PREPREGNANCY ADVICE AND DIET

[slayer]

Hi Guys,

I had a miscarriage a couple of years ago and have not fallen pregnant since. I have polycystic ovaries, but my doctor said a recent scan shows no follicles/cysts on my ovaries. They have carried out various tests, but still no positive pregnancy tests!

I have issues with my stomach bloating and gluten and dairy free seems to prevent it, but I am living off next to nothing when I avoid both things. I am vegan and do not eat eggs or fish.

Today, my doctor told me he thinks its my blood sugars. Now, I am really stuck because I don't find my diabetes nurse or dietician helpful. I am hoping someone can give me some advice on my diet and blood sugars...

My most recent hbac1 was 55 which is the lowest it has ever been.

I am on lantus 10 units am and pm and apidra 1 unit per 10 grams of carbs or sometimes 1 and a half. I also take two metformin tablets in the evening. On a typical day, this is what I eat:

8am Banana 2units
11am Salt and vinegar hula hoops no insulin
1pm a handful of walnuts
7pm homemade chips with beans or toast with branston pickle and lactose free cheese or veg curry
3 to 4 pints of water during the day
I am staying away from takeaways and restaurants as they shoot my blood sugars up to 18!!!
Cup of green tea
10pm sometimes a snack - gluten free crispbread with peanut butter.

Am I doing anything wrong?

 

[Juicyj]

Hi @slayer It's pretty hard to judge from what you've said here how improvements can be made without knowing what your BG readings are like during the day, so from waking to before meals. However looking at your food intake, is there any reason why you don't take insulin for hula hoops as they are about 20g of carb so you should be taking a couple of units. Are you accurately matching the rest of the day's carb intake to insulin ? Can you accurately measure home made food to calculate carb content or is this guess work ? How do you calculate correction ratios if you're running high ?

Matching everything you eat as accurately as you can with insulin doses is doing the best you can do, if your BG results are not reflecting this then you need to review your insulin/carb ratios, mine change during the course of the day.

I would also tap into your DSN for more support too, you do need their backing to get really on track with this - tell them that you are planning to conceive and need support, I believe depending on the trust that you can get support for a pump which will really help manage your control much better, ideally for pregnancy they would want to see your HbA1c drop to below 48mmol/l or 6.5% which is NICE guidelines and this is for the health of the baby rather than improving your chances of conceiving.

 

[slayer]

If I take insulin for the hula hoops, I hypo! The DSN seemed haopy for me to go on freestyle libre and the pump - I was considering omnipod but has now changed their mind!

My blood sugars are as follows:
7am 5
6 or 7 throughout day
Evening 12 to 18

I really struggle in the evenings with correcting as I take 1 unit for 3mmol and either stay high,hypo or come down too slowly.

 

[catapillar]

Target blood sugars in pregnancy are much tighter:

• <5.3 fasting
• <7.8 1 hr post prandial
• <6.4 2hr post prandial

because high blood sugars can cause foetal abnormalities and miscarriage. So if you're trying to conceive you'd be well placed to try and stop spending the evening in double figure, cos it'll be easier to try and solve it now than when pregnant with all the hormones over complicating things.

If you're struggling with with highs in the evening have you considered basal testing to see if you need to up your am lantus dose - https://mysugr.com/basal-rate-testing/

Ladies with type 1 trying to conceive are advised to have hba1c under 48.

Making sure your basal dose is working well for you is probably a good first step in improving hba1c because once you know that's keeping you flat-ish it's much easier to tweak I:C ratios.

Have you got a half unit pen? Is the metformin for PCOS, which you now apparently don't have, or is it for insulin resistance? Your TDD doesn't particularly suggest insulin resistance.

Do push your DSN for pump and libre if you can. They've changed their mind doesn't really seem good enough. Input diabetes might be worth a look if you're stuggling to get access to a pump you want, might just give you some tips on things to discuss with the DSN to push towards a pump - http://www.inputdiabetes.org.uk

 

[Juicyj]

Apologies my error - the recommended HbA1C is 48mmol/l https://www.nice.org.uk/guidance/ng...-and-hba1c-levels-in-the-preconception-period

 

[Juicyj]

Agree with @catapillar changing their mind over offering you a pump is not a good enough reason, you need to push your team more on this, also a structured plan to support you should be put in place, so monthly appointments as well as monthly HbA1c tests.

 

[slayer]

I didn't even realise they could do monthly hbac1s or that there was such a thing as a half unit insulin pen!

I will push them to get me on the pump and give me monthly appointments because they seem to have left me to my own devices.

This evening I had one tortilla wrap for dinner which was 30 grams of carbs and I injected 4 units of insulin going with the 1 and a half units for 10 grams of carbs. My blood sugars an hour later were 15!!! I am scared to up my dose to 2 units for 10 grams as I was worried about hypoing. Prior to my meal my levels were 6!

I think all my injection sites are worn out and I know this sounds silly but I feel like novorapid is rubbish and doesn't work.

The metaformin was for PCOS and I do still take it although two tablets instead of four.

 

[M80]

Hello I have used novorapid for 15 years and now use fiasp.compared, novorapid is rubbish it is very hard to predict when it will work. tresiba much better. I hope you figure it all out .Recommend reading all books by dr Bernstein. You might question not eating meat or fish after reading his books. Best wishes!

 

[slayer]

Hello I have used novorapid for 15 years and now use fiasp.compared, novorapid is rubbish it is very hard to predict when it will work. tresiba much better. I hope you figure it all out .Recommend reading all books by dr Bernstein. You might question not eating meat or fish after reading his books. Best wishes!

I felt like I had to take too much Fiasp and my sugars were still high! Have not tried Tresiba. I have one of his books on my Kindle app so will read it. Thanks for your well wishes!

 

[Mel©]

Don't forget to get started on your 5mg of folic acid ..its recommended that you take it up to 3months before you conceive. I'm pregnant and a major tip for breakfast I have found is avocado with toast as this is the only way my 1hr reading will stay below 7.8

 

[slayer]

Don't forget to get started on your 5mg of folic acid ..its recommended that you take it up to 3months before you conceive. I'm pregnant and a major tip for breakfast I have found is avocado with toast as this is the only way my 1hr reading will stay below 7.8

Yes, I take folic acid, pregnacare and omega 3. It just feels like I will never fall pregnant again since my blood sugars have been 18 in the evening
I like avocado but having it in on toast sounds like it would be bland?!

 

[M80]

Sorry I mixed up the insulin and was supposed to only write fiasp. I am also using tresiba however and like it.

 

[NaijaChick]

Any diabetic thinking of getting pregnant must be referred to their local pre- conception clinic. I would go and get a referral and get on the diabetic dose of folic acid. Also it might be worse seeing a fertility expert. Good luck

 

[NicoleC1971]

Hi. I think the blood sugars are important but it is not certain that this is what is causing your failure to conceive (so far).
You are vegan and I think that needs a carefully planned diet to get vitamins B12 to assist the folic acid to do its job, Vitamin A and zinc. Animal products do provide better sources than vegetables or popping into Holland and Barrett so is there a compromise to be had if the reason for your veganism is to be healthy?
I am not any kind of expert so perhaps it would be worth checking this aspect of the puzzle with a dietician even if you do have to wait a while to see someone or pay.
I am so sorry to hear you suffered a miscarriage and are now worried about not getting pregnant. Its a bit obvious but is there any way you can take the pressure off so that stress doesn't make your blood sugars worse? Btw I don't think my diabetic control was perfect either before conception or during my 3 pregnancies so perhaps you could relax and enjoy a curry every now and then whilst you are trying! Good luck in any case.