In one of many jokes of the diabetic pregnancy, just as you've become used to the lower insulin needs and increased sensitivity of the late first-early second trimester, your placenta throws you for a loop.
The placenta, masterful organ that it is, has one keen interest... keeping your baby well fed. It releases a hormone cocktail with many baby-promotiing properties, one of which is counteracting mom's insulin to keep more sugar circulating in the blood and consequently more available food for baby.
In non-diabetic moms, the pancreas pumps out more insulin to compensate. For some non-diabetic women, the placental hormones are too much for the pancreas to handle, causing a condition known as gestational diabetes. This is a temporary form of diabetes that goes away after delivery.
For those moms that are already diabetic, the 2nd trimester means you'll be taking more insulin, potentially LOTS of it. My doctors told me to expect to take double my pre-pregnancy insulin or more by the time pregnancy-induced insulin resistance peeks in the third trimester.
Currently, I've had to do one big bump at about 18 weeks. I changed my insulin to carb ratio from 1 unit to 7 grams to 1 unit to 4 grams (at breakfast) and 5 grams (rest of the day). I've also upped some of my morning basal rates. Now, because I'm taking so much more insulin, I'm changing my pump sites out once every two days instead of three. My insurance company understands at the moment, but I may switch back to plain old needles for some meal boluses to save costs.
I'd suggest not waiting too long to talk with the docs about changing your levels. You know it's coming, as do they. I found that making smaller changes more frequently is less traumatic then going for the big jumps, or seeing 200s and higher regularly.
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