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Keezheekoni

Okay remind me since I have preggo brain...

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Keezheekoni

Is it bad if your insulin needs increase or decrease in the third trimester? Ugh. I was having this discussion at lunch and noted that I've been hypo a lot lately. I'm going to change my basal settings, but my insulin needs have dramatically decreased in the past few days. For instance, I'm not bolusing for dinner anymore. :eek: I'm waking in the 80s, so I'm cool there, but pre-lunch the last few days I've been in the 60s.

 

Obviously I'll be mentioning this to my OB, but I just can't for the life of me remember which way is the bad way! :T

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mazea

I'm not sure. My doc said insulin needs increase in the second semester. I know insulin needs drop straight after birth. I hope you get some answers soon Keez, but I wouldn't be worried as pregnancy does all funny things to blood sugar levels.

Mentioning it to your doc sounds like a good plan.

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jball

It's been my understanding that later in pregnancy we get to be more insulin resistant (of course this is only my first time) meaning we need more insulin. My endo recently went to some conference where diabetes and pregnancy was discussed, and aparently it is preferred to increase bolus ratios instead of basals. Luckily, my endo had already been keeping my basal rates basically the same as pre prego...but but bolus rates are INSANELY HIGH!!!

 

Of course, you are the resident expert in this area....you seem to have all the answers!!!! Hope you are feeling well and all is good.

 

I've been hearing horror stories about how long it takes diabetic mother's milk to come in...is it true??? Also, if supplemental dextrose is necessary to raise the baby's blood sugar, what is the best method of delivery do you think? I just want to be prepared!!

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gettingby

Honestly Rikki, I can't remember. It's been 18 yrs for me. I hope you remember soon or your OB can tell you. Hang in there. Not long now.:)

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Keezheekoni

So a decrease is probably bad. I'll talk with my OB about it tomorrow...

 

jball: my milk comes in extremely quickly. I try and have my babies latch immediately after birth, so usually within the 24 hour stay in the hospital I'm begging for nursing pads. If the baby needs supplementation, you can finger feed them. It's what I did with my 4th when she needed some emergency nutrients. Also, for a few weeks before your due date you can pump out colostrum, freeze it, and bring it to the hospital with you...that way baby gets no formula or sugar water.

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ccryder19

My doctor told me a decrease in insulin needs is bad in the 3rd trimester. The reason insulin need during pregnancy increases in the first place is the placenta is absorbing some of the insulin. So if you suddenly are having lows or having to decrease insulin, it may be signaling something wrong with the placenta and this needs to be reported to the doc right away. I'm currently 33 weeks pregnant with twins and I have 2 placentas so they have me on an "insulin decrease lookout". Fun, fun.

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christie

i was always told that the sugars run higher towards the end. i guess too they worry about the baby's weight.

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lorilei

wondering how both you and the baby are gaining weight? please fill us in on your results from the doc regarding this question and you in particular..keeping you in my prayers..

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sarahspins

Increasing in the 3rd tri is TOTALLY normal.. and it's a good thing. A sudden decrease in basal needs or having PP lows is not good - it could be a sign the placenta isn't functioning well. It's why I consented to an induction with my duaghter (baby #2 of 3) a few days earlier than we planned on.. there were some concerns with my NST's and how my BG had been running that she wasn't doing so well. It's a good thing we got her out when we did because there were TWO knots in her cord and that was just an accident waiting to happen (that of course was unrelated to the placenta). My OB said my placenta didn't look too great either. She was born at 38w5d, and I think her induction was originally scheduled for 39w3d. Ironically I think my BG control was better with her than it had been with pregnancy #1 or #3, with wall of my a1c's between 5.7 and 6.2, but my sons were born at 39w (induced) and 39w1d (all natural spntaneous labor) and my OB said their placentas were perfect, and I never had weird BG issues at the end with them... my a1c's ran in the upper 6's.

 

To jball - how soon and how often you nurse after birth really influences how quickly your milk comes in. With my first, I didn't know better and I let them give bottles to keep his BG up... and as a result he wasn't too interested in nursing, and my milk took a full 5 days to come in, and he never really could latch well enough to nurse, so I ended up pumping for him.

 

With my second, she never needed any supplementation (I labored in the 80's and 90's, WITH a glucose drip and running 50% basal rates - so my BG wasn't high at all before or during her birth), so I nursed her exclusively, and my milk came in at about 36 hours - we'd already come home from the hospital by then.

