Any previously pregnant T1s insulin NOT increasing

[Nicklenocky]

Hi All

This is a question to any T1 previously pregnant.

I am currently in my 18th week of pregnancy, last HBA1C 6, blood sugars doing okay but do tend to be a bit erratic as expected and still suffer a lot of hypos (though managable). I can have some days where bloods are excellent, other days not so great.

I have been advised and read in many books that a T1s insulin requirement will go up as the pregnancy progresses. Well I am 18 weeks in and I have perhaps increased my overall basal by 1.5u and noticed a higher morning ratio bolus for breakfast but only slightly. I wouldnt say my insulin requirement went up at all and i had an extremely sensitive 5 weeks at the beginning that saw my insulin requirement go down.

I am on small-ish basal of 12u a day on a pump and approx 14-15units of bolus depending on what I am eating per day, so total insulin per day works out at about 27 units a day. I am just a bit worried, I expected my insulin needs to go up by now and have been waiting ready to tackle it, but nothing has happened! My diabetic doctor here in the Middle East tells me not to worry, it will just happen, but it hasnt! I thought originally perhaps it was due to me not putting on much weight, but I have actually put on 4kg since I found out I was pregnant so I am gaining weight. I have had all recent scans and baby seems to be okay, I have the big scan in a few weeks. Pyschologically, I cant help worrying that my insulin not increasing is somehow harming the baby since all I have seen from all sources is that it does go up...or is 18 weeks too early for this happen? In my worrying state, when I have a few days erratic sugars I increase my basal slightly to see if I can kind of 'grow into it', however the next day when my bloods are not so erratic the increased basal leads to hypos.

Did this happen to anyone else? Could you share your exeperiences please?

Thanks in advance.

 

[Geri]

Hi, yes, when I was pregnant my insulin stayed almost the same all the way through the pregnancy.
I was also on a similar dose of insulin to you, perhaps a little smaller at first and then just increasing a couple of units in total until the end of the pregnancy. Everything was fine with baby too, however, I was diaganosed with an underactive thyroid after baby was born. This was picked up when my milk didnt come through so bottle feeds were used all the way through my childs early months. I also went hypo very quickly and could become unconscious at the drop of a hat! I had to take it easy but not all women with diabetes have such symptoms.
I think some mums with diabetes dont need an increased insulin dose, it was considered strange when I went into see the diabetes and pregnancy nurses each week, but all was fine. My 'boy' is now a strapping 6 foot tall lad who is fit, smart and happy, so please dont be too concerned.
All the best with your pregnancy.
Geri xxx

 

[Nicklenocky]

Hi Geri

Thanks for replying to my message. Reassuring to know your experience and that I am not the only one suffering the same problem....well I say problem, though my doc doesnt think its a problem, but you know you read all these sources saying one thing, and the exact opposite is happening!

 

[weeezer]

gonna see if i've still got my BS diary from pregnancy, to see exactly how much it increased. i know my weight increased steadily (and by quite alot!) & maybe this was the reason i needed more? so if you've only gained 4kg (i say 'only'! i think i had gained 2 stones/15kg by halfway thru!!!) this is keeping you nice & steady in relation to your insulin requirements? both my pregnancies saw me gain 5 stone! if you can avoid that, all the better, looks like you well on the way to a 'sensible' weight gain. well done...keep it up!

 

[Lucie75]

I've had two pregnancies, with my HBA1C at around 6.8. My insulin requirements did just about double by the time I got to the end of the pregnancies, but I don't think this really started until around 20 weeks or so. My insulin requirements also dropped in the first trimester, mainly because (I think) your body is using up much more energy developing baby. As others have said - don't worry - not everyone is the same, it's just that 'most' type 1's need more insulin, not necessarily everyone. It's probably a good thing if you don't need more insulin anyway as this would mean your body is still using the insulin really efficiently, rather than becoming more resistant to it. Whatever happens, once baby is born you'll immediately (and I mean IMMEDIATELY - within minutes!!) need to drop your insulin right down, especially if you're breastfeeding. I think I went from a pre-meal dose of about 16u down to about 3u!! Good luck!

