Crank it up.

Max BolusEveryone said it would happen this way. The books, the blogs, and all the doctor friends I have in my line of work warned me: starting at about 24 weeks your insulin needs are going to go up. Like way up. And they’re gonna keep going up until you deliver. So why I wasn’t mentally prepared for this change I don’t know but I wasn’t.

I saw my endo the same week I wrote that particularly depressing, down-in-the-dumps blog post about the guilt I was having with high BGs. Watching her well-trained expert eyes scan my CGM and pump download, I was reminded once again that it doesn’t matter how long I’ve had diabetes, it’s always good to have a (smart) medical professional on your team too. She took a look at one particularly ridiculous evening – the night Thai food had sent me soaring and taken twenty effing units to get back under control, and pulled out a calculator.

“I know this sounds crazy, but I’m calculating your insulin to carb ratio right now at 1 unit to 4 carbs.”

Yep. That did indeed sound crazy. Because I’ve been using 1:10 for several years, and 1:12 or less when I’m training for distance race and ramped up on cardio and now she wanted me to more than double down on that ratio? But we checked the math against some other examples and all signs pointed to “crazy” actually being “spot on.” Except that being that agressive made her nervous, so we split the difference at 1:7, essentially coming down halfway. We also slashed my correction factor by more than half, with one unit for every 20 mg/dL I wanted to come down. And to round things out, we bumped up my basals to an even unit per hour around the clock.

All the tweaks have added up to a much, much smoother past few weeks. Numbers are looking so much better but more importantly, I’m feeling much more in control of my diabetes. There were a few weeks there where I felt like I couldn’t win. And yes, the total daily units are climbing on the pump, but I’m trying my best to just be ok with that. Even if I gain more weight because of taking so much insulin, the baby’s weight is dependent on how much he or she has to output for insulin to combat hiighs. So the best way for me to prevent a big baby is to make sure that little munchkin doesn’t have to overproduce insulin because of a high that I caused. So, let the units pile up – as long as it keeps the BGs down. You’ll see the steam coming off my pump pretty soon with that motor in overdrive!

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Speaking of steam coming off of things, how are you doing with the warm weather? Old time Northwest folks don’t have a problem because they have two floors and one of them is a daylight basement. And a daylight basement is always cool on the warm days!

One thing to keep in mind with the omnipod is that it takes awhile to deliver that much insulin. When I was doing 20+ units of insulin while pregnant I calculated the time it took to deliver that much insulin and I think it was something crazy like 15-20 minutes – so keep that in mind when you are bolusing if you have post prandial high’s.

Alexis, love your blog and congrats on the pregnancy. We miss you in the office.

Congrats! I hadn’t had a chance to check out your blog in a while. Enjoy pregnancy and don’t let the doctors scare you…I’m type 1 and when I went in to be induced they said stuff like the baby would be big and would surely be in ICU…even talked about how the IV would go in their scalp. Terrifying enuf, I didn’t need that. But she was so healthy and 7 pounds 1 ounce. They ended up being so wrong…but I was glad I had good team of doctors.

Good to hear from your Dr. Dysart! Things are well but I certainly miss seeing all of you too! Hope you are doing great.

Kim that makes me feel better -thank you! It’s hard to to feel like everything is your fault during this time, but I have to remember that sometimes things can simply be blamed on being a totally normal, healthy pregnancy.

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