Diabetes & pregnancy: the first 12 weeks

By | 2 November, 2012

Well, this diabetes and pregnancy lark is certainly interesting. It’s a bit like riding a rollercoaster without any safety barriers, it’s not a very smooth ride and you feel like any mistake might have catastrophic consequences. I’ve spent the first 3 months of pregnancy feeling thoroughly ill – huge amounts of nausea, a sprinkling of vomit and an inability to stay awake. But actually, that was all kind of nice, because it showed that hormones were at work and stuff was happening. The diabetes side of things is harder – it’s difficult to see that as a positive rather than a bloody inconvenience. But I’m trying. Here’s a summary of the first 12 weeks:

  • Week 4: slightly raised BG levels, which I put down to an impending period. I’m wrong.
  • Week 5: massive insulin resistance starts to kick in. Basal rates are up around 20%, and I’ve increased my insulin/carb ratio to 4g per unit at which point my pump says “Warning! That’s a valid ratio, but it’s quite high. Are you sure?” Given that even looking at food seems to send me high, I’m sure. I also reset my high alarm levels on my CGM so it goes off when I go over 8. This leads to a noisy few days, but it’s amazing how motivating it is to know that by injecting 30mins before food you can avoid that bloody alarm going off.
  • This week we also met every medical professional employed by the NHS in north west England. Or that’s certainly what it feels like. In one week I had my initial scan where we saw the vibrating blob that is our child for the first time. Then we went to the combined diabetes and pregnancy clinic, which is only combined in the sense of being in the same building at the same time. I saw the diabetes registrar, followed by the obstetrician, followed by the midwife, told all of them I don’t smoke (but was thinking of taking it up to relieve the stress of being asked that question 10 times a day), I take insulin for it and numerous other mundane facts that could have been easily stored on one single electronic patient record and saved everyone a lot of time. Then I had my booking appointment with the midwife and had the same conversations again. My HbA1c of 6.1% allowed me to negotiate that they please just leave me alone to get on with the diabetes stuff, which they kindly agreed. 
  • Week 7: basal rates need to be increased a bit more. I’m getting the hang of injecting insulin by the bucket rather than by the unit for meals – it’s scary at first, but the pump helps a lot, without the bolus wizard there’s no way I’d believe I needed 3 units for an apple, but I do.
  • Week 8: things seem to be settling down a bit. Or perhaps I’ve just got the hang of dealing with the insulin resistance, who knows? Morning sickness is getting worse. The traditional remedy of having something to eat as soon as you wake up to help reduce the nausea is a nice idea, but when you’re playing at being a pancreas and growing a human, this leads to unacceptable BG spikes. So I take a more time consuming approach of wake up early, bolus for breakfast, wait 30 mins, eat breakfast, get up. Or I bolus, get up, accept I feel rough, wait as long as I can, eat.
  • Week 9: my life is a blur of nausea and vomit. The pump has been a godsend in allowing me to reduce basal rates to compensate for all those unabsorbed carbs that just reappeared. Or to bolus for half a meal upfront, and then the rest of it afterwards if I manage to keep it down. HbA1c down to 5.7% and I have a reasonably useful session with the dietician, wonders will never cease.
  • Week 10: I suddenly seem to be immune to sugar. A whole afternoon spent as a 3 despite a full litre of apple juice and other goodies indicates that insulin requirements seem to be dropping. A quick internet search shows this to be apparently normal, although it would also be normal for them to increase or stay the same. I’m starting to understand the definition of normal in pregnancy – if you’re not in agonising pain or loosing blood by the pint, any other symptoms seem to be classed as “to be expected”.
  • This week also saw an eye check and a quick visit to the DSN to make sure all is still on track. I have to admit, as someone who’s always been very independent when it comes to managing my diabetes, I’m feeling a bit smothered with all this extra care (I did write interference originally, but that seems harsh, they are trying to help, it’s just I’m so used to doing it without them, there isn’t much they can usefully do – I think I might be the diabetic equivalent of a hermit).
  • Week 11: I’m scared to say it, but I think I might be feeling a bit more human. I don’t feel quite as sick or quite as tired. Insulin requirements are down to about 10% higher than pre pregnancy rates, down from the previous 20%. Although total daily dose is down massively because I’m not eating very much due to the nausea.
  • Week 12: Hurrah, three months down, six to go and a healthy, wriggling baby on the scan plus another visit to the obstetrician and the diabetes team. I have to admit, I knew diabetes and pregnancy would be tough, I’ve heard it a hundred times, but I didn’t expect it to be this tough. The constant change combined with an incredible pressure not to mess it up don’t make for an easy ride. But it’s definitely doable, I’ll say that much!
Category: Living with diabetes Pregnancy Tags:

About Alison

Diagnosed with Type One in 1983 at the age of four, Alison's been at this for a while now. She uses Humalog in a combined insulin pump and continuous glucose monitoring system and any blood glucose meter as long as it takes five seconds or less.

11 thoughts on “Diabetes & pregnancy: the first 12 weeks

  1. Megs

    Thank goodness for an insulin pump and CGM to help you through the minefield.

    Your hard work puts the shambles I’ve been making recently just dealing with food to shame. Off to try harder.

