Pregnant and stressed

[Brittney911]

Hi everyone.. So I am almost 20 weeks pregnant (2 days to go) and I have been having a lot of problems with my sugar levels and my doctors.
My sugar levels have always been very high (was diagnosed 11 years ago) but luckily I started getting them down before falling pregnant (unplanned). My Hba1c when I was about 5 weeks was 8.6%.
After seeing my OB Gyn, he terrified me about the complications my diabetes could cause. At about 10 weeks, he booked me into hospital to change my insulin to Novorapid and Humulin N, without explaining much about the new insulin or what to do if my sugar was high (he never really answered any questions, just told me I was coming up with excuses every time I asked something or tried to explain what had happened).
Unfortunately, because of this, I was trying to keep my sugar down as I was scared of my baby having any complications. At 12 weeks, I went into a coma twice in one day. The first time I got woken up from my fiance shoving honey down my throat, the second time I woke up in the emergency room of the hospital being woken up by a drip of glucose. Doctor booked me in again and blamed me for giving myself too much insulin. At this point, I was terrified, confused and angry. He once again changed my insulin, this time to Novorapid and Levemir. Please keep in mind, he is not a diabetic specialist at all but refused to call one in.

I have now changed to a different OB Gyn who is also keeping a close eye on my sugar levels (also not a specialist). After seeing my sugar levels going to 12 or so every morning, she is wanting me to be booked into hospital again. I have explained that it is because of the Dawn Phenomenon as I do not eat during the night and my sugar is always perfect before bed. I also recently found out that the last box of insulin pens I got were leaking and I was not getting all the insulin I was meant to.

I am trying really hard to get my levels below 8 so I can show I am trying and make sure baby will be safe, but insulin resistance seems to have gone up and my sugar levels are not coming down like they were.
Baby is safe and growing well. But I am having an abnormality scan next week to check everything out. There don't seem to be any signs of problems yet though.

I am really scared and starting to give up hope on these doctors as they seem to know less about what would work than anyone. I am also too scared to let me sugar drop below 4 because of my previous experience with waking up in the emergency room.

Is it really that harmful for your sugar levels to go to 9 or 10 during pregnancy? I understand it going to 12, 13 or 14 being bad, but I am battling to keep it under 10.

Any advice would be appreciated. I am going to see my Diabetic Specialist tomorrow evening, hoping he can give some sort of advice on this.

 

[himtoo]

hi there @Brittney911
welcome to the forum

I can't offer any direct help but I know some lovely ladies on the forum that i will tag to come along with some support.

@Mrsass , @1Sarah1 , @azure , @ohitsnicola

 

[azure]

Hi @Brittney911

It sounds like you've had a very frustrating time with your insulin changes and things nor being explained to you. That would be stressful at the best of times, but doubly so when you're pregnant.

Can I ask why you can't see a diabetes specialist regularly during pregnancy? Do you see one normally when not pregnant ? In the UK, pregnant ladies see a team of people - OB, diabetes consultant, diabetes specialist nurse, midwife, etc. Are you able to see a diabetes specialist yourself, or a new doctor who will refer you to one?

The first tip I have is to test lots - and I really do mean lots. If you test lots of times each day, you can spot sugars dropping or rising too high in good time and then act to treat it if necessary. I'd also recommend testing during the night to check all's well. I tested at 2am, but another time may be more suitable for you.

When do you take your Levemir each day? Do you count carbs in your meals and adjust your Novorapid dose to match them? Your meal time ratios can change a lot during pregnancy.

The targets I was given for post meal blood sugar was 7.8 or under two hours after eating. I didn't always get it right, especially as pregnancy progressed, so I sometimes had to do a correction dose. Are you confident doing corrections?

So, yes. You should definitely aim for strict control, but understand that sometimes you may not achieve it, especially after meals and may need to correct and then alter your meal time ratios if it's a continuing problem for that meal. As an example, my breakfast ratio more than doubled - ie I was having twice as much insulin as before I was pregnant. That's just to give you an example of how our needs can increase.

Regarding your Dawn Phenomenon, it may be that your Levemir amount and/or timing needs adjusting. If you can't get good control that way, would you be able to get a pump?

