This week was probably the first time in this pregnancy when I felt like there was something just hugely off about my insulin regimen. But honestly, I couldn't say whether a new, moderately stable regimen would be required, or whether it will prove to be a passing problem. This is because my husband and I went on a 10-year anniversary trip and my days were very different than usual. We went hiking and slept in, for example. I'm making a few tweaks here and there, but trying to avoid huge changes until I have a few more days to observe.
As an example of some of the blood sugar weirdness, after returning from our trip, I had three overnight lows where my blood sugar simply tanked. I had previously been struggling with overnight lows between 1a and 4a. I had gotten them basically under control by the middle of the first trimester, with the help of the CGM. These new lows occurred at the same time, but were very extreme, and evaded all my standard prevention techniques. I am only moderately ashamed to say that I woke up in the middle of the night and ate an entire pint of ice cream on one of those nights. On another night, I ate two small 12g-carbohydrate cookies and an entire cup (er, approximately, because I never actually measure these things out) of boiled potatoes before I went to sleep, and that seemed to prevent the worst of it.
Another difficulty I've mentioned reared its odd-shaped head again: a rise in my blood sugar that seems somehow related to the meal, but begins much longer after the meal than you'd expect (1.5-2 hours), and is not associated with a high-fat meal. I have been told by multiple diabetes educators that this is probably due to a high fat meal like pizza or Chinese food, but this is never the case for me. Sometimes the meal was a big one, usually moderate in carbohydrate content (40g), and very infrequently something out of the ordinary. This postprandial rise happens in such a way that I have zero ideas about why, because it's very irregular. A few nights after dinner here, once after lunch there, and then it goes away for a few weeks. I'm sure that it was occurring before I had the sensor too, but I have only been able to observe it clearly in the last few months. Before I probably would have attributed it to a 2-hour postprandial high associated with poor carb counting.
The last example is this that my meals - especially breakfast - almost universally seemed to require a higher bolus ratio. It's possible but doubtful that it's a problem of carb counting because I control carbs tightly during pregnancy to avoid really big swings (and because I know I will end up consuming the carbs I missed at meal time to treat a low blood sugar some time later). It's possible that it's related to the hormone progesterone that helps to maintain pregnancy except that I don't think progesterone varies so much day-to-day. I think it's most likely that it's related to metabolic processes like the burning of fat and glycogen which are either so messed up because I've been diabetic so long or that are just difficult to predict because they are sensitive to so many changeable factors (caloric intake, hormones including those related to stress, and baby happenings). And also, I'm not sure I have any idea how to fix any of these problems, should one or the other prove to be the source of the symptom.
I have also experienced a few episodes of low blood pressure. Not exactly the problem that you expect during pregnancy, right? I am struggling with how to treat for it, because it requires an increased intake of salt. An increased intake of salt means an increased intake of food; an increased intake of food usually means an increased weight; an increased weight means an increased amounts of insulin to deliver; increased amounts of insulin to deliver give me hives because if I get it wrong my blood sugar is so, so wrong. Do I sound like I'm developing an eating disorder? I feel like I sound like I'm developing an eating disorder. Anyone know of salty (high sodium or high potassium) foods that don't mess with blood sugars too much? Maybe peanuts?
By the by, in case you're worried about that eating disorder joke, which I maybe shouldn't joke about at all because I think its sadly common among diabetics, I will note that my weight gain has been perfectly normal this pregnancy. Twelve pounds at 17 weeks, and that's about half the recommended weight gain for pregnant women by the end of their pregnancies. I've tried really hard to keep weight gain moderate because of my personal experience that modest weight gain prevents serious insulin resistance. But I know its a temptation, and if I had any indication that my eating habits were harming myself or baby in any way, I would bite the diabetes bullet and just give the extra insulin.