25 weeks pregnant & decreasing insulin resistance

[Carole_Type1]

Hi Everyone,

I am 25 weeks pregnant and was told from the start by my diabetic ante-natal team to expect my insulin needs to rise steadily in the second trimester, however in the past couple of weeks I have been noticing more and more hypos so have actually had to decrease my basal rates by up to 20% at some times of the day. I've read that falling blood glucose levels towards the end of pregnancy can indicate a problem with the placenta - does anyone know if this could be the case for the second trimester too? Is anyone else experiencing falls in insulin requirements rather than increases?

 

[1Sarah1]

Hi
Both my pregnancies (singleton then twins) ended up in decreasing insulin and they brought them. I had pre eclampsia the first time and it was a big sign so knew what to watch for but i just got to 35w for delivery.
I strongly suggest you get in touch with your consultant to discuss and you might need to get monitored/scanned to check on baby. In some ways having diabetes is an advantage in picking up changes with baby.
Good luck x

 

[Vick22]

Hi, I have just seen this post and I am 28+1 and have been steadily having to reduce my basal rate through my pregnancy so far. I didn't have a clue that this could be an issue as seeing my ob 6 weeks ago and told him of the reduction he was happy with my progress. I have since reduced my basal further and now I am worried. I've called the maternity ward and they have told me to call back on Monday morning and then I will prob have to go in and be checked out, I am booked in for my growth scan on Tuesday anyway. Just really worried now and I know I won't settle until then. Very frustrated that there are no diabetes specialists in to talk to until the beginning of the week

 

[1Sarah1]

Hi, I have just seen this post and I am 28+1 and have been steadily having to reduce my basal rate through my pregnancy so far. I didn't have a clue that this could be an issue as seeing my ob 6 weeks ago and told him of the reduction he was happy with my progress. I have since reduced my basal further and now I am worried. I've called the maternity ward and they have told me to call back on Monday morning and then I will prob have to go in and be checked out, I am booked in for my growth scan on Tuesday anyway. Just really worried now and I know I won't settle until then. Very frustrated that there are no diabetes specialists in to talk to until the beginning of the week

Hi Vick
Can you still feel baby moving?

 

[Vick22]

Yes, she never seems to stop. Midwife on the phone said as long as she is still moving the same a dim not losing anything then just to call back monday

 

[1Sarah1]

Yes, she never seems to stop. Midwife on the phone said as long as she is still moving the same a dim not losing anything then just to call back monday

Well that's a really good sign, hopefully on Tuesday they will check your growth plotting.
How much basal were you on before, how much has it gone upto and how much has it come down? Are you on a pump?

I found my insulin really increased in the third trimester so hopefully it's just hormones for you at the moment x

 

[Vick22]

Pre pregnancy I was on 23.3u, yes I'm on a pump also. I gradually dropped it down to 17.5, 15.4, 13.5, 12.9,12.2 and now 11.5. I had put my ratio up from 2:1 to 3:1 which helped my post meal readings in my 2nd trimester.

This last basal reduction was about 2 weeks ago, but I've also at some points, mainly at night, had to put a TBR on of -80%. Sometimes my levels stay steady with this, and sometimes it has still dropped. I also found that I could eat 2 slices of toast and not bolus for them and still be between 4-5. And sometimes i could even have a carton of fresh orange (my preferred hypo treatment) and it not affect my levels. I don't tend to go to sleep on a 4/5 as I usually end up waking with a 3 ish during the night.

I am hoping that as I'm only just into my third trimester that it will start to increase soon, but I worry when I can't explain some hypos such as yesterday at 4pm my level was 7.5, 30 mins later it had dropped to 2.7.

Thank you for you're replies, it helps to talk to a fellow type 1 xx

 

[1Sarah1]

Hi I wish I'd had more support for my first pregnancy as I felt very alone as a type 1! I live in a big city and suggested to my midwife it might be good to have a network... My daughter just diagnosed at type 1 (just age 2) so trying to manage things with her so all very fresh.

Do you eat the same sorts of things now as before? Are you doing a low GI diet? Feeling sick? Vomiting? Pain?

Have you tried checking your basal rate and eating no carbs? I was forever adjusting my ratios and testing-all the time! (Still do now whenever I'm up in the night with the babies). Is everything else ok-like your blood pressure etc?

Was your last growth scan ok? -did you have one at 24/26w?
x

 

[Vick22]

Sorry to hear you're going through it with your daughter. Hope things go smoothly with her.

I haven't had any scans/antenatal appointments since my 20 week scan. My ob sees me every 6weeks. As far as I know my bp is okay...

I'm eating the same as I did pre pregnancy, tried cutting my carb in take down(love my carbs) I have lowered my ratio back down to 2:1 to see if that makes a difference. Went to bed an hour ago at a 7.5, woke up just now with 4.9 and I'd put a tbr on so my hourly rate for the passed 2hours has been 0.04u/hr. Feeling pretty shaky at the min like I'm cold but not sure if that's just nerves, worrying about everything, also getting heartburn too x

 

[Vick22]

I'm also pretty paranoid about getting pre eclampsia, have been since day one of my pregnancy and I'm not sure what exactly to look out for so any little thing makes me worry about that too. Feel silly as I'm not normally this much of a worrier

 

[1Sarah1]

Don't worry yet it will send your bp up if you are stressing. If she is moving that's a really good sign.
Do you not have a diabetes consultant or seen a midwife? I know the NICE guidelines have been updated but pretty sure contact for pregnant lady with diabetes is supposed to be minimum fortnightly.
If you are really unsure then phone them back again and say you want to come in for continuous monitoring to check baby ok. I know for me they would rather me go everyday and get checked out than not.
x

 

[Vick22]

It is my diabetes OB that wanted me back after 6 weeks because my control has been really good. Haven't seen the diabetes midwife and the community midwife said there was no need to see her unless there was an issue!