Don't get too stressed - stress isn't good for,you or baby. You're doing ok {{hug}}

 

[Brittney911]

Hi @azure

Thank you for the response.
I was seeing my diabetic specialist every month before the pregnancy, but he did not seem very interested after the pregnancy, he just kept telling me to see the OB Gyn. Because of being in and out of hospital during the pregnancy, I have not had much of a chance to see him again and his office has been closed for a week or two, that is why I am only going tomorrow evening again.
Unfortunately, my medical aid I am on, does not cover costs of seeing a diabetic specialist. The one I see is practicing as a GP, but he has studied diabetes.

I have been testing between 6 and 8 times a day, this includes a test at 2 AM and at 4 AM every night. However, I only get 1 box of 50 strips a month.
I was taking my Levemir at 10 PM each night (instructions given by the first OB Gyn) but have since moved it to 12 AM as the dawn phenomenon seems to start a bit later if I do my Levemir injection later.
I do not carb count, I have heard a lot about it, but have never been given much information on how to actually go about starting it. I am also a bit worried to start doing this while pregnant in case the adjustment takes my sugar even higher.

I was doing correction doses before my insulin was changed to Novorapid. However, since changing, I have only done a correction dose once and this was before I went into the diabetic coma. The first OB Gyn then advised me not to do correction doses but rather leave my sugar a bit higher and just increase the dose before my meal the following day, this also worries me as I do not want my sugar too high for too long while pregnant, but correction doses scare me now since the coma.

I have tried increasing my Levemir at night but if I have any more than 12 units, my sugar drops below 3 during the night.

My medical aid will not cover getting a pump, and I cannot afford it on my own.

It is just a worry, as the OB Gyns here do not seem to know enough about diabetes and pregnancy to give advice, but are very quick to tell you about the complications you could be causing for the baby and why they think you are not doing enough. It is rather scary as a first time mom.

Thank you for your help. It is definitely appreciated, any bit of information is helpful.

 

[azure]

That must be incredibly hard only having 50 strips a month. I can't imagine that. I get mine free on the NHS so I don't know much at all about insurance. Is there any way the number of strips can be temporarily increased during your pregnancy?

Carb counting is absolutely crucial for control, pregnant or not. When you don't have diabetes, your own pancreas reacts to the carbs in your food and releases just the right amount of insulin to cover them. So a meal like a large serving of chips (fries) and lasagne would have more carbs than something like a Tuna Salad with a small bread roll. Your pancreas would release very different amounts of insulin for those two meals so that your blood sugar remained in range. When you have diabetes, you have to 'be your own pancreas' and assess the carb content of each meal to inject the right amount (or as close to,right as you can get it). If you just have the same dose no matter what you eat, your blood sugar afterwards could easily be too high or too low.

There are online carb counting courses like this one:

http://www.bdec-e-learning.com

Even a little knowledge may help you get better control.

If you don't want to do a course, then a simple thing to do is learn what insulin amount you need for a particular meal. Here's an example - you eat a 6oz (raw weight) baked potato, salmon fillet and broccoli. You inject your normal 10 units of insulin (NB - I made this figure up just as an example). You test two hours after your meal and your blood sugar is 11. That's too high. Eat exactly the same meal the next day but ever so slightly increase the insulin dose (if you have a half unit pen it makes it easier to do this in small increments and gradually) So you try having 11 units for that meal the next day. This time your blood sugar two hours after is 9. That's better, but you want to improve it a little more. So on the third day you again eat exactly the same meal but have 12 units of insulin. This time your blood sugar is 7. You're happy with that and now know that your dose for that meal is 12 units. You can do that for lots of meals.

Bear in mind that your insulin needs during pregnancy will increase so in a few weeks that same meal will almost definitely need more insulin to get the same blood test result.

I don't normallly go into such detail, but I really think that even if you do something simple as detailed above, you should improve your figures and reduce your risk of unexpected highs or lows too.

I can't stress enough how important some kind of carb counting is. If you don't carb count, you're driving blind.

I think your other issue is your basal and yourvDawn Phenomenon. It's good that you've carefully experimented with a basal increase, and it's good that you've got info from that - it sent you too low during the night. Do speak to,your diabetes doctor about this. I don't use Levemir as I have a pump, but many people on Levemir split their dose and take a dose in the morning and a second dose in the evening as this gives them smoother blood sugars. Could you try this?

