Generation D.

Almost two and a half months ago, I became a married woman. My husband (it’s still fun to say “husband”) and I are enjoying our status as newlyweds, and we’re both making strides forward in our careers and in our lives.

While we’d like to have a family, we aren’t quite there yet. However, even though we aren’t ready to be parents at the moment, we need to start preparing my body for baby. And thanks to recent developments, this ramping-up time could be tricky.

I hate to admit it, but during my wedding planning, diabetes fell to the wayside. Somehow, between creating guest lists and cake tastings, my blood sugars stopped responding to logic. Insulin didn’t bring my numbers down effectively during this high-stress time. Exercise sometimes raised my blood sugar, even if I wasn’t spilling ketones. My stress levels were so insane that every emotional blip caused a corresponding blood sugar spike. The wedding was beautiful and everything I’d dreamed it would be, but my A1C left a whole lot to be desired. My last A1C result was the highest I’ve seen in five years.

Perfect. A ripe ol’ A1C, just as I’m starting to focus on pre-pregnancy planning.

In addition, I was diagnosed with a rare clotting disorder, leaving my body with an elevated A1c, a propensity for clotting, and a history of mild hypertension. Discouraged but not giving up, I needed to develop a plan for my future pregnancy.

I made an appointment with my endocrinologist at the Joslin Clinic, I visited my gynecologist, and I checked in with my local primary care physician. My gynecologist encouraged me to get my A1C closer to 6% and then, once I was ready to conceive, I should call her about three months beforehand to create a plan. My primary care doctor said the same. And I’m meeting with my endocrinologist next week, but I’m assuming she’ll echo the rest of my team.

While I wait for my appointment at Joslin, I am soaking in as much information as I can. I attended a pregnancy focus group, lead by Nicole Johnson and Dr. Francine Kaufman at the recent Children With Diabetes “Friends for Life” conference, in efforts to get some details. Nicole, type 1 since 1993, gave birth to her first child almost three years ago and Dr. Kaufman is a past president of the American Diabetes Association and Professor of Pediatrics, Keck School of Medicine – making these two ladies leaders in the diabetes community and terrific sources of information.

“You want to get your A1C as tight as possible, at least six months before you are ready to get pregnant.”

“How tight?” I asked.

“Six percent or lower.” Dr. Kaufman responded. And I heard the collective intake of breath from the group.

“You’ll also want to find the right team to help you through your pregnancy and to deliver your baby. Find a doctor who has delivered several babies to diabetic moms,” offered Nicole.

Dr. Kaufman and Nicole talked about the importance of maintaining tight control before, during, and at least through breast-feeding. We touched base on A1C goals, questions to ask our medical team, and the importance of pre-natal vitamins. We also talked about the different issues that may come into play during a pregnancy, like hypertension. So many factors to consider, with so many variables for each.

My mind was flooded with emotions. I felt guilty for letting my A1C climb to a disagreeable level. I felt scared of the potential complications related to a diabetic pregnancy, and nervous about the health of my future baby. I felt daunted by the task of achieving tight diabetes control. And I felt a little bit overwhelmed by the disease.

“It’s worth it, though, right?” I asked, reading the faces of my fellow attendees and seeing my nervousness reflected in their eyes.

“It’s totally worth it.” Dr. Kaufman and Nicole responded in unison, without taking a breath.

Since I was about 18 years old, I knew I wanted to have a family someday, and I knew I wanted to try and carry that child myself. I need to bring my health into a sharp and concentrated focus, despite how daunting it may seem some days. I’m working hard to get my body ready for baby, and I want to be in optimal health when my husband and I are ready to start our family. Having a healthy pregnancy will be a tricky maneuver, but I know in my heart that every step of this journey will be worth it.

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