I’m 37 weeks pregnant. For those of you who don’t count in weeks (I sure as heck didn’t until I became pregnant), that’s 9 months and 1 week pregnant. Yes, pregnancy is actually 10 months long (add that to the list of fun facts they don’t mention before you decide to have kids). Things are going ok. In the grand scheme of things actually, I should consider them spectacular because our baby is healthy and really, that’s all the matters.
Mama on the other hand, oy. I’ve had a whole host of health issues pop up in the 11th hour here, none of which are life-threatening but are conditions to monitor nonetheless. I don’t like getting that kind of news but I’m keeping my eye on the prize which at this point, is only 1-2 weeks away (depending on what the doctors decide).
Interestingly enough, my diabetes control is at the bottom of the list of worries right now. About two or three weeks ago, I started getting some lows during the night. They became more and more consistent, and around the same time, I found that my carb ratio was too aggressive for my breakfast and lunch as well. Basically, everything started needing less insulin.
This came as a total surprise because every book/blog/endocrinologist has said my insulin needs will continue to ramp up throughout my pregnancy to the very end, and then sharply drop off right after delivery. I examined my food choices and exercise, and although I know I tightened the reigns after my uptick in A1c at the last endo visit, I was barely bumping over 120 most days. Plus, my fastings were under 70mg/dL (which at that point shouldn’t be called “fastings” but instead “low bg alarm clocks that will wake you up when you desperately need that last half hour of sleep”).
It was my high-risk OB (also known as a Maternal-Fetal Medicine or MFM doctor) who finally had some insight. She asked me at my last visit if my blood sugars had been easier to control recently. I wondered in that moment if, she had powers of mind reading as well as an MD, since the topic had been on my brain. I confirmed they had indeed been a little too easy to manage – the lows were back. She told me at this stage in pregnancy, the placenta is fully grown and no longer demanding such a high metabolic need on my system. She also mentioned most of her patients with diabetes saw this relaxation in insulin needs towards the end of the line.
I emailed my endo a download of my CGM, and we started coming down on the overnight basals gradually, which is helping, but I’ll need a reduction in everything overall I think as I’m still riding too low. I guess the one perk is that my final A1c before baby should come back in the heart of the fives! But, not sure it’s worth the amount of glucose tablets I’ve been rolling through. Regardless, I find it interesting that no one/no blog/no book mentioned this little downturn – truly it came out of the blue for me.
Diabetes: Adjust, test, adjust again. Rinse, repeat. Forever.