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FarmerCathy

Pregnancy and Insulin Pump

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FarmerCathy

Hi all,

 

First visit to my endo while pregnant. He says he wants me to get a pump. Anyone else get a pump while pregnant? He says he wants me to keep it after the pregnancy and I'm assuming its because of breastfeeding after and how that would probably make my numbers go up and down as well. I just haven't been able to keep up, everyday to the next is different. Either I need more or less. He says he wants me to be able to eat when I need to.

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aiah23
Hi all,

 

First visit to my endo while pregnant. He says he wants me to get a pump. Anyone else get a pump while pregnant? He says he wants me to keep it after the pregnancy and I'm assuming its because of breastfeeding after and how that would probably make my numbers go up and down as well. I just haven't been able to keep up, everyday to the next is different. Either I need more or less. He says he wants me to be able to eat when I need to.

 

Hey there Cathy. I can't pump due to insurance not covering enough and severe adhesive allergies but I did pump for a number of years and wanted to offer you some assurance. There are plenty of women who end up going on the pump while pregnant b/c it gets their numbers down quickly and allows for greater flexibility (figuring out the ups and downs on MDI with basal really sucks when you hit 2nd trimester!). Probably the first month you're on it you'll have more appointments, not just with your perinatologist and endo but a diabetes educator, if you can find one who has experience with plenty of pregnant patients, OMG it makes a HUGE difference! Once you get the hang of pumping, your appointments will taper off again and you'll probably touch base once or twice a week on the phone to discuss basal rate changes, etc. Another great thing about pumping while pregnant: since your digestion is slowed during pregnancy, you can bolus for your food and do what's called an extended or square wave bolus (delivering smaller increments of insulin over a longer period of time). This is really useful if you eat something fatty too b/c it really eliminates the fear of having a low blood sugar an hour after you eat, or 2, followed by a high blood sugar. You will probably find lots of helpful information on the type 1 pregnancy sub-forum and I know there have been threads discussing pumping while pregnant (I was told from my docs that they start you on a pump prior to becoming pregnant but that apparently isn't usually the case and seeing all those posts made me appreciate the different school of thought on that). You will do fine Cathy, I have complete confidence in you and this will be so much better for both you and your developing baby!

 

Fawn

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FarmerCathy

Thanks Fawn. They are sending me over to the nutrition specialist and they have a video apparently on what happens when your diabetic and pregnant. Sounds cool. I think it will be fine, I was just feeling a little bit off about it all. It was a lot to take in, but my doc really thought it would be best and I trust his judgment. The bolusing sounds confusing, but other than that I think I'll be able to figure it out. I've been having a lot of lows after meals because I mainly eat protein, fat and veggies. I'm pretty strict so I don't have to take as much insulin. When I went in they took my blood sugar and I was 10 minutes shy of two hours after lunch and at 102. I've been in the 90's a lot after meals lately and I can feel it. I think it will help if I can eat when I feel hungry instead of waiting to take my bg at an hour and a half.

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aiah23
Thanks Fawn. They are sending me over to the nutrition specialist and they have a video apparently on what happens when your diabetic and pregnant. Sounds cool. I think it will be fine, I was just feeling a little bit off about it all. It was a lot to take in, but my doc really thought it would be best and I trust his judgment. The bolusing sounds confusing, but other than that I think I'll be able to figure it out. I've been having a lot of lows after meals because I mainly eat protein, fat and veggies. I'm pretty strict so I don't have to take as much insulin. When I went in they took my blood sugar and I was 10 minutes shy of two hours after lunch and at 102. I've been in the 90's a lot after meals lately and I can feel it. I think it will help if I can eat when I feel hungry instead of waiting to take my bg at an hour and a half.

 

Yes, you really do need to eat when you're hungry (at this point in my pregnancy I'm hungry almost every hour except for after dinner). and you may need to add a tiny amount of carbs to your diet, but testing will give you an idea. I had to triple the amount of carbs I consumed and I still had a lot of lows, even with really adjusting insulin. It isn't easy, no kidding there, but it's always worth it:)

 

Fawn

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FarmerCathy

What kinds of carbs were you able to add? So far I've been adding beans (sometimes they don't do very much for me though), a couple slices of apple with almond butter, today I tried eating some popcorn at work, it tasted so good I ate about a cup and a half and it did not spike me. I need some ideas to start trying.

