Pregnancy insulin Requirements

Diabetes and Pregnancy
1

Hi everyone!

I am new here and hoping to get some answers from people who have “been through it!”

I am 34 years old. About a year and a half ago I was diagnosed as diabetic. My primary doctor at the time told me type 2. I basically got sick with some form of hand foot mouth and about 3 to 4 months later went back to the doctor and a1c was through the roof. 11! Maybe totally unrelated. I felt like I was having some issues prior to that as well.
My primary put me on metformin and I was able to bring my a1c down to about 8 and then down slightly again with the start of trulicity.

Fast forward to now. I started seeing an endocrinologist to get ready for pregnancy and was put on Lantus and some meal time insulin. Currently I am still looking like type 2 but don’t really fit the molds. My numbers looked much better and a1c is currently 6.8. We got pregnant but last week we were told it was a blighted ovum and I had a d&c. We were 10 weeks into the pregnancy.

My specific question is what insulin changes do you typically see early on in pregnancy. When I found out I noticed very unexplained highs. I went from 20 units daily for lantus. About 3 weeks ago I was switched from lantus to levemir and am now on 22 units twice daily. My endocrinologist tries to explain that we were increasing the amounts anyway and they are unrelated to pregnancy. I think I disagree. Earlier in the pregnancy I was seeing huge swings but better over all control. I feel like I needed more insulin as things progressed. Two weeks ago I could barely stay under 200 overnight and would get up and correct with humalog 1 to 2 times in the middle of the night. Now I am much more in range and going low often on the same dose.

Anyone relate? Any advice? I want to get my a1c in tight control before we try again. Any help is appreciated!

2

Hormonal changes are going to alter your insulin requirements.
Pregnancy is a big hormonal swing. You might want to get tested for LADA if you suspect you are a latent type 1. Taht would make sense that your insulin needs are going up.

But it could be hormones and increased insulin resistance.
You won’t know without getting a fasting cpeptide and maybe throw in some antibody tests just to ease your mind about your type.
As far as sugars go, you should do what you need to do to stay in the normal range and get your a1c in normal range. Taht goes for everyone. Not just you.
So if you need more insulin then you should take more. It doesn’t really matter how much as long as ur not going low

1 Like
3

Hi! Thanks for responding. We did test for LADA and nothing really remarkable found so we are treating as type 2 right now. May need to test again? Not sure.

I am seeing some lows now but also some highs. Seems like the levemir will wear off between doses. It is not as consistent as the lantas was I think.

I appreciate your advice and it definitely helps ease some of my worries!

4

Levemir likes to be a split dose, bed time and breakfast. It doesn’t last 24hrs in most. Doctor may suggest high at breakfast increase evening dose. high before evening meal, with a correct bolus for lunch. increase morning dose.
You can also do miss a meal basal testing.

Google told me, 1st and 3rd trimester may need more insulin.

5

Thank you! Great info!