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.

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.