Type 1 Diabetes Pregnancy with Poly Cystic Ovarian Syndrome

Diabetes and Pregnancy
1

Hello I’m in my early first trimester and have noticed that my insulin resistance has greatly increased. I feel like I’m injecting water instead of insulin most of the time. My basal has gone from 1.5 to 2.1 and even then I’m still needing large corrections to control my numbers. I was told that I should be experiencing lows during my pregnancy and highs would come in the third trimester. This is not my case, and I’m wondering has it been yours? Here’s a few short questions to begin this thread…

At what point did you noticed your needs change?
Do I have a choice in seeing a High Risk Specialist or can I see a regular OB?
How many carbs daily do you consume?
Thoughts on Dr. Bernstein’s approach?
What do you do for your PCOS?

Thanks

2

Hello, @LovetoHike, and congratulations!

I have been hoping to connect with other T1D women who are currently expecting and so will reply, even though I don’t have PCOS. I just started my 14th week and also had an increase in basal needs as soon as implantation happened (I actually knew when since we used IVF that cycle), to about 20-25% over my prior levels. This is common due to the immediate increase in progesterone production (still released by the corpus luteum) which has a countering effect to insulin.

The lows you were told to expect are still likely to come, but only once the placenta develops and takes over hormonal production and delivery to the fetus. (A bit more on this from a related recent discussion here: 10w - insulin sensitivity). So make sure to keep an eye out for that transition after your 10th week or so. If you don’t wear a CGM, I’d recommend waking yourself up to test around 3am, although lower fasting levels might be a sufficient sign.

I personally see a high-risk specialist and knew that would my choice from the time we were ready to start trying to conceive. Originally, my endocrinologist informed me that his professional insurance does not allow him to see pregnant patients which I found shocking and disappointing. But then I made a pre-conception consultation appointment with the local maternal-and-fetal medicine center and the doctor we met there was great! So I decided that he would be sufficient and I won’t be seeing my regular OB/GYN either during the pregnancy and delivery. I think the options are different depending on where you live / what is available, but I actually would highly recommend a MFM specialist. You get to have a lot more frequent checkups (including ultrasounds!) and to me that’s only an advantage.

Normally (i.e., eating what I actually feel like eating), I consume 75-100g carb/day and focus on variety and clean, whole foods more than on the carbs themselves. Since I have great results this way, am not interested in anything lower than that since it will mean a major shift in lifestyle, but if I was struggling with BG results, I might feel differently. Related to this, from my perspective, Bernstein and his followers are a little too fanatical. So the general approach (lower carb amounts than what the “typical” American diet contains) is actually great, but the details of the recommendations (under 30g) are simply not for me. Now, during pregnancy, I will feel OK ramping up the carbs some, as my natural sense of hunger might suggest. It hasn’t happened yet, but I anticipate my appetite will change, esp. in the second half of the term. Also, I haven’t yet had to change my I:C ratio, though I expect that is coming later too.

As I said, I don’t have PCOS, so I will leave the last question to others to chime in on.

Best of luck!

3

Congratulations! I don’t have PCOS but I’m 29 weeks at the moment. I knew I was pregnant right away (or strongly suspected while I waited a few days to take a HPT) because my bg levels were running about 30-40 points higher than normal. I had gotten them down to a science, so it was noticeably higher even though it was still within a normal range. Then, a few weeks later, I started to need less insulin and decreased my basal rates. Now, a few weeks ago, I started to hit resistance and almost every weekend it seems like I have to up my basal profiles in order to keep up.

My gyn doesn’t handle pregnancy, so I was referred to both an MFM and an OB. The MFM handles all of the ultrasounds and will be doing weekly NSTs soon. The OB will deliver the baby and does regular basic checks for heartrate, etc. My endo manages my diabetes (well, I make most of the corrections myself, sometimes she makes additional recommendations). I’ve also been working with a CDE who specializes in T1D pregnancies, and she has been great about spotting trends and giving good advice about how to manage everything and advocate for myself.

I follow a low carb diet and am usually at about 50 carbs per day. I started with Dr. Bernstein’s approach last summer to improve my A1C and reduce the bg spikes. My endo was supportive, the MFM not so much but she was willing to take a wait and see approach. In the last few months, I’ve added in some extra carbs (some fruits, sweet potatoes, quinoa, etc.) to help reduce the minor ketones that were showing up in my urine at my ob visits. On low carb, I feel like I’m eating healthier and more intentionally. Also, I feel like I’m less hungry and eat quite a bit less than I used to when I was eating all the carbs. It helps that I love vegetables and we love to cook in our house, so I don’t feel deprived.

Good luck with your pregnancy!

4

How far along are you?

If you have PCOS are you currently taking Metformin? How much?

I am 5w4d and I have been super sensitive to insulin lately and keep hypoing which has been frustrating for me. I noticed this sensitivity shortly after 4 weeks and members of the Type 1 Diabetes and Pregnancy group I am a member of on Facebook, say the sensitivity sticks around until 16-20 weeks.

If you are experiencing resistance then I’d recommend taking Metformin if you are not already and increasing your dosage to the maximum. I am on 2,000 mg a day and take 1,000 mg after breakfast and 1,000 mg after dinner. This will also help the pregnancy “stick” if you have PCOS.

As far as a High Risk Specialist vs. OB, it really depends on your OB. I was able to find one that had no issue treating me as long as it was in conjunction with my Endo.

I typically consume 150-200 carbs a day.

I’ve heard of Dr. Bernstein’s approach but have not researched it further nor tried it myself.

Congratulations on the pregnancy!! Wishing you a happy & healthy 9 months!