Can I safely plan my pregnancy with type 2 diabetes at 34?

Question

Hello doctor,

I am 34 and was diagnosed with type 2 diabetes three years ago. My recent labs showed:

A1C: 7.8 percent.
Fasting glucose: 145–165 mg/dL.
Post-meal spikes: up to 220 mg/dL.

I am currently taking Metformin 1000 mg twice daily and Jardiance 10 mg.

My husband and I are trying to plan for a pregnancy, but I am very anxious about how diabetes might affect it.

My periods have been irregular over the past year, anywhere from 26 to 45 days, and they have become much heavier with clotting and painful cramps.

My doctor advised me to get my A1C below 6.5 percent before conceiving, but I am struggling to reach that despite taking my medications and following a diet. I have also gained weight and now weigh 185 lbs at 5 feet 4 inches, even though I have cut down carbs significantly.

I have a few specific questions and concerns:

Do I need to switch from metformin to insulin before trying to conceive?
If yes, how long before conception should the switch happen?
What are the risks of birth defects or complications if blood sugar control is not perfect before or during pregnancy?
My mother had gestational diabetes with all her pregnancies - does this increase my risk even more?
Could I develop preeclampsia because of diabetes?
I have been getting recurrent yeast infections (about one every two months) - is this related to my blood sugar, and will it get worse during pregnancy?
Should I take any specific prenatal vitamins for diabetics?
With my irregular periods, weight gain, and difficulty losing weight, could this also be PCOS?

I really want to prepare my body safely for pregnancy, but right now I feel scared and confused. I would be grateful for clear guidance on the safest next steps.

Please help.

Thank you.

Answer 1

Hi,

Welcome to icliniq.com.

I read your query and can understand your concern.

Type 2 diabetes mellitus (high blood sugar levels) is what we call a lifestyle disorder, meaning it often develops due to the way the body handles food, exercise, and stress over time. It also has a genetic link, so it can run in families.

With the right diet, regular exercise, stress control, and proper medications, diabetes can be well-managed.

Your HbA1c (Hemoglobin A1c) test - which measures the average blood sugar level over the past 90 days - ideally should be below 6.5 percent for most people. However, this target may be adjusted slightly based on your earlier results and overall health.

To move toward better control, I recommend:

Keeping a close watch on your weight.
Doing brisk walking (fast-paced walking) for 35 to 40 minutes, five days a week.
Following a strict diabetic diet - reducing excess carbohydrates (rice, bread, sweets) and increasing fiber-rich foods (vegetables, salads, whole grains).

Regarding medications, you may need to add an SGLT2 (sodium–glucose co-transporter 2) inhibitor. These medicines help the kidneys remove extra sugar from the urine, which lowers blood sugar and also helps with weight control.

Metformin and Jardiance (Empagliflozin) are already good medications, but to adjust or add anything safely, I will first need to check your serum creatinine level - this is a simple blood test that shows how well your kidneys are working.

Talking about pregnancy, uncontrolled blood sugar can make it harder to conceive, and even during pregnancy, blood sugar levels can rise more than usual. This can lead to:

A baby gaining too much weight inside the womb can make the pregnancy high-risk and make normal vaginal delivery difficult.
A slightly higher risk of birth defects.
The baby has very low blood sugar or breathing problems shortly after birth.

The good news is that all of these risks can be greatly minimized with good diabetes control and proper monitoring during pregnancy.

You also asked about high blood pressure and PCOS (polycystic ovary syndrome). These are also lifestyle-related conditions, and sometimes diabetes, PCOS, and high blood pressure can happen together.

When several of these issues occur at the same time, it is called metabolic syndrome, which means the body’s metabolism is under strain.

So the next step is to please share your serum creatinine report, so I can safely adjust your medication and recommend the right dose.

You are doing the right thing by reaching out, and with the right plan, you absolutely can move toward a safe and healthy pregnancy.

I hope this helps.

Please revert in case of further queries.

Thank you.