Now that I am more than half way through this pregnancy, I am finally giving more insulin in a day than I would have on an average non-pregnant day. This week, I increased basal rates, bolus ratios, and even insulin sensitivities across the board. It will become increasingly difficult to chase the post-bolus lows, and only in my more foolish moments will I be caught outside the house without any Gatorade.
By the way, I recently learned something interesting from my mother about Gatorade (she's a big fan too, for purposes of re-hydration). Unlike juice, Gatorade is absorbed in your stomach. With juice, you have to wait until it gets to your intestines. That's why, when your low blood sugar is low and you take a big swig of Gatorade, you feel better within 5 minutes, as opposed to 15. OK, promotional moment over.
This being my third pregnancy, I've noticed that I can divide my blood sugars into three distinct phases of pregnancy management.
Phase 1: Don't Go Too Far From Home
Immediately after I adjust my insulin rates, my postprandial blood sugars are usually closer to 60 than 100, and this is what I mean when I say I'm constantly trending low. In some ways, this feels more comfortable than the other two phases, because I can be quite confident that my next A1C will win me brownie points with all my doctors. On the other hand, 60 is closer to 40 than 100, and lows are a serious risk. I always keep Gatorade with me, and I don't hesitate to check it before the 2 hours is up if I think I might already be low. In my better moments, I can be pretty precise about how much Gatorade, crackers, cookie, or whatnot that I need to raise my blood sugar without going overboard.
Phase 2: Optimum
After a week, or two, or three with my 2-hour postprandials trending low, I find that they rise to about 100. Ahhhh. That feels good. Unfortunately, this phase always seems to be exceedingly brief, and I still have to worry about the fasting levels (3 hours or more). Because my meal-time boluses tend to be large, I have a lot of extra insulin hanging around in my system that keeps the numbers going down rapidly the longer I go without eating. Needless to say, fasting levels become increasingly uncommon as the pregnancy winds down (up?), since I just can't keep my blood sugar up with eating a small something.
Phase 3: Panic Mode
I despise phase 3. It gives me the creeps, on behalf of my unborn child. I will tolerate it only for about 5-7 days. During this phase, my 2-hour postprandials are 120 or higher, and if I get a day with 2 or more postprandials above 140, I make changes. I don't check with my endocrinologist first, but I always make sure he knows what I did. Since I'm sending him the blood sugars every week, he's sufficiently updated to know I'm not doing anything wild and crazy over here. Plus, now that I can adjust bolus ratios by decimal point (thanks, Minimed!), I don't need to do anything too dramatic to correct postprandial problems.
As for morning fasting levels, I check pretty frequently during the night. I check every time I go to the bathroom, which, by the end of the pregnancy, is 2 times every night. So I don't usually miss an unexpected high. I also use that to know when to adapt my basal rates, which seems to happen less frequently than adjustments to bolus ratios. Since I can barely go 3 hours without eating during the day, it's hard to know when I'm having a basal rate problem compared to a bolus ratio or carb counting problem. Night-time blood sugar readings are good for that.
In other pregnancy news, I am getting really, really large. I would include a picture, but it's kind of embarrassing. My oldest son said to me this week, "Mommy's belly is getting heavy." (I must have complained about having to pick him up or something). My 15-month-old son, who can't even say the word "baby," recently poked it, looked up at me, and grinned. My husband seems to think it's cute, but I have my doubts. I especially have doubts about how everyone is going to feel about it when I'm seven months pregnant and I look like I'm about to pop. I promise, I have gained far less weight this pregnancy (13 pounds) than others (24 pounds), but the bump is out of control.
Oh well. As Simcha Fisher so elegantly put it recently, "I love the way your abdominal muscles look, all separated like that."