I am 12 weeks pregnant and appear to have already gained six pounds. I am fairly tall and started out at a normal weight for my height. I have been experiencing some water retention, though it’s hard to tell how much that is affecting my weight. My biggest problem is that I am extremely insulin sensitive and am constantly having to eat to avoid hypoglycemia. I have always been sensitive to insulin, but this is much more pronounced than usual. I have lowered my boluses by nearly 40% and I require about one unit of Humalog per 40 grams of carbohydrates. My blood sugars are in excellent control. My A1c is 5.1, but it came at the cost of cutting way back on exercise and eating more than I need to. For how long can I expect this insulin sensitivity to continue? Do type 1 diabetics in good control often gain more than other women during pregnancy?

Pregnancy significantly affects how your body responds to insulin. Usually, a pregnant woman has increased insulin resistance and requires more insulin to achieve good glucose control as the pregnancy progresses. This may happen to you as you move out of the first trimester. You are not doing anything wrong. My best advice is to monitor your glucose values closely and adjust your insulin dosing as needed. You may consider consultation with a dietician to make sure that you are taking in enough calories for the pregnancy. The weight gain question is difficult to answer. I am not aware that women with diabetes gain more weight than women without diabetes. The expected weight gain of 25 to 35 pounds for the entire pregnancy applies to both groups. Some women gain more early in the pregnancy. For others, weight gain occurs later. A weight gain of six pounds in the first 12 weeks is reasonable.

OWJ