10w - insulin sensitivity

Diabetes and Pregnancy Managing Pregnancy with Diabetes
#1

Hello! I had an A1C of 6.4, got pregnant and am at 10w now, already saw heartbeat and baby do a funny kick/fold while on ultrasound! :slight_smile: so cool!

I have minimed pump and CGM. Had been doing quite okay for the first 9w, then started experiencing some lows. The last couple days have been really roller coastery and I’m wondering did others keep same basal and cut carb ratio almost in half? Now I’m feeling worried about all the lows, and was riding too high yesterday.

Hoping to make better adjustments, my next appointment with my diabetes team is in 5 days… But that feels tooooo far! Thanks for pointers!

Type 1 Diabetes Pregnancy with Poly Cystic Ovarian Syndrome
#2

Hi there and congratulations!

I am also recently pregnant (first one) and experienced the same thing around 11 weeks (I am now in the middle of my 13th week). I had read on this old blog that this is to be expected in general terms. But when it happened, I was also reading a new book called Pregnancy and Type 1 Diabetes by Ginger Vieira and Jennifer Smith where they go into a little more detail about why that happens and also how to manage it when it does. I do recommend the book and if you get it, the relevant pages are 63-67.

In short, there are two main reasons for this: the development of the placenta around this time, which takes over the progesterone-producing action previously conducted by the ovaries. They don’t explain why exactly that different source of progesterone impacts the insulin sensitivity, but my own guess is that the hormone gets directly to the fetus from the placenta, without circulating as much in the mother’s blood (maybe). The second factor is that the immune system apparently “backs off” a little bit from its normal level of activity in order not to treat the fetus as a “foreign body” and so if the mother has some residual beta cells (I happen to know I do since I was part of a study that looked at that right after diagnosis + tried a medication that seemed to additionally help preserve some of the beta cell action), they are able to produce some small levels of insulin. Pretty insane, ha? :slight_smile: All in all, this can be expected to last until about weeks 15-16 when insulin needs start to gradually increase again.

As far as management, in my case, I have been lowering my basal rates a little bit at a time (0.005 each time, but I am fairly insulin sensitive to begin with) a few times now over the past 2 weeks. I have also started planning for a little fresh-fruit snack at the times that I seem to start going low (I am also on a CGM which helps catch the trend quickly), esp. in the middle of the afternoon.

I do all my own adjustments anyway (I mean, prior to pregnancy) and am very comfortable doing that. If you are not used to it, however, I would try to contact the doctor’s office now, even before it’s time for your appointment. Mine specifically advised me to call anytime I want assistance with adjustments and they’ll review my BG results over the phone and discuss what can be changed. I am pretty sure your doctor’s office won’t refuse to do the same (and in fact it might be common procedure but they just forgot to mention it – make sure you ask how best to get your results to them in case they need them faxed or something else).

Best of luck and feel free to update us here on the thread how you’re dealing with things!

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#3

Well, I have made it into week 17! Now on the other end, had an extreme high. It really didn’t seem to want to come down… Changed my set and was testing and bolusing a lot… Took forever to get it back in range.

My last A1C was 5.5 and doc was happy… Hoping the next is similar!

Figured I’d come back on here and see about others’ experiences. I know around now I can expect some insulin resistance so it must be kicking in… Hope your pregnancy is going well!

#4

Hey, @AshGr – glad to see an update from you (although it took me more than a week to reply, so you must be 18w now)!

I just started my week 22 yesterday and the past few days my BG levels have been a major challenge. I have upped the basals across the board and am slowly raising I:C ratios for different meals. It must be the insulin resistance kicking in, but I also do still have some random very low lows so am afraid to jump too much at once on everything… It’s a tight balance, as we all know. I hate the enormous variability I am experiencing now and hope to figure out the “new normal” (for 14 days; for 7 days; for 5 days? :slight_smile: until it needs to change again).

On a more positive note, we had our anatomic scan and the baby looked great, including in terms of all her measurements. This was a bit of relief! (But also it happened before all the current BG craziness began, so now I am a little more apprehensive for the next growth scan, at the end of July.)

