Weeks 13&14: insulin requirements nosedive

By | 16 November, 2012
A small hand and a big hand

A small hand and a big hand

For a bit of variety over the last fortnight, instead of the trend in the early weeks of insulin requirements rising, they started to fall, and then plummet, causing a little bit of a scare.

Week 13: this week is a mixture of unexplained highs and lows. Basal requirements seem to be dropping, but my carb ratio isn’t – so I need less basal, but still need more insulin to deal with food. Although don’t put any money on this pattern, as it is a little inconsistent.

I also read the best description ever of baby size – apparently between 11 and 14 weeks the baby grows from the size of a mini Mars bar to a full sized Mars bar. I assume it goes king size after that, and then we move onto boxes of chocolate.

Week 14: insulin requirements are still dropping gently. And then they plummet in a single day to below pre-pregnancy rates. I spend the entire day as a 4, despite temp basal rates and mountains of food. I knew to expect variations in insulin requirements, but I wasn’t expecting something quite so sudden and dramatic. In the back of my head I wonder if this is normal (bearing in mind there is no such thing as normal) so I invoke the privilege of all pregnant women everywhere to be a bit worried and call my DSN to put my mind at ease. She agrees it is a significant change and isn’t really sure whether its anything to worry about or not, so she books me in for a scan the next day to check all is well and stop me worrying.

All is fine, the baby is wriggling around and the placenta looks just as a placenta should.

What scared me about the sudden drop was that towards the end of pregnancy such a drop could indicate that the placenta is deteriorating. Could the same thing happen earlier in pregnancy? I’d been warned to expect hypos, but despite questioning, no one could really explain why. It all seemed to link back to having tighter control meaning you may have more hypos, and you’re pregnant so this stuff just happens, but that wouldn’t explain such a sudden drop. So I was a little surprised and concerned to simply fall off a cliff in terms of insulin requirements.

Knowing about the bit of research below before this happened would probably have helped me. In brief, it basically says that diabetic pregnant women can expect to see a drop in insulin requirements late in the first trimester, due to their systems becoming more sensitive to insulin. And that drop may sometimes be sudden and dramatic.

In conclusion, a decline in insulin dosage in type 1 diabetic subjects treated early in the first trimester of pregnancy has been demonstrated in the largest and most carefully studied cohort of pregnant diabetic subjects examined to date…

…Thus, all insulin-dependent diabetic women and their caregivers should be taught to anticipate the possibility of a decrease in insulin requirement in mid-late first trimester. From the physiological point of view, these clinical observations are consistent with the underlying pattern of declining glucose in the first trimester of normal pregnancy. The decline in glucose appears to reflect a transient increase in insulin sensitivity in the latter half of the first trimester, which in turn is rooted in the underlying maternal endocrine adaptations to pregnancy. This trend is the opposite of the better-known late rise in insulin requirement, which reflects a rise in maternal contra-insulin hormones in late pregnancy. Taken together, these data provide a basis to anticipate a sometimes sudden and dramatic decrease in insulin requirement in mid-late first trimester of the diabetic pregnancy.’

Report in full: http://care.diabetesjournals.org/content/24/7/1130.full

So, all is well again, and I feel much better for understanding the science behind what’s going on in my body.

And thank you to father who dug out that research to help me understand what the hell was going on, proving indeed that the duties of a diabetic parent never end, even when the offspring gets to 33!

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.

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