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kristica84

Having a Minor Breakdown

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kristica84

I am 24 weeks pregnant with my first baby and I've had type 1 diabetes since I was 6 months old (I'm 23 now). Throughout the second trimester my blood sugars have been way above what doctors say they should be (200s are my average). I've just moved and I feel like I'm totally out of control. Tonight I am in a total panic that my poor baby will have some horrible thing wrong because I wasn't able to keep my blood sugars more perfect. I feel like all the doctors I had where I moved from were looking down on me because I wasn't good enough to do this. I have my first doctor appointment with my new doctor on Monday and I'm scared to death of the lectures and the condescending tones and looks from yet another professional who should be on my side. What if I've made the biggest mistake of all by not being in better control before I got pregnant. Ah!!

 

Please excuse the melodrama here... I blame my hormones tonight.

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k_dub

Hi Kristica:

 

I'm Kelly. I'm 21 weeks pregnant right now. I understand your concerns.

 

So no sense in worrying now about your past BGs - what done is done.

 

How can we help you get your BGs down now?

Do you have a good healthcare provider where you are at now?

What do you think your challenges are with control?

What have you tried so far?

Are you on MDI or a pump?

What insulins are you on?

 

Let's start there, and maybe we can help you sort out some stuff?

 

I can tell that I've had increasing insulin resistance over the last few weeks. About once a week, I'm having to increase my basal dose (I have a pump).

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kristica84

Oh I should have included that. I am going to an obstetrics specialist on Monday and I'm going to be asking for any endo recommendations they have. I'm new to the area and have had particularly uncaring endos in the past. So at this point I would say I don't have a good health care provider, but my fingers are crossed that that will change Monday. My last A1c was a 7.6% about a month ago. I think it's higher now. Probably an 8.5 or so if my CGM has been accurate. I am on an insulin pump and a CGM (continuous glucose monitor) thank goodness. My A1cs have always been high. That 7.6 was the lowest I've had since I was 9 years old. My challenges... I think my diet has a lot to do with it. I try to plan but I feel like I'm ALWAYS starving. (Pregnancy symptom?) Even when I stock up on no carb or low carb snacks they still shoot off my blood sugars. I think the biggest thing I can control is that. I have raised my basal rates to see if that helps. I think I need some professional help with the outrageous insulin resistance that I think has been brought on by stress. When I got pregnant I inadvertently had my job threatened and in the end my husband and I decided to move. It's been a stressful month. I feel like I have to take double the insulin to get my blood sugars down. So frustrating. Right now with the pump I'm only on Humalog. I also have hypothyroid problems.

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k_dub

Great that you are on a pump and CGM. Nice technology to have and to use to determine what doses need to change, etc.

It does sound like maybe your basal rate needs to come up. I have a great endo (he is Type 1) who works at a T1 research center in Denver. He told me to expect to change my basal rates in the 2nd tri about every 10 days. That is pretty much been true for me. Each time I change a "week" in the pregnancy, I've been trying to assess my BGs and determine what kind of increase I need (over what time period, etc).

 

Are there certain times of day that you are having problems?

 

I have thyroid problems as well. Have you had your TSH checked all through pregnancy? Typically, your thyroid med will need to be increased as you progress as well (sorry, if I'm repeating stuff you know). Having my thyroid under control was huge for helping me get my basal down pat...

 

I've also had to change my insulin to carb ratio. I feel like I'm taking double boluses these days...

 

Hoping things calm down for you soon...

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Tanikit

:hugs: - pregnancy is stressful enough without all the extras you are having to deal with - I hope you will find a really great endo who you can work with. By the end of pregnancy many type 1s are on 3 times their normal insulin and some even more than this - so if you were taking 30 units total before pregnancy then by the end doses of 90 units per day would not be unusual - though of course everyone differs. This increase goes up gradually from the second trimester so you need a lot of adjustments continuously.

 

Firstly as kdub says get your TSH checked - what dose of thyroid hormone are you on - I was on 0.1mg of eltroxin at the beginning of pregnancy and moved to 0.15 halfway through which is a 50% increase.

 

Next keep really good records of your sugar levels - if they are high all day or premeal then increase your basal and keep increasing it slowly.

 

But most importantly don't worry about what had passed - just keep moving forward. Both my pregnancies were really difficult and stressful and I struggled with both severe lows and highs. My 2 year old is sitting painting here on the floor while I type and my 6 year is doing the same - both girls are fine. The hormones of pregnancy affect you emotionally and you have to just do the best you can.

 

One word of advice: if you can get an endo and an obstretric that can work well together that will help you a lot when you have to give birth. I did not have this with either pregnancy and it caused some trouble after the birth when I had to adjust the insulin down all by myself.

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Lizzie G

hi

 

im so sorry you are having such a hard time and beating yourself up. you are right though ypu DO deserve to have a team on ypur side to helpyou, but maybe you can do a little more to help yourself too (thats not meant as a criticism just an honest observation based on what you said).

 

have you had your20 week scan? if everything was ok there be reassured that at this point your baby is "structurally sound"! and main risks of less than perfect control are pre term labour big baby etc. ie you can turn things around now and reduce the risk of problems.

 

its very common to have insulin resistance kick in at this stage. in my last pregnancy i was increasing about 5% per week and carb ratios changing similarly.

 

at this point, to get things as basic as possible id say your not taking enough insulin overall and even if not a very scientific/quantified approach, increasing your basal and boluses by 10-15% just to bring those numbers down might be a start. it sounds like you have plenty of room for manoevure before you risk major hypos or anything but do make sure you keep a good supply of fast acting glucose if changing your insulin. also if you arent hypo aware ignore my advice and see a doctor!

 

i have to go but hope your ok x

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kristica84

Thank you all SO much. This has REALLY helped. I actually have questions to ask my doctor today and that is a really good feeling. I raised my basal rate and ta da! My blood sugars are coming back into a manageable range. I haven't had many issues with insulin resistance so far in my pregnancy and I was worried when this started. I have had my 20 week exam and everything was fine. We had a specialist look at her heart and brain and those seem normal too, so I just need to remember that so far she's okay. Thank you all for your support. It is wonderful to have diabetics who've done pregnancy before and know exactly what I'm going through to vent to.

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Lizzie G
Thank you all SO much. This has REALLY helped. I actually have questions to ask my doctor today and that is a really good feeling. I raised my basal rate and ta da! My blood sugars are coming back into a manageable range. I haven't had many issues with insulin resistance so far in my pregnancy and I was worried when this started. I have had my 20 week exam and everything was fine. We had a specialist look at her heart and brain and those seem normal too, so I just need to remember that so far she's okay. Thank you all for your support. It is wonderful to have diabetics who've done pregnancy before and know exactly what I'm going through to vent to.

 

so pleased your babys well and your feeling better about everything x

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