Second trimester: Insulin don't fail me now.

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.

Plan your celebration strategy.

I love Thanksgiving. I have great memories of the days of preparation and celebration that started with shelling pecans with my Great Aunt Leta for the cranberries and pie and culminated in hours of eating, when many a male member of my family headed back to the buffet for third and forth helpings.

But, things are a bit different now. Almost no body ends up with thirds on their plate. And for those of us with dietary concerns or diet-related health issues, enjoying the gluttony is a bit more complicated than a food coma. While pre-pregnancy, I would be fine with hitting a blood sugar of 300 on Thanksgiving, I'm not comfortable seeing numbers that big with a fetus in tow.

Finding a strategy to help you through the day while still allowing yourself to join in the epicurean fun is important. So here's what I'm going to do:

I'm planning to try to avoid unhealthful snacking during the day, sticking with fruit, yogurt and protein so I'm not starving, but not full. At dinner, I'll try everything, then go big with my one, true Thanksgiving love--Grandma Falk's Party Mashed Potatoes.

After that, before pie time, I'm going to strap on my tennis shoes and take a walk when my blood sugars are peaking. This is a strategy I use almost every day. I find that moderate exercise really helps my insulin 'kick in' so I come down from post-meal highs faster. And, if I get to it while those sugar levels are peaking, I don't end up with a low blood sugar like I do if insulin is already bringing me down.

Dessert comes after the exercise. This is also a good strategy for me. My body isn't too friendly with meals containing more than about 80 grams of carbohydrate, and it's not just me. Insulin to carbohydrate ratios can stop working when you get to levels this big. So, taking some time between dinner and dessert is an easy way for me to let my body deal with one cycle of eating before I start another.

Happy Thanksgiving everyone!

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.