We're always thrilled to get happy news from those in our Diabetes Community, and when there's a question that comes with it... well, it's a perfect combination for our weekly advice column, Ask D'Mine! As always, the column is hosted by longtime type 1 Wil Dubois who works as a community diabetes educator and is a well-respected author as well.

Today, Wil tackles a question from a fellow type 1 who is pregnant with her first child.

{Need help navigating life with diabetes? Email us at AskDMine@diabetesmine.com}

 

Sal, type 1 from the UK, writes: I am 10 weeks pregnant and I believe my Lantus is no longer working. I go to bed on a normal blood sugar of between 5-8 [90-144 mg/dL for us Yanks] and wake up at anything between 9 and 19 [162-342 mg/dL]. I have been a type 1 diabetic for 33 years and am now aged 40, soon to become 41. I am sooo happy that I am pregnant, as it is my first, but in the last 2 weeks am finding it very hard to control overnight blood sugars. I take Humalog and Lantus and have been for 10 years, so this is proving difficult. Maybe I am now becoming insulin resistant?

Wil@Ask D'Mine answers: Number one: Congratulations on your pregnancy! Number two: Get your ass off the computer and go see your doctor and your Diabetes Specialist Nurse [Brit for CDE] right now! Blood sugars that are merely annoying to us PWDs can be toxic to unborn babies, causing all manner of birth defects, and can also trigger miscarriages. You're going to need extremely close following by your medical team, who will double-fret about you both because of your age (don't take that in the wrong way, I personally find 40-year-old ladies very sexy, but obstetricians don't generally share my enthusiasm) and your diabetes—either of which by themselves would classify you as having a "high risk" pregnancy.

So what does high risk mean? Well, it's actually not as bad as it sounds. In medicine high risk is a milder concept than in society at large. Out in the world, high risk would be having unprotected sex with a prostitute in Nigeria, where they have the second highest prevalence of HIV in the world. High risk would be taking a turn at Russian Roulette in the fifth round of play. High risk would be being the first to try out a new bungee-jumping site using a clearance-sale cord; hunting rhinoceros with bow and arrow; sleeping on the centerline of Interstate 10 in Los Angeles; or motorcycle jousting. But in medicine, "high risk" really just means that much more work needs to be done to ensure a happy outcome. High risk in medicine is the opposite of the old, "Take two aspirin and call me in the morning" approach.

Bottom line: Don't freak out. Well, freak out enough to get your butt in to see your doctor before another sun sets, but don't live in fear for the next 26 weeks. We've come a long way since Steel Magnolias.

While your pregnancy won't be risky in the way rhinoceros hunting would be, it will be a lot ofpregnancyautism hard work. Blood sugars that any of us would consider enviable under any other circumstance won't be good enough. You'll be asked to maintain the kinds of blood sugars that all your non-diabetic pregnant sisters maintain. That's a tall order. You'll probably be looking at some diet changes for the next few months and you and your Humalog are going to be constant companions. You might also have to get up to speed on the annoying practice of "pre-bolusing," or taking your insulin earlier before your meals than ever before.

But to your question about insulin resistance: yes, you are absolutely becoming more insulin resistant. For about one more week. Then the tide is going to go out rapidly on you, and you'll be at risk of blood sugar lows in the middle of the night.

Ain't pregnancy fun?

The main culprit behind the shifting sands of insulin resistance in pregnancy is progesterone, a hormone that increases blood flow to the uterus to feed the growing baby. Progesterone drives up insulin resistance. Big time. After all, it's also a steroid, and we all know what steroids do to blood sugar, right?

When you first got knocked up... What? Oh, sorry, I'm told I need to be all formal and medical here... When your egg was first implanted in your uterus, your ovaries went into overtime making progesterone. Six weeks after the big event, insulin requirements are usually 20% higher than they were before the hanky-panky.

And it doesn't stop there. A pregnant woman's body's new-found thirst for insulin will steadily rise until the ninth or eleventh week, at which time the ovaries' progesterone factory shuts down and the placenta takes over. Overnight, insulin resistance returns to normal or even lower than pre-pregnancy levels.

But it doesn't stop there. A week or so later the insulin resistance starts to rise again, and is likely to continue to do so for the remainder of the pregnancy. This second wave of insulin resistance is likely tied to the normal weight gain during pregnancy. More of you means more insulin is needed. Plus, you are eating for two, so you need insulin for two as well.

The good news is that this second onslaught of insulin resistance is slow and steady, so adjusting on the fly will be easier. Well, right up until the first contraction, anyway.

So we all know that muscles in action vacuum up glucose, right? Well, the uterus is exercising when it starts the powerful contractions to push the baby out. Labor can actually cause hypoglycemia! And, of course, after the baby is born everything settles back to normal.

Oh, right. No it doesn't. Because now you'll be waking up every two hours to feed your little bundle of joy, and your bank account will remain unaccountably empty for the next eighteen years.

But it will be worth every penny and every minute of lost sleep. Parenthood rocks.

Of course every lady is different, so 'fer God's sake don't write all these weeks in your day planner. Thinner ladies and heavier ladies respond a bit differently, which is why you need to go see your doctor.

Not your advice columnist.

 

This is not a medical advice column. We are PWDs freely and openly sharing the wisdom of our collected experiences — our been-there-done-that knowledge from the trenches. But we are not MDs, RNs, NPs, PAs, CDEs, or partridges in pear trees. Bottom line: we are only a small part of your total prescription. You still need the professional advice, treatment, and care of a licensed medical professional.

 

 

Disclaimer: Content created by the Diabetes Mine team. For more details click here.

Disclaimer

This content is created for Diabetes Mine, a consumer health blog focused on the diabetes community. The content is not medically reviewed and doesn't adhere to Healthline's editorial guidelines. For more information about Healthline's partnership with Diabetes Mine, please click here.