Insulin Resistance

During my first trimester, I was experiencing so many lows, that my A1C was 5.2.  Slightly misleading because of all the lows I had.  Now, like clockwork, I'm 15 weeks, in my 2nd trimester, and the insulin resistance has started.  I can't seem to get my 2 hour post meal sugars below 120.  I am bolusing hard, increasing the basal rate, doing all the necessary carb counting, and I still haven't quite nailed it yet.  I'm scared that these approx 180 sugar readings are hurting my child.  Am I overreacting?  I suppose I should anticipate even harder control once the 3rd trimester happens.  This is my 1st baby and I'm just so nervous that anything I do may be wrong.

You are being too hard on yourself... you will have days where you stick around 200 all day, but you're not doing any damage to your little one, you just can't stay there. I am by no means trying to sound pessimistic, but consider this trimester as training for number 3, it's quite a doozie. I'm 33 weeks, I've had days where I couldn't do a thing to bring my sugar down, for me, it comes on quick and at random ( i was advised that by this point I'd be upping my basal probably every 3 days and I've been upping my daily dose every single day for the past week). I've had 8 ultrasounds with one more detailed scan to go at the end of this month,  twice a week I have NST's which has a quick ultrasound to measure amniotic fluid, and so far every single thing has been perfect even though I've spent some time with higher sugars than I like. I can't tell you not to get upset because it's a lot to deal with and hormones make it really easy to get upset when your after meal reading is 174, but you'll have high sugars here and there.... and you'll have lows after you possibly increased too much... just check your sugar a ton ( I do 10 - 14 times a day) and understand that spells of high sugars are not killing or hurting your baby. Just do your best to stay in control and remember that getting upset and crying your lungs out will only keep those sugars sky-rocketed. A fun fact that might help you cope with insulin resistance  (especially when you hit the third trimester) is understanding that your placenta is still working. A sudden drop in insulin needs (at least in the third) is generally not a good sign, so as frustrating as it is, just try and remain calm, correct your highs, and up your doses as needed... your bambino should be just fine even if your control isn't perfect every single day. Your docs should keep a close eye on you, and although I feel sometimes it's all a bit much, in the end I'm glad that I get to see my little guy so often and I know that he's trucking along just fine and I believe that he will continue to do so. Do not beat yourself up when you have an off day or two!

Yeah, not to be a downer, but what MamaEngland said is true. It gets worse and worse. Your numbers are NOT bad. Just keep in touch with your endo/CDE and make changes as needed. I go in once a week just to download my BG's and we make changes every 4-7 days. It works. The highs are random, too. It gets very frustrating. Don't get too bent out of shape, you will be fine.

This is somewhat encouraging for me to hear about other people struggling with the same things I am. I'm only 8 weeks along with my first and even though I've only known about the pregnancy for about a month it has still been crazy. My OB would like my A1c at 6 (I was 6.4 prior to pregnancy) But I'm definitely struggling with the after meal blood sugars. I've been taking almost twice the amount of insulin I was before I was pregnant and still having 2 hour after meal blood sugars of 160 to 170 but I've just had to be okay with that because usually by hour 3 they're down to the 120's. If found if I take enough insulin to get that 120 at the 2 hour mark I've usually crashed by hour 3.

(I'm also a L&D nurse and trust me I see women all the time who have consistently uncontrolled blood sugars for a large portion of their pregnancy that deliver pretty healthy babies, Large, but healthy!)

Hi Caitlin, just wondering if you found a way to adjust your insulin to fix your 2 hour mark without crashing.  My husband and I are in the pre-pregancy phase right now and similar to you, my last A1c early this month was 6.4.  I've found a similar issue with being 160-170 at 2 hrs post meal but when I attempt to correct for it, I crash by hour 3.  Ive been experimenting with different ways to fix this (maybe an increased temp basal for 1 hr when I eat and then a decreased basal to balance the other increase between hour 2 and 3) but was just curious about whether you found other ways to even out the up and down. Thanks! -Emily

The toughest part of the 3rd trimester is getting over your fear of taking large doses of insulin.  Keep a log so you can dose accurately, even though it may seem like an obscene amount.  

I used a pump during my pregnancy, but in the third trimester took large boluses with shots.  Pumps just aren't as effective with large amounts of insulin.  The fresh skin makes absorption quicker.  

If you don't already, take your insulin 15 minutes before you eat.  (If you're at a restaurant, make sure to have glucose tablets or sugar around in case your order is delayed).  Then about an hour after eating test again and take a correction bolus.  It should help the insulin hit when your blood sugars rise.

When pregnant I also had to avoid high carb meals at night.  They made blood sugar high, no matter how much insulin I took.

ekcheung - have you thought about using the dual wave or square wave bolus feature on your pump? i have found that helps when i eat heavy or fatty meals, but it may be useful if you use that feature while decreasing your basal rate post meal too...just a thought? It may help you avoid crashing if you spread the insulin out over a period of time.