Type 1 diabetes living in pregnancy

Overview

Type 1 diabetes is a condition where your body cannot produce insulin, a hormone that controls blood sugar. When you are pregnant, managing your blood sugar becomes even more important for your health and your baby's health. With careful planning and support, most women with type 1 diabetes have healthy pregnancies.

Type 1 diabetes in pregnancy is not very common. About 1 in 300 pregnancies in the UK involves a woman with pre‑existing diabetes, and type 1 diabetes makes up a small but important part of these cases.

It affects women with type 1 diabetes who become pregnant. This includes women who have had diabetes since childhood and those diagnosed later in life.

Symptoms

Common symptoms

• High blood sugar (hyperglycaemia) – can cause thirst, needing to pee often, blurred vision
• Low blood sugar (hypoglycaemia) – can cause shakiness, sweating, confusion, feeling very hungry
• Feeling very tired
• Nausea or vomiting (morning sickness can be more challenging with diabetes)

Causes

Main causes

• Type 1 diabetes is an autoimmune condition – your immune system attacks the cells in your pancreas that make insulin.
• Pregnancy itself does not cause type 1 diabetes, but the hormonal changes of pregnancy can affect how your body responds to insulin.

Risk factors

• Having a close family member with type 1 diabetes (but many people with type 1 diabetes have no family history)
• Living with type 1 diabetes before pregnancy

When to see a doctor

See a doctor urgently if:

• If you have symptoms of diabetic ketoacidosis (DKA), such as severe vomiting, deep breathing, or confusion
• If you have a hypoglycaemic emergency and cannot treat it yourself
• If you have severe abdominal pain or bleeding in pregnancy

Book a routine appointment if:

• As soon as you find out you are pregnant, or if you are planning a pregnancy, make an appointment with your diabetes team
• Regular prenatal visits as recommended by your healthcare provider
• Any time you are unsure about your blood sugar targets or insulin adjustments

Diagnosis

Most women already know they have type 1 diabetes before pregnancy. If you are diagnosed during pregnancy, it is usually confirmed with a blood test that checks your blood sugar level and a test for autoantibodies.

Tests that may be done

• HbA1c test – shows your average blood sugar over the past 2–3 months
• Blood glucose monitoring – you will check your blood sugar several times a day
• Continuous glucose monitoring (CGM) – a sensor that tracks your sugar levels (may be offered by your team)
• Urine tests – to check for ketones (a sign of DKA) and protein

What to expect at your appointment

Your healthcare team will work closely with you to set blood sugar targets for pregnancy. You will have more frequent appointments, including ultrasound scans to check your baby’s growth. Your diabetes team will help you adjust your insulin as needed.

Treatment

The main treatment for type 1 diabetes in pregnancy is insulin. You will need to take insulin every day, usually through injections or an insulin pump. The goal is to keep your blood sugar as close to normal as possible to protect you and your baby. Your insulin needs will change as your pregnancy progresses, so your team will help you adjust your doses.

Self-care at home

• Check your blood sugar regularly – often before and after meals and at bedtime
• Learn to recognise and treat high and low blood sugar quickly
• Eat a balanced diet with consistent carbohydrate intake – ask your team for a plan
• Stay active with activities like walking or swimming, but talk to your doctor first
• Have a plan for sick days – for example, when you have a stomach bug

Medical treatments

Treatment is based on insulin therapy. Your healthcare provider will help you choose the type of insulin and schedule that works best for you. This may involve multiple daily injections or using an insulin pump. Regular monitoring and dose adjustments are essential. You will also be offered extra scans and checks to monitor your baby’s health.

When is surgery considered?

Most women with type 1 diabetes do not need surgery for their diabetes during pregnancy. However, if you have a caesarean section, your diabetes team will help manage your insulin around the delivery.

Living with this condition

Living with type 1 diabetes while pregnant means paying more attention to your blood sugar levels. You will be checking your levels several times a day, adjusting insulin, and attending more medical appointments. It can feel like a lot, but your healthcare team is there to support you.

Lifestyle tips

• Eat regular meals with consistent carbohydrate amounts
• Stay physically active – aim for 30 minutes of moderate activity most days, unless your doctor advises otherwise
• Get enough sleep – lack of sleep can affect blood sugar
• Avoid alcohol and smoking – both can harm your baby

Diet and exercise

Eating a healthy diet with balanced carbohydrates, protein, and fats helps manage your blood sugar. Your team may refer you to a dietitian. Exercise helps your body use insulin better, but it can also cause low blood sugar, so check your levels before, during, and after activity. Always carry a fast‑acting carbohydrate source like glucose tablets or fruit juice.

Mental health and emotional wellbeing

Pregnancy with type 1 diabetes can be stressful. You may feel anxious about blood sugar numbers, the baby’s health, or the extra appointments. It is normal to feel this way. Talk to your partner, friends, or a counsellor. If your mood is low, tell your healthcare team – they can offer support and resources.

Prevention

You cannot prevent type 1 diabetes itself, but you can reduce the risks for you and your baby by planning your pregnancy carefully. Aim for good blood sugar control (HbA1c below 48 mmol/mol) before you conceive, if possible. Taking folic acid before and during early pregnancy helps prevent neural tube defects.

Vaccines

Your healthcare provider may recommend the flu vaccine and the whooping cough vaccine during pregnancy. These are safe for women with type 1 diabetes.

Screening programmes

During pregnancy, you will be offered routine scans and tests to check your baby’s growth and well‑being. You may also be screened for eye problems (diabetic retinopathy) and kidney function, as pregnancy can affect these.

Complications

If left untreated

• High blood sugar can increase the risk of miscarriage or stillbirth
• Your baby may grow larger than usual (macrosomia), which can make delivery harder
• Your baby may have low blood sugar after birth (neonatal hypoglycaemia)
• You may be at higher risk for pre‑eclampsia (high blood pressure in pregnancy)

Long-term outlook

With careful management and a strong healthcare team, most women with type 1 diabetes have successful pregnancies and healthy babies. It takes extra effort, but many women find it very rewarding. Your team will be with you every step of the way.

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