Needing Less Insulin after 34 Weeks

Patient Expert

Pregnancy Tracker: 35 weeks** Size of the Baby:** Crown to rump length is 13.5 inches.

Biggest Obstacle: Some of the baby's kicks are starting to hurt

One of the most frustrating aspects of a diabetic pregnancy is the dreaded insulin resistance -- at least it was for me.

I found it quite disheartening to see my insulin needs increase while my food and exercise habits remained the same. Of course there wasn't anything I could do about it. Pregnancy hormones are to blame.

So, really it should not bother me that much. However, after years of thinking, "Less insulin is good; more insulin is bad" it's difficult to change that mindset.

My Certified Diabetes Educator and one of the OBs mentioned several times that insulin resistance kicks in strongly around 28 weeks and tapers off after 34 weeks. Again, it's just amazing to see my body conform to a pattern that medical professionals have already figured out! Just around 28 weeks, my insulin to carb ratio shot up. At the peak of my insulin needs, 32-33 weeks, I was taking 1 unit of insulin for every 6 grams of carbohydrate.

Then, last week on Tuesday I was 34 weeks pregnant. On both Tuesday and Wednesday, my blood sugars were beautiful. I barely topped 100 mg/dl during the day, without any substantial lows. Then, I started noticing that, perhaps, I didn't need as much insulin anymore. Thinking back to the advice my CDE had given me, I realized I was at the wonderful 34 week mark. My insulin needs were finally decreasing, trending in the other direction!

At my OB appointment last Friday, the doctor, CDE, and I decided to change my insulin to carb ratio. Now I'm taking 1 unit for every 7-8 grams of carbohydrate (depending on the time of day).

Also, during my peak of insulin resistance, I found that bolusing 30-45 minutes before eating helped a lot. Sometimes even an hour prior to eating worked well. The key was to match the insulin activity to the carbs. When your body is resistant to insulin, you've got to give the bolus time to start working before that glucose hits your system.

I can tell that the insulin resistance has subsided because I don't need to bolus that early anymore. Yesterday, I had a particularly busy day at work. I bolused for my lunch around 12:45 p.m. and then got busy with a few projects. Finally, feeling low, I gobbled down my lunch at 1:30 p.m. and added an extra granola bar for good measure (which I later bolused for). I definitely didn't need to wait that long to eat!

Before conceiving, I'd heard that a pregnant diabetic would double or even triple their total daily dose of insulin during their pregnancy. Now that my insulin needs are decreasing, I can look back and gauge just how much more insulin I needed during the period of resistance from 28 to 34 weeks.

While my insulin to carb ratio more than doubled, from 1:15 or so to 1:6, my total daily dose barely doubled. Prior to becoming pregnant I typically took 25-30 units per day. Looking at my pump history, I see that my average daily dose for the last month was 45 units. There were certainly days when I took 50-55 units of insulin, but they were seldom. Thanksgiving Day I delivered an all time high of 62 units of insulin to combat the stuffing, mashed potatoes, and pumpkin pie!

Obviously every woman's body is different, and I have always been somewhat sensitive to insulin. However, I think the real reason that my insulin needs didn't end up tripling during my pregnancy was because of diet choices. Other than special treats like holiday meals, I've eaten a relatively low carb diet during my pregnancy. Certainly I've had less carbs on a daily basis then I did before conceiving.

This has had multiple advantages. By eating less carbs I've kept my insulin levels low thus I gained a modest amount of weight, while the baby is just the right size. Also, keeping fit and exercising regularly has clearly helped with both the weight gain and keeping my insulin needs down. During my pregnancy I have rediscovered my love for swimming and plan to keep it up for a lifetime.

All in all, with less than 5 weeks to go, I can report that I've felt pretty wonderfully throughout my pregnancy. Between eating more healthfully, exercising regularly, and keeping up habits like drinking enough water most days and getting enough sleep, I have felt very strong and healthy over the past 8 months. I am more convinced than ever that diabetes and pregnancy are quite compatible; in fact having diabetes can really inspire a mother-to-be to keep herself healthy.