Increasing amounts of insulin and insulin resistance

[Colette15]

Hello,

I am now 28 weeks and I would say insulin resistance has been kicking in for quite a few weeks now but has really kicked in this week. I am now on 3 and a half units of humalog for every 10g of carbs at breakfast and 4 units of humalog for every 10g carbs at lunch and dinner. My amount of lantus has jumped up every week I would say. I take 34 units of lantus in the evening and 29 units of a morning.

I know everyone would be on different amounts of insulin at different points but I was just wondering what everyone's experience is with insulin amounts increasing.

Does the amount keep increasing?
What is the maximum amount you can take. For example does it stop at 4 units for every 10g of carbs or could that go up.

Also I rotate my injection sites but am finding it hard to find room. I still go for a daily walk to help move the insulin around as it seems to cause a lot more bruising and lumps at the moment.

 

[Inka]

Hi @Colette15 The insulin resistance you’re seeing is very normal in pregnancy. It’s totally weird, isn’t it? I knew it would happen but not the extent of it. Mine really kicked in around 25 weeks very approx. Then at 30-32 weeks there was another surge. Basically you take as much insulin as you need. As an example, my breakfast bolus almost quadrupled and so did my daily basal total! It all goes back to normal as soon as the baby and placenta are delivered.

A lady who was at my clinic’s evening meal ratio changed from 1:10g to 1:1g ! I’d have to convert all your ratios to compare properly, but hers was higher than yours at 10 units for 10g carbs.

Yes, injecting or putting in cannulas becomes harder. I used my thighs a lot, just making sure to rotate the sites. I used my arms for bolus injections, and even the top of my bum too. I avoided my tummy because it freaked me out!

Have you done your birth plan? That’s a good distraction if you haven’t, but it’s also important to start thinking about things and planning. The last few weeks go very quickly!

 

[Colette15]

Hi @Inka,
Thank you for your reply. Yes it is very weird how much insulin dosage increases throughout pregnancy. I knew it would happen but the extent has come as a surprise. I haven’t done my birth plan yet but have been thinking about the birth and am writing a list of questions to ask midwife/ doctor. They said I won’t go past 38 weeks but will monitor each growth scan.
what week do they tend to go through the birth plan ? Also depending on what kind of birth I have what happens regarding eating and managing the diabetes as well as the birth. Do they hook me up to a drip and take over ? A lot of people always talk about taking lots of snacks in but how does that work being a type 1 diabetic. Do you tend to be more on the low side ? Sorry it is a lot of questions. Thank you.

 

[Inka]

I don’t think anyone formally went through my birth plan @Colette15 It was mentioned and I referred to it, but nobody sat and went through it. I did mention important points in my later appointments though.

I took a few weeks doing mine, thinking about all the various possibilities. I then made 3 copies of it. I got one put in my notes, kept one myself and gave one to the midwife in the Maternity wing when I was admitted to be induced. I know they read it because I stressed part of it to her, and she completed the sentence I was referring to.

Induction can take some time. I was admitted on a Tuesday, induction started on the Wednesday and gave birth on the Friday.(I don’t respond well to the induction drugs but many women do and things happen more quickly so don’t think you’ll repeat my experience - you could be quick or average). I was given meals and I ate snacks, bolusing on my pump like normal. The first bit of the induction was a pessary, and then I had a drip with the induction drug in. This was an ambulatory drip which allowed me to move around the room like normal. I’d specifically asked for this because I believe in active birth. I also had a monitor that allowed me to move around too (monitoring baby). I didn’t feel at all encumbered by these things and mainly forgot they were there.

Later on, once labour was underway, they put up a saline drip too which might have allowed them to put glucose in (I was too involved in the birth to ask) but my pump kept my blood sugar fine. Throughout, my blood sugar was pretty stable. I did eat a few Dextro tablets when needed but that was partly psychological, I think. I never feel like eating much during labour. I had some toast and picked at the meals they brought in early on.

So yes, do take in snacks. Take plenty of hypo treatments as you’ll need them in hospital anyway. I took loads and I’m glad I did as after the birth, you’re prone to hypos due to the massive hormone changes. I also took snacks like cereal bars, biscuits, etc, as they appealed more than big meals. They’re also good for after the birth.

No, they don’t take-over during the birth. Ask to keep your pump on. I still controlled my pump and my blood sugar. It was only during the final stages that they had the saline and possibly glucose up, but that was more a precaution. To my knowledge, they never used the glucose at all. My blood sugar went low when I was first admitted (stress and rushing around) but then stayed in target the vast majority of the time. I tried to keep in in the 5s and 6s if I could so ate something small if I was in the 4s.

All three of my births were natural, but one needed some ventouse help due to baby having a strange head position. I specifically put No Forceps in my birth plan and that was why they used the ventouse and knew to do that without having to check with me. During the births, I felt pretty much normal, like I would have done if I didn’t have diabetes - just thinking about how fast labour was going and so on. Of course, the diabetes was there in the background but I kept it that way just like I try to do in daily life.

 

[Colette15]

Thank you for sharing your experience. It is nice to get an idea of what to expect. I think I will get a bag just for snacks and hypo treatment.