Any advice for using mdi while pregnant?

Hi all,

I am currently 13 weeks pregnant and use MDI.  I haven't gone on a pump for several reasons, predominantly due to severe sensitive skin issues, but my a1c's are in the 5's so my endo hasn't pushed it (though my ob/gyn has brought it up a couple of times).  I do see some of the limitations to being on MDI, mostly being able to take smaller doses and more often, though I suspect the smaller doses will be less of an issue once the insulin resistance really starts to kick in.  I'm currently on Levemir and Novolog (kid's pen which let's me take 1/2 units), and honestly taking 5-7 shots a day doesn't bother me at all.

Anyway, just wanted to say hello and ask if anyone has any advice in particular related to MDI and being pregnant.


Hey - I went off a pump for allergy issues years ago, and MDI'ed through my pregnancy. Not much to compare it to because it's my usual routine, but it went fine. Only problem was needing more Lantus during the day, but low at night. Ended up drinking a LOT of juice at night! My doctors didn't seem to care either way, so I figured, why make any big changes while pregnant and risk highs during the change.

My only advice is what you'd do anyways - use of CGM and lots of testing.

Hope your pregnancy continues well -- sounds like great a1c's! (-:

It sounds like MDI works well for you, so you should be fine.  In your 2nd trimester you may have a slight increase in your insulin needs, mostly because you're gaining weight.  Insulin resistance really hits in the the 3rd trimester.

It might help is to eat the same breakfast every day, as a nutirtionist recommended to me when I was expecting.  Helped me see early in the day when my insulin rates needed to be adjusted.  

Also in the 3rd trimester your insulin needs can seem obscenely high.  Trust your meter and your correction and carbohydrate factors and take what's needed.

Excercise also makes a huge difference with 3rd trimester insulin resistance.  Walking, swimming, whatever you can do will make you feel better.

After pregnancy some people experience dramatically lower insulin needs.  Guess it's a combination of the post delivery hormones, lack of sleep and irregular eating.  Not sure how common it is, but I took no insulin at all for the first 2 weeks after my son was born.  That was after having type 1 diabetes for 28 years!  My blood sugars slowly started to climb and within about a month I was back to my pre-pregnancy insulin dose.

Also Cheryl Alkon's book "Balancing Pregnancy with Pre-Existing Diabetes" is a great resource.

Congratulations on your little baby.  -Jenna

I'm currently 21 weeks pregnant and have been using MDI for the past few years. My doctor suggested going back on the insulin pump while pregnant, but I just had too many problems with it in the past with injection sites gettign infected that I decided to stay on MDI. No use giving myself bigger problems while pregnant.

It seems like you have a good handle on it though. An A1C in the 5's is awesome! Just make sure to work with your doctor as the pregnancy progresses, as you'll need to adjust your doses. Congrats and good luck!