My other thought is could you do a very tiny correction dose during the night as your blood sugar begins its rise? Again, something to ask your doctor.

 

[Brittney911]

Hi @azure

I will be requesting more strips when I see the diabetic specialist, he will be able to hopefully put a request through to my medical aid.

Thank you very much, I will definitely have a look at that link and see if I can start doing this.
I do generally stick to the same meals every day as I know that changing the carb intake a lot will have a very different effect on your sugar levels if you are not taking the right insulin amounts to cover it. The only meal that changes is my dinner, but we generally only eat some meat and vegetables so we do not have any carbs for this meal.

I will definitely suggest the correction dose during the night to my doctor as well and see what he suggests.

I do take the Levemir in the morning and evening. My after meal levels have not been too bad, highest being 9, but I have noticed my levels going up a lot more over the past few days when eating the same thing I was previously. Definitely think I need to increase the doses now.

I will be doing more research on the carb counting and hopefully be trying this to get my levels down more.
Thanks for all the suggestions, at least I have a few things to suggest to my doctor tomorrow.

 

[azure]

Good luck with your appointment You do sound like you're doing ok despite all the frustrations you've had, and you also sound like you're very committed to doing things right

 

[Brittney911]

Thank you I am determined to do anything I need to do to make sure our little baby girl is healthy and safe. I am feeling a bit more positive now because of your advice

 

[Deleted member 83869]

Thank you I am determined to do anything I need to do to make sure our little baby girl is healthy and safe. I am feeling a bit more positive now because of your advice

Hello, I haven't had the time to read this...apologies!! But hope you are doing well?? xx

 

[Brittney911]

No problem at all! I'm doing very well almost 23 weeks now.. my new doctor I'm going to is a lot more patient and helpful with my levels. They are looking much better now! Anomaly scan showed that my little girl is growing perfectly and healthy

 

[Sarahkylie88]

I'm so glad things r looking better for u @britney911! I had dawn phenomenon exactly the same as u! A split dose of long acting insulin helped but didn't solve the issue! I'd be low in the night then be up at 15/16 mmol in the morning! It was incredibly frustrating as the daytimes were fine! I did have the support of the diabetes team but we didn't really find a solution to combat it apart from for this pregnancy I'm on the pump which is working and shows just how much my insulin requirements change from evening to early hours of the morning! My little boy was big when he was born as a result of this, but is perfectly healthy now!

Are u managing with all the carb counting advice given by these lovely ladies? Sometimes, just as u have done by posting on here, you need to do your own research and find out the information for yourself because it seems to me like you weren't being given anything and were being expected to manage your diabetes with very little of your own input! Just a doctor telling you what to do which isn't fair! I'm glad u have changed doctors and hope they are being more supportive of u!


Hope u are finding things easier and managing to enjoy your pregnancy X X X X

 

[Brittney911]

Thank you @Sarahkylie88
I did have my long acting split into 2, one at 10pm and one at 10am. But my new doctor has advised me to stop taking my 10am one and my sugar hasn't changed at all! So it seems that that injection was a bit useless. good to know!

I did try the carb counting but my sugar levels were changing way too drastically, after speaking to my GP that usually deals with my sugar, he has said that he's noticed that my body is very sensitive to certain foods, especially bread and rice and stuff like that. So the carb counting has not worked too well for me. I have just cut out all of those foods and try stick to only fruits and vegetables and it seems to be going well.

The Dawn Phenomenon seems to have stopped the past week or so. But my sugar levels in the morning are still higher than the doctor wants it, so she's looking at changing my 10pm dose a bit.
hopefully I get it right soon!

Being booked into hospital at 37 weeks and having my girl at 38 weeks by c section. can't wait!

 

[azure]

@Brittney911 Carb counting is crucial for good control. It sounds like you haven't received much help with this. I'm not a doctor but I doubt you can be sensitive to bread, rice and other carbs. It's perfectly possible to eat moderate quantities of those and have good sugars (unless you have other medical problems affecting this, of course),

Most people find they need to inject earlier than just before the meal in order to cover carbs. Even if you can't carb count, you can still work out how much insulin you need for various meals by eating the same thing (exactly the same) a few days in a row and gradually increasing your insulin if necessary.

Although tight cintrol is the most important thing, you also need to be able to eat a nutritious and varied diet for you and baby.