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aiah23
What kinds of carbs were you able to add? So far I've been adding beans (sometimes they don't do very much for me though), a couple slices of apple with almond butter, today I tried eating some popcorn at work, it tasted so good I ate about a cup and a half and it did not spike me. I need some ideas to start trying.

 

Honestly I was amazed at the things I could get away with, regular cheerios, pasta (except mac n cheese, that still spiked me) burger with buns, occasionally french fries. sopapillas (notorious for causing a spike but I could even eat it w/ a little honey). A tsp of nutella even and I can handle peanut butter before bed (prior to pregnancy that'd cause an unmanageable spike). A lot of testing will give you an idea of what you can and can't handle. I was almost low carb before pregnancy and when my nurse saw my food journal, she was shocked and worried I wasn't consuming enough carbs. I went from maybe 25-40 g/meal and <15g/snack but now it's closer to 55g/meal and ~25-35 g/snack. Realize that's broken down over time though. meal is eaten in two courses about 1.5 hrs apart and I tend to just do a carby snack in the afternoon but low carb snacks in the morning. Hope this helps :)

 

Fawn

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FarmerCathy

Thanks Fawn. I did have chicken tenders for dinner. Only 11g carbs and I'm curious to see what happens. They tasted so good.

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FarmerCathy

I'm not sure if the chicken tender test was fair I did eat two slices of cheese on the way home from the grocery store. I think I need to try them again. In other news I tried some kashi granola bars with 5 g sugar and I did fine on them. This is so great. I'm going to try some o's with milk, if my body doesn't like them I can always give them to my son.

What's funny is I can eat more carbs during snacks than during meals. It's weird. I'll take it though. I was thinking about what you said about spiking when consuming diary products. Could be your lactose intolerant, at least during pregnancy. It's because your body can't process the lactose that makes you go high when you try to eat mac and cheese.

I'm excited to try the flaxseed cakes I make with a little maple syrup or honey. Mmmm..... Something to try tomorrow.

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aiah23
I'm not sure if the chicken tender test was fair I did eat two slices of cheese on the way home from the grocery store. I think I need to try them again. In other news I tried some kashi granola bars with 5 g sugar and I did fine on them. This is so great. I'm going to try some o's with milk, if my body doesn't like them I can always give them to my son.

What's funny is I can eat more carbs during snacks than during meals. It's weird. I'll take it though. I was thinking about what you said about spiking when consuming diary products. Could be your lactose intolerant, at least during pregnancy. It's because your body can't process the lactose that makes you go high when you try to eat mac and cheese.

I'm excited to try the flaxseed cakes I make with a little maple syrup or honey. Mmmm..... Something to try tomorrow.

 

Oh I already know I'm lactose intolerant. I use lactaid milk and consume greek yogurt, tolerate that great but not regular. No problems with cheese whatsoever though (thankfully b/c that's a staple snack during pregnancy currently). So I make my mac n cheese with lactaid (and rarely will make myself lactaid ice cream too but haven't really craved it much during pregnancy like I thought I would). The issue with mac n cheese is that I cannot stop myself at a single serving or so, I probably eat 3-4 servings at a time and external insulin dosing cannot keep up with that so I just try to be careful about it and not do it often (usually it's a I'm sick comfort food). I did have it more when I had extreme nausea and the nausea could also have been contributing to the high blood sugars though.

 

Fawn

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aiah23
Ah I see. Gotcha.

 

Yeah, I wondered if nausea caused high blood sugar.

 

I think nausea raises blood sugars but vomitting can plummet them. Oh yeah, be wary of vomitting, when you strain you can get a bloody nose, that was rough when I realized it. At first I thought I was throwing up blood until I blew my nose.

 

Fawn

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FarmerCathy
I think nausea raises blood sugars but vomitting can plummet them. Oh yeah, be wary of vomitting, when you strain you can get a bloody nose, that was rough when I realized it. At first I thought I was throwing up blood until I blew my nose.

