Hello all! I'm currently 21 weeks pregnant with my little girl. Things have been going great so far, minus some white coat syndrome BP issues. My A1c's so far have been 5.6, 5.5, 5.2, and 5.1. Lows have plagued me pretty bad, but I can handle them alright. But I've noticed that I need more correction after meals that I normally have down to a science. And my nighttime trends used to hanging around the 70s and 80s, but now I'm waking up in the mid-90s. All of these numbers are still fine, but I'm noticing an obvious upwards trend. I want to stay ahead of these numbers before the dreaded insulin resistance really hits.
So my question for those who have gone through this before: What did you change first, basal rates or bolus ratios? I feel like I need to up my bolus ratios first, since I'm needing more insulin at the end of most of my meals. My overall trends seems to be OK, but I know I'll have to change my basal rates eventually.
I had to up my overnight/early AM basals pretty much immediately -- my numbers crept to the mid 90's and occasional over 100, and small, gentle tweaks to my pump settings fixed it. (I don't know what I would have done if I were still on Lantus.) Like maybe .25 or even just .125 per hour. Those tiny tweaks will just gently bump you a few points, without real risk of nasty overnight lows.
Since then, I've made small adjustments to both basal and bolus along the way. Nothing drastic, though, and like you I'm waiting to see what will happen -- and looking forward to other people's answers! My doc said this morning that although I will definitely get more and more insulin resistant, it might not be as startling as happens to some women, because I'm still pretty active (I still jog, e.g.)
I'm almost 23 weeks, and just got my A1c this AM -- *4.9*!! Which is silly, really; I was running pretty low the first 2 weeks of Jan for various reasons. It was nice, though; it let me eat a lot of garbage...
The best answer is...everyone is DIFFERENT so take all this with a grain of salt. But my biggest advice is be aggressive and don't be afraid to make what seems like big adjustments fairly quickly. I tinkered around with temporary basals for about a week when resistance started because my post prandials were still good. Not sure that was the "correct" course of action, but it worked for a little while.
As it turned out, I upped my basals first, but that only outpaced lowering my insulin to carb ratio and my correction factors by a couple of days. And the crazy thing is that my early morning basals (until I get up) are STILL LOWER than they were pre-pregnancy, after having some serious lows weeks 12-20. That's just crazy, and I would have never seen that coming.
My correction factor was the one that needed the biggest and most ongoing adjustment, right up to about 32 weeks, where I leveled off. My i:c ratio went from 1:15 to 1:6, my correction factor from 1:45 to 1:20, and my basals are up about 30% from where they were pre-pregnancy. It was a BIG adjustment believing my pump when it told me the calculated dose for a meal or correction!!!!
I'm now almost 38 weeks pregnant, and while I haven't had to lower any of my doses, I am experiencing a few more lows and REALLY sweet blood sugars with otherwise difficult foods like pizza (which is like weeks 12-20).
Even with all the insulin resistance, I've been able to keep my A1cs 4.9-5.2 for the majority of my pregnancy (I started out right around 5.5 I think).