    1. Alison Post author

      I think without the pump and CGM @megs I’d be hiding under the table by now crying! I’d be lost without the pump.

      It’s amazing how the motivation of pregnancy does make it much easier to put the effort in. And knowing that its only for 9 months helps a lot too, there is an end to it all!

  2. Heidi

    Apart from the nausea, your description sounds an awful lot like my first three months of pregnancy – so nice to hear that I’m not the only one to have experienced an initial increase in insulin requirements 🙂

    I was told, both before and during pregnancy, that if you had to do anything to the amount of insulin you sent into your body, it would be to reduce it, as there would be an increased risk of hypos in the first three months of pregnancy. I, however, much like you, experienced an initial increased need of insulin, and then after 8-10 weeks, the hypos started, causing reduced basal rates once again. I had countless hypos, some of them quite severe, from then and all the way through the 5. months of pregnancy, before things evened out and insulin requirements slowly started to rise again.

    What saved my behind time and time again in that 38+ weeks of pregnancy was my pump and CGM, not to mention my precious diabetes nurse, who helped me through all the needed tweekings and adjustments – I didn’t trust that to the OB-endo team that I’d been assigned at the pregnancy clinic as they didn’t knew me nor my record, apart from what they could read in it if they had the time to do so, which I suspect they didn’t 😉 Still, it was nice that they were actually sitting at the same table for all appointment, minimizing any discrepancies between their given advice 🙂

    Best of luck in your forward baby building with the extra challenges that the presence of diabetes adds to it 🙂

    1. Alison Post author

      That’s so nice to hear someone else had a similar pattern – thank you! I’d been led to believe I’d see an increase in hypos in the first 3 months, and I did, but only when I overreacted to the highs and gave too much insulin, the pregnancy itself caused highs, not lows.

      I’ve given up trying to predict what’s going to happen, it’s too confusing and unpredictable, now I just take it day by day and adjust accordingly.

  3. katherine cromwell

    Hi Alison I did send message of congrats via facebook but not sure if you had it- anyway its brilliant news. Although my info is at least 12years old I was told that when the baby grows the insulin levels increase but you can have sudden swings (especially when having twins) Not that anything will go wrong but in my case because they thought babes may be early I had steroids to promote the size of their lungs instead of having 40 units basal it had to be upped to 120 units and I was still above 8mmol. Serious lows can occur at the end of your pregnancy due to the placenta becoming detached which is why the hospital monitors you so much. I know we girls like to be independent but you are experiencing being responsible for another person and therefore you need try to work with the diabetic team they do know how pregnancy can effect the baby. the best bit is the frequent scans that you have so that when babe arrives you know what it looks like already. Will you find out the sex of babe? and will you tell us??

    1. Alison Post author

      Thanks @mustard , I didn’t get your Facebook message, but it’s lovely to hear from you.

      I think we probably will find out the sex, I don’t really see any reason not to. And if you’re good, I’ll probably share it with you all too 🙂

  4. Bridget McNulty

    Fascinating post, thanks… I’m starting this journey near the end of the year, so trying to find out all I can!
    Two questions for you:
    1. How have you got your HbA1c so low? Have you been extra strict with your diet? How have the frequency of lows been?
    2. Do you always inject 30 mins before a meal? I thought it wasn’t necessary with today’s modern fast-acting insulin?
    Many thanks for the help!

    1. Alison Post author

      Welcome to ShootUp @bridgetmcnulty

      I’ve managed to keep my HbA1c around 6.2 or below since I started on the pump and CGM 6 years ago. Before that, I tended to be in the 7’s. There’s more here on what about the pump and CGM made the difference for me http://www.shootuporputup.co.uk/2010/06/what-made-the-difference/

      For pregnancy, I tightened things up further by being much stricter about pretty much everything – see here for more http://www.shootuporputup.co.uk/2012/11/what-diabetic-men-can-learn-from-pregnant-diabetic-women/

      At the moment I have about 1 hypo a day on a typical day. Nothing major just I’m 3.5 and need to eat something. The CGM really helps me prevent them as I can see myself dropping and generally eat/reduce my basal before I get low.

      Re injecting 30mins before a meal, I don’t do it if I’m say a 4 before the meal. Then I’d just bolus around 10-15 mins before. But if I’m anything above about a 5 I’ll take it 20-30mins before – if its a high fat meal I might split that and take half that early and the rest as I eat/after I’ve eaten. Remember pregnancy causes insulin resistance so what works in normal life doesn’t always work in pregnancy – I find if I don’t give the insulin plenty of time to get working, my really BG shoots up. Much worse than before I was pregnant.

      Good luck, and feel free to keep asking questions.

  5. Bridget McNulty

    That’s really helpful, thanks Alison! I’ll be sure to read those other posts too… I’m still on injections and testing with a good ol’ fashioned glucometer, but this is still so helpful, thanks!

    1. Alison Post author

      A lot of the stuff I’ve done you can do on injections, I think its just harder because you don’t have the precision dosing you have on the pump and also the flexibility with basal rates – getting my overnight blood sugars to run flat at around 4.5/5 made such a difference to me, and I just couldn’t achieve that on Lantus.

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