 

[weeezer]

found my BS diary and noticed that insulin requirements went up straight away, then settled after 12 wks. only goes up to 16 wks, there must be another diary somewhere. i reckon because you're on a pump it's easier to deal with (the usual resistance to insulin i mean)...and i really think i overestimated the increase because i was so paranoid, as i am finding now, i've increased but then am constantly surfing hypo's.

wish i had started this pregnancy on a bloomin pump.

 

[Nicklenocky]

@ Lucie thanks for your reply. Its interesting what you say about your insulin not increasing until after 20 weeks. I am just 20 weeks today and last night my usual basal didnt keep me within range, bolus wasnt shifting it so I am wondering if this is the beginning of insulin resistance....saying that however, I have had to decrease my basals a tad during the day as I am still 'feeding' the insulin as its slightly too high, doctors says its not good to keep feeding it and we should try to get the correct basal...oh its so hard when everyday is different! I would say that in general I am quite insulin sensitive with a sensitivity factor of 4.5

@weezer....amazing you still have all of your records, you sound very diligent! I wish I was as organised as you! Like you I have also over estimated my basals which as I just mentioned is leading to feeding the insulin which in turn will make me gain unwanted weight from all the sugar i take when having a hypo. As I said earlier, I am hoping to grow into these slightly higher basals but my doctor doesnt agree so I am now decreasing to try and get a perfect fit.

 

[weeezer]

hehe i'm not diligent at all, just sentimental & not good at chucking stuff out! (i have the pregnancy tests from last time because it was such a miracle i couldn't believe my eyes, what a softy!)

yes - if you can get on top of 'feeding' the insulin you'll be doing great. i didn't manage it the last 2 times because i was paranoid about getting higher readings & it damaging baby or causing too much growth. although this was great for baby it meant i put 5 stone on each time! oo it's a vicious circle innit? oping your pump will help you out with this and it sounds like you haven't gained too much so far (from previous posts?) bet i've put on a stone by 12 weeks!!!!!!!

 

[Nicklenocky]

Hi weezer

Yes it would be great not to feed the insulin, but I am failing miserably. Like you say, it's a physiological thing, I can deal with correcting lows and having the hypos and I test 15+ times a day to catch them before they get too low....but I can't deal with highs, I over correct telling myself I will deal with a hypo I just need to get my bloods down. It's a viscous circle like you say, I now try to treat a hypo with milk, a small biscuit or even an apple, depends how low I am. I was having 100ml coke for hypo but then I would shoot up quite high and suffer all night. Obviously jelly babies are great and I find them quite predictable with how they effect my sugars, however it was getting to a point where I was having 15 plus jelly babies a day so now I have stopped with those!

With regards to weight gain....5 kg I gave gained at 20 weeks, I do feel that this steady gain will be difficult to maintain though as I hear it becomes very easy to gain the weight from now on. I am a new pumper, perhaps 6 months so I don't know how much this helps with the weight. My doctor here has given me a target of 10 kg weight gain by the end with a maximum of 12kg. This seems a bit ambitious to me but I will try my best. I eat mostly the same things every day, exactly the same quantity so I spot patterns easily in insulin, however I must say that it's not always easy to spit these patterns at all. I have now started to drink more milk to account for the extra calories I am supposed to consume.

All this hard work and with what I think is quite strict control yet my recent hba1c was 6.2 up from 6....was not happy at all!

 

[Nicklenocky]

That should read pyschological not physiological....bloody predictive text!

 

[MrsBinns]

when i was pregnant, mine only slowly went up. by 18 weeks i had probably only just got back to normal dose or a little more as like you, those first few weeks i had to reduce my insulin as i had lots of hypos. By the end i had doubled my insulin.