There was time when anything over 30 total daily units on my pump meant I’d had a serious carb-heavy day. Like I must have had a bowl of ice cream, or a pasta dinner to warrant something in the upper 30s or GASP: 40 units! In one day! (Keep in mind everyone’s total daily units vary and this is not a commentary on the “right” amount of insulin, simply what I am used to).
Those days, honey, are long gone. The past few weeks, I’m a regular in the high 50s. Sometimes I have a 60 unit plus day and I don’t bat an eye. I will crank that pump up until steam comes off. But as I hit the home stretch here of the last 10 (-ish? We might deliver early!) weeks it’s amazing to see how things done changed with my management. If I thought I had vigilance before, I’ve taken hawk-like monitoring to a whole new level. Our baby is measuring a bit big, despite me having a normal person’s A1c. And although this can simply be chalked up to the fact that both my husband and I were on the larger side as babies, I’m still trying to keep my blood sugars from having anything to do with it. Which means running through 60 units of insulin a day, occluding a few more pump sites than normal, and aggressively checking CalorieKing.com to make SURE I’ve got that carb ratio right. In the spirit of “I can do this damnit,” I thought I’d share a few practical tips, besides investing in Humalog stock, that are working for me during the last trimester of this pregnancy:
1.) Eating dinner no later than 7:30. This was a BIG change for Jacob and I. He and I work late and tend to eat late. Cooking together is our bonding time so we wait until emails are done and everything is buttoned up before we head to the kitchen to cook, catch up on the day, and dine. It was normal for us to eat dinner at 8:30 or 9pm. But since I struggled with overnight BGs, my doctor suggested eating earlier to 1.) have more time to fix a problem before bed and 2.) actually get to the problem (i.e. latent digestion issue, post-prandial spikes) sooner. It’s been hard for us but we’re consistently eating by 7:30 or earlier and it’s made a huge difference. It’s meant leaving emails to the next day and not always feeling “settled,” but it’s working. By the time I hop into bed (um….more like lumber and fall these days actually), I’m usually recovered from any issues and going into the overnight with steady numbers.
2.) Using my bolus calculator at times when I”m at higher risk for stacking boluses. For me, the mornings are when I stack boluses aggressively. I would get annoyed if my number started to drift up, feeling like it would ruin my day. Then I’d pile to much insulin on top of itself and end up low by lunch. Making sure I stop to actually plug in my BG and carb count prevents me from overdoing it too much, and that’s exactly what bolus calculators are for.
3.) Slashing carbs even more than before. Summer time is the best time for all my favorite fruits. I look forward each year to peaches and nectarines and watermelon. And those things aren’t totally off the list, but I’ve reduced all carbs in general, including fruit. I make sure to get plenty of nutrition for me and baby with tons of veggies, proteins, and dairy, but when I’m already taking this much insulin and still being resistant, I can help myself by downsizing the carbs. And don’t worry, I’ll make up for it after the baby is here!
4.) Walking every morning. I stopped running at 22 weeks (about halfway through the pregnancy) but exercise is key to keeping my BGs low and preventing me from using up an entire bottle of Humalog a day. It’s meant getting up much earlier on work days, and sometimes it takes a colossal effort to get my sneakers on and a leash on the dog but I have to move my butt every single day, no matter what. A brisk walk after a meal has also helped my insulin work harder and prevent post-prandial spikes.
5.) Doing my best to ignore the scale. This is a pretty hard one. I have gained weight! Already more than the recommended amount for pregnancy but I’m doing my best to not give a crap (easier said than done). Per my doctor, it’s more important that I keep my BGs as good as they are right now than worry about the weight that’s piling on due to taking so much more insulin than I’m used to. I don’t love this new body type on myself but guess what? It’s not about me anymore. And that’s totally worth it to me!