Is it really possible to maintain such tight control?!

Hello, all! I'm currently 25 weeks pregnant, and my basal rates are up to 1.0u/hr and my bolus ratio is 1:7 (originally 0.8u/hr and 1:12 pre-pregnancy). My A1c as of last week was 5.4%, up from 5.1% at 20 weeks.

My endo told me at the beginning of my pregnancy that my goals are to be <90mg/dL before meals and <120mg/dL two hours after meals. I've been trying my best to adhere to these goals, and of course I'm having a lot of lows because of it. Well, my endo told me last week that he wants to me increase my bolus ratio to 1:9 and extend my IOB time from 4 to 6 hours. He wants me to do this to avoid the number of lows I'm having, which there are a lot.

The thing is, if I switch to his suggestions, then I'm going to see numbers a lot higher than 120 mg/dL after meals. I just don't see how ANYBODY can stick to the 90/120 rule without either a) eating extremely low carb (which I've decided is not healthy for me or baby because I believe in having balanced nutrition) or b) having a low after every meal unless it's packed with a lot of protein and fat (I've yet to find that perfect balance).

I guess I'm feeling a little bit overwhelmed feeling like I need to maintain this tight control without having a ton of lows. I feel like it's impossible. And right now it's more important to me to try to keep lower numbers than to worry about my lows. I can handle lows, I don't want my baby to handle higher numbers.

Anyone else feel this way?

I definitely felt that way. In spite of my best efforts, I still had highs and lows, often in the same day. One thing that did help, especially toward the end, as I got really insulin resistant, was bolusing at least 30 minutes before a meal. That's not something I can do when not pregnant without going low, but when I was pregnant, it was necessary. Also exercising right after a meal whenever you can.

Good luck.

My endo's first priority was always getting rid of the lows. She never wanted good control at the price of more lows. Sometimes I wished she would just leave the lows and worry more about the numbers above 120!

My A1c never went below 6. It was 6.8 when we started trying to conceive and stayed between 6 and 6.5 during the pregnancy. When I expressed frustration at still not getting below 6, she reminded me that I should be more concerned about my BG numbers than about my A1c. I was seeing some spikes too, of course, but they were pretty rare.

My endo also insisted on a very strict schedule of eating every 3 hours during the day and I think the method to her madness was that the previous bolus and basal partly covered the next meal or snack. This meant that my post prandial numbers rarely went about 140 (they DID go above 120 though!).

Like E. Louise said, another approach that worked for me too is to bolus early.

I agree with the others.

1) Bolus early

2) Eat smaller portioned and as a result smaller carbs meals/snacks more frequently to prevent the low that might occur if you aggressively bolus.

I'm totally with you; I'm willing to deal with the lows in order to avoid the highs. I really don't think the lows are that dangerous for us -- remember, non diabetic pregnant women run in the 50s-60s when they are hungry. (Not dangerous as long as a) we test a lot, especially before driving b) we can feel the lows, c) etc.)

All that said, unfortunately my lows are sort of a thing of the past. At 27 weeks (and still exercising), my basal is 3x pre-pregnancy, and I don't even know what my carb ratios used to be. My numbers started going nuts around the 25 week mark. Good lord I take a lot of insulin now. (I don't low carb either: I'd be *miserable*.)

But my A1c is still low 5's!

One tip: look, it sounds like you KNOW you're going to go low after meals. If you now roughly *when*, head it off at the pass: get in the habit of eating 2-4 skittles 3 hours after meals, or whenever the relevant time is.