Bring it on, 2nd tri highs!


#1

Hello everyone, im 18 weeks preggo with twins and am just starting to notice i need more insulin. I have a few questions (below) and would appreciate knowing what you found helpful to maintain a healthy A1C during this time.

Questions: im noticing my insulin needs at night are increasing but daytime is fine, anyone else notice that? What did you have to change first/most often carb ratios, basal rates, correction sensitivity? Any rules of thumb for knowing when to change what? Any keys to success: low carb, exercise, etc? Thanks in advance!


#2

I just wanted to say welcome and congratulations!

Others with experience being pregnant while dosing will be about to help you.


#3

Hey there! I’m 25 weeks with just one baby. Do you use a CGM? My advice is kind of based around trends I see in my CGM, but with regular BG checks, you might notice the same trends even without a CGM.

If your sugars are creeping up overnight in the absence of food, definitely increase your basal rate. Personally my carb ratios have undergone the biggest changes so far, followed by my correction ratios, less so my basals. But everyone is different! I started noticing some spikes after eating, that was my biggest hurdle to overcome, so my carb ratios, especially at breakfast have already increased to some degree. Breakfast is almost double! Lunch and dinner not quite as much.

As a general rule of thumb, again, if you are fasting and you are still too high but stable, increase your basals. Otherwise, BGs after eating may go up some but should come back down within a few hours. If they don’t, I’d change carb ratios first before changing basals at the times you’re eating. Correction ratios are a bit harder, but if your basals and carb ratios seem to be right, and you’re doing a correction that isn’t bringing you down to where you’d expect, you can and should tweak that too.

One thing that is also very important to know is that you may have to lengthen your prebolus for simple carbs! This change alone may be all that’s required sometimes, as opposed to doing more insulin for your meal. Pacing is key.

Sometimes I’ll make a pretty big change on my carb or correction ratios, and just 3 days later I have to make another pretty big change! Especially in the last 2-3 weeks. So my best advice is to be bold… within reason. Safest way is to ensure you haven’t simply made a mistake in counting carbs or in accommodating for heavy exercise. My best BG days are those in which I only eat things for which I KNOW the carb counts of, or I eat low carb, and I just do my regular lighter exercise. Remove as many variables as you can before making big changes to your dosing if you want to be more confident.

I guess there’s a lot to say, but those are the highlights I guess! I do recommend this book, where I got a lot of my strategies: https://www.amazon.com/Pregnancy-Type-Diabetes-Month-Month/dp/1544267347/ref=sr_1_1?s=books&ie=UTF8&qid=1540404432&sr=1-1&keywords=type+1+diabetes+and+pregnancy Best wishes for the rest of your pregnancy!


#4

Thank you so much, that was super helpful! I have a GCM and have been “too reactive” with changing my settings so this is a good reminder to keep it simple and eliminate variables. I know I will be re- reading this in the future. Hope everything is going well for you and your baby


#5

No problem! It is so very tempting to make changes when just one meal, activity, etc. lands your sugars way out of range. I’m guilty of it, too! But I do feel much more confident in my changes when I wait until I can try to isolate the cause. It’s an exercise in patience to get us ready for when our babies are here! :slight_smile:


#6

During the second half of my pregnancy I just started eating the same thing every day. It was the easiest thing to control: eggs and sausage, ham or bacon for breakfast; turkey or ham sandwich for lunch with a side for lunch; and a green salad with grilled meat on top for dinner.

Even while not pregnant your body reacts differently each day to the same things no matter how much you try and control everything!