they've ever had to think about their blood sugar. For someone with Type 1 or Type 2 diabetes, they may already be experienced with diabetes management but find that pregnancy changes everything they thought they knew about their own body.
Insulin needs can change. Hormones can affect blood sugar. Foods that were previously predictable may suddenly produce different results. Stress, illness, activity and countless other factors all affect your blood sugar.
You can know your diabetes incredibly well and still have a blood sugar reading that makes you stop and wonder, “What happened there?”
That is where the emotional side of pregnancy with diabetes can become difficult. When your blood sugar is being watched closely, it can start to feel like you are being watched closely too.
You have a high number.
Someone asks what you ate.
You have another high number.
Someone asks what happened.
Your numbers are reviewed at your next appointment.
The baby is measured.
Your blood pressure is checked.
Another ultrasound is scheduled.
Another appointment is added.
Before long, it can start to feel like you're being given a report card on how well you're doing at being pregnant.
That can be especially difficult when the numbers don't go exactly the way you hoped.
Did I eat the wrong thing?
Did I do something wrong?
Am I hurting my baby?
Why can't I get this right?
Blood sugar targets matter. Patterns matter. Your care team should absolutely be paying attention to them, but an occasional blood sugar outside your target range is not a moral failing, and it does not mean you are failing your baby.
Diabetes is complicated. Blood sugar can change because of hormones, illness, stress, food, activity, insulin sensitivity and plenty of other factors. You are not a number on a glucose log. And you are certainly not a bad mother because your blood sugar isn't perfect.
Unfortunately, the feeling of constantly being monitored doesn't stop with your blood sugar.
Depending on your individual circumstances, pregnancy with diabetes can mean more appointments, additional ultrasounds, fetal monitoring and more people involved in your care. What might have been one routine appointment can become several. A scan leads to another scan. A conversation about blood sugar leads to a conversation about fetal growth. Another appointment gets added to discuss the results.
The extra monitoring can be important, but there is a mental and emotional cost to constantly wondering what the next appointment might find.
Every additional appointment is also another opportunity for intervention to enter the conversation.
Induction is already a common conversation in pregnancy, even when diabetes isn't involved. Add diabetes to the picture and the pressure can become even stronger.
There are more opportunities to discuss fetal growth.
More opportunities to discuss monitoring.
More opportunities to discuss blood sugar control.
More opportunities to talk about how far along you are.
Eventually, all of those individual conversations can start to build toward one question:
When are we going to deliver this baby?
There are absolutely situations where earlier delivery is appropriate. Diabetes can increase certain pregnancy risks, and recommendations around timing of birth may depend on blood sugar control, fetal growth, maternal or fetal complications and other circumstances. Sometimes, induction really is the safest option.
There is however a big difference between being offered an induction because of a specific concern in your pregnancy and feeling like induction is simply the inevitable outcome of having diabetes.
When an induction is recommended, you deserve to understand why. What specifically is your provider concerned about? Is something changing, or is the recommendation based on the risks associated with your diagnosis in general? What are the potential benefits of delivering now? What are the potential risks of waiting? Are there other options for managing the concern?
These are reasonable questions to ask, even when you have a condition that requires additional monitoring. You can take the risks seriously and still want to understand how they apply to you.
The same is true when the conversation turns to your baby's size.
Diabetes can increase the likelihood of increased fetal growth, particularly when blood sugars are running high, which is one reason blood sugar management matters, but having diabetes does not automatically mean you are going to have a large baby.
There is also another important piece to remember: an ultrasound estimate of your baby's size is just that — an estimate. Ultrasound estimates, especially in the third trimester can be off by 1 to 2 lbs or more.
I know this one personally. During my first pregnancy, I was told between 32 and 36 weeks that my baby was measuring very large, to the point that an induction at 36 weeks was recommended. Then the measurements changed. Suddenly, I was being told that my baby was measuring small. At first around the 15th percentile and then closer to the 10th percentile.
My baby ultimately arrived at 40 weeks and 5 days weighing 7 pounds, 7 ounces. A very average sized baby.
The measurements were giving us very different pictures of what was happening, and the actual baby was somewhere else entirely.
That isn't to say that growth ultrasounds aren't useful. They can provide valuable information, particularly when there are concerns about fetal growth. But they aren't a crystal ball, and an estimated weight or percentile needs to be considered alongside everything else happening in your pregnancy.
