Quick Vocabulary Guide

Hello all,

It occurred to me that I'm throwing a lot of terms around that a new diabetic or someone who is non-diabetic might not know. Here's a list of some of the most common. Please let me know if you'd like me to include others.

Basal insulin: The programed schedule of background insulin you need to function in a day, excluding meals.

Blood sugar or blood glucose: This is how much sugar is in your bloodstream at a particular time. It's the reading that you get from a glucometer. One hundred is roughly considered normal.

Bolus: The amount of insulin you take with a meal to cover the carbohydrate grams you're about to eat.

Carbs: An abbreviation of carbohydrate grams. This refers to how many grams of carbs you're eating at a particular meal. Diabetics use this number divided by their insulin to carb ratio to figure out how much insulin to take with each meal.

Endocrinologist: A diabetes doctor. More specifically, a doctor specializing in hormones and glands, of which insulin and the pancreas are a very important subset.

Glucometer: Also known as a finger pricker, this is the small machine used to determine your blood glucose level using a drop of blood from your finger and a test strip.


Hemoglobin A1c: Also called HbA1c. This test measures how well you've controlled your blood sugars over the last three months by looking at the surface of your red blood cells to see what percentage of them have been chemically changed by high blood sugar. 7.0 (7 percent of those red blood cells) is ideal for a diabetic, but tighter control is always better. A non-diabetic HbA1c is between 4.0 and 6.0.

Insulin to Carb Ratio: This is the number you use to determine how much insulin to take with each meal. For lunch I'm going to have about 60 grams of carbs in leftover Chinese food. I'll take that 60, divide by my insulin to carb ratio of 4, to get a bolus number of 15 units of insulin.

Pump: A beeper-looking device that automatically gives you insulin through a small catheter you insert about every three days. Pumps provide a daily schedule of background insulin, the basal rate, and let you program in the carbs you're taking with a meal to give you boluses for meals. This is an alternative to taking multiple daily injections of insulin.

Sensitivity or correction factor: The amount of insulin you need to take to get high blood sugars back into to normal range. For me that's about 1 unit to 15 blood sugar points above 100.

Weird Tests

Pretty early in your diabetic pregnancy, your doctor will want to check you for the three major groups of complications that can effect pregnancy: your eyes, your kidneys, and your heart.

Diabetic eye disease can sometimes mean you need a c-section because pushing could further damage your retina. A recent diabetic eye exam can rule that out.

For the heart, I had an EKG to make sure I had experienced

no 'hidden heart attacks' which sometimes strike diabetics, and women in particular. This involved 10 minutes of getting sensors placed on my chest, followed by being hooked up to a machine and about 20 seconds of actual testing. Totally non-invasive.

The worst funny test, by leaps and bounds, was a 24-hour urine collection to make sure my kidneys were working well. Kidney disease and pregnancy can interact to increase high blood pressure or preeclampsia for moms.

During the test, you must collect every single drop of urine for a day by peeing into a toilet 'hat' then running through the house with your 'specimen' to a big plastic jug you keep in the... wait for it... refrigerator! Wrap that sucker up in as many plastic bags as you want, it won't help that icky feeling. I think I ate out for a week afterwards, despite disinfecting everything!

Hopefully you'll only have to do this once and can pick a day when 1) you don't have to go anywhere with your toilet hat and pee jug and 2) no one is coming over to your house.

Prenatal Genetic Testing: There's a lot ot say.

I put off writing this post for quite sometime because of one of the most scary parts of prenatal genetic testing: the false positive.

My doctor advised, and I wanted to have a first round of non-invasive genetic testing. We had a sequential scan. This involved an ultrasound at 11 weeks to measure the baby's nuchal fold (the skin covering the back of the a baby's neck) and a blood test, followed by another blood test at 18 weeks.

The sequential scan looks at the nuchal fold measurement and four hormone and chemical markers in your blood to help pin down the risk a baby might have Down Syndrome (three copies of chromosome 21) Trisomy 18 (again, an extra copy of chromosome 18), a neural tube defect (like spinal bifida) or a congenital heart defect. This gives more information about risks that maternal age alone.

Every pregnant woman has the opportunity to have these tests done. Diabetic women may be counseled more strongly to have the tests because their risk of neural tube and congenital heart defects are already higher.

But, it's important to remember that the tests are completely your choice. If you know that a result will not change how you feel or what you do with a pregnancy, than by all means forgo the testing.

The second blood draw showed higher levels of a hormone called alpha-fetoprotein. This is an indicator of an increased risk of a neural tube defect. The increase was not high, so my risk for having a baby with a problem changed from 1 out of 150 to 1 out of 140 with the result... not too substantial, but definitely worth some tears.

The high AFP value could also indicate a variety of other situations. They ranged from, in the best case, a baby whose growth was a bit stunted, to, in the worst case, a pregnancy had that ended. Interestingly AFP is also a marker for some cancers.

Needless to say getting the call from the genetic councilor was terrifying, and the two week wait until the ultrasound was tense. My doctor reminded me that 1 out of 140 means that 139 babies are just perfect.

