Mama in the City

I'm nearing the 32 week mark and as a perinatal nurse that is an important milestone to me. It also means that if needed, I could deliver at my work place without being deemed too premature and shipped off to a more acute high risk hospital. 28-32 weeks also marks a massive growth surge in pregnancy and for me that has required a major increase in my insulin doses.

(Side note: this is why all you regular folk get your gestational diabetes screen at this point in your pregnancy. The need for more insulin just happens to be a lot more visual for a type 1 diabetic who has to fill up insulin syringes through out the day.).

I feel so fortunate to have the knowledge and understanding about how to adjust my own insulin doses as my pregnancy progresses. It is definitely empowering to be able to manage your own health and make well informed decisions. However, the other day I had a bit of a minor freak out as my placenta oozed out all its terrific growth hormones that help grow my baby but make my body need more insulin. I had been doing really well with monitoring my blood sugars and keeping them in a solid range, so this blip took me aback a little.

This particular night I had taken my current dose of insulin at bedtime, 68 units, but when I woke up in the morning something different was going on. I had high blood sugar after a good nights rest and that is very unusual for me. I did my usual dance of the insulin doses and titrated and bolused and waited to see my blood sugars fall back into range, but this time around it wasn't lowering to a normal range at the usual speed. It was maddening for me!

It's one thing to eat a large pan of fudge and get high blood sugars but I hadn't! I knew that it was just my placenta growing and chugging along and telling my body to provide more insulin but I still felt sick with guilt. It took all day to get back to the blood sugar numbers that I'm happy with. Each finger poke that resulted in a high number made me feel so let down.

That whole day I ended up feeling a weird guilt about having high blood sugars. Even though the logical part of me knew it was nothing I had done and it was just a normal spurt in pregnancy growth, I still couldn't shake the guilt and worry that I wasn't doing a good job at managing my diabetes. I will admit to being obsessed with my blood sugar numbers that day, and tested an obscene amount of times until I found the dose that my body required.

My placenta is now requiring me to take 78 units of long acting insulin in the morning and 80 units at bedtime in this pregnancy. That is a huge jump from the 68 units I was taking a week ago. It is also way more insulin than I ever required in my first pregnancy with Ben. Different placenta=different insulin requirements.

One thing that I really hate is hearing remarks from health care providers (non endocrine smart HCP that is!) about insulin requirements in pregnancy. I've heard comments like, 'so-and-so is taking XX amount of insulin at XX weeks pregnant, can you believe it's so much?!'. I know that it is a lack of education but it is still something that gets under my skin.

My motto is this: the placenta gets what the placenta wants, whatever that insulin dose may be!