A suspected “big baby” does not automatically mean you need to be induced. The Society of Obstetricians and Gynaecologists of Canada states that suspected macrosomia, or a baby measuring larger than expected, is not by itself an indication for induction before 39 weeks. In a pregnancy complicated by diabetes, factors such as blood sugar control, the baby's growth and other complications may influence recommendations about timing of birth, but a size estimate alone should not automatically determine how or when your baby is born.
If your baby's estimated size becomes part of a conversation about induction or a planned C-section, you deserve to understand why. How reliable is the estimate? What does it mean in your particular pregnancy? Are there other factors influencing the recommendation? And what are the potential benefits and risks of intervening compared with waiting?
The goal isn't to dismiss concerns about fetal growth. It is to make sure a measurement doesn't become a frightening prediction or an automatic decision about how your baby needs to be born.
Unfortunately, when you've spent months having your blood sugar watched, your baby measured and your pregnancy treated as higher risk, it can become difficult to separate an individual concern from the feeling that something is always about to go wrong.
You may start to assume that your body cannot be trusted. You may feel that your provider must know what is best because your pregnancy is considered high risk. You may start ignoring your intuition. You may hesitate to ask questions because you don't want to be seen as difficult or, worse, as someone who is putting their baby at risk by questioning a recommendation.
Being monitored doesn't mean you have to hand over your voice.
Your medical team has an important role in managing your diabetes and monitoring the health of you and your baby. Their expertise matters, and so does your understanding of your own care. You are the person living this pregnancy. You are the one who will experience the birth and live with the decisions being made.
You deserve to understand those decisions and to be part of making them.
I also think it is important to remember that diabetes does not automatically mean a traumatic birth.
It can be easy to build a whole story in your head before labour has even begun. Diabetes means high risk. High risk means induction. Induction means interventions. Interventions mean a C-section.
Suddenly, you've gone from a positive pregnancy test to imagining the worst possible birth.
That is not the only possible outcome.
People with gestational diabetes, Type 1 diabetes and Type 2 diabetes can have healthy pregnancies and positive birth experiences. Sometimes birth involves an induction. Sometimes a C-section is the safest or most appropriate option. And sometimes labour begins spontaneously and progresses without major complications.
There is no single “diabetes birth,” just as there is no single birth experience that is right for everyone.
Your diagnosis may influence your care. It may mean additional monitoring, more conversations about risk or decisions that require extra consideration. It does not tell you exactly how your birth will unfold.
This is why I believe preparation matters so much.
I'm not suggesting that you ignore the risks, disregard your care team's recommendations or assume that everything will go according to plan. I believe in understanding what is happening in your pregnancy, why certain things are being recommended and what your options are.
Learn about the interventions that may be offered. Ask questions when a recommendation is made. Understand the difference between something that is being suggested as a precaution and something that is being recommended because of a specific concern. If circumstances change, make sure you understand what has changed and how that affects your options.
You don't have to know everything or make every decision in advance. You simply deserve the opportunity to make informed decisions as your pregnancy progresses.
Being informed doesn't mean believing nothing will go wrong. It means knowing that if something changes, you can ask questions, understand your options and participate in decisions about your care.
Pregnancy with diabetes can be a lot. The extra appointments are real. The extra monitoring is real. The pressure to keep your numbers in range is real. The risks are real, and sometimes an intervention really is the safest choice.
None of that means you should have to spend your entire pregnancy feeling as though you are waiting for something to go wrong. You deserve care that looks at the whole picture. You deserve providers who see the woman behind the diagnosis. You deserve to ask questions without feeling as though you are being difficult, and you deserve to understand why something is being recommended rather than simply hearing, “because you have diabetes.”
You also deserve support as you prepare for birth — not just someone managing the medical side of your pregnancy, but someone who can help you talk through your preferences, understand your options and feel more confident using your voice throughout the process.
Diabetes may be part of your pregnancy story. It does not have to write the whole story for you.
If you're pregnant with diabetes and preparing for birth in Winnipeg or the surrounding communities, this is one of the reasons I believe continuous doula support can be so valuable. I can't replace your medical team, but I can help you prepare for birth, talk through your questions and preferences, explore your options and feel supported as you navigate the decisions that come with pregnancy and birth.
You deserve to go into birth informed, supported and feeling like you — not just a diagnosis on a chart.
If you're pregnant with diabetes and preparing for birth, you don't have to navigate all of the decisions and possibilities on your own.
I provide continuous birth doula support for families in Winnipeg, the Interlake and surrounding communities, helping you prepare for birth, understand your options and feel supported throughout the process.
If you'd like to talk about what doula support could look like for you, I'd love to hear from you.