Insulin Resistance Revisited

Pregnancy Tracker: 27 weeks

Size of the Baby: Total length is 15 inches!

Biggest Obstacle: Finding interesting, nutritious, low-carb snacks.

Obviously, one's hormones are on overdrive during pregnancy. A side effect of raging hormones is insulin resistance. I've mentioned this in a previous blog post, back in week 18 of my pregnancy, when I noticed a hint of insulin resistance setting in.

That increase in insulin requirements became the norm. For the last several weeks, my insulin to carbohydrate ratios have hovered around 1:12 or 1:11, while my basal rates were largely unchanged from my pre-pregnancy numbers.

Last week I had a particularly great week. My blood sugars were, without sounding too boastful, awesome! Each day my total daily dose of insulin was less than 30 units. I did not have many numbers over 150 mg/dl and very little hypoglycemia. I'd been eating relatively low carbohydrate meals and snacks and exercising each day. Last Friday, when I spoke to Michelle, my CDE, she said not to change anything on my basals and boluses. My numbers looked great!

As a side note, both of my Certified Diabetes Educators had mentioned that insulin resistance really kicks in with vengeance around week 28 of pregnancy. Therefore, I should not have been too surprised when everything changed this weekend.

Just about immediately after my conversation with Michelle, suddenly, insulin was not dropping my blood sugar. I'd deliver an aggressive correction bolus for a number around 140 mg/dl, only to see it barely trickle down after a couple hours. My standard breakfast of egg salad on a slice of wheat bread was not reacting to the insulin dose that had been working for months.

Then, yesterday, after a larger breakfast and morning snack bolus, I was around 130 mg/dl at lunchtime. I decided to bolus for my sandwich about 30 minutes early to stay ahead of the obvious insulin resistance I was experiencing. A half hour later, my blood sugar was 135 mg/dl! I gave myself another unit of insulin, waited 30 more minutes and finally ate my lunch when my blood sugar was 85 mg/dl. I'd delivered over 5 units of insulin and it dropped my blood sugar less than 50 points in the span of an hour. This is not typical for me, at all.

While it's amazing to see how my body falls into a clearly established pattern for pregnant diabetics, I still hate to see my insulin needs increase. Mentally, I just like to know that I'm managing my disease with healthy food choices and exercise, as much as with insulin. My pre-pregnancy brain keeps chiming in, "More insulin, bad. Less insulin, good."

On the other hand, I recently read that all pregnant women experience insulin resistance during their third trimester. Thus, bodies of non-diabetic women simply compensate for this need by producing more insulin. Since women with type 1 diabetes have to deliver their insulin manually, we notice this increase need, while non-diabetics do not. I'll have to ask my doctor about this... but it does make sense.