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Re: [IP] diabetes and pregnancy with twins
> I am looking for experiences of other women during their pregnancies.
> How did your insulin needs change? For example did you just increase
> your entire basal by a certain percentage straight across or did you
> have to make different changes at different times of the day?
It didn't change that smoothly. Changes had to be made pretty much across
the board, but not all at once. Both basals and insulin to carb ratios
changed DRAMATICALLY. Early on, perhaps beginning for you even now,
(typically around 10 to 14 weeks gestation) many women experience increased
insulin sensitivity. The insulin needs go down. I remember my endo
anticipated those lowered needs and lowered my doses at times of day that
tended on the low side. Even with the changes she recommended (changes that
I would have thought would be too aggressive), I still had some scary lows
during that time.
Then, around the beginning of the third trimester, perhaps even earlier
(during my second pregnancy, it happened at 20 or 21 weeks) the insulin
needs tend to go up. I have talked to several women that this actually
never happened to, but it did happen to me and I understand it is most
EVERYTHING went up, and it varied as to time of day. What worked great one
week would not be enough the next. Gradually my insulin use went up from
pre-pregnancy (about 55-60 units a day) to more than double toward the end
(130-135 units a day).
I remember it was most dramatic with my breakfast insulin to carb ratio.
Prior to pregnancy, I was taking one unit for every 9 grams of carb. For
probably a month, I was taking one unit for every two grams at breakfast!
Other times of the day were not nearly so dramatic.
Then, at the very end (around 38 weeks with my second, but the first it
never happened) insulin needs begin to decrease again. This is also
typical, but may not happen. If it does, I was told, "You know it will be
over soon." I had a scheduled C-section at exactly 39 weeks, but when I
went in, I was contracting, sometimes pretty uncomfortably, every 2-3
minutes. I believe I would have had my daughter that day one way or
another! So it happened for me about a week before time to deliver. YMMV.
Do the very best you can controlling your blood sugars. I think sometimes
people get the idea that I'm not recommending that you do. OF COURSE, you
need to stay on top of it and adjust as necessary.
But if you have highs of 200 or even greater, DON'T PANIC. Worry will be
worse for your baby than an occasional high.
I was told that the times when your blood sugar control are most critical is
from six months prior to pregnancy through the first trimester. If your A1c
during that time period runs below 7.0, statistically, your chances of
defect are no greater than anyone elses.
It worked that way for me. Prior to pregnancy, my A1c was about 6.5.
During the pregnancy it ran around 5.5, and drifted back up to about 6.5
toward the end. At the end, I had two beautiful, very healthy children.
Unfortunately, however, I have no experience with twins.
By the way, about the A1c's above. I was told that, because you have a
higher blood plasma level during pregnancy, the A1c results are interpreted
differently. My 5.5's during the first two trimesters were comparable to a
non-pregnant 6.5. My 6.5 at the end was comparable to a 7.5. So you see,
the highs did happen at the end, though my numbers may not make it readily
It can be tempting to panic over the occasional high. All you can do is the
best you can do, but when that happens, it happens. Make adjustment to you
insulin dosages, and go on. Don't allow an occasional high cause you to
panic or mentally beat yourself up over it. Occasional highs don't cause
birth defects. Uncontrolled highs that result in elevated A1c's do.
But even taking the best care of yourself doesn't always work. These things
are, unfortunately, out of our control. It is impossible to ensure defect
free babies, and even non-diabetics have babies with congenital defects.
So you do the best that you can with those risk factors you control, and
then don't worry or second guess about problems.
Feel free to email me personally, if you'd like.
dxd 1985, pumping since 1990
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