Pregnancy, diabetes and lowering high blood sugar
For the next five months, readers will be able to track Kelsey's progress and find out how she controls her diabetes while pregnant.
Pregnancy Tracker: 16 weeks
Size of the Baby: the size of an open palm
Biggest Obstacle: Fitting into clothes -- maternity are still too big, but I can't button my pants!
Excellent blood glucose control for a non-pregnant, type 1 diabetic often includes testing many times per day and correcting any high readings. Even with tight control, diabetics are used to the occasional postprandial spike or unexpected high blood glucose. However, once you add pregnancy to the mix, excellent blood glucose control hits an entirely new level. Testing up to 20 times a day is typical, target blood sugars become unbelievably low, and those postprandial spikes, or for that matter any high readings, are no longer bearable for a pregnant woman with diabetes.
An occasional high reading is going to happen while you are pregnant. Yes, I said it: pregnant women will have instances of high blood glucose!
When I first learned I was expecting, I planned to avoid any and all BG spikes for the duration of my pregnancy. Of course, this is an ideal, and we live in the real world where pump tubing gets clogged, infusion sites go bad, carbohydrate counting is not a perfect science, dawn phenomenon rears its ugly head, and pregnancy hormones mess up everything you thought you knew about your body!
Worrying about a high reading does not help, nor does beating yourself up for allowing your BG to rise. Stress is not going to benefit you or your baby, much less facilitate lowering your BG to the desired level. Here are a few things that will help:
1. If you use an insulin pump, make sure your pump is not causing the problem. You may want to disconnect and attempt to fill the tubing with insulin to ensure everything is working mechanically before administering a correction bolus.
2. For real stubborn highs, nothing beats testing, correcting, testing, correcting. Often diabetics worry about stacking insulin, but when facing an unyielding high blood glucose, stacking can work for you. Just be sure to keep testing every 30 to 60 minutes so you can gauge when your BG starts satisfactorily lowering, and be prepared to snack to avoid "bottoming out" later.
3. Being high and hungry at the same time is a pain, but it only makes things worse to eat carbohydrates when your BG is already high. Ideally, a pregnant woman should begin a meal with a BG between 60-90 mg/dl. If I have a blood sugar higher than about 150 mg/dl, I'll bolus 15-20 minutes before a meal, and test again to make sure my BG is starting to drop before eating. If I am absolutely starving, and my BG is too high, I will snack on nuts or vegetables without much carbohydrate content.
4. One tip for lowering a high BG quickly is to add future basal insulin to your correction bolus. A variation on John Walsh's "super bolus," this method allows you to quickly lower your blood glucose value, without dropping too low later on. Simply add one to two hours of basal insulin to your correction bolus, and then suspend your basal rate for the hours you administered up front.
5. Without having to load up on insulin, a great way to lower blood sugar is through exercise. Walking briskly with a small amount of insulin will likely lower your blood sugar as much as being sedentary after taking a large correction bolus. Intense activities, such as running or swimming (my personal favorite pregnancy workout), will lower blood sugar even more.
I experienced an unexpected high BG this month while visiting my hometown for my sister's wedding. We had sandwiches from a local deli, where they make this delicious bread that I have never seen outside of Eureka, Calif. The bread is white, (which is a rare treat for me), and I knew it would probably spike my BG so I bloused accordingly (or so I thought). Going into lunch I was at 110 mg/dl, I bloused for my half sandwich and ¼ cup of potato salad. Less than 90 minutes later, my blood sugar rang in at 299 mg/dl, definitely the highest number I have seen in over three months!
I regained my composure and plugged in a "super correction bolus" of 3.5 units, while suspending my basal rate of 0.50 units/hour for 90 minutes. Because I am a little neurotic, I tested several times over the next hour and was pleased to see 142 mg/dl show up on my meter just an hour later. The basal suspension worked too, because I was right in range at 97 mg/dl before dinner.
These are just a few methods I have been using with more frequency since becoming pregnant, when being high, even for just a little while, became increasingly bothersome. Even though having my blood sugar high still drives me a little crazy, knowing that I have the tools to correct efficiently makes those temporary highs easier to bear.