PREGNANT T1 WOULD LIKE TO ASK SOME QUESTIONS

[Nicklenocky]

Hi All, apologies in advance as I know this thread should be in the Gestational Diabetes but I have been keeping an eye on that section and it doesnt see much action at the moment!

I have recently found out that I am 9 weeks pregnant, it has just conincided with me going on the pump. I would love to ask some questions to any T1s who have had babies in particular reference to differing insulin needs during different times of the pregnancy. I would also love any advice on how to avoid self inflicted (though not intentional) daily hypos!

 

[snickers]

Dear Nicklenocky,

Congratulations!

I've had type 1 for 20 years next week and have two children, one nearly 3 and one 4 months. I started on a pump in between and deifinitely found getting my sugars within pregnancy targets (pre-meal 3.5-5.9 and <7.8 post meal I think) much easier second time around although still very hard work.

Both times I found I was quite prone to hypos in the first trimester. Difficult because I was especially aware how important tight control was in the first 12 weeks for preventing abnormailites in the baby, so it was tempting to try and run on the low side. Only thing I can suggest which may sound completely obvious is to test in-between meals to check you're not running low as even if you've tested after a meal and it's 7-8, it could be much lower only an hour later. Also make use of the temporary basal rate function on your pump to reduce your rate prior to and during exercise ( I would sometimes forget that walking to the shops is still exercise). Other than that stock up on the lucozade-especially make sure it's handy at work ( assuming you work), and although people often don't like telling people until they are 12 weeks, it's worth telling at least someone at work that you'll be more prone to hypos in the first few weeks and tell them your hypo symptoms/signs so they can help you out if needs be.

I was seen fairly regularly at the clinic and as far as I can remember increased basal rates and CHO ratios fairly gradually-I don't remeber there being a massive jump. I stayed pretty active during pregnancy though which may be why I didn't have to increase insulin quite as much as some people. Make a note of what your rates and ratios are now though for when the baby is born, as they will have changed so much that you might not remeber what to put them back to. The target I found hardest-especially in late pregnancy was to be in range pre and post breakfast and I know of other diabetic Mums who found the same thing. The massive advantage of the pump is that you can increase your basal rates for early morning if you need to. Even though I did this I really struggled to keep my post-breakfast sugars within range without taking such a big bolus that I'd be really hypo before lunch. The only thing I found I could do was to eat a smaller breakfast and have some more food later in the morning (with another small bolus) or to give my breakfast bolus a while before I actually ate it.

Hope that's helpful. It's really hard work and I think my fingers are still recovering from all the testing but it's definitely worth it.

Good luck!

 

[Nicklenocky]

Hi Snickers

Thanks very much for your reply, it was indeed helpful.

I certainly agree with you regarding the pump and how much easier it is getting within targets, the pregnancy was not planned and I believe I conceived with a hba1c of 8, I started the pump roughly the same time as becoming pregnant, so 10 weeks later my hba1c is now 6.2, this of course is much better than 8 but cannot reverse any damage caused by the higher hba1c when conceived. Now that I know I am pregnant, I am nursing the diabetes 24 hours a day, but its really, really tough.

A few things I have noticed for far...at the beginning it seemed I needed slightly more insulin, my bloods were all over the place, food that were tried and tested all of a sudden didnt work. At 9 weeks, thats when the constant hypos started, I dont really know why, luckily I catch them on time and wake up 3 times a night to test, but dealing with the anxiety of 4 or 5 hypos daily is starting to take its toll, I have reduced all my basals, revised my ratios and yet I find I can run very low 1 hour after eating still, then I get on this horrid see-saw of up and down, correcting a hypo, correcting a hyper...I guess the only thing I can do is to react as and when things happen, it just seems so unpredictable at the moment.

I am hoping the sugars will become a bit more predicatable as time progresses, I can deal with a gradual rise of insulin, but the constant hypos is very difficult. Dont get me started on the nausea!

Thanks again for your reply!