My Second Trimester Pregnancy & T1D Recap
I can’t believe I’m now at the beginning of the third trimester, time is really flying along. It still doesn’t feel real that I’ll have a baby in just a few short months! With that in mind, we’re trying our best to really enjoy this summer and soak up as much time just the two of us before things get busy in the fall. I’m definitely excited though, just a little bit delusional that it’s actually happening!
Things really changed a lot in the second trimester from a diabetes point of view, swinging from one end of the spectrum to the other. At the beginning of the second trimester (weeks 14-17ish) I was still struggling with a lot of food aversions and morning sickness that was nice enough to hang around all day. It made dosing insulin a real challenge, as well as any sort of healthy eating (waffles and toast 24/7!). As a result, I was dealing with more lows than usual. However, that has since changed…a lot, in basically every way imaginable. Here are some of the big diabetes changes I noticed in the second trimester.
A snapshot of a fun date night we did a few weeks back at Casa Loma for my birthday!
Resuming Typical Eating Habits
As I mentioned above, at the beginning of the second trimester I was experiencing a lot of lows. This was due partly to hormone changes and partly because I was eating a lot less (and a lot less nutritious) food due to feeling not so great. At around week 18, it was like the sun came out and the clouds disappeared and suddenly my typical pre-pregnancy food didn’t seem so disgusting. I continued to struggle with some of the aversions (chocolate is still largely a no-go, and I used to have chocolate peanut butter smoothies almost every morning pre-pregnancy) and I often get a metallic taste in my mouth after eating, but otherwise things went largely back to normal around week 18, thankfully.
I did end up switching my eating times and meal sizes a bit in the second trimester. Before becoming pregnant, I would typically have:
breakfast around 7am
lunch around 1pm
afternoon snack around 4pm
dinner around 6-7pm
I might have had the odd additional thing here or there (*cough* dessert *cough*) but 90% of the time my eating followed this pattern and I felt nice and full.
Now in my second trimester, I’m eating a lot of smaller portions more often. A typical day looks like:
breakfast at 7am
snack at 10am
Lunch around 12pm
snack around 3pm
dinner around 6pm
snack around 9pm
This wasn’t something I was specifically told I had to do by my OB or endocrinologist, but it was something my body naturally wanted to do. I find that my breakfast is largely the same size (I’m a breakfast girl and have my smoothie every single day without fail), but my other meals have naturally gotten a bit smaller to account for the extra snacking.
In terms of what I’ve been eating in the second trimester, here are a few of the meals and snacks that I’ve had on repeat:
My breakfast smoothie (sometimes with or without a banana because the morning can be tough for insulin resistance…more on that below!)
Apple with mixed nuts
Carrots and/or crackers with hummus
Kale salads with avocado, strawberries, pecans, goat cheese, and a dressing of olive oil, sea salt, and vinegar
Avocado toast with two fried eggs
Rx Bars (especially the vanilla and blueberry kinds)
Energy bites (oats, chia seeds, flax seeds, coconut, sugar-free chocolate chips, natural peanut butter, and a reduced amount of maple syrup - I often use this recipe!)
Plain Greek yogurt with berries
Cottage cheese
Salmon and roasted veggies
Taco salad (basically regular taco ingredients in a salad with 1-2 shells crumpled on top)
As the trimester has progressed, I’ve naturally found myself defaulting to more lower-carb options to help with blood sugar spikes and the insulin resistance I’ve been experiencing. However, my endocrinology clinic has advised not going below 135 grams of carbs for baby’s well being, so I’ve been trying to be diligent to keep carbs IN my diet as much as possible, even though it does make things a lot more challenging sometimes. Which leads me to…
Increased Insulin Resistance
As the second trimester progressed along, I noticed my insulin needs were definitely increasing. There was a sweet spot from about weeks 18-22 where I wasn’t having many lows and was also not having too many spikes, and I hate to admit it but I got cocky. I thought, “hey, this doesn’t seem so bad! Look at me, nailing this whole diabetes and pregnancy thing.”
LOL
While I will say that I was doing well back then and deserved to acknowledge my hard work, I did not know what was coming my way. As I neared the end of the second trimester (weeks 24-28), I started noticing stubborn spikes between 7.8-9.5 after I would eat, and that my nighttime blood sugar was no longer sitting around 5.5 but had increased to 6.5 seemingly overnight (...no pun intended). No big deal I thought, I just went ahead and adjusted my carb ratios a bit for meals, became more diligent about prebolusing 15-20 minutes ahead of time, and altered my overnight basal rates to be a bit more aggressive. Since I’ve been living with diabetes for 20 years and know my body well, I was very confident I would see my blood sugars head back into range without much issue.
