What to Expect When You’re Pregnant and Have Type 2 Diabetes

Pregnancy may feel overwhelming and scary. Your treatment plan will differ from someone without diabetes, but that doesn’t mean complications will happen.

Whether it’s a first child or a fourth, discovering you’re expecting can feel exciting and scary. We’ve all heard the stories of what can potentially go wrong, even in people who don’t have a preexisting condition.

But when it comes to pregnancy and preexisting type 2 diabetes, that fear can rise to a whole new level, especially when discussing with your care team the risks of complications to you and your baby.

While well-meaning doctors might warn you of the risks, it doesn’t mean any of those potential complications will happen.

Although there are no guarantees in pregnancy — whether you have type 2 diabetes or not — I’m living proof that a pregnancy can be complication-free, even when you have preexisting type 2 diabetes.

The key to a complication-free pregnancy with type 2 diabetes is keeping blood glucose well-controlled. And that starts with understanding your care plan. Here’s what to expect.

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You’ll be considered a high risk pregnancy

Fortunately, I was already prepared that my pregnancy would be treated as high risk before trying to conceive since my sister, who had her son several years before I did, had prediabetes when she became pregnant. Her prediabetes evolved into gestational diabetes.

However, had I not been prepared, just the term “high risk” would have scared me. But high risk doesn’t always mean your pregnancy is at risk. It only means you’ll receive a higher level of care.

For example, you’ll be referred to a maternal fetal medicine care team and expected to meet more often with them than someone without type 2 diabetes. This is so the team can closely monitor your blood glucose levels and adjust your insulin needs as necessary.

You’ll also get more ultrasounds and nonstress tests, which involve regularly checking the baby’s heartbeat while you recline for 30 minutes, compared with someone without diabetes.

It’s also worth knowing that anyone over age 35 who gets pregnant, even without a preexisting condition, is also considered high risk. (I was 38 when I had my son.) So, again, it doesn’t mean anything is wrong. It only means you’ll be treated with more care.

I actually found it reassuring to see my team and be tested more often. I’m an anxious person by nature. So, although it began to feel like a full-time job in the third trimester when care got amped up even further, I appreciated the frequent reassurance that everything was OK.

Your blood glucose will be closely monitored

If you have preexisting type 2 diabetes, it’s important to talk with your doctor about your medications before you try to conceive.

I was taking a combination of metformin and Victoza, a precursor to Ozempic, before trying to conceive. Although I could stay on metformin — and my care team recommended it throughout my entire pregnancy — I needed to replace the Victoza with insulin to reduce the risk of potential complications and congenital disabilities.

If you’re put on insulin as I was, your care team will continually adjust the types and doses to keep your blood glucose within a very tight range. I was put on a combination of short- and long-acting insulin almost immediately after I got pregnant to meet my treatment goals.

Because continuous glucose monitors weren’t yet commonly used when I had my son, I also had to check my glucose with finger sticks before and after every meal, before bed, and first thing in the morning. I kept all this information in a log and sent it to my care team every week so they could adjust my insulin doses as needed.

Using insulin to maintain tight control can lead to low glucose levels. I had frequent lows, so I know this can happen. I carried a med bag everywhere and kept it stocked with my glucose meter and candy.

If you’ve never experienced a low before, you’ll quickly recognize the symptoms of low blood glucose. Sometimes it’s obvious.

I usually felt as though I was about to pass out when I had a low. But other times, it’s not so obvious, especially in pregnancy. For example, I remember finishing a lecture (I’m a college instructor) and feeling a little tired, hot, and sweaty but otherwise fine.

But when I tested my blood glucose, it was extremely low. Fortunately, I had candy on hand to treat it.

You may have to be careful about what and when you eat

To keep your blood sugar within range, your doctor will probably prescribe a nutrition plan with specific guidelines about what to eat and how often to eat. This might involve staying within a specific ratio of carbs, fat, and protein with every meal and snack, and eating more frequently.

For example, I currently eat three meals a day and rarely snack. However, I was told it was important to add snacks to my diet to ensure my blood glucose remained steady.

This can be difficult if you experience morning sickness (which should be renamed all-day sickness!) But, most of the time, the hunger that comes with pregnancy makes this easy.

It’s important to remember that foods affect everyone differently. So, even though you may be prescribed a specific nutrition plan, the most important thing is to keep your blood sugar in range. I found that I was having so many lows, I needed to eat more carbs than my plan initially included.

You’ll want to continue your diabetes self-care

Many things we do to care for ourselves in “normal” times also translate to good diabetes care during pregnancy. In addition to eating habits, this includes adequate sleep, exercise, and stress-relieving activities.

You will naturally want to sleep more while pregnant; after all, your body is growing a tiny human!

Plus, a 2020 review of research found that a lack of sleep may affect blood glucose levels. Plan for this and allow yourself to rest as much as your body wants.

Stress can increase blood sugar levels, too. This is also true in pregnancy. Allow yourself to rest, relax, and do activities that help keep your stress levels low.

As most of us know, physical activity is part of managing type 2 diabetes, with or without a pregnancy. Check in with your care team to learn how to adapt your current routine to one you can enjoy throughout pregnancy.

If you’re used to weightlifting or intense exercise, you may need to make a few adjustments, but generally, most exercises are safe during pregnancy.

I worked with a personal trainer while pregnant and did cardio and strength training. And although there were a few positions he needed to modify for me, I could do most things right up until delivery.

The takeaway

Although it can feel extra scary to navigate a pregnancy while having type 2 diabetes, it doesn’t mean you’ll experience complications.

I’m living proof of that. Although any pregnancy can involve complications that are no fault of one’s own, I was fortunate enough to have an easy, complication-free pregnancy despite having preexisting type 2 diabetes.

Good diabetes management ensures you won’t be at any greater risk than someone without type 2 diabetes.