I need your help! Miscarriage, D&C and high blood sugar

Hello everyone,

I had just gotten pregnant for the first time. I was just over 12 weeks, and when I went for my 12 week ultrasound on March 14th, they discovered that there was no heartbeat, little to no blood flow to the placenta and fetus, and the gestational size of the fetus was just over 9 weeks. So very sad. I didn't even have any bleeding -- there didn't seem to be any signs. The doctor assured me it had nothing to do with my diabetes. My husband and I were (and are) heartbroken. My 9 week ultrasound was really great -- heartbeat was strong, and size was spot-on. So, I'm grieving the loss, but also have another problem...

I had a D&C done on Friday, March 16th. Seems like it went well, and I had my two week follow up visit yesterday (3/30), and all seems well. BUT, my blood sugar is out of control. I am getting unexplained highs, especially overnight.

Let me just preface this by saying that I've had type 1 for over 18 years, I'm 32 years old, my pre-conception A1C was 5.8, and my A1C if the middle of February was 5.7. I've been on an insulin pump for about 13 years, and I've been using a CGM for a few years -- and used it religiously before conception and all during the (albeit brief) pregnancy. I really felt like my blood sugar was quite good, as a whole, all during the first trimester. We didn't even need to make very many changes at all to my basal rates.

But now, I have no idea what's going on. Here were my blood sugar readings & insulin dosages from yesterday (I'll just start at noon):
12:13pm  112 (took 5.0u to cover lunch)
3:19pm    133 (took 0.2u because I should be lower than this 3 hours post meal)
6:30pm    150 (took 8.1u to cover dinner -- more than I'd usually need, but since I've been running high, I took a few units extra)
8:56pm    102 (and pump indicated that I still had about 3.0u in my system, but I didn't eat anything, just to see what would happen)
9:34pm    142 (took 0.5u because I should be lower than this 3 hours post meal -- didn't eat anything)
10:32pm  146 (took 0.4u to correct -- still haven't eaten anything since dinner)
11:33pm  113 (didn't take any insulin, because this is a good number before sleep -- still haven't eaten since dinner)
3:04am    228 (CGM woke me up, so I tested and took 2.1u to correct)
9:06am    110 (it seems that correction worked -- not a bad waking number. But I took insulin to cover a breakfast that has always worked for me, and was 255 when I tested 2 hours post-meal. Totally not the norm for me.)

I'm going crazy. This has been pretty typical for the past 2 weeks -- it's usually worse, actually. I don't understand why this is happening. I've never experienced this in my 18 years of living with type 1. Insulin resistance? Could it be hormonal, still, 2 weeks after the D&C? Might I still have part of the placenta in my uterus, and could that cause high blood sugar or insulin resistance? I'm kicking myself, because I should have insisted on an ultrasound at the 2 week follow up appointment -- just to check if there was still tissue remaining. They were going to do that, but then decided against it because I had pretty much stopped bleeding (since the day prior to the appointment). But then, low and behold, I started bleeding again later that day (yesterday) in the evening. Is it normal to still be bleeding? I never really had any particularly heavy bleeding... kind of just on and off bleeding throughout the 2 weeks, and light spotting in between.

Also, I did send my CGM data to my CDE, and she and I spoke on the phone yesterday as well. She just recommended some basal rate changes -- and as you can see from my readings up above, those changes didn't really seem to help. I have an appointment to see the PA to my endocrinologist (she's great) this Thursday. But I don't even know if that will help... because no one seems to know why this is happening. I DID tell the OB at my 2-week follow up about my unexplained blood sugar, but she didn't understand why either, and just said I needed to get it under control before husband and I try to conceive again. Duh.

I just don't understand why this is even happening in the first place! I've never needed to make such severe basal rate changes before! And I'm afraid -- what if I go back to "normal" (whatever that might mean)? I'll get a severe low overnight, then! I'm just feeling scared, and the high blood sugar is making me feel really lousy. I sincerely appreciate your input, thoughts and advice. Thank you so much in advance, and sorry for the EXTREMELY long post!!

Hi Elise,

I am very sorry to hear your news. Sometimes things happen for reasons we dont understand, but keep your spirit up. After reading through you post, I have to wonder, over the 12-13 weeks that you were pregnant, did your endo make lots of reductions to your basal rates? I know my endo has brought me down considerable for the first trimester to help with lows all the time. I just wonder if maybe they need to make a little more drastic changes to your basals to get your back to where you were previously. Also, could it just be some severe hormone fluctionations? Hope this helps a little.


Thanks so much, Keara. Actually, no, we really didn't adjust my basal rates down at all throughout the 1st trimester. I didn't seem to need that. So, it's not just that I need to set them back to where they were -- they were there already! Yes, it could possibly be hormones... I'm just so frustrated that I really don't know why this is happening!! Today has been ok -- I've managed to stay under 150 since 11:30 this morning... but that's with A LOT of testing. I wish CGMs were more accurate!

Anyway, I appreciate your input! Thank you for writing. :)

Sounds likely that you're dealing with post miscarriage hormones.  Especially since your blood sugars are only sporadically high.  Your body is also recovering from a surgery and that kind of stress can raise blood sugars for a while until you're completely healed.

Don't worry if you need to increase your basal rates.  Adjusting them is just a part of life, as far as I can tell.  That's especially true after going through a pregnancy and miscarriage.  

I'm so sorry about your baby.  You're doing such a great job managing your diabetes and that will help you in future pregnancies and when you're a mom.  Take care.  -Jenna

Thanks so much, Jenna. You're right... the increased basals are definitely helping. It must be hormones... still bleeding after D&C, now about 3 1/2 weeks later. I'm sure that's related to hormones and what not as well. I imagine I won't go back to "normal" with my blood sugar and basals until I stop bleeding at least!

Thanks very much for the support -- I really appreciate it.