breastfeeding and working out basal/bolus rates

[tigger]

I have an 8 wk old baby exclusively breastfed and my levels are all over the place. In the beginning i kept in going low so i adjusted carb ratios and basal to try and adjust it so i didn't hypo constantly and have to eat when not hungry. I had put on very little weight while pregnant but was suddenly putting on weight with all the hypos. So i adjusted down and it seemed fine for a couple of weeks but in the last 2 weeks my levels keep going high especially after eating. I've played around with carb ratios and a little bit on the basal but it's still not brilliant.

I'm also not sure if i'm having absorption issues as i've only really got on with my stomach. I only got the pump when i was 10 wks pregnant so have no usual rates to compare against.

As i'm breastfeeding i can't do basal testing as going 10 hours without food will have a bad effect on my milk supply. I'm trying to spot trends and correct on that basis. I have my hospital appointment next week but don't hold high hopes of receiving solutionsas due to using a non standard insulin the dsn pretty much left me to work out my rates when pregnant.

Does anyone have any tips on how to work out basal rate and carb ratio if you can't fast?

 

[1Sarah1]

Hi my twins are 5m but my insulin is a bit all over the place still. I was expressing not bf bit was trying to do it every 3 hours.
Does your baby feed roughly the same time? I've tried to get my twins to feed 3 hourly during the day at least. It helps me plan roughly when I can eat and know how it might affect my sugars.
I actually think it's really hard as your hormones are all over the place which obviously impacts your sugars.
How high have your bs got?
My ratios are still down compared to pre pregnancy.
Have you tried first of all at maybe a third/half what you were by the end of your pregnancy and what does that do? xx

 

[tigger]

Yes. I started by gradually decreasing basal until i eventually got to half. With the carb ratios i increased those to 10 and then increased and decreased depending on post meal hypos and hypers.

I was managing ok for the 1st 6 weeks but the last 2 have really gone haywire. Highest i've been is 24.9. I've also had issues with sets coming out which has further conplicated it. Some of my feeds are regular but sometimes he tries to do it more frequently in the day and go for longer at night The patterns i seem to be getting are a lot of highs in the morning post breakfast continuing well into lunch but then i treat them and suddenly crash in the afternoon. Then sometimes with supper it works well but then i often have too much insulin on board and hypo overnight. But if i eat according to insulin on board i end up going high.

Basically I think i could probably eat without bolusing for some feeds but not all. Plus i'm starving a lot of the time but don't want to eat if i'm high. The baby is doing well. He's putting on between 175-190g per week and is in the next size of clothes a month early!

I just wish there was some logic to this and i knew for sure my rates could be trusted. Not knowing that makes me very nervous about eating.

 

[1Sarah1]

Hi what are your pre breakfast sugars like? Maybe increase your carb ratio a little at breakfast if they are ok. If not maybe increase your basal slightly from about 5am. See if that helps to start with.

Why are your sets coming out/how? Which pump are you on?

I've been using my pump for about 7 yrs now and my sugars now after the twins are high and low -assuming it's all these hormones!! I'm not sure there is a scientific way -it's hard enough without any babies involved.

 

[tigger]

Thanks a lot. It's reassuring to know it's not just me. I need to write my results in a chart to bettet identify the trends. The main issue i have with the morning is i'm either hypoing between 2 and 4 or if i think i go to bed with too much insulin i eat and it's 14 around 2. I never find thar my nighttime correction dose works that fast so either way i wakeup higher than i want to be. Last night i went to sleep at 10.8 with 1.2 on board and decreasing which should have put me in 5 range and woke up at 2 at 2.4. I think the issue is i oroduce more milk whén deeply asleep but eating seems to raise my levels too much. Do you get this?

The set issue is how i'm wearing it. When i was pregnant i attached it to the wiring of my bra and it worked fine. I can't do that now as my bras aren't underwired so i got the hid in pouches and wear them round my waist. I have a frequent issue with the pump falling out and if it does sometimes but not always it drags the canula out. The problem is i can't tell by looking so only find out later. I also really sread putting canulas in as it's often painful and with my current set type i have a 10% failure rate on it delivering which is much lower than on the other 2 i tried! I've tried wearing it on my leg but it slips when i walk so only do it at night. I don't want anyone seeing it and don't really want to attach it to the waistband of my skirts as it's a 640g and quite heavy and i don't want to ruin my clothes. Any suggestions?

 

[tigger]

The chart helped. I think if i increase my carb ratio for breakfast and split my evening basal to lower it sooner that might do something. Now i just have to be patient for a few days and see if that works. Thanks for listening it's really helpful to have a knowledgeable more experienced sounding board.

 

[1Sarah1]

Hi honestly it's hard no matter what!
What are your basal rates overnight do you have different timed doses through the night? Did you correct down when you were 10.8? Is baby waking for night feeds now? Assume so if only 8 weeks? Do you set your alarm or are you demand feeding? Sorry lots of questions.

I understand what you mean about the pump I do tend to clip them to my bra but with the babies I've clipped them to my waistband or put them in my pockets as does slip off. The clip broke the other day arrghhh. My 2yr old is on the 640g and hers is a big issue as falls out or she tries to pull it! You can get pouches that dangle from your bra if you can't clip on?

 

[tigger]

Yes to different basal rates. No to correcting down from 10.8. Yes but usually only 1 feed amazingly. Yes he's demand fed.

I have one of those pouches but it looks ridiculous as it just makes the whole bra sag even more than it does already and with most tops shows as a lump.

 

[1Sarah1]

So what time were you 10.8? Had you eaten? I would personally reduce my basal rate down between going to bed and 2am and see if that reduces your hypos during the night. Just reduce it down a little-obviously it depends on how much you have at that point but I would probably look to taking it down by about 5% to start with. I found my lowest was during 2-3am ish too it must be the deep sleep thing. I think you are that tired after having a baby it is then hard to get yourself up to check sugars. But you don't want to be going that low a lot.

 

[ealingr]

I found it really was trial and error - small adjustments, wait a few days to see what happened, more small adjustments. Some days felt completely random, though!

I found these bras were great (expensive, but worth it) - I just pop my insulin pump into the space between the cups. It has a really wide band so I can move it round when feeding.

http://www.johnlewis.com/bravado-seamless-nursing-bra/p1813159

 

[tigger]

10.8 was about 3 hrs after eating. I've reduced and am just waiting and seeing at the moment. It's risen both nights now and i've had to correct. I wake quite often as i cosleep so little windy sounds often wake me and he then settles. I test if that happens so i usually have a couple of results to work out trends.

@ealingr i have one of those bras and will give it a try. Thanks