Second Trimester with Type One Diabetes
- amandajeren
- Sep 9
- 12 min read
Blink... there goes second trimester.
I am currently 30 weeks and have felt the start of third trimester go by so-freaking-slow. So to reminisce on second trimester, it went so quickly! Second trimester occured over my favorite time of the year; summer! And although many people think being pregnant in the summer would be the worst in terms of heat, I found that I absolutely loved it! It encouraged me to get outside, move more, relax in the sun and truly indulge in summer pool days. The extra events that occur in the summer allowed me to be somewhat distracted as I grew week by week. It also helped me stay active as I walked more and hosted parties outside. We also went on a babymoon in July, which was absolutely needed. If I could chalk up three words to describe second trimester, it would be excitement, amazed, and transition. Excitement, because we found out the genders of our babies and had some pretty pivotal appointments like growth scans and anatomy scans that checked off as an A+. Amazed at how incredible the female body is; I experienced major sickness this trimester which was all due to growing literally two humans at once. And transition... to actually acting like a pregnant person. During this trimester, I had to sleep on my side, modify more exercises and workouts, and literally give myself more time in the mornings to get moving. All things considered, this trimester was enjoyable, challenging, and full of gratitude.
Type One Diabetes Management During Second Trimester
During this trimester, most people see insulin resistance again between weeks 20-25. Then from 25 and on, even more resistance. This is tackled with the help of your MFM team and endocrinologist. I was encouraged to email my MFM team with weekly glucose reviews where I gave every ounce of information from my pump settings, to then recieve suggestions from them to change a variable or two. Since we're being honest, I think I emailed MFM twice out of all thirteen weeks. This isn't me being difficult or reckless; this is me truly feeling capable to managing my type one diabetes myself. The very few times I emailed MFM, I'd get rediculous responses like "turn off manual overnight to reduce lows" (when, I maybe had one bad night of one low, during that entire week span). I'd leave notes with my emails to let them know, "hey, I was sick Tuesday and had a hard time with higher numbers but felt better Wednesday, and my numbers were normal then", in which they'd ignore my notes and give me advice based on the one bad day. It truly was more frustrating to email a team of doctors that had no context then it was for me to just manage it on my own.
Well, managing it on my own landed me two A1C's (six weeks apart) of 5.3. So my advice to you is to take your guidance with a grain of salt and if you have really good control of your diabetes, rememeber you know your body better than anyone else. That's all I'll say about that!
As part of being a high risk paitent, you'll get some detailed scans during this trimester. We got our 20 week anatomy scan, 22 week fetal echo scan, and began monthly growth scans around 24 weeks.
20 week anatomy scan will go over every anatomical detail about your baby. This scan can directly link to your first trimester diabetes management, as baby's growth and development here is cruical. Going through each body part, measurement, and seeing the blood flow through the heart is an incredible and extremely relieving sight. This scan takes a long time, and guess what...even longer if you're having two! I encourage you to bring your partner to this scan as we both were excited- and relieved- to see they developed just fine and are continuing to grow.
fetal echo scan- looks into the heart specifically. At my hospital, they brought in a Children's Hospital cardiologist who looked at the footage in real time, while the nurse did the ultra sound + took photos. This scan looked at the four heart chambers, valves, arteries, veins and ensured there were no abnormalities. For type one diabetics, there's a higher risk for holes in the heart. This can sometimes resolve itself with time and better diabetes management over the rest of pregnancy; but it can also cause heart murmurs and rythem problems throughout your babies' life.
monthly growth scans- more ultrasound photos to ensure the baby is developing at a good speed and ensure no abnornalities are occuring. These growth scans are impacted by your type one management because higher bloodsugars can cause bigger babies. Big babies= greater risk for c section and health for mom. It's so important that you are on top of controling your bloodsugar numbers so your baby is growing and developing at a good rate.
Second trimester and on, gets harder. There is no dounbt about that. But having these scans, a great care team, and advocating for yourself willl get you through it on top!
Month Five (weeks 18-21)
I saw my first true wave of insulin resistance during this month. We increased my insulin ratios to around 1 unit for every 7 grams of carbohydrates. This was a huge jump for me, but seemed to work out really well for weeks. One thing that I noticed during second trimester was once I needed the insulin increase, I stayed there for 3-4 weeks before needing another increase. I know many people say their insulin needs changed daily. This was not my experience but I also attribute my insulin sesitivity to remaining physically active and eating healthy meals.
Symptoms: As soon as I hit second trimester, I began getting sick. What's really strange is my nausea went away, but I would puke at least once a day, every day. There was no reason in terms of kind of food, time of day, or aroma around me. It was a pain in the ass to be honest because the puking would last between 5-10 minutes, and sometimes required my husbands trusty cleaning skills to attend to me.