My consultant and dietician were very helpful. I didn't see my GP once during pregnancy because - to be blunt - they didn't know much at all.

 

[Brittney911]

I have been sticking to the same meals every day for the past few weeks, this is how I've gotten my levels under control.
1 piece of Low GI bread pushes my sugar up over 10 for a few hours, this is with my sugar being below 3 when I have it. Whereas a healthy snack, like yoghurt, will bring my sugar up to 4 or 5.

My GP does specialise in diabetes and family planning so he does have some information regarding both of these. This is why I went to him when I was having problems with my Gynae. His advice has helped a lot with my levels and this has been the only way I can get my levels down.

I am getting enough of what I need and baby needs, the only things being cut out are starches and major carbs like bread. I am still eating meat, variety of vegetables and lots of fruit.

 

[azure]

Try normal bread maybe? Sometimes low GI can be harder to match insulin with, especially when pregnant.
It's up to you what you eat

Sometimes some foods take a bit of tweaking with the bolus timing and amount eg I used to,eat my breakfast cereal and get a 2 hour result of 11-13. I thought that was just how it was - that's what cereal did, and I could either put up with the spike or not eat it. But when I discovered that lots of people were bolusing earlier than the 'official advice' then it was incredible. I then moved my bolus forward gradually and I found I can eat cereal - now my two hour result will be between 5.5 and 7. I would never ever have believed such a small change could have that effect! In pregnancy, I had to move my bolus for breakfast even further in advance but still had in range sugars.

Sorry to go on about it, but it's an amazing tool and, although I've been diabetic for more than 20 years, I only learnt about it in the last few years. It's helped my control so much. It was fantastic during pregnancy and kept my control very tight.

I'm sure you're doing the very best for your baby Pregnancy with diabetes is a huge amount of work and I don't think people realise just how much work it is unless they've done it.

 

[Sarahkylie88]

I agree with @azure I've only started strictly carb counting recently too! I kind of taught myself and I have found it brill! I find that my carb to insulin ratio really helps keep my sugar level. I had to start this when I began the insulin pump. I think bread may push my sugar up more than a yoghurt too but it contains more carbs. The doc may be saying not to change this now as he may not want u making drastic changes when u are pregnant, but maybe start by looking at the nutrition information and seeing how many carbs you are consuming and monitor your levels. U may see that u need more insulin as u get further along in your pregnancy...

I also inject about 20 mins before my breakfast as I am particularly insulin resistant in the morning!

Don't want to be doom and gloom but my dawn phenomenon worsened drastically in the 3 rd trimester! just want u to be prepared. Something they did try with me that may work with u should this happen (hopefully it won't) but was to have a small snack when going to bed/ middle of night to combat the low so that the high wasn't as bad if u get me? It worked to shave the high off so it wasn't as bad, but it was still high and at least it stopped the low!! Have u had your hba1c done for your second trimester yet? Glad your gp is involved do u see a specialist?

I've got my scan next week to find out what we're having!!

 

[Brittney911]

I think it is safer just to stay away from the bread for now, because trying to find how much insulin is needed to cover that is going to cause a lot of unnecessary highs at the moment which isn't really a good idea during the pregnancy..
I inject right before eating breakfast, it's also my most insulin resistant time, but I find when I stick to something without carbs I don't have any problems with my levels.. If I have cereal or bread, double my usual dose still isn't enough to cover it.

I also tried that while I was having the dawn phenomenon happen, I found it was working well but my doctor doesn't want me having to wake up during the night to eat and inject. Now that the dawn phenomenon is gone, I understand why she says that and I'm hoping I can get this under control as my morning levels are the only ones she isn't happy with.

I haven't had it done as yet. Maybe they will do it at my next appointment, haven't really had any mention of my HBA1C from my doctor.

My GP is technically my specialist. He gives me my scripts for my medication as he does specialise in it but practices as a GP, but an actual specialist isn't covered by the medical aid and is too expensive to pay cash.

 

[Deleted member 83869]

No problem at all! I'm doing very well almost 23 weeks now.. my new doctor I'm going to is a lot more patient and helpful with my levels. They are looking much better now! Anomaly scan showed that my little girl is growing perfectly and healthy

I have a very needy 3 month old girl lol hence the rubbish replies! Ah half way through now! Not long! I'm glad your scan went well...you can stop stressing as much now! xx