My shaking has calmed a the mo, sipping on a glass of water. I had this happen at 24 weeks and I was sick (sorry if tmi) and felt fine after that. Had called maternity ward then and they weren't concerned. So hoping it's just the same thing now. Glucose is currently staying steady from my last test too. Just feel frustrated that I can't seem to get a true reading as I'm having to put tbrs on and drink lucozade etc to keep my levels up on a night. X

 

[1Sarah1]

Pre eclampsia -headaches, blurred vision, swelling of face in particular (feet common in pregnancy!-I could only get into flip flops this pregnancy as was so swollen but it was twins).

Have you tried having some cereal like porridge before bed as its low gi and might help keep your sugars up?

Obviously you stressing and hormones going to play a big part. I'm not an expert just know what happened to me. I think go and get monitored today to check baby's heart rate. The thing with growth scans as its retrospective -not what is happening right now.
x

 

[Carole_Type1]

Hi Vick, just read your latest posts and sounds like we are in a very similar boat! I am also experiencing sudden blood glucose drops, one minute reading 5.5 or 6 then the next dropping down to 3 or even sometimes 2. I am also having to use tbr a couple of times a day, sometimes even removing my pump completely for a couple of hours just to combat hypos. Over the past two weeks my total daily basal intake has come down from 12.6 to 11.5 (and I am now 26 weeks pregnant).

Like you I am paranoid about developing pre-eclampsia (even though so far I haven't displayed any of the symptoms) so earlier this week I contacted my ante-natal diabetic nurse (who I have seen every 2 weeks since the start of pregnancy and who helps me decide which basal rates and bolus ratios to adjust) and said I was worried my decreasing insulin levels were a sign that something could be wrong. Her reply was quite reassuring (hopefully it will reassure you too!) - she said that whilst it is expected that insulin needs go up for Type 1 diabetics from week 20 onwards, it is not always the case and as long as the baby is moving and growing ok it could just be 'normal' for me that I am experiencing a decrease. She did say that sometimes it can be a warning sign that the blood flow to the placenta is restricted, however this is not definitely the case and as long as the baby is moving ok it should'nt be a problem and might just mean a few extra checks on top of the upcoming 28, 32, 36 week growth scans. She has booked me in to have a meeting with the obstetrician on Tuesday so that I can discuss with her in more detail - I'll let you know how that goes.

Hope your check up and growth scan go ok this week and let me know what advice you get

 

[Vick22]

Thanks Sarah, fortunately I've had no signs of pre eclampsia. I will try having some cereal before bed to see if that helps. I will give the ward a call again today.

Hi Carole_Type1, thanks for your post. I was under the apprehension that my drop in basal was just normal for me until I read some posts on here and began to start to worry. I would have carried on as normal if I'd not seen the posts! So now I'm watching babies movements like a hawk! (Which prob won't calm me down either if I think she's quieter than normal!)

I too had to take my pump off a few times over the last few weeks in the night to combat the drops, then it would creep up again around 3am when my dawns phenomenon would kick in! As did last night I think, was 4.7 whilst I was up feeling really shaky and within half an hour was up to 7.5. At least it was enough to feel comfortable to sleep!

Hope your meeting goes okay too on Tuesday, my scan is at 8.30am so luckily I won't be waiting all day. And the midwife last night told me to call tomorrow (Monday) as there's no diabetes specialist in over the weekend. X

 

[azure]

Hi Vick,

Insulin resistance does come in at different times for ladies, so you might just get it a little later and this could be the end of the early hypos, maybe? We're all different and react to pregnancy in different ways.

For the nighttime lows, which I got too, I always set an alarm for 2am, tested, treated and ate if necessary.

I do think you should ask to see your obstetrician more often though. My control was "amazing" according to mine but I still saw her every 4 weeks. I also saw my community midwife every two weeks. That was arranged through my GP. She did the normal pregnancy checks like any woman would have. I found it very reassuring always having an appointment coming up.

If baby us moving normally, then that's great Try not to stress, look after yourself and get checked out to put your mind at rest. I'm also going to repeat about getting seen more frequently too. You may have to push a bit for that!

Take care. XX

 

[Vick22]

Hi azure, thanks for your advice. I will be definitely requesting more appointments when I go in. Apparently there's not much to advise me on until the diabetes team are back at the hospital tomorrow... They've told me to call back then.

Because I'm usually pretty stable during the day I just thought it was just a night time low issue, and that its 'just me'.

Taking it easy for today, and meant to be going to cinema later, not sure whether I should go or not xx

 

[azure]

See how you feel about the cinema. It might be relaxing or it might be the last thing you're in the mood for. Mummy knows best in this situations, I always think. Do what feels right for you

 

[Vick22]

Thanks. Feeling okay at the minute, prob about as confident as I've been over the last 12 hours, thanks to you all.

Baby girl is moving nicely, belly looking like something from alien haha. I think she may enjoy Star Wars later lol

Thank you again xxx