Week 19: Right on Schedule

Kelsey Bonilla Health Guide
  • Pregnancy Tracker: 19 weeks, 2 days

    Size of the Baby: 6 inches long!

    Biggest Obstacle: Adjusting to changing insulin needs.


    From the first time I heard that pregnant women with diabetes will use up to triple the amount of insulin by the end of their pregnancy, that fact stuck with me. I couldn't imagine using more than my typical total daily dose (TDD) of 26 to 28 units. Taking upwards of 90 units a day? Impossible!


    What I could not wrap my mind around was how this increasing insulin need presented itself. Naively, I hoped that it would be gradual, increasing a little bit of my basal rates and bolus ratios each week at a nice, consistent pace. However, by the time I was 18 weeks pregnant, and still using less than 30 units of insulin per day, I knew that this insulin resistance was not going to be that predictable.

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    As I mentioned in my post "Diabetes and Insulin Resistance" I had one isolated experience with an impossibly stubborn breakfast postprandial blood glucose last week. However, all of my other blood sugars post-breakfast were fine that week, and I did not notice any other insulin resistance throughout the day.


    This mystery of "when will my insulin needs increase?" began to consume my thoughts. So, I read up on the topic and asked my doctor what to expect. From all of the information I could find, it seems that insulin resistance in woman with preexisting diabetes typically begins by 19 to 20 weeks and lasts until about 36 weeks. After that, our insulin needs drop dramatically, as the baby puts more strain on our bodies.


    Here I am at 19 weeks and I'm definitely starting to see new patterns emerge that require more insulin. Whereas my 14-day average TDD was 28 units, my 5 to 6 day average is now 35 units. For the most part I'm noticing high readings after breakfast and after lunch. I keep bombarding these highs with insulin, testing often, and waiting to eat something once my blood sugar gets down under 100 mg/dl. Previously, I contributed high postprandial readings to poor meal choices, such as cereal or something else high on the glycemic index. However, now I'm eating eggs most mornings, and still I've had some really resistant highs.


    The frustrating thing is these instances of insulin resistance are not uniform throughout the day. While I've needed a lot more insulin for breakfast and lunch, my regular dinner boluses are working great! Initially, when I experienced those stubborn highs early in the day, I compensated by increasing my meal and correction boluses for the rest of the day. Consequently, I've been around 55 mg/dl both of the last two evenings!


    At least there is a pattern emerging, and one that my doctor warned me about. He told me that many patients have to take much larger doses in the morning hours to combat insulin resistance, while their afternoon and dinner insulin needs remain unchanged. I suppose the medical reason for this is an extension of the dawn phenomenon many of us diabetics experience.


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    I find it reassuring, but also a little odd, how my body fits the same model of all other diabetic mothers-to-be. We're used to thinking about each person's medical history or personal experiences as unique, whereas, in this case, my body is doing precisely what doctors expect. So, I'm on schedule at 19 weeks along and starting to deal with increasing insulin needs.


    Thank goodness my insulin pump reservoirs hold 300 units... I may need all of them!


    Read all of Kelsey's posts on her diabetic pregnancy here

Published On: August 17, 2007