By: Katherine Marple
Welcome to the second trimester! By now, many type 1s are experiencing fewer hypoglycemic episodes, and insulin resistance is just beginning to rear its head. You’re on the other side of the miscarriage worry hump and getting settled into the pregnancy routine. Congratulations! Take a few minutes each day to celebrate your successes and pat your stomach with a smile, knowing you are doing the best you can to give your growing child everything she needs.
You probably have a large support network built by now and are often leaning on those with experience and insight, or just some kind words, to get you through these stressful days. If you haven’t already spoken about your concerns and announced your successes to a diabetes online community, I suggest you do so now. Many women on social network sites have already been through pregnancy with diabetes, are muddling their way through it now, or are trying to jump on the bandwagon. I found enormous amounts of support there and couldn’t have made it through my pregnancy without it.
After the first trimester was over, around week 15, I switched from NPH back to Levemir, feeling confident that my baby’s major organ development was completed. My stresses with NPH during the first trimester nearly cost us both our lives numerous times. I felt it was less of a risk to simply switch back to Levemir than to battle the insulin shocks I dealt with in the first weeks. Research and speak with your doctors to decide if this is an option for you.
Around week 20, most women with diabetes are experiencing insulin resistance. My doctors explained that the placenta gives off hormones that lead to insulin resistance. As your pregnancy progresses, the placenta gives off more and more of these hormones, making your resistance steadily increase. By the third trimester, most women with diabetes are injecting four times the amount of insulin they were taking pre-pregnancy.
If this is just beginning for you, remember: Insulin is not your enemy. It is a tool to keep your body “normal,” so take as much as you need to take. Do not starve yourself in order to limit your insulin needs. You and your baby need carbohydrates and calories to keep your body functioning and to keep hers growing. If you have to take a few more units at each meal, don’t stress. Your body will return to normal after baby comes.
My insulin resistance began around week 20, after which I began increasing my basals by five units every two days to keep my levels down. By the end of pregnancy, it was normal for me to take 30 units of Apidra at each meal. I was also taking 135 units of Levemir twice per day, compared to before pregnancy, when I took only 35 to 45 units of Levemir twice per day. It was a huge increase, but my baby is six weeks old now, and I’m back down to 8 to 10 units of Apidra per meal and 45 units of Levemir twice per day.
Around week 20, I started taking 500 milligrams of metformin in the mornings to combat my insulin resistance and dawn phenomenon. This may be an option for you. Work with your doctors and discuss the risks of taking this prescription to decide if it’s the right choice.
There are a lot of stresses in day-to-day life while pregnant. Add in being an insulin-dependent woman with diabetes, and your days will sometimes go by in a numeric blur. The key is to remember what you’re working toward and the fact that this will pass. It takes hard work and determination to check your glucose readings ten times per day, take 20 or more injections per day (or corrections on the insulin pump), measure all of your food intake, and worry over your baby’s progress. But in a few more months you will be returned to your diabetes norm while holding that sweet baby in your arms.
Take pride in what you’ve accomplished so far. It is not easy being pregnant, and it is no small feat to be diabetic. What you’ve achieved so far is amazing. Stay on top of things and manage your glucose ranges, but remember to celebrate every small success. If she understood, your baby would be dancing inside of you, celebrating too.