Pregnancy Tracker: 29 weeks, 3 days
Size of the Baby: Head to toe length is about 16 inches** Biggest Obstacle:** Getting my daily exercise.
Over the past couple weeks I've seen my insulin needs creep up.
I've been eating a consistent number of carbohydrates for my meals and snacks. My breakfast has been the same each day for at least two months: one slice high fiber wheat bread with egg salad for 15 carbs. This eating schedule allows me to track my insulin needs quite precisely. For several weeks my breakfast required 1.5 units of insulin. Then, just a couple weeks ago, that stopped working.
This is my adversary: insulin resistance.
During these days of increasing insulin needs, I have battled a few high numbers. Since I'm testing just about every hour, I haven't run into many numbers over 200 mg/dl. However, I've had a few instances where I've hovered around 170-180 mg/dl for several hours. Sometimes it seemed that my insulin was not working. Nope, my pump was fine, the insulin was good. My body just would not respond to insulin as it used to.
I discovered that increasing my insulin to carbohydrate ratio was not enough to fix these postprandial peaks. By bolusing before meals (even in ever larger quantities) and eating as I normally would, I was constantly playing "catch-up." I would deliver substantial corrective boluses and wait impatiently for my blood sugar to come back down.
Then, it dawned on me. The timing of my insulin could be a factor.
I noticed that my body would eventually use the insulin efficiently (sometimes ending in lows), but it seemed that the glucose was getting into my blood stream before the insulin had fully kicked in. I started experimenting with delivering my boluses 30-60 minutes before I ate.
The results have been great Instead of playing "catch up" with my insulin, I'm proactively delivering the insulin so it's dropping my blood sugar before I add food to the mix. Returning to my egg salad breakfast: this morning I bolused 2.5 units, with a fasting blood sugar of 90 mg/dl. I waited 45 minutes before eating and two hours later I was at a comfortable 109 mg/dl.
This concept is a little hard to implement at first, because you keep thinking that you'll go low before you finally eat your meal or snack. If I didn't have all of these pregnancy hormones pulsing through my body, I'm sure I would have had a few lows already. However, for now, bolusing an hour before I eat matches my body's needs perfectly.
For example, yesterday at 12:30 p.m. my blood sugar was 108 mg/dl. I bolused 4 units for my lunch and waited one hour before eating. At 1:30 p.m., when my blood sugar rang in at 84 mg/dl, I had my homemade chicken burrito in a whole wheat tortilla. I may have needed just a little more insulin, because 90 minutes later I was 132 mg/dl. But still, that's nothing compared to the numbers around 200 mg/dl that I saw a couple weeks ago.
Ideally, when pregnant, you want to eat when your blood sugar is between 60-90 mg/dl. If I bolus early for a meal or snack when my blood sugar is already in a good range, say 90-120 mg/dl, I can feel my blood sugar start to drop over the hour. It hasn't gotten low per se, but I can feel it dropping into that 60-90 mg/dl range.
This bolusing early plan has me quite excited. Instead of just cranking up my insulin to carb ratio, which would likely lead to low blood sugars later, I can now eat my relatively low carb diet with a moderate amount of insulin required.
Also, by eating every few hours, in addition to bolusing early, I always have some bolus insulin in my system. In a way, I am "stacking" the insulin, which helps greatly when you're fighting insulin resistance. With these tools, my numbers have been remarkably steady the last couple of days. Yesterday my high was 132 mg/dl and my low was 84 mg/dl. So far today, I've stayed between 71 mg/dl and 109 mg/dl.
So, I have a handle on things this week. However, the fun of a diabetic pregnancy is that everything will change again shortly!