Hi friends, I'm T1 and 25 weeks along now, using a Ping and a Dexcom CGM. For the past week or so I've noticed that my blood sugars start going up about 2-3 hours after I eat (and spiking much higher than I'd like- 150 or 170 or even 200)! A correction bolus seems to do pretty much nothing to help once it starts to climb, either. I'm not sure if this phenomenon is from super delayed pregnancy digestion (maybe I should be doing a combo bolus?) or from basals that need adjustment (and are just coincidentally timed to ~3 hours after meals).
Has anybody else noticed anything like this during second trimester? Any tips/ideas? My endo is young and hasn't dealt with many pregnant women before, so she has not been much help.
I've had this experience, particularly during pregnancy (my last one and the one I'm currently in). There were three different culprits that were suggested to me: (1) delayed gastric emptying / digestion
(2) weird infusion site absorption issues
(3) shifts in insulin resistance during the day
My doctor suggested (1) and I think it's supposed to be quite common. I don't think in my case it explained very much though and I was mostly being hit by (2) and (3).
Re absorption issues, when I started moving away from my abdomen (my normal, non-pregnant area) that I would get differences in the way my blood sugar responds to insulin in different areas. So last pregnancy I started avoiding areas where there were big muscles nearby (e.g. my rear) as these would give me really uneven numbers. I haven't had this problem this pregnancy -- I was super slim then, but baby #1 left me with some extra flab that has made finding good infusion sites easier this time around.
Re (3) timing --- the red flag here is if the weird delay only happens for a certain meal, and it coincides with a particular time of day. So, in both my pregnancies, I noticed my insulin resistance suddenly rises around 9-10pm, stays high until about 12-1am (when I am going to sleep) then drops back to pre-9pm level. What would happen is my blood sugar would suddenly go up around 9pm, which tended to be about 2-3 hours after I ate. It took me *FOREVER* to figure this out, but once I realized, I adjusted my numbers to account for the insulin resistance shift. I'm not sure how common this is, but if you find this is happening at the same time of day it could be the same for you.
I experienced this too. I have NO idea why, but how my endo and I adjusted my pump settings were: (1) if I was going up within two hours of eating (i.e. postmeal spike), increase bolus.
(2) if I was going up any other time than that, increase basal two hours prior to increase
(3) if I was seeing big spikes after meal, increase both.
As a result, my basals were twice or even three times as high for the 4 hours after each meal than for the other times of the day. I'm not sure if I have basal partly covering my meals, but the important thing is that it worked and prevented me from spiking. However, I did eat my meals at FIXED times in order to remove one variable from the equation.
If you don't want to fix your eating times, you could try a dual wave bolus and see if that prevents the later spike (though I would think that you would need to give more insulin plus dual wave unless your current bolus is making you go low before 3 hours post meal).
Laura, Thanks so much for your reply! Unfortunately, I have ruled out none of those possibilities so far. :-P I think it might be a combination of several (or all), actually. Currently my worst insulin-resistant time is also around 9pm to midnight, so I set the basals up quite a bit and we'll see how that goes tonight!
On the issue of infusion sites- I had always used my stomach (the front, slightly flabby part) but obviously that is stretched way too tight right now. I've been trying to use the "love handle" area on my sides, a little bit above my underwear line (since maternity pants go waaaaay above that), but I've had several leak or randomly quit working as well in those spots. Do you have any other suggestions for good sites??
Kristin, Thanks for your ideas! I think for now I'm going to try the "both" method and hope that works! I keep looking at what the actual basal rates are and thinking, "that can't be right..." to have such varied (and high) rates, but I think I need to quit biasing myself like that in order to survive the rest of this pregnancy! :)
I just wanted to say thanks also for all of your other pregnancy-related posts throughout this forum. I've already incorporated a number of your suggestions into my pregnant life so far, and I've found your detailed, thoughtful advice to be wonderful!!