Diabetes management: As noted above, I did need to increase my ratios to 1 unit for every 7 grams of carbohydrates. After making the change, it worked for weeks before needing to make another change. Another thing that worked for me was using manual mode overnight. As you may know, omnipod has two modes: auto mode and manual mode. Auto mode will read my bloodsugar by looping with my dexcom and give insulin based on both algorithms and the status of my bloodsugar/insulin on board. Manual mode gives a bassal amount of insulin; something I preset into my pump and it gives me no matter what my number is. By turning off auto mode and giving myself insulin throughout the night despite where my numbers may be, I was able to achieve fasting bloodsugar under 100. This is ideal during pregnancy!
One thing I have zero advice on, but need to shed light to is how hard it was when I would get sick before or after eating a meal. Sometimes, I'd puke after taking one bite of food. Luckily, I could still eat the food afterwards although was pretty grossed out at the thought. But when I would eat a full meal (with insulin on board), and get sick after eating- that was incredibly hard. Almost every time I'd go low within the hour becasue I'd puke up the carbs my insulin was covering. There was no way around this besides having simple sugary items on hand that didn't require an appetite, like orange juice or fruit snacks.
Movement: I began to feel my belly stretch in the beginning of every run. It was a weird sensation, but I think the pounding and the gravity pulling my heavier self down caused my core to feel a stretching sensation. After 2-3 minutes of this, it would go away and not bother me. I had many times where I'd question if this was the end of my running journey while pregnant, but I did not stop. Instead, I just slowed my pace and mileage to what was comfortable to me.
Month Six (weeks 22-25)
During this month, we had our gender reveal party and learned we are having two baby boys! Although there was an intial shock (not so much about the fact I am having two boys, more so the fact that now we KNOW), I am so incredibly excited and relieved. This was exactly in God's doing.. to have the opportunity to raise two God-fearing men, much like my husband, which we all know the world needs more of. It's an honor to get such a responsibility, and I cannot wait to embark on this journey!
Around week 24, we went on our babymoon to San Diego. I don't quite understand how my bloodsugar loves traveling so much, but it truly does. When I think about it, it makes sense. I get 8+ hours of sleep every night, no cortisol producing alarm clocks, ability to spend hours at the gym, consume more local fresh foods, and exploring the area by foot. Being more active and eating more seasonal, fresh foods makes my diabetes feel cured.
One thing I can't recommend enough about my experience doing a babymoon is: well first, do it. I was hesitant on spending money on a week when everything I love doing needed modified (eating oyseters, drinking wine, going to cool and challenging workout classes, to name a few). But having a trip to look forward to while you don't feel quite like yourself was more enjoyable. It would also be the last trip my husband and I could go on alone, without tons of planning for childcare and parental guilt. The second thing I would recommend is doing everything you love doing anyways. I thought that I'd miss drinking wine and eating fresh oyseters....well, I did. But I got a mocktail and shrimp cocktail instead. It didn't make me think twice about what I'd normally do, and I felt so present in every moment that I didn't feel like I was "missing out" on anything. We also went to a national park and hiked in 100 degree heat. Smart for a pregnnat person? You make your decision there, but I was so glad we went anyways and did all the hiking. I just made sure to stay hydrated, take breaks when needed, and watch my bloodsugar per usual. I did not have to modify a thing to truly enjoy this trip.
Symptoms: Still getting sick, but my enery levels were 100% back in action. I felt like I was most tired in the morning, and would get an energy rush later in the day/ before bed. Strange, but was very helpful when I needed to go on a late night walk to bring blood sugars down.
Diabetes difficulties: Another increase of insulin to one unit for every 5 grams of carbohydrates. When I describe this to my clients, I imagine them taking an injection for just two crackers! When it comes to hitting resistance and knowing what to do, here's how I approach it:
if i have more than one meal in a day where insulin results in a spike that takes forever to come down, I just assume I've hit insulin resistane. I do ensure that it's not a pump kink or low insulin in the pod. Sometimes this would result in me ripping off a site early to apply a new fresh one. But if the next meal saw another bloodsugar spike, I'd just increase my ratio by 1 unit. I did not wait days or wait to talk to my endorcinologist about the changes. I just did it on my own, and I think those actions helped me to never stay out of range for too long and to stay conifdent in my diabetes management.
I also stopped "dropping" with insulin on board and activity. This is a wild, wild outcome of insulin resistance. I'd bolus 10-12 units of insulin each morning for a higher carb breakfast, and my bloodsugar would just stay put during my morning workout. Before pregnancy, this would never have happened. I would drop immediately and have to chug juices. This is a sign of insulin resistance, but I was managing it okay since my numbers would always stay in range.
Food choices: I became more fearless with food choices during this time. Strange, becasue I was taking high amounts of insulin.. but the desire bolus for carbs correctly triggered a challenge mentality that I can indeed incorporate carbs, I just need to take more insulin to do so. During this month, I made pastas, tried more sub sandwiches, and wasn't afraid to add tortilla chips to my mexican salad.
