How do you do it???

[vandar]

Hi everyone,

I have been T1 for 15 years and my husband and I have decided it's time to start a family. I have been on an insulin pump for just under 10 years and my A1C levels have always been ok - typically around 7.0. I test often, eat healthy, exercise and stay in good contact with my endo. To prepare for pregnancy, I have been working hard and lowered my A1C to 6.3, so my endo has given us the go-ahead to try and conceive.

My concern is this: although my A1C is good, my day-to-day numbers don't look so hot! I bounce around a lot, and am still regularly over 200. I test 8+ times a day, so my doctors have told me I am catching highs right away and correcting them, allowing for a good A1C, and that they will help me tighten them even more once I am pregnant. But based on all I've read, these high numbers really concern me! How on earth do I do this?? Nine months of super tight control just seems overwhelming to me. Any advice/insight would be appreciated. Thank you!!

[e||ement]

Vandar...I'll be following this thread because I'm curious as well! I was ttc #2 when I got my diagnoses, and am hoping to get my A1C down soon to get the thumbs up to start trying again. But I wonder too how difficult it is to have such tight control.

What insulin are you using?
My endo has me on Humulog and Humulin-N in anticipation of a pregnancy...

[mortis505]

Hello vandar and welcome to DF!

Have you looked into basal testing?

http://www.diabetesforums.com/forum/pumping-insulin/28110-how-do-basal-testing.html#post330495

Its also highly recommended to get the book "Pumping Insulin" by John Walsh. He clearly outlines and defines proper basal testing procedures.

You may also want to have a look at your I:C(Insulin to Carb ratio).

[Gordonm]

I saw "How do you do it" under pregnancy and was a little worried. :D

Seriously, not haven ever been pregnant I can't say but you might look into a CGMS system. Maybe for just the 9 months if insurance does ot cover it. With the CGMS you can see yourself going up or down and make the corrections before it goes way up or down. It has leveled out my control. I always had A1cs in the high 5s to low 6s but was having some high and lows. Now I catch them before it happens.

[Keezheekoni]

Like Mortis said, do some basal testing. You're on a pump, you should do that several times a year anyhow.

Pregnancy treats everyone differently. For me, in the first trimester my basals doubled, in the second they went back to normal. Now I'm in the third and they need to go up again. In others, it's the opposite, or a mixture.

The first piece of advice that a perinatologist will tell you is that you need to have all your fasting numbers under 95. Then 2 hours post meal need to be under 120. This is extremely difficult to do, but if your basal and ratio are working right, you can do it.

Yes, it's hard work. Trust me, it's worth it! You definitely don't want to be pushing out a 12lb baby!!!

[vandar]

Your suggestions are all great, but I guess that's where my frustration/concern comes in -- I have done all those things!! I have been in touch with my endo on almost a weekly basis, sending basal checks, two hour post meal blood sugars, etc. etc. We've tweaked both my basal and bolus rates, as we have done continuously since I was diagnosed years ago. My body seems to be so inconsistent - I eat the same carefully measured breakfast each day, and one day my numbers will turn out great, and the next they are horrible. It just seems so random. Do the rest of you typically have very stable basal/bolus settings???

[vandar]

Gordonm, I meant to ask about your CGM as well. I have already started a fight with my insurance company to get them to cover one, but have been denied repeatedly because it is "experiemental." (Which makes me wonder: would they pass this up for the sake of their OWN children???) What was your experience with this?