Diabetes and Insulin Resistance
Pregnancy Tracker: 18 weeks
Size of the Baby: The size of a small can of soup.
Biggest Obstacle: Waking up in the morning -- sleep feels so good!
Yesterday, at 17 weeks and 6 days into my pregnancy, I had my first experience with insulin resistance. I can see that there are many frustrating days ahead!
Up until now, my blood glucose has been fairly easy to control. I have not increased my total daily dose (TDD) since the pregnancy began, and for a few weeks, between weeks 9 and 13, my insulin needs actually decreased. I had been able to rely on my body to do pretty much the same thing each day, and I was confident in my ability to estimate insulin needs and reactions.
Things are changing.
I had Grape Nuts cereal and skim milk, ½ cup of each, and ¼ cup fresh blueberries for breakfast on Monday morning. The doctor recently upped my breakfast insulin to carb ratio, so I'm now at 1:15. Thus, I bolused 4.25 units for 65 grams of carbohydrate. In fact, with a fasting blood glucose of 104 mg/dl, I bolused for breakfast 20-30 minutes before eating, just to make sure I wouldn't have a postprandial spike.
Upon arriving at work and getting settled in a bit, I checked my blood sugar and clocked in at 212 mg/dl. "Darn pump!" I thought to myself. (I had a problem with clogged tubing on Sunday morning, so I figured my pump had failed me again.) I decided to prime the tubing to see if indeed I had another mechanical issue on my hands. Nope, the pump seemed to be working fine, and I had just changed the reservoir and tubing the day before. The pump was not a likely culprit. "Must have been the cereal," I then concluded. I gave myself an aggressive correction bolus of 2.5 units, with a healthy amount of insulin-on-board. "That should do it."
An hour later I checked my blood sugar, supposing that I should be well on my way to a low after the huge correction bolus. My meter rang in at: 205 mg/dl.
Frustrated, I gave myself another correction of 2.5 units and called my husband for moral support. I explained the high, and how I had no idea what was going on. "Perhaps the insulin is bad?" I suggested, even though it was a new vial, and had been working perfecting fine for the past week. We decided that if it didn't come down in the next hour or so, I'd run home to do a site change.
I bloused for a second correction in anticipation for my morning snack. I obviously didn't want to eat with my blood sugar still above 200 mg/dl, but I was starting to get a little hungry.
Another hour later, I tested and was warmly greeted by this result: 92 mg/dl. I felt so relieved, and really enjoyed my Larabar and decaf coffee, which I did not bolus for.
At noon, my blood sugar was 97 mg/dl, and at 1:30 p.m., just before lunch, I had remained steady at 90 mg/dl. Looking back on my morning highs, I was stumped. It could not be that my Grape Nuts breakfast really required 9.25 units of insulin!
Luckily, I had a doctor's appointment that afternoon, so I shared my tale with the OB. She agreed that the cereal should not have caused such a stubborn high. "Is this the insulin resistance I've read about?" I asked her.
Yes, it turns out, I'm right in the period of time when insulin resistance begins. Between weeks 18 and 36, the placenta releases pregnancy hormones that wreak havoc on blood sugar control. This is going to make everything more complicated, and frustrating, she warned me.
So, mystery solved. I have been wondering for some time now when my insulin needs would start increasing. Everything I've read talks about how a pregnant diabetic increases their TDD by at least double, if not triple their original doses by the end of their term. Was this going to happen in large strides, or gradually, I wondered.
Now I see insulin resistance is not going to fit some neat pattern for me. I'm going to have to respond to highs, predict reactions, and hope for the best.