April 25, 2007
Daily Care, Hypoglycemia
Question from Winston-Salem, North Carolina, USA:
I have had type 1 diabetes since September 1996. On February 9, 2007, I gave birth to my second child. I have no known complications, but have not had urine protein test since giving birth. I was expecting a decrease in my insulin dosages for a few days to a couple weeks with a gradual return to my previous insulin dosages, which were around 14 to 16 units for my total daily dose (TDD). This hasn’t happened yet. I am still having to decrease my insulin dosages and am currently taking around eight units a day on my insulin pump. I’m still having lows throughout the day. I have had a lower insulin requirement since the birth of my first child in 2002, but not to this extent. I eat roughly 180 grams of carbohydrates a day. My bolus ratios are 1 to 16 for breakfast and 1 to 30 for all other meals. My total basal dose for one day is 1.8 units and I have had a doctor question whether or not this is actually needed. My obstetrician says that the postpartum decrease usually only lasts around three to five weeks. I’m worried that I might have some underlying cause for my low insulin needs of which I’m not aware. Are there any health issues that can cause a drastically reduced need for insulin and what are their symptoms?
Answer:
I do not think you need to worry about an increase in insulin sensitivity. That is a sign of health. It is a loss of insulin sensitivity that may predict some other concomitant medical problem. It will take a few more months for you to arrive at a usual baseline dose. Activity and food intake are also predictive of your insulin dose. You were already sensitive to insulin before your most recent pregnancy. I don’t think it is necessarily something to worry about.
Congratulations on the birth of your new baby.
JTL
