My a1c at 16 weeks was 5.1. I’ll get another done at 28w but that will be artificially low due to pregnancy… Now at 25u lantus morning + night (50/day). Humalog Ratios 1:3-1:5.5. And still running a touch high despite daily (albeit too conservative) adjustments.
Carb cravings have been insane. I’ve eaten meals with 200+ carbs. My appetite is finally slowing down since my uterus is starting to invade my stomach space. There is not much pre-bolusing. Pregnancy hangry is just too much to resist. Immediate walk after instead gets the job done. IMHO even better.
I haven’t really run since about 10 weeks but its been extremely helpful to walk approx 2mi after nearly every meal. Until resistance really hit hard about 2 weeks ago, I rarely spiked above 150 and if I did it was very brief (minimizing the area under the curve is my goal).
The poster’s own insulin requirements here have more closely mirrored mine than the theoretical numbers: https://www.reddit.com/r/BumpersWhoBolus/comments/d28eg6/pregnancy_and_insulin_requirements_a_guide/
I read another guide which indicated a “rule of thumb” is double insulin at 20 weeks and triple at 30 weeks compared to pre-pregnancy numbers. I’ll be even higher than that. Mostly due to 2 placentas I think.
I’ve been having virtual appts with my endo monthly but really its all self-managed. I like her and she just notes my ratios, gives me a few pointed about specific days where I screwed up, and lets me do my own thing. I’ve refused diabetes management from anyone else (mfm/ob). The first mfm appointment left me nearly in tears because she just gave me a lecture on how I’d kill my babies if I ever went above 120. The stress from that alone had me in the 170’s. I’ve just shut them down if they even bring it up every since and say my endo is happy, talk to her.
Pre-pregnancy I read on a t1 and pregnancy facebook group about hitting ratios of 1:1 or even 1:0.5 with over a hundred units basal/day and it just seemed mind-boggling and impossible. Now, not so much.
Really fantastic update! So glad things are moving along swimmingly with the pregnancy. Twins, yikes that sounds like a lot to manage, and walking after every meal seems like a nice compromise from your formerly running self.
Babies are doing well. They are very small. The smaller one is considered growth restricted (<10th percentiles) so I’ve been going in for weekly scans / blood flow checks since 26 weeks. Cause is most likely some sort of placental insufficiency. All have been reassuring so far.
Its gotten much harder for me to exercise and function in the last couple weeks. I’m huge. I’ve put on 40lbs and its pretty much all belly. Got maternity photos done last weekend and it was not too early. Walking 1-2 miles / day rather than the 5-6 I was doing not too long ago. I’ve also been swimming 1-2x / week which feels good.
I’m up to ~65u lantus / day (split dose) and need to bump that up a little. Humalog ratios are about 1:2.5-1:3.5 now. A1c at 28w was 4.8. Its artificially low at this point in pregnancy but dexcom average is right at 98-100 so kind of running at ~5.1 like I was earlier. I still have high’s, usually due to ice cream (regular ice cream, the low carb stuff is gross).
I can’t eat as much as once any more or I get reflux since babies invade stomach space and my digestion is slower/unpredictable.
I’m starting to stress about hospital management. I think as long as I can eat, I will opt out of their management. I did get a durable healthcare power of attorney done for my boyfriend which specifically indicates diabetic management preferences and he is a smart numbers person that I’ve brought up to speed. But I know there will be a potentially lengthy time period where I won’t be allowed to eat and am very worried about that period. Do I risk hoping my lantus is good and sneak clear gatorade if I drop or risk them letting me run stupid high? I am worried about how to make that happen without being labelled as noncompliant and not being cared for well in regards to the rest of my health and the babies’ health.
Honestly, I would be careful about sneaking things your medical team doesn’t know about. The reason they have you on ice chips is to be able to administer anesthesia in the event surgery is required. With that being said, I think many hospitals are now allowing clear fluids during labor, so you may be able to have your clear gatorade with their full knowledge.
I’ve read that too. Hopefully clear liquids are allowed. At my next appts (endo, ob, mfm), I’m going to try to get some clarity on their policies. There are so many horror stories out there… We will see which direction twin A is facing when its time (they can still move around quite a bit), but anything other than head down and its automatic C section since they can’t try to turn anyone when there are 2 in there.
Not sure how much you like to bend the rules, and certainly they would be putting dextrose in your IV if you dropped low, so you might not ever need to worry about it.
But if you wanted to self-manage a low before things get really dicey and before they give you anesthesia, sugar-water in a water bottle really looks like water!
And having two different brands of water bottles lets you keep track of which is normal, and which is the sweet one. Just let your BF handle that for you, and he can make sure he is giving you the right one.
My sister had identical twins, and all went well!!
So just HUMOUR story:
One interesting observation was that first one out had a smaller head! They explained the first born had the tougher time “pushing” through, before the second one slid right out!
In early photos, we checked head size to identify, and first few months, first one out had nail polish on toe nail to make sure who was who.
34w now, getting really close! They won’t let me go past 36w if I make it that far.
Insulin resistance peaked around 31-32 weeks and its been gradually decreasing since then. I’m being monitored 2+ per week now because of my crappy placentas (decreased insulin resistance is a sign of that but we already knew my placentas are crap). My endo has had me loosen up a bit on the tight control with the steadily decreasing resistance and tiny babies… not that its awful, just less unintentional time <55.
Both twins are growth restricted (most likely cause is placental insufficiency), the smaller one severely so (1st percentile), the larger on has increased cord resistance and is in the 3rd percentile at last check and her fluid decreased in the last week. Lots of monitoring and I’m supposed to (and have gone) go to L&D if I feel decreased movement or fluid leakage. A C section is likely since both are breach at last check, I just want them to be safe so I’m ok with that.
Walking around the block is about all I can do now before my hips feel like they are about to split in half. I still haven’t used valet parking at the hospital during the day and its almost a kilometer hike from the parking garage. I’m stubborn.
Wow, sorry to hear about the issues. But really glad you are almost there. Might be about time to use the valet. Plenty of time afterward to get back into shape. Hoping the best for you and the twins!
Babies arrived at 36w1d via scheduled c section! They are healthy and we are exhausted. Boy (4lb12oz) had zero nicu time. Girl (4lb14oz) will be home in another day or 2 ~10 days nicu time due to lung development. Neither had blood sugar issues. My endo and I came up with projected post pregnancy humalog and lantus doses and she talked to my ob and he got those orders in. Immediate post pregnancy lantus was 10u/day and humalog at a 1:15 ratio with 1:50 correction. They didn’t want to correct me unless I hit 150 but I would just tell them I was eating 15 more carbs than I actually was so it all worked out. At first they used my dexcom numbers and checked against their machine once a day then someone told them they had to use their machine every time they gave me insulin. I just let them since it was just 4x/day… I had my own insulin too but only used it once. This is about 2/3 of my prepregnancy ratios and were pretty much spot on. I’ve had to adjust slightly since I’ve been home but not by much.
So happy that the babies arrived and doing well. Zero NICU time is amazing for your boy! Glad your daughter is OK. Wow, having babies is tiring enough, having twins while managing diabetes should qualify you for superhero status.
Congratulations!! 