The ultrasound went better than well. We got to see the baby's spine and brain. I've never seen anything more lovely. The weird alpha-fetoprotein reading was an anomaly. The baby is growing well.

I have mixed feelings about the genetic screening process. I learned more information about my child's risk of some conditions, but was worried about another, unnecessarily. However, I think, given the increased concern with diabetic pregnancies, I gained some valuable information and I will likely go for it again if I decide to have another child.

First Trimester: Baby is a sugar monster!

About 10 weeks into pregnancy, many diabetic women start to become more sensitive to insulin. Growing a baby and a placenta is hard work and a great deal of energy, a.k.a sugar, is required. Since you're responsible for making that sugar, you might need a little less insulin along the way.

After an initial increase in insulin to get those early-pregnancy sugars better under control, I needed a decreasing amount of insulin from weeks 10 to 12. I noticed this because I had lots of non-exercise related low blood sugars, especially in the afternoons, and in some cases my blood sugars didn't increase at all after meals. You like to see a moderate bump.

So, my endocrinologist and I toned down my insulin by about 10 percent in a combination of decreasing afternoon basal rates (or long-acting insulin if you're not on a pump) and reducing my insulin to carb ratio (the amount of insulin you take for however many grams of carbohydrate you eat) in the evening. My correction factors, the insulin amount you give if you have high blood sugar, also came WAY down, by more than half.

During this time, I recommend being extremely vigilant about those low blood sugars. My own blood sugar thermostat can usually catch symptoms of lows around 70 mg/dL... but the magic of pregnancy and its hormonal influence on the 'flight or fight' response pushed that well into the 50s. You will likely be asked to check some 3 a.m. readings to make sure you're not going low in the night when many people are unable to sense their changing blood sugars or wake up to treat them.

Around week 15, as the placenta and its 'evil' hormones kicked in, this insulin sensitivity trend began to reverse, and I was again upping afternoon and evening basal rates as well as jacking up my evening carb ratios. My endocrinologist said some women continue to be insulin sensitive until week 16 to 18 of pregnancy.

You'll get to hear a lot more about my love hate relationship with the placenta in coming posts. It is an amazing organ, as it better be since you spend half of your pregnancy growing it. But, since it's only looking out for maximizing fuel for baby, it presents some challenges for the diabetic mom.

Blood Glucose Goals... Babies are tough customers

Although you've already been encouraged to keep rigorous control over blood sugars and document them daily through glucose logs and food and exercise diaries, once you're pregnant, diabetes control expectations skyrocket.

Here's a picture of what the recommended Blood Glucose goals for pregnant women look like, according to my doctors.

Fasting: (that's your first finger stick, right after you wake up)
Under 95 mg/dL

Pre-meals, similar to fasting:
100 mg/dL or less

1hour after you eat:
under 140 mg/dL

2 hours post meal:
under 120 mg/dL

Notice something different? Yep. Those are pretty significantly lower than your pre-pregnancy guidelines.

Women adopt many strategies to reach these goals. Some limit their carbs to under 45 grams per meal (a recommendation of my doctor) to make sure that they don't overload the system, but still get some of the carbs that are necessary for baby's good neurological development. For this reason, I was cautioned against going on a low or no carbohydrate diet, especially during the first trimester.

Other women continue to eat as they'd like, but really up the insulin. Given that diabetes in pregnancy is a fluid issue, women will likely have to reset their insulin to carb ratios and correction factors very frequently. I'm changing things on a weekly basis at this point, 16 weeks. More on that later.

I found that overeating or having a second portion of anything that wasn't salad or vegetable significantly raised my post-meal blood glucose values, especially after dinner which then carried over through the night. So, I now try to concentrate on putting dinner away when I'm full, with the promise of some dessert if I'm hungry later.

The first trimester- Morning sickness

Since about half of all pregnant women experience the all-day nausea and vomiting erroneously termed 'morning sickness,' it's fair to say a bunch of diabetic ladies are going share this joy as well.

I escaped morning sickness, but it remained high on my endocrinologist and obstetrician's lists of concerns. When diabetic women have trouble keeping food (or sometimes even drink) down, dangerous low blood sugars can become a major problem. Being passed out and nauseous is definitely worse than just being nauseous. Not to mention that low blood sugars themselves can often cause nausea... a double diabetic mom whammy.

So, if you're feeling ill and getting a lot of lows, don't hesitate. Call your doctor. Together you may change your basal insulin rates, if you're on a pump, or your long-acting insulin dose. It will be easy to change back once you're feeling less sick, or if you reduce them too far.

Doctors recommend anything full-sugar and ginger-based to me, as ginger is a natural anti-nausea food. A sailor friend of mine keeps ginger gum on his boat. Think ginger ale, ginger snaps and other easy on the tummy products that can help you keep blood glucose up, especially if you can't eat regular meals. It will definitely feel weird to drink real soda. Enjoy the moment if possible! It will not last very long.