 

Fawn

 

Good to know. Yeah, last pregnancy and even this one I get bloody noses every once in awhile. I remember right after I had my son I bent over to investigate our guard dogs mouth after being attacked by a live pin cushion and my nose just started bleeding all over the both of us. It was quite impressive.

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FarmerCathy

So, I went to the Nutrition person at the Maternal and Fetal Health Center. They are first going to get my doctor to put me on a fast acting insulin for my meals until I can meet with the person who is certified to consult me with a pump. They will then let me have a used pump to rent for my pregnancy. She said I am doing better than most with my numbers even if they do go up to 150 in the afternoon. She has a mom with Type 1 whose fasting numbers are between 130-150. So, I guess I'm doing well. Yeah! Though now I have to count my calories. Ugh. Food will become the bane of my existence.

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aiah23
So, I went to the Nutrition person at the Maternal and Fetal Health Center. They are first going to get my doctor to put me on a fast acting insulin for my meals until I can meet with the person who is certified to consult me with a pump. They will then let me have a used pump to rent for my pregnancy. She said I am doing better than most with my numbers even if they do go up to 150 in the afternoon. She has a mom with Type 1 whose fasting numbers are between 130-150. So, I guess I'm doing well. Yeah! Though now I have to count my calories. Ugh. Food will become the bane of my existence.

 

I'm glad they're putting you on fast acting insulin, that'll help a lot with the 150s post meal. Just a recommendation though, so you don't have lows with your nausea, you may wanna take 1/2 your dose before eating and half your dose at the end of eating. That way if you end up being too sick from whatever you are eating, you won't be at risk for falling low, that was one of my problems earlier in pregnancy. It got to the point that I just took my bolus insulin after eating and I ate really slowly.

 

Fawn

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aiah23
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Congratulations on your pregnancy Cathy! (And hi Fawn!)

 

Hello Jan to you :D You've been missed but I see you started posting recently again so hooray:)

Fawn

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FarmerCathy
I'm glad they're putting you on fast acting insulin, that'll help a lot with the 150s post meal. Just a recommendation though, so you don't have lows with your nausea, you may wanna take 1/2 your dose before eating and half your dose at the end of eating. That way if you end up being too sick from whatever you are eating, you won't be at risk for falling low, that was one of my problems earlier in pregnancy. It got to the point that I just took my bolus insulin after eating and I ate really slowly.

 

Fawn

 

That's a great idea. I've never thrown up during just nausea, but there's always a first time. LOL! I will do so if I have a problem. Usually my nausea ends by 9 1/2 weeks so I'm hoping that's the case with this pregnancy, but that doesn't mean I won't puke later in the pregnancy. I developed allergies with the last and had vertigo and couldn't keep anything down so that may happen again too.

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FarmerCathy

Ahhhh...... I just ate an egg salad sandwich with two pieces of bread and a whole glass of milk. My body is very happy.

 

I will be getting the pump in the next couple of weeks, but I got humalog today for my main meals until then. I have a feeling my nausea might start going away a little faster now. :D Went away at 9.5 wks with my son and I will be 9wks on Friday.

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Judi Paul Bear

Hi. I am new to this site but not new to diabetes. I have been diabetic since age 12 and am now 45. I have three children, 19, 13, and 8. I was on the pump for my last pregnancy and it worked very well. I used a pump for 9 years but it sent me to the ER four times. I had my A1C at 6 during pregnancy.

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FarmerCathy

Ok, I know this isn't a pump specific question, but in the last few days my body is obviously got a mind of its own. Since Sat. my basal numbers have steadily climbed to 100, 118, and now this am at 132. I had a 115 last night before bed and that usually means I will be down to 70 in the am, but its not going that way. Do I need to up my basal dose? I have also had trouble between meals and am usually up to 200 before a meal and had to bolus yesterday to have a snack and even then it went up to 200 before dinner. I'm not doing anything drastic, no cookies or cakes or anything. I will be 10 weeks on Friday. They told me this would happen, but I'm not quite sure how to manage it. Any help would be much appreciated. :)

