Once upon a time I was pregnant with T1D, and in that pregnancy I struggled greatly with preserving my mental health. The reason: the constant, incessant, judgemental focus on my weight.
My son turned 13 last month – how is that even possible??? Some days, I feel like it was just yesterday that I was pregnant. But, friends, I am so happy it was not just yesterday.
Overall, my pregnancy was not a difficult pregnancy. But, because I have type-1 diabetes, I had to attend many, many healthcare provider appointments that often made the experience feel extremely difficult. Some of these appointments included:
- Maternity clinic
- High risk obstetrician
- Diabetes and pregnancy clinic, which featured appointments with an endocrinologist, nurse, and dietitian
- Non-stress tests
- Multiple ultrasounds
- Etc., etc., etc
Of all, it was the diabetes and pregnancy clinic that had me constantly fretting about weight gain in pregnancy.
Pregnant with T1D: heavy focus on weight
Leading into pregnancy, I was very active.
I had completed a marathon and a couple of half marathons just months prior to conception. I was also hiking and cycling regularly. And once pregnant, I continued the running up to about 4 or 5 months – only stopping because I did not enjoy the frequent pee stops I was enduring. But I did continue the hikes all throughout my pregnancy.
And yet, the numbers on the scale and the measured size of my belly started increasing pretty quickly once pregnant.
The reason:
My blood sugars were constantly low in the first trimester. I swear I was drinking a jug of orange juice a day just to keep my blood sugars afloat. I was lowering my insulin massively during that time as well, but to no avail – they just kept going low up until the second trimester.
Pregnant with T1D tip: increased insulin sensitivity in the first trimester is very much a thing, which was likely causing all those lows!
Pressure of the scale at the diabetes and pregnancy clinic
The endos in the clinic were great. They loved how active I was. They loved how independent I was with my insulin adjustments. But the diabetes and pregnancy dietitian was another story.
Every time I saw her, she grilled me on the foods I was eating. I kid you not, she asked me – multiple times – if I was sure I wasn’t snacking on chips every night.
Friends, I was so scared of growing a two-headed baby in me that I rarely succumbed to my cravings of strawberry milkshakes and hotdogs. That entire pregnancy, I had one strawberry milkshake total, despite constantly wanting more!
The questioning and subsequent emotions got so bad that I started taking extreme precautions before weighing myself at those appointments. The clinic’s scale was located behind a closed door in the washroom. Before getting on the scale, I removed all my clothes and my inulin pump to take off any minute extra weight I might be carrying.
I left those appointments often in tears. I felt shattered, thinking no matter what I did, I wasn’t doing good enough. It didn’t matter that my blood sugars were mostly consistent in the tighter pregnancy target ranges. It didn’t matter that my HbA1c was the lowest it had ever been. It didn’t matter that I was incorporating an abundance of activity daily. The weight seemed to be the only thing that mattered.
That is a huge issue.
Mental health costs of weight-centred care
I am not the only one to have experienced such mental health trauma during pregnancy with type-1. I have since met others who have had similar experiences. I’ve also read through significant literature and social media posts declaring the same.
This needs to change.
I would like to think that after 13 years, my healthcare colleagues are moving in the right direction with regards to de-stigmatizing weight. But in our Diabetes and Pregnancy clinics, weight is still a significant focus. There is still a heavy presence on the number on the scale, but not so much other health factors. There is still a huge focus on the number of carbs consumed and blood sugar values, but not enough focus on the person that is pregnant with T1D.
Yes, carbs cause blood sugars to rise, but they are not the only thing. Furthermore, we need an adequate amount of carbs for our body and brain health, and for fetal health also. Carb intake during pregnancy is a combination of quality and quantity, but also experimenting to see what works for the person. All bodies with T1D are different, which means that all bodies pregnant with T1D are also different. Some things may work for one, but not for the other. We need to go beyond the textbook. We need to think outside the box. We need to be creative. We need to do better.
And we can do better. Let’s bring the person into the care focus.
Shifting the focus in T1D pregnancy care
On Nov. 10, 2025, I am hosting the first in a two-part, virtual workshop series on Pregnancy with T1D. The first workshop focuses on all the things a person with T1D needs to know in preparing for pregnancy and managing the first trimester. The second workshop is on Nov. 24, and focuses on third trimester, labour, delivery and post pregnancy with T1D. These workshops provide a set of tools and resources to use for a successful, comfortable, and emotionally strong pregnancy with T1D.
For more information or to register, click the link: bit.ly/4lwXo9G. These workshops are virtual, which means anyone can join. One workshop is $60 or both for $100. Receipts will be provided for extended health / tax purposes. If you have any questions, email me at info@katiebartel.ca.