3rd trimester blood sugars

I have always been a bit eradic as far as my blood sugars go, but for the end of 1st trimester and most of the 2nd, things were going pretty well. I still had the occasional random highs (outside of those that I know for sure were me miscalculating my carbs for my pump), but we were really doing pretty well, and it's like the DAY I hit the 3rd trimester, they went completely wonky! I have been back up into the mid-200s, despite me taking additional insulin to bring them down, and while my endo is working with me constantly to make adjustments, etc. it is soooooooo frustrating!! Is this normal? I know that insulin resistance becomes a bigger issue at this point, but I was expecting that to mean I might have more in the 160 - 180 range, not more that are between 200 - 300! This makes me nervous that I am hurting the baby or he will become diabetic and it is stressing me out. Is anyone else out there having this kind of craziness??? Any tips??

By the end of my pregnancy I was giving 1 unit of insulin for every 2 grams of carbohydrates.  I was having to refill the insulin pump cartridge just over 24 hours.  Crazy amounts of insulin.  It sounds like you've got some resistance going on, and you should probably talk to your doctor about a game plan.  It's going to just keep needing more insulin for carbs and fixes until you get to the last week or few days (this is a sign it's time to get baby out... placenta starts to fail and the insulin resistance goes away).  

Plan on checking even MORE often (which can seem crazy given I'm sure you are already checking a ton).   

You are on this and keep in touch with your doctor.  Your baby will be fine... but obviously less sugar in your blood is better.  The extra sugar in your blood will not cause him to get diabetes, so wipe those thoughts right out.  It will make him bigger and you and he/she don't need that.   It will also cause his body to produce too much insulin so he'll need more/extra care after he's born for his body to regulate itself again.  This will just mean he'll need some blood sugar checks and maybe some glucose put into his stomach.  Lots of kids born to mom's with type 1 need this... both of mine did and I had A1Cs in the 5's for my pregnancies.   Both of my babies got themselves regulated within a few hours.

You are doing great.  You are in the home stretch now.  Try to relax and enjoy!

Like Katie already said, this is a completely normal occurance.  Before pregnancy, I was using an average of about 22 units per day in my insulin pump and by the end of my 3rd trimester I was using somewhere between 70-80 units...I even had a couple days when I used 100 units!!  Just keep touching base with your doctor and the two of you will find the right balance to keep your blood sugars in line.  And don't worry about the highs that you have while your adjusting and figuring things out, you and your baby will be just fine.  The important part is that you're checking often and working on finding the right basals and ratios.  You will get there!

OMG, in my last semester, I was taking 40-50 units to cover dinner some nights! I found I had to increase my basals about every 2-3 days to keep up with it! The good news is the baby has already formed all the important organs.

Around week 35, my insulin resistance actually started to go down a bit, and my numbers were generally very even (but only on my 90-100 units a day, lol). The drs. were worried something was wrong with my placenta, but my NST's were fine. After delivery, I talked to some other T1's who also had less insulin resistance around this time. It made my last 3 1/2 weeks nice b/c my BG's were so even. Hopefully the same thing happens to you. (:

[quote user="Sarah"]

OMG, in my last semester, I was taking 40-50 units to cover dinner some nights!


HOLY INSULIN!  :D  That's a crazy-lot.  Can I ask how much you average per day, when you're not pregnant?  The amount of insulin pregnancy requires concerns me quite a bit, as I'm already pretty insulin resistant.  I realize everyone's body is different, just trying to get an idea of what to expect... 

I usually use about 30 units over all a day, about 6-8 to cover dinner. (It was slightly more wasn't I wasn't on this stupid diet trying to loose weight!). The 3rd trimester was quite an experience with all the insulin I went through!

I'm looking forward to talking with a dietician, then, because maybe I'll have to further cut down on the carbs while pregnant.  Because, wow, that will be a lot of insulin.  I'm typically taking between 75 - 90 units a day, right now.  Yeesh.

I def. cut down my carbs slightly when I was pregnant b/c my endo told me those post-meals spikes, even with a good overall a1c, can lead to a big baby. I didn't eat pizza or pasta at all. But, I personally wouldn't have been able to cut down my carbs too, too much b/c I was hungry and needed extra calories. There was only so much veggies and dip and grilled chicken I could eat before I was like, "I need a sandwich!" (That's why I feel bad for these people w/ gestational D that aren't put on insulin -- I CAN'T imagine being pregnant and told to avoid almost all carbs. I would have died!) I'd be interested to hear what your dietitian says!

Of course, everyone if different, so your resistance could be less than mine was. Or, you could be refilling your insulin twice a day... The good thing about being on MDI is I'd just dial up as many units as I needed, and my endo wrote an rx for extra pens each month. My endo's philosophy was just take as much insulin as you need even if you're clearing out the supply at CVS -- it's only temporary and worth it to get the sugars down. Again, I don't know if other endos differ.

This is a normal phenomenon in women with type 1 diabetes (and actually many of those without). In the 3rd trimester, the placenta makes more hormones that work "against" insulin and increase your resistance to it. Though it is is common, it should still be taken very seriously!

I think my 3rd trimester in both pregnancies were the most vexing part of pregnancy. The problem with the hormones noted above is that they make your post-prandial (after meal) blood glucose rise steadily. If you wear a CGM, you might notice that with the first bite of food, the blood glucose starts to rise. This is not food glucose, its liver glucose and the hormones enhance its release/production. Argh!

Traditionally there are 2 ways to handle this: 1) use a lag time between meal insulin and eating. For me, this could mean up to 1 hour between a bolus and meal initiation.

2). Turn to alternative therapies. Symlin is not FDA approved for use in pregnancy (a LOT medications aren't!) However, there has been a study done that suggested that it does not cross the placenta. For those of you who don't know, Symlin is an amylin analog. Amylin is secreted with insulin by the beta cells in the pancreas. With type 1 diabetes, we lose amylin as well as insulin. Amylin works to suppress teh liver from releasing glucose with a meal (by decreasing glucagon release), control the emptying of your stomach into your intestine and tell your brain that you are full. The biggest side effect is nausea.

It is not FDA approved for use in pregnancy. However, sometimes the benefit outweighs the risk. High blood sugars have been proven to be bad in pregnancy. Though the data is limited, there are multiple cases of pregnant women using Symlin with good outcomes (myself included). By the 3rd trimester, the organs have developed (with a few exception) and so teratogenic (or mutation-causing) effects are less likely. Because the medication is newish, the long-term effects are unknown. However, again, one study I found (3 years ago) indicated that it does not cross the placenta.

Hang in there. I would encourage you to discuss this option with your endocrinologist and or MFM physician. When I used it, no one would prescribe it and I had to get it from a friend who'd used it and had connections. A lot has changed since then fortunately. Though I am not pregnant now, I plan to use Symlin in the 3rd trimester of my next pregnancy as well! Good luck and congratulations!