Pregnant and Diabetic: Dealing with anti-insulin hormones
We're now almost three weeks into January, and I wish I could say that I've figured everything out. Earlier in the month, I had posted about my January resolution, which was to maintain my A1C during pregnancy. In my mind, it was more about closely monitoring and really paying rapt attention to every blood sugar change. I thought these fluctuations were a result of something I was or wasn't doing.
I had no idea my baby's placenta was plotting against me.
Apparently, now that my baby is in her 24th week of gestation, the placenta is producing anti-insulin hormones. Anti-insulin. As in, my placenta is seriously working against my diabetes these days, causing me to raise my basals to almost double what they were pre-pregnancy, and throwing my insulin-to-carb ratio completely out of whack. These highs I've been seeing? And the need for more insulin? NOT SOMETHING I DID WRONG. It isn't what I'm eating or what I'm drinking or how I'm sleeping or exercising or any of that stuff. It's the fault of that lovely placenta that is nourishing my daughter.
So I can't get THAT mad at the thing. Instead, I have to be ready to adjust at any given moment.
I had another appointment at the Joslin Clinic last week, and met with my endocrinologist to discuss these new developments at length. Ultimately, it comes down to two things: I need to be vigilant in monitoring and I need to be comfortable making adjustments as needed. My doctor and I decided that 'two days makes a trend,' which means that if I see high blood sugars first thing in the morning for two days in a row, I should make a basal adjustment. If I see nasty post-prandials after lunch on Monday and Tuesday, I should think about negotiating a new insuiln-to-carb ratio. I have three months left before this baby arrives, and during the next 90 days, I need to get comfortable making changes every few days. I can't be afraid to tweak, and I can't be reluctant to track trends. It's a time of extreme focus, but knowing it's not my fault and that it's an expected part of this pregnancy makes things easier across the board.
So things have been readjusted for the month of January, and my resolutions have taken a more forgiving turn. For the duration of the month, I'm focusing on staying steady and closely connected with my medical team in efforts to make adjustments to my insulin needs and food intake as needed. It's scary, making these changes on my own because I'm never sure what the "right" thing to do actually is, but if my docs and I can work together for the next 90 days, it will be okay.
My goals are set week-by-week now: just get through the next week at a steady, solid blood sugar range, and keep my mental state confident as well. The baby and I will be fine, and my terrific medical team will help me "get there."
Another resolution update coming in February - stay tuned!