Workouts: Are vital to my insulin sensitivity. As I alluded to above, my bloodsugar stopped dropping with insulin on board. I truly think staying active for at least an hour each day kept my numbers from creeping up over time. In fact, one of the MFM nurses was amazed by my bloodsugar control and once I told her that I was a personal trainer, she said physical activity is one of the best management tools a type one diabetic can do for themselves while pregnant. So my goals for workouts shifted from "maintaining my fitness" to "controling my bloodsugars". This mentality change also motivated me to go on walks after meals and to resort to exercise when I didn't like where my blood sugar was headed.
Month Seven (Weeks 26-29)
As the weeks come quicker, so did more unexpected challenges. This month held both very exciting fun memories, like our baby shower. It also came with the start of more difficulties, like the diagnosis of ICP. Each week brought new challenges but with support from my husband and constant leaning into my faith, we got through it.
At week 28, we hosted my baby shower at a winery located in greater Columbus. We had friends and family fly in from Michigan, South Carolina, and all over the state of Ohio. It was so magical to be surrounded by people who have supported and loved on us throughout this entire journey. We didn't host a traditional baby shower. Ours welcomed significant others, kids, and grandparents. We wanted to simply celebrate the new additions to our family with everyone we loved. We did zero games and didn't have a "start and finish time"; but more of a come-and-go style with food, lots of wine, and the Ohio State Buckete football game playing on the outdoor patio. It was such a fabulous day.
A week prior to the baby shower, I started having really strange symptoms that I was convinced were unrelated to pregnancy. I started experiencing extreme foot itchiness, specifically in the soles of my feet. The first night I had this happen, I was up almost all night itching like crazy. I thought initially it was a bug bite. But after days of the same symptoms and zero visuals of any bug bites, I was beginning to get worried it was athletes foot. We bought all the necessary athletes foot creams, which provided a little bit of relief but not a ton. About five days into these symptoms, we went into urgent care to get some bloodwork done. There lists of "'itchy foot causes" on google and I wanted to rule out the most scary ones, liver or kidney failure. Unfortunately, the first round of blood work ran did not correspond with any liver function enzymes. So, that following week I covered my bases and got into a podiatrist and informed my OB. The podiatrist was useless and unhelpful, but my OB called in more bloodwork orders, including Bile Acid. If my bile acid levels were high, it would indicated I had ICP (cholestasis of pregnancy). Sure enough, my number came back elevated. This means my liver isn't filering bile out as quickly or efficently as it should. I was prescribed medication to take three times a day to relieve my symptoms, but to actually get rid of ICP would be impossible. Instead, I needed to monitor my symptoms and the babies' movement. To be honest, I was scared. This is not something I anticipated happening, especially since it's unrelated to diabetes. So this is just another high risk factor just piled on top of the buffet of risks I am dealing with. When I give birth, my bile acid levels should come back to normal. But, the risk of pre-term labor is much greater now.
Symptoms: I finally stopped throwing up by week 29! Again, I am so unsure why I was getting sick this late in the game but I truly think it's more related to the fact I am having twins than it is just being pregnant.
Workouts: As soon as I hit week 28, I decided to untie my laces from running. This decision came less from discomfort of being big, but more from discomfort everywhere else in my body. My left hip flexor started to pinch after every run which was more annoying than enjoying the run itself. It left me feeling sore and in pain the rest of the day, to wake up completely fine the next day. But it was truly becasue my stomach is so big, every step with ignition I took was too much for my hip flexors to carry. So I started replacing my runs with elliptical sessions, stairmaster sweats, and good ol long incline walks. I am doing fine mentally and physcially, but somewhat wish my body could've handeled the impact better to continue running for longer. My strength workouts have also shifted into more functional training, where I am working less with loaded barbells and more with the cable machine, unilateral work, and exercsies that test my balance & coordination. I am hoping this change will keep me fit, but also prepare me for movements that I'll be doing post-partum with babies.
Third Tri.. Here I Come!
For the next 8-10 weeks, I am hoping to control my A1C as best I can. I know these will be the hardest weeks, but I am determined to do everything necessary to keep my babies as healthy as possible. As I write this at week 30, I can confidentally tell you I've hit resistance about three times this past week alone... so prayers are welcome!
I am also dialing back my training to accomodate the needs of upcoming appointments and to truly give myself time to rest. I was telling a friend the other day, I don't think i've "not worked" since the age of 15. I am pretty excited to focus on the life changing things ahead of me, be a supportive wife, and really dive into nesting.
I am also hopeful that aICP, diabetes, preeclampsia, and all the other risk factors that rear their ugly head around this time just STAY AWAY! I'd love to be able to enjoy this time as much as I can with my husband and pups.
If this helps you as a type one diabetic in their ~pregnancy era~.. give my instagram a follow or feel free to leave a comment and share!
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