 

With my third (and last), I nursed him as soon as they would let me have him (I tore a bit, so they had to stitch me up, which took maybe 15-20 minutes) and he did need some supplementing so I used a SNS w/formula the first day, and he was always at the breast - and by always I mean I was constantly nursing him because I was afraid they'd tell me he needed more than he was getting from the SNS and they'd take him to the nursery, but he was a MUCH more aggressive nurser than my daughter was, and my milk was fully in by 18 hours after birth and I stopped using the SNS. I needed a pump the next day to actually relieve some engorgement to make it possible for him to latch on... and that continued for about a week.

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Keezheekoni

So I talked with my OB and perinatologist yesterday. Both told me something I hadn't known... :)

 

So in the last month of pregnancy a T1's insulin needs *should* go back to almost pre-pregnancy levels. Your insulin resistance should go away. If it doesn't, *then* is when they worry. If you get resistance during the last month, they worry a lot.

 

However, it's opposite for T2s and GDs. If they don't see resistance in the last month, then they worry about them. In a T2 or GD, if they triple their insulin needs then everything is fine.

 

So, completely normal for me. :) I'll post in another thread about the u/s, NST, and other stuff...

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jball

Thank you for all the info about breastfeeding!!! The lactation consultant I've been working with has been encouraging me to rent a hospital grade pump for something stronger to encourage the milk to come in and also to buy from a mother's milk bank (4.75 per oz.) to be sure there is no need for formula. I'm thrilled to hear that colostrum has the ability to possibly cover for her needs when she gets here and that it may not take as long as I'd heard for milk to come in!! I'd like to be prepared, but I don't want to do anything that isn't necessary (plus, I'm not sure how I feel about using a milk bank). When I talked to nurses at the hospital (I'm an occupational therapist there) they seemed like they would be very open to nursing right away, but I'm just hoping the doctors are on the same page. I've heard there is some resistance from some on birth plans and parent requests, but I've only had good experiences so far.

 

I have a CGMS, so I feel like I'll be able to keep my BG's under control during labor/delivery, but during my last appointment at the endo (I saw PA that I've never been extremely fond of) she said that it's ok if my BG's run a little high (to avoid having to have any carbs for lows during labor/delivery) like in the 200s....it seemed as if no matter what I said, we were never on the sam page. It's my understanding that the higher your BG is during labor/delivery, the lower the baby's BG will be.

 

I have my 36 week appointment tomorrow and they will be doing a biophysical profile and NST....this is my first BPP so I am curious to find out what it is all about.

 

Thanks again for all of the advice/help!!

 

Julie

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sarahspins
It's my understanding that the higher your BG is during labor/delivery, the lower the baby's BG will be.

 

That's how it was with my sons.... I labored between 130 and 150, and they both had moderately low BG (both dropped into the upper 40's, and then hovered in the upper 50's for a couple of days). Neither one needed any major intervention though.. both did receive some formula.

 

My daughter, I was pumping and left it on during labor, and I labored in the 80's and 90's, and her lowest BG after birth was 63. They only did 3 checks on her, but since she was always in the 60's and then in the 70's, decided she was totally fine.

 

I would be worried about the advice to labor in the 200's... to me, that's just asking for trouble, and a potential NICU stay if your baby's BG drops too low after birth. I wouldn't be comfortable laboring at 200.

 

If you have an IV, and a glucose drop hanging and ready (you don't need to be receiving any), there's absolutely NO reason you can't labor at a "normal" BG level. If you did happen to go low, they can easily handle it and it's not a problem.. and they should be checking at least every hour, and preferably every half hour, to see what your BG is. No one was worried when I was in the 80's with my daughter.. my OB was actually quite happy with it, and wasn't concerned I would go low (I did go low a few hours after she was born though... but I expected it, and it wasn't worth running higher during labor "just in case" - you'll have a lot of unpredictable lows after birth and in the first weeks of nursing, it's very much like the first trimester all over again).

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mazea

Only 4 weeks to go Keezheekoni! Wow. Your bun is almost ready to come out of the oven.

 

I was hoping you could let us know how your blood sugar levels react at different stages of labour. I would like to keep my blood sugars below 9mmol during labor in October. Hearing a story about what happens to your blood sugar levels in labor would help me know what to expect.

 

My worst fear is that I am going to go above 10mmol for hours during the labor. I don't want my bub's blood sugar levels to be low, and fear the stressful arguing with the doc over my insulin medications.

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