Hi Lauren, thanks for the questions!
It is important to discuss pregnancy and exercise with all of the healthcare providers who help you manage your health, including your endocrinologist and obstetrician. They can help you better understand how pregnancy will impact your unique needs.
In general, exercise is recommended during pregnancy, as long as your healthcare providers say it is ok. It is recommended that pregnant individuals try to get at least 150 minutes per week of moderate-intensity aerobic activity. This means that you are moving enough to raise your heart rate and start sweating a bit. Things like vacuuming, gardening, raking, and walking can all count towards this goal. If someone is new to exercise, they should start out very slowly and gradually increase activity over time. If someone was very active prior to pregnancy, they may be able continue with some of the same workouts, but should discuss them with their obstetrician. Modifications to activities, especially during the later stages of pregnancy, are oftentimes recommended.
During pregnancy, the body is changing a lot! Hormones that are produced to support the pregnancy can cause joints to feel looser (ligaments become relaxed), weight changes can also impact balance, and people may feel out of breath more quickly when they exercise during pregnancy. During the later stages of pregnancy, it is important to avoid high impact activities, activities where you could fall easily, heavy weightlifting, or activities that require you to lie flat your back for extended periods of time.
When thinking about T1D, exercise, and pregnancy, it is complicated! Many people find that they need to make insulin dose adjustments frequently in response to continuous pregnancy hormone changes. With exercise, there can be some important concepts to be aware of to help someone predict how they may need to adapt to exercise. Most importantly, listen to your body! If something doesn’t feel safe, or something doesn’t feel right, don’t do it!
Early in pregnancy, insulin sensitivity can increase, meaning that the same amount of insulin works more effectively, and someone with T1D may be at higher risk of hypoglycemia. However, for some people, glucose levels rise and insulin requirements increase! So, understanding your unique needs is very important.
During the late second trimester, hormones that cause higher blood sugars gradually increase until the end of the pregnancy, causing insulin resistance, meaning increased insulin is needed to maintain glucose levels in the pregnancy target range. This insulin resistance is actually something the body does to help shift glucose to the growing fetus! While it may be frustrating when insulin needs increase as the pregnancy continues, this insulin resistance does have a purpose!
As insulin resistance increases, people may find that their body responds differently to exercise. They may not experience as many low glucose levels during exercise, and they may find that they actually need to take insulin to prevent hyperglycemia during exercise. Each person’s glucose changes are unique, so individualizing treatment approaches is most important!
If someone is experiencing more hypoglcyemia, then taking additional precautions, like bringing EXTRA carbohydrate containing snacks to help support exercise and taking breaks during exercise to re-hydrated and re-fuel. It’s very important to be sure you’re getting enough nutrition to support physical activity and the pregnancy, and it’s a good idea to discuss this with someone who specializes in managing diabetes during pregnancy. Drink plenty of fluids to stay hydrate, and avoid becoming overheated. Some will also wear a “belly support belt” to help reduce discomfort while walking/running as the belly gets bigger.
I hope this information is helpful!
