Insulin Resistance

Hello everybody? I've got a question that I'm sure has been touched upon in other posts, but is there a way to combat the insulin resistance that starts during the second trimester?

I'm between 10 and 11 wks with my first successful pregnancy. I've had several lows during this first trimester, but I know that that will be coming to an end here soon. My a1c is decent, it was 6.3 at conception and was 5.6 at my last appointment. Is there anything that I can do or do I just correct like crazy when it starts giving me grief? I'm on an animas pump and I'm looking at starting a cgm soon.

For those with babies or those going through pregnancy now, what has your experience been with resistance? How did you keep a decent a1c?

Don't stress about this.  It's just part of diabetic pregnancy and the increase happens gradually.  Didn't really notice it in the 2nd trimester, but your insulin will increase like crazy in the 3rd trimester when progesterone levels increase.  Just correct as you go and increase your basal rate if you're high at the same time for 2 days in a row.  Be extra dilligent to test or use your CGM and also take the time to carb  count so you're bolusing accurately.

One of the biggest keys for me was eating the same breakfast every day.  When my insulin needs would increase I'd always see it first in the morning.  I ate my same english muffin with peanut butter everyday, so if I tested mid-morning and was higher that expected it was usually a sign that I needed to increase basal.

I also had better blood sugars after my moms-to-be water aerobics and yoga classes.  Your 2nd trimester is a great time to exercise and will help a little with insulin resistance.  

Before pregnancy I was taking about 40u of insulin with my pump but by the end was taking over 100!   Still was able to maintain a 5.1 A1c without much trouble.  You're doing a great job with your A1c now, so there's no reason you can't adjust your insulin as changes are needed through the rest of your pregnancy.

Take care and congratulations on your baby!

Insulin resistant typically starts to ramp up in   the 3rd trimester. Oh the joy. I agree with Jenna that increasing exercise is a great idea at this stage. Typically, resistance is highest in the morning and so a pre-breakfast routine can be of great use. This spike in resistance is due to the increase in daily counter-regulatory hormone fluctuations (ie. insulin resistant hormones) which frequently start to rise at around 3-4 AM and peak at approximately 7-8 AM.

Another helpful approach is implementing lag times. During my 2nd pregnancy, I used a 1-1.5 hour lag time before transitioning to an alternative (and not FDA-approved approach). This is not particularly convenient but as your insulin doses increase, so does the time for absorption.

Your physician should be titrating your basal rates, insulin:carb ratios and correction factor every other week during the 3rd trimester to accommodate increasing insulin requirements. Its critical that someone who knows type 1 diabetes is managing this.