Happy to continue updating each other here (this thread or personal messages) – I think we’re fairly close in the pregnancy timeline and no other pregnant forum participant has chimed in with similar dates.

#5

@Dessito
Hope things are still going great with you! I’m thinking you’re 35 weeks now? I’m at 31weeks today and all is going surprisingly well from what I’m gathering!

Anatomy scan went well, and so have my biophysical ultrasounds. Baby got 8/8 for movements and everything. Happy to say at 30w5d, baby was 3lbs9oz, which I understand is not monster size. I have gotten a lot better at managing my own changes in insulin, so that’s been helpful too! My retinal scans have both been good too!

As far as I know so far, my OB is waiting to see, I have not been told that early induction is necessary or even likely, so I’ve still got about 9 more weeks to go!

Hope things are still smooth sailing with you! Is this your first? Did you find out if you’d be having a boy or a girl?

#6

Excited to jump in on this back and forth!

I am 19wks1d with my first. I have been T1D for 8 years and am working my â– â– â–  off to keep my blood sugars as good as they can possibly be. Just now getting into the insulin resistance phase.

Really interested to see how your birth experiences go and any advice you have.

#7

Congratulations!!! So far, things have been better than I could have
expected, so I am loving that!!! We got a bit of a heat wave about a week
ago, and at 32 weeks, apparently those slightly swollen feet are beginning!
Not too horrible, just not my fav!

I am into NST every 2 weeks and ultrasound/ob appointment the other every
two weeks. So far, all good! Asked OB if it keeps going this great, could I
expect that on my due date I will magically go into labour, arrive at the
hospital and have my baby 1 hour later? And he said if all keeps going this
well, we could look at scheduling the week b4 my due date, to be induced.
So, that’s where we are now! Wait and see! :slight_smile: Hope your pregnancy has been
going great too!!!

#8

Glad to hear it! Things have been going well for me too. I have my anatomy scan next week, so that’s a big milestone to get past. Currently locked in a quiet battle with my many doctors over induction. So far my A1Cs have been under 4.9 the entire pregnancy and all tests have come back perfectly normal. I just hate being pushed into the “diabetes protocol” when there is no medical indication that it is needed. So frustrating!

Hope things continue to go well for you! Definitely keep me updated!

#9

Hello, ladies!

Sorry I was not as active on the thread as I had been in the past. Started 37th week today and, thankfully, things are still looking great for me and the little girl inside me. Most recent HbA1c from last week is 4.7%; my BP stable as it has been the whole pregnancy (103/68); baby’s estimated weight 6lb10oz (58 percentile) and all her length measurements are within the normal limits; amniotic fluid index has varied little so far: 13-17cm; placenta is still Grade I!

Since mid-September I’ve been going for the non-stress tests and AFI checks twice a week, which might feel like a waste of time, but I am happy to get the reassurance every time. Baby’s HR is always good (125-144 on different occasions) and reactive, though sometimes I have to drink a cold cup of water to wake her up at the time they hook me up to the monitor. :slight_smile:

I’ve also confirmed that the hospital I will deliver in will allow me to do my own BG monitoring and insulin delivery throughout labor (again, unless a true emergency arises and/or I am unconscious) and also allows food and drink as the mother chooses.

All in all, I feel even more confident that I will be able to resist the standard induction protocol. I have made my preferences for a natural birth known to my perinatal team since our very first meeting, but always with the reasonable caveat, “as long as things continue progressing well.” I think otherwise I would have unnecessarily antagonized the relationship in a way that wouldn’t be helpful for my ultimate goal. (On this point, I would recommend the most recent book I read as preparation for labor: https://www.amazon.com/Natural-Hospital-Birth-Best-Worlds/dp/1558328815. It obviously does not talk about mothers with diabetes, but if you are in good control, I feel almost all of the advice is very helpful.)

Hope you are both doing well also and will be happy to read further updates!

#10

One piece of advice on insulin adjustments (which I assume you do yourself as the need arises): don’t be scared of the high amounts you will inevitably have to take! I was on fairly low amounts pre-pregnancy and quite insulin sensitive, so psychologically it was a battle within myself, especially in the 6th and 7th month, to make the constant and seemingly huge increases I had to apply. By last week (36th) I had reached MORE THAN 3X THE TDD I took pre-pregnancy! It seems insane, but it is the amount that works to keep me in the good range. (This week I am noticing starting to wake up a little on the low side so I am lowering the basal by tiny amounts for the first time in months.)

