Over the last couple of weeks, I’ve seem some consistent increases in the amount of insulin that I’m using each day.
Whilst the first trimester saw some of the lowest insulin doses of my adult life, less than half way through the second trimester things are starting to head skyward, with my basal rates creeping up almost every other day and – even more significantly – my total daily doses of insulin up by a good 15%.
I’m not normally one to get overly hung up about how much insulin I’m using, preferring to adopt the understanding that I need to take what my body needs in order to keep my blood glucose levels under control. But I can’t help little worries rising to the surface, because from everything I’ve read twenty weeks is pretty early to be meeting with insulin resistance.
I’m not sure why I’m worried really. Insulin resistance is caused by the hormones being spat out by the placenta. A good healthy placenta presumably spits out plenty of hormones, so the ever increasing insulin needs are presumably a sign that everything is growing and progressing as it should.
But of course, along with rapid changes in insulin doses come less stable blood sugars, which the nagging voice of worry at the back of my head reminds me isn’t good for Flangelina. And there is more than a tiny bit of guilt in the mix when I look at some of the things I’m doing that could be contributing to those increasing insulin needs. Like not being so fastidious about minimising the number of carbs in each meal, which leads to bigger bolus doses. Bolus doses that might not, however, be enough, because I’m not very good at altering bolus ratios. I’m eating more at similar times each day so I’m using increased basals to compensate for these carbs, which makes it appear that my basal need has gone up even more than it should.
At the root of both these things is: ravenous hunger. After spending the first trimester with perma-nausea and a very restricted palate, it seems my body is making up for it. I probably wouldn’t stop stuffing my face if it weren’t for these insulin doses spelling out in black and white exactly how much I must be eating.
And as for those bolus doses needing to be bigger still – well that’s a problem that’s a result of years of bad habits. I know how to carb count. I really do. But I was on multiple daily injections for years, and then my first insulin pump came before the advent of so-called “smart pumps”. Neither of these methods had fancy bolus calculators that allowed me to enter the number of carbs I was eating and then gave me a resulting bolus dose based my insulin-to-carb ratio. So I learned to think in units of insulin rather than grams of carbs. I can look at a lot of plates of food and know how many units of insulin are required to cover them.
But now that everything has changed so much, I’ve come unstuck. The number of units of insulin that used to cover a plate of pasta or a bowl of cereal doesn’t even come close anymore. But psychologically it’s hard to take so much more insulin. When I’m used to a meal needing 4 units and suddenly it needs 10, it’s hard not freak out and think “I can’t take that much insulin, I’ll be on the floor”. Basals are comparatively easier to alter, because once they’re done, the tick along in the background without constantly screaming in your face “Look how high I am. Look how much insulin you’re using”.
It’s as much a psychological battle as simply a numbers game. I’m still struggling, but I’m getting there. I know that I have to, each time I feel Flangelina kick. And if Flangelina’s presence means I need to use 120 units a day, then I‘ll do it. I’ll do anything.