From North Carolina, USA:
I'm 32, diabetic for 9 years. I'm 7 weeks pregnant and am on the insulin pump. I haven't seen a pump doctor for years thanks to insurance problems as well as distance. Obviously, that has to change. (Please don't lecture, I know how stupid I have been) Anyway, my blood glucose has been pretty good, but I know I'm in for some drastic changes once I get in to see a pump doctor. I have also heard that people are using Humalog in their pumps--what a concept!
Right now I'm really struggling with my night basal rate. I am being very cautious because I have had some severe insulin reactions over the years, landing me in ICU, but I also need to find some way to control the rise that I have first thing in the morning. Any advice? I have upped it again at 3 A.M., but that doesn't seem to be helping at all, and I wake up high and then have to take a shot (brings it down quicker).
For the last few days my blood glucose have been excellent, other than the first morning, nothing higher than 150. I would love to meet women who have been on the pump while pregnant and learn from them. I have an 11 month old and they put me on shots, and let me tell you, my control really, really stunk, despite 4 shots a day! I go in to see the high risk OB (3 hours away) and they will refer me to a pump doctor (at least 2 hours away, opposite direction) but, I don't want to go in with horrific control and have the doctor look at me like a total idiot! I have achieved, on my own, an A1C of 5.4 on the pump (though I know it's higher now because I became a human slug and haven't been as intelligent about my blood glucose). I know one person who is pregnant and on the pump and she tells me she uses only 2 different basal rates. I have mine set for 2 different doses, but it's varied, so I end up with 4 different basal rates. I think I may be making it harder than it has to be. Anyway, please e-mail me, anybody! (Okay, small, short little mini-lectures are allowed.) I really need to connect with people who are on the pump who can help.
Congratulations on your pregnancy. Despite your troubles managing your diabetes your hemoglobin A1c is in a good range for pregnancy. I have included my standard answer to insulin dependent diabetes and pregnancy. For specific management of your blood sugars, I would prefer that you consult with your obstetrician and endocrinologist.
Probably one of the most significant factors contributing to successful pregnancy outcome is preconceptual glucose control. Basically the closer that fasting and postprandial blood sugar values are to normal (I use <105 mg/dl fasting, and <130 mg/dl at 1 hour postprandial as guidelines) the greater the likelihood that the risk of congenital abnormalities will be minimized. However, do not drive yourself crazy over an occasional elevated blood glucose value. Similarly, your hemoglobin A1c should also be in the normal range. Check with your doctor's office to find out what the normal values are (usually between 5 and 7% depending on the assay).
The more times you check your blood sugar the more information can be gained about your glucose control. However, you have to be practical. At a minimum I would recommend checking a fasting, before lunch, before dinner and bedtime blood sugar. If you want to check at 1 hour after meals this would also be useful but not necessary after each meal.
Depending on your blood sugar control and any other problems, you will be seeing your obstetrician once a week to maybe once every two weeks.
Your overall medical condition is important. As long as your blood pressure is normal and you have no evidence of kidney disease then the risk to a pregnancy is minimized. Therefore, it is important to assess these factors prior to conception. As I mentioned above it is important that you work with a diabetes team (an obstetrician, an internist or endocrinologist with expertise in diabetes during pregnancy, and a dietitian). This group usually will have established contacts with other useful specialists such as an ophthalmologist.
[Editor's comment: If you're pregnant, and aiming for tight control as you should be, you are taking an awesome responsibility to manage your insulin delivery without an endocrinologist's input. Obviously, you've been doing pretty good so far, but I'd suggest that you call the endocrinologist's office at once, and be sure that you have established a line of communication (either phone, fax, or e-mail) so you can reach the doc and the doc's staff if you have problems. WWQ]
Original posting 6 Oct 97
Last Updated: Tuesday April 06, 2010 15:08:54
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