Boy, was I wrong! It was almost like my insulin turned into water overnight. Day after day, I’ve increased carb ratios, insulin sensitivities, correction factors, basal rates…you name it, I’ve increased it. I’ve even gotten to the point where I’m bolusing multiple units for foods that previously required no insulin at all, and have been giving myself often a full hour between bolusing and eating, which I never would have believed before. In total, my insulin needs are now about 60% higher than they were pre-pregnancy, all in the matter of a month. All of this has been supervised by my medical team and they assure me it’s normal, but even now at the beginning of the third trimester I’m still struggling to get the balance right. So if you’ve ever been in the same boat, or find yourself there now, I’m sending you good vibes! It’s definitely not easy, and I’ve found myself more frustrated with diabetes in the past month than I have been in the past five years.
Exercising
Another thing that changed in the second trimester was my activity levels. I had to dial back the exercise in the first trimester, but was able to resume my typical workout routine around week 17, which was nice both from a physical perspective and for my mental health. For most of the second trimester I’ve been able to workout 3-4 times a week doing a few weighted strength workouts, some barre and pilates studio classes, and alternating between yoga and spin as a compliment to the weight lifting. Up until the end of the second trimester everything has felt pretty normal and I haven’t had to modify much beyond core work, so that has been nice.
I’ve also tried to stay active by taking the stairs at work and opting to walk whenever possible, including walks after eating to help with blood sugar spikes. I am definitely starting to notice some shortness of breath and having to reduce the intensity of my exercise as my belly gets bigger, but not by too much so far. I’m committed to staying active until the end as long as I’m able to, so fingers crossed!
Dealing with Heat
When I announced I was pregnant and due in September, I had a lot of people make comments that I was going to have a fun summer navigating the heat and being in my late second/third trimester…and I hate to admit that they were right, it has been a real pain. I swear I’ve sweat more in the past few months than I have in my entire life.
How does this impact diabetes, you ask? While I haven’t noticed a big change in my blood sugars (although honestly I couldn’t nail down what exactly impacts them these days), I did come across a fun dilemma with my insulin pump. I wear the Tandem T-Slim X2 pump and often have it in my bra as lots of women’s clothing doesn’t have pockets (ugh!) or anywhere to easily clip a pump. I’ve been doing this for years without any issue, and I’d say I wear my pump in my bra almost 95% of the time. But since I’ve been sweating so much as a big pregnant lady, the venting holes on the back of the pump gathered more moisture than usual and started to set off false Altitude Alarms which would stop all of the insulin from being delivered until I changed my cartridge. Needless to say, it was a massive pain, especially when trying to keep my blood sugars so tightly managed. Thankfully, after it started happening several times one day I was able to get a new replacement pump sent out. I also ordered a silicone case and belt from Sugar Medical and I’m hoping that will help solve the moisture issue going forward. I’ve found this situation to be especially tricky because maternity clothing options are quite limited these days, so finding clothes that work for both a pump and a bump is a tall order.
My Tandem T-slim x2 insulin pump altitude alarm incorrectly going off on hot day while in the middle of brunch! Not ideal timing...
So yeah, never thought I’d overheat so much it would cause my pump to malfunction! It has, however, been a great reminder to always pack more diabetes supplies than I think I need, something that’s become a rule in the second trimester. Even if I’m just going out for a quick dinner, I always grab a syringe and vial of insulin just in case, as minor inconveniences are a much bigger deal with a baby on board.
So many appointments!
Throughout most of the second trimester I was on an appointment frequency of bi-weekly phone calls with my endocrinologist and monthly in-person appointments, with a monthly in-person appointment with my OB team as well. As I got closer to the third trimester, it became bi-weekly OB appointments and bi-weekly endocrinology appointments, plus blood work, regular ultrasounds, and additional specialist appointments as needed. As a result, I feel like I practically live at the hospital these days, and will continue to do so until I deliver. I’m very grateful to have an excellent care team for both the baby and my diabetes so I can’t complain too much, and thankfully my hospital is not too far for us to travel to. If you’re in the same boat or will be soon, make sure to bring your laptop and lots of snacks as the in-person appointments often take 2-4 hours end-to-end. I find having my laptop with me allows me to not miss as much work since I’m only in the actual appointment for 10-20 minutes max.
Babymooning in Greece
A big second trimester highlight was the two-week babymoon we took to Greece at 21 weeks. I did a whole recap about the travel experience that you can check out if you’re planning a babymoon while pregnant with type 1 diabetes, but it was a great experience that I would definitely recommend! I can also say the early 20 week point is the ideal time to travel as you’re not too big yet, still have lots of energy, and aren’t dealing with the insulin resistance that comes at the end of the second trimester that could put a damper on things.
I can’t believe I’m now 30 weeks and heading into the final stretch! I have a bunch of blog and social posts planned for the lead up to delivering as I know that’s something a lot of type 1s are curious about (I love hearing other people’s birth prep and delivery experiences!). Overall, the second trimester was quite positive for me and brought a lot of normalcy that I was craving following a tougher first trimester. I’m keeping my fingers crossed the third trimester will be kind to me and the insulin resistance will become a bit more predictable! Stay tuned for more updates as we get ready for baby 😊