#11

Definitely. I am bracing for those changes. Are you still taking all your
insulin through your site or do you use needles for boluses now that your
amounts are so high? I know some people use the needles to try and save
their sites.

I was at a diabetes meet up shortly before I got pregnant and everyone was
sharing how much insulin they use total a day. I was just amazed that some
people (not pregnant) were up in the three digits for a normal day! Makes
me feel a little more comfortable eventually getting that high for
pregnancy, at least.

#12

Never even occurred to me to add injections for boluses. Not sure what exactly makes others do that, but I don’t seem to have any issues with the sites/absorption so I just do my regular pumping. I use a Medtronic pump and have to change the reservoir (and I usually do reservoir+site out of habit) about every 72 hours now (which is what the company recommends anyway, but is not what I used to do before when a reservoir could last me 6-7 days). I have always used the 1.8U and have a bunch of them still, hence the frequency. I considered buying some 3U ones but it seemed like too much of a hassle, so in the end I didn’t.

#13

I have a mini-med. As long as my site hold up, I’ll probably keep going only through the pump if I can.

At 37 weeks, you are getting close to the finish line! Are you being induced? Do you have a birth plan you are hoping to stick with?

#14

I’ve described before (I think also on this thread, but maybe on others in the Diabetes and Pregnancy sub-forum) that I do not want to be induced and in general the baseline of all my birth line preferences is for as natural birth as possible.

I actually have an extended version of the birth plan for my husband and me, and a brief 1-page bullet-pointed one for the medical staff, which is a suggestion I liked from the book I referenced just above. All of it is premised on doing my best for a fully natural birth, but it isn’t dogmatic since I fully realize we can’t know what will really happen in the delivery room. The real challenge, however, is knowing what to do with with that document.

At the high-risk (MFM) practice I have been going to during the pregnancy I have been seeing about 10 people (multiple nurse practitioners, who are the routine caregivers, and two midwives, who do rotations in the hospital where I will deliver, as well as the doctor whose name is formally on my plan of care). There are two other doctors I have yet to meet. But from what I understand, the medical personnel who will mainly be with me during the actual L&D are the hospital staff, whom I have no way of meeting until I am admitted there. (I couldn’t see my regular endo due to his medical insurance limit. Basically there is no T1D endo in the region who is allowed to see pregnant patients.) I have a friend (not high risk) who recently gave birth at the same hospital and she said the nurses were very supportive of natural birth as a first option and she was able to deliver that way. This, as well as the birth classes we took through the same hospital, are making me feel generally optimistic about the prospect.

As I mentioned, I have made it clear in all conversations at the MFM clinic where induction and standard protocol were brought up that I prefer to wait for natural birth, as long as everything continues well. Until this week, basically the response was “OK, let’s talk again after the 36w growth scan.” So now that we have the numbers from that scan and they do look good, I am restating my decision more frequently and my husband and I plan to make an appointment with the doctor during week 39. This is when they would normally do a scheduled induction. If I have started giving birth naturally by then, that’s fine by me. If I haven’t, we’ve postponed the conversation as late as possible. Again, there is a necessary element of strategic flexibility that I additionally try to employ as effectively as possible. :slight_smile:

#15

That’s awesome! I read some previous feeds that you had discussed that in but wasn’t sure if things had changed (aka your doctors forcing the issue) since the last one I had read.

I am completely on the same page. So long as there are no issues or complications, I am adamant that they let me go until 40 weeks at least. I’m not working my ■■■ off just to be judged by the label on the top of my file! This is hard work and I am doing because I have dreamed of a natural birth since I can remember and I know its the best thing for me and my baby.

I love those articles you posted (on a previous feed) btw. I have printed off multiple copies and stuck them in my purse in case I need to pull them out at my next appointment!

Please keep me updated on your progress. It is so easy to get discouraged when your own doctors are fighting you with no real evidence and a whole ton of scare tactics.