Insulin Resistance question

Okay, I’m 24.5 weeks, and insulin resistance is starting to kick in, but not quite like I expected, so I’d like some feedback.

I’m on a fairly standard 1:12 insulin to carb ratio and my correction factor is 1:40. When I eat my standard breakfast, English muffin w/peanut butter, I can dose appropriately and manage the curve pretty well. However, for the last couple of days, it’s been more like:

7:06 68, eat, 3.05 u
8:15 135
9:00 145, 1.25 (trying to head off the inevitable)
9:45 176, 1,5
10:30 195 1.45
11:15 213, 2.00 (more than suggested correction, but getting frustrated)
12:00 191, 1.25
1:00 97, time to eat again…and I probably OD’s a little to come down so quickly

The same thing happens with virtually every meal, unless I lo-carb it, which I don’t much want to do because I’m hungry if I don’t eat carbs, but I do try to keep carbs under 45g a meal :slight_smile:

Anyone else have patterns like that? I could up my correction factor to 1:30 but I really don’t think I should change my insulin:carb ration because I’ll bottom out at one hour and two hours post prandial readings.

Do you have any thoughts?

Increase your basal rates!

If I don’t eat, my basals are fine…so I’m not sure that’s the problem, at least not yet.

But that’s definitely not off the table. I guess I could set a temporary basal rate with meals to see how that goes…but not sure how to even estimate that. I’m getting pizza-style spikes and sustained highs.

Do you ever not eat breakfast? Because if you always eat breakfast, and it’s always the same amount of carbs at about the same time, a basal increase will still help. Also, how far ahead are you bolusing for your meals?

How frustrating!

I ate on a schedule and increased my basals for three hours after eating. This really helped the insulin resistance. You may try a temp basal of 120% to start with after eating. Or try using extra insulin and give a dual wave bolus.

Also, even if you didn’t need more basal a few days ago, you might need more now. I was astounded by how suddenly my basal needs increased during this period.

Thanks for the suggestion. I typically eat bfast pretty close to when I bolus because I tend to run 60-70 every morning (intentionally) and don’t want to run too low. As it is, I’m hardly breaking 75 the first 30 minutes or so after eating.

The rest of the day, I’ve upped it to 15 minutes ahead…just to see if that helps some, too.

Thanks for sharing what worked for you…it seems like the consensus thus far is to set a temporary basal whenever I eat, and I’m going to try it at dinner and see how it goes. :slight_smile:

Who knew that’d be the first thing to change??? I’ve heard adjusting insulin:carb and correction factor and standard basals to combat the inevitable…love taking different approaches back to my doctor!

Also are you eating right when you bolus or do you wait? Many of us find that waiting 10-20 minutes makes a big difference (though my endo does not like that I do that!).

Actually, I thought maybe you were bolusing too far ahead–causing you to be lower immediately but not having enough to sustain you for very long (I think that makes sense…) But it doesn’t sound like that’s the case!

Yes, I had to increase my basals about every 3 days for awhile. I also had to get over my fears of increasing too much. It really does seem like you are taking an incredible amount of insulin and increasing way too often, but it’s just what you have to do.

I’m at 35 weeks and have finally leveled off and am experiencing some pretty sweet BGs. My insulin resistance in this pregnancy wasn’t as bad as it was with my daughter.
I found the square wave bolus and waiting 15 minutes before eating made a huge difference for me especially in the morning. The reality is that you are looking at decreasing your I:C ratio, mine went from 1:7 to 1:3 in 8 weeks, as well as increasing your basal rates and decreasing your correction factors. Based on your BGs, I would change my I:C ratio first, then my correction factor and then the next day my basal rate if I’m having the same BGs. You may want to decrease your predawn basal rate just a little bit. What has your Endo told you?

Why increase basal for 3 hours after eating, rather than use a dual wave or square wave bolus? I guess it all comes out the same in the end, but I’m curious.

You’re right that this would have the same effect. I ate on a schedule – so the increased basal seemed easier. But I may try the dual wave bolus in the future.

I am just not sure how to calculate a dual/square wave bolus that makes any sense to me, so increasing my temporary basal rate has seemed “easier” as long as I keep carbs under 45g per meal and the meal relatively low fat. I wouldn’t dream of eating pizza these days.

I might try adjusting my insulin:carb ratio (again), and then trying to split out the dose rather than arbitrarily upping my basal to see if I find a solution that works.

I’ve also upped my basals, which like another mentioned isn’t as necessary if I don’t eat, but since I am on much more of an eating schedule these days, I don’t have to worry much about lows.

Just glad I am not insulin resistant when not pregnant. I know that a fair number of diabetics deal with that problem, and it would totally stink.

What are the rest of you eating for breakfast to keep it low carb? Eggs? Cottage cheese?

I have never been much of a breakfast eater (pretty much just a South Beach bar until they stopped making those) to keep me from getting hungry before lunch. Trying to keep the baby AND my body happy is hard work :slight_smile:

EVERY single day for my pregnancy, I ate:
two eggs (changed how they were prepared)
50g of whole wheat bread (this is two small slices)
fresh veggies

This helped me maintain my diet during the rest of the day because I didn’t feel as hungry. It helps that I actually really like eggs.

I don’t have an endo. I have a GP who is also diabetic and on an insulin pump himself. He is generally wonderful (but I always have an A1c under 6.0 so I am a star patient regardless), but he’s not particularly helpful when it comes to managing the day-to-day pregnancy numbers. He and I have a great relationship, and I am checking in every other week with blood sugars and seeing him monthly, but I haven’t found his recent recommendations particularly…insightful at this point.

Lately I’ve been eating a whole grain english muffin (23g) with a single egg and cheese. Sometimes bacon. Sometimes I also have 1/2 a grapefruit (~15g).

I also bolus for the milk in my (decaf!) coffee. 2 cups of coffee will be 4-6g of milk, which makes a difference.

I’m only 11 1/2 weeks, so haven’t hit insulin resistance yet (though I totally had to raise my basals the first few weeks). But I do have to prebolus for breakfast now – by 15 minutes or so. Though today I went low (42) before that egg sandwich kicked in, so maybe I should back it off a bit.

It sounds to me like you should dual wave. Total guess at a starting point: total the carbs at a bit over what they actually are. E.g. instead of 25g, do 28. Take 75% when you eat, or 5 minutes before, and the rest over 2 hours. Worth a try, no?

I was originally sent to Maternal Fetal Medicine at the hospital which was an utter disaster. They called my OB and told her they didn’t want to handle my case b/c I was non-compliant. The reason for this nasty little label…I was making my own adjustments without prior approval…which is totally stupid!! I’ve been self managed for many years and after months of looking I finally found an Endo who would work with me throughout my pregnancy. I see him once a month, he looks at my pump stats, my dex read outs and tells me I’m making all the right adjustments. He’s just there to advise me when I run into something I can’t explain. This is my second diabetic pregnancy so I still had all my notes from my last one that I end up going back to. My last pregnancy was in Montreal at a teaching hospital so I was seeing an Endo weekly which sometimes is overkill but I did learn alot from the other T1 diabetics in the clinic.This website is a good place to bounce ideas around and then to take the info to discuss with your doc. In the end the best advice I have is to chart and look for your trends. Do occasional basal testing and test like a crazy!

It was a high risk OB that gave me the label. They were not properly equipped to deal with a self managed T1, especially one who speaks her mind. My endo told me that as long as my numbers stay within a proper range than he’s cool with me being self managed but that I need to be willing to let him take over when my numbers head down the crapper. I’m okay with that.