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aiah23
Ok, I know this isn't a pump specific question, but in the last few days my body is obviously got a mind of its own. Since Sat. my basal numbers have steadily climbed to 100, 118, and now this am at 132. I had a 115 last night before bed and that usually means I will be down to 70 in the am, but its not going that way. Do I need to up my basal dose? I have also had trouble between meals and am usually up to 200 before a meal and had to bolus yesterday to have a snack and even then it went up to 200 before dinner. I'm not doing anything drastic, no cookies or cakes or anything. I will be 10 weeks on Friday. They told me this would happen, but I'm not quite sure how to manage it. Any help would be much appreciated. :)

 

Sounds like you're going to need to up both your bolus and your basal. How are you bolusing for snacks and correcting blood sugars? Do you have a set I:C (insulin: carbs ratio) or an insulin sensitivity factor (e.g taking 1 u for every X u over 100?). Having something like this will be necessary and you're going to continue to have to up it over the course of your pregnancy. You may find you have to switch to more low carbing or more undigestible fiber to combat some of this rather than allowing yourself treats (like any potatoes, wheat bread, oatmeal, etc). I don't know if you're eating any of this or not but you're going to see more pronounced spikes and it'll only get worse b/c of pregnancy hormones. I really like having cucumber chunks and hummus for snacks, I have to take a couple of units of fast acting for it (otherwise my post prandial is in the 140-170s range) but it fills me up and is lower carb. Prior to this insulin resistance, I wouldn't even have to bolus for a small bowl of cereal. You just have to roll with the punches, pregnancy is an insulin chasing game unfortunately. As soon as you figure out a good dose for yourself, it changes the next day if not sooner.

 

Fawn

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FarmerCathy

I did up my basal by a couple units this am. I do a unit for every 50 over 100, that was my sensitivity last week, now it seems a lot lower. I may have to go to 35 like my dr. suggested. I could have this am for breakfast that is for sure. Yeah, I was able to eat potato, bread, oatmeal, etc. last week. So far this week, none of that is ok, esp. during snack time.

 

I'm also having shortness of breath when my bg goes too high. I was taking care of the critters yesterday and had to stop to take my bg to make sure it wasn't too low and it was 160. Seems highs make me feel awful. I had bolused for my snack, but still was back at 200 before dinner.

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aiah23
I did up my basal by a couple units this am. I do a unit for every 50 over 100, that was my sensitivity last week, now it seems a lot lower. I may have to go to 35 like my dr. suggested. I could have this am for breakfast that is for sure. Yeah, I was able to eat potato, bread, oatmeal, etc. last week. So far this week, none of that is ok, esp. during snack time.

 

I'm also having shortness of breath when my bg goes too high. I was taking care of the critters yesterday and had to stop to take my bg to make sure it wasn't too low and it was 160. Seems highs make me feel awful. I had bolused for my snack, but still was back at 200 before dinner.

 

Sounds like you aren't bolusing enough for your snack then. How much do you bolus for snacks? You didn't mention that in your post, just your ISF (insulin sensitivity factor); which you agree seems to be changing and it probably will the rest of this pregnancy. What do you typically eat for your snack and how much do you bolus? That would be a good starting point and we can try to pinpoint where you need to increase that bolus, or by how much, and why. :) I know this is frustrating, you can only do your best and people are here to help. If it's any consolation, I'm facing the same darn thing right now. It just seems to get worse and worse every few days.

 

Fawn

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FarmerCathy

I had a bowl of cereal yesterday for my snack. I bolused 1 unit per 15 g of carb. Cereal is not a typical snack. Usually for my snack in the am I will have some flaxseed brownies with milk (recipe I got on here from another member, which seems to help), then I will have 1/2 an apple dipped in almond butter in the mornings, then in the afternoon its usually nuts (which I haven't been able to the last couple days, my stomach does not like it) or whole wheat toast with almond butter. Yesterday I had half a chicken salad sandwich for my first snack after lunch and then the cereal. I seemed to be really hungry yesterday afternoon. I made chicken and rice soup for dinner last night and was at 112 after that and then had whole wheat toast with almond butter and was back down to 115 a little more than an hour after that, so I thought I'd be fine this am because lately its been 150 or 170 before I go to bed and my numbers have been way lower. I'm thinking a protein snack in the middle of the night might have helped. I think I'm going to make some deviled eggs today for snacks and hope that helps.

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