Decreased injected insulin dose - 2nd trimester

[hose1975]

Hi,

This is my second time with GDM and frankly, I'm confused!

I got put on insulin for breakfast at 19 weeks and overnight at 21 weeks. The dose went slowly up (although still quite a small amount) but my numbers have suddenly dropped across the board, to the extent that I've had to decrease my insulin doses. I'm currently at 22 weeks.

I started this pregnancy with a BMI of 23 and a relatively moderate pasta / rice / potato / bread intake.

Is this odd? I didn't think that insulin resistance usually started so soon in GDM; to me it seems rather like the 'honeymoon' described by type 1s and LADAs... And I do already have a pre-existing autoimmune disease.

Last time was rather simpler: I wasn't diagnosed until 28 weeks and had a BMI of 30 so figured it was my weight that had caused it!

I will be talking to the diabetes team next time I see them but unti then does anybody have any idea what could be going on?

Many thanks

Jo

 

[KatieCat]

Hi Jo, not sure I can give much knowledge/medical information but you're situation sounds familiar to mine. I've only had one pregnancy so far and was diagnosed with GDM at about 26/27 weeks with GTT test Fasting 5.4 and 2 hours 8.7. I'm 39 years old and my BMI was around 30 at the time of conception. I probably wouldn't have been offered the test if I hadn't mentioned that there is a history of type 2 diabetes in the family. I was constantly told that the diabetes would go away after giving birth though I'd be at higher risk of getting it later on. I did the GTT test 6 weeks after giving birth and was told that the results were normal. Fasting 5.4 and 2 hours after 2.8 (I had drunk lots of water and felt dizzy and think I must have spiked high and then had a reactive low as my insulin went into overdrive!) so even though the 2.8 was classed as normal, it did seem oddly low to me and I have read since that it may indicate insulin resistance when the body reacts to high spikes. Anyway, with this doubt in mind I went to GP and asked for an HBA1c test and the results indicated that I am pre-diabetic (44 or 6.17%). I have a feeling I may have been pre-diabetic before my pregnancy without realising it and it may not have been the pregnancy itself that brought it on.

Jo, could I ask you if you took a GTT after giving birth and were the results ok? Did your blood sugars go back to the normal range after giving birth. I am losing weight at the moment as I'd like to reverse the pre-diabtes if I can. It sounds like I have a lot more to lose than you did ...your BMI of 23 is fab by the way and something I aspire to! My BMI is currently 28 and I have 3 more stone to lose to reach the ideal weight for my height and have a BMI of 23, . We're thinking of having a another baby once I've lost the weight and I want to be as healthy as possible and try to avoid getting GDM though like you, despite losing weight and being within the healthy range, I may well get it again. Anyway, I hope your pregnancy is going really well and the awfully strict GDM regime will be worth it in the end when your lovely bundle of joy arrives . That's what I kept telling myself and we have a gorgeous baby son now...he's eight months old already...time goes so fast! All the best, Kate

 

[hose1975]

Hi Kate,

My six weeks post-birth OGTT came back okay (certainly the hospital never said that there was anything to be concerned about), but one year after my son's birth my fasting came back at 6.9 - holy moley, batman!

That was the spur I needed to do something about my weight. Prior to pregnancy I was 5'1" and 11st 2lbs; a year post-birth I was 10st 10lbs (my height hadn't changed :lol: ) However, it wasn't until I got a smartphone that I finally started to make the necessary changes. I like making lists, and control, and order. So I used the myfitnesspal app to count calories. I know that calorie counting doesn't work for everyone, but it appeals to my inner control freak! I basically followed a low GI diet, and cut pasta portions to 40g, rice to 50g, only had boiled baby new potatoes and almost completely cut out bread (but did occasionally make my own 100% rye bread). Took a couple of weeks to get used to it, but I didn't feel hungry at all. Hell, I made sure that twice a week I had a full sugar, maximum calorie (500 of 'em!) triple choc muffin from the coffee shop along the way from my work, but always compensated by having a low-calorie lunch. I also installed the cardio trainer app and started walking at lunch time. Just before I got pregnant again I was managing about three miles in about 50 mins I then entered the amount of calories burned into the calorie counter app and ate them back

You need to find a way that works for you, but you do remember to build in treats to your week, and remember also that it needs to be a diet, not a Diet. It needs to be a way of eating that you can sustain for pretty much the rest of your life. You can still have occasional blow-outs, for which you shouldn't feel guily because you just pick the good habits back up the next day. You should also make your daily calorie allowance realistic. 1400-1500 per day worked for me. It took nearly 9 months to lose the 2 stone but, recurring GDM aside, it's definitely been worth it. In fact, it's been quite hard to learn to eat more now I'm pregnant - I've been so disciplined and it's hard to let go, even a little!

My last pre-pregnancy fasting test came back at 5.9. Much better, but I realise that I'm probably only delaying the inevitable. Still, unlike most things, kicking this particular can down the road is a great option :thumbup:

Good luck; let me know how you're getting on if you'd like.

Best wishes

Jo