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9 weeks pregnant with erratic blood sugars

C

Carole_Type1

Member
Messages
12
Type of diabetes
Type 1
Treatment type
Pump
I am a new forum member, Type 1 diabetic, 9 weeks 4 days pregnant and very anxious about my erratic blood sugar levels. My Hba1c going into pregnancy was 7.6% and although I have managed to lower this in the past few weeks by increasing the number of tests throughout the day and night I know that my control needs to be much tighter and I feel guilty and frustrated that despite lots of effort I can't seem to get on top of it all.

I am already using the Accu-Chek Insight pump and have just ordered a Dexcom G4 CGM to try and achieve better control but I am worried about the damage I may have already caused by experiencing daily hypos and hypers, bouncing from 2.8 all the way up to 17. I always correct as soon as I reach double figures and although my diabetic ante-natal team have told me not to worry unless my glucose levels run high over a sustained period of time, I can't help worrying that all of these dramatic swings are harming my baby. I had a scan at 6 weeks where everything was fine (we saw a heartbeat) but I am really scared that my baby won't continue to develop properly if I keep having erratic levels. I have done lots of internet research to try and find out the facts on exactly how high blood sugar damages foetal development but I can't seem to find anything conclusive other than statements that poor control can be fatal for the baby and that it is vital blood sugar levels are very tightly controlled.

I would really appreciate any advice / facts / reassurance that this forum can offer as I am getting myself into such a state and feel on the verge of tears most of the time at the moment. Does anyone know the impact of large blood sugar swings on a baby's development in the first trimester? Is anyone else experiencing the same situation and have any tips on how to re-gain control?
 
Hi Carole
Congratulations on your pregnancy.
I'm t1 on a pump currently second pregnancy (with twins this time).

First of all have you tested your basal rates to make sure they are correct. Ie no carbs for a block of time?

What are your night sugars like I normally test twice a night but my basal increases significantly from about midnight as I suffer with dawn phenomenon?

Your insulin rates do increase in pregnancy so you might need to increase if you notice your sugars increasing.

Low blood sugars aren't as damaging for babies as high ones but are not good for mums. What is your hypo awareness like?

I test probably every 1-2 hours as its the only way I feel in control but it doesn't stop an odd high or low creeping in.

Your hba1c wasn't bad to start with (I had about the same with my dd) but you can work to bring it down- it is possible but takes some work. For this pregnancy I'm averaging between 5.5-6.

Try to understand what is causing your highs first. Your bolus to carb ratio will also change. Look at what you are eating. Can you change to a low GI diet to keep sugars smooth?

I remember being a nervous wreck my first pregnancy when the sugars were high. Work on getting them down ASAP. Your dose to reduce them will probably need increasing.

Also other factors such as work, stress, weather etc - try and understand how they impact on them if you don't know already.

Try and put your energy into controlling the sugars rather than scaring yourself silly over googling what can happen.

You might need to change the timing of your bolus at meals ie have it 15 mins before. If you don't eat all your carbs for any reason you could try topping up with fruit juice on that occasion so you don't go hypo.

Hope some of that helps
Good luck!
Sarah
 
Hi Sarah,

Thanks for your quick response and congratulations on your pregnancy too.

Yes I've done basal rate testing for each time block, but I probably need to repeat more often because it seems my insulin needs are changing quite rapidly in pregnancy.

I do a test at 2am each night and my readings at this time average 8, then my pre-breakfast readings are the lowest of the day (5.1 on average). It seems to be from late morning to evening that things bounce around and I get the hypos followed by hypers. I've noticed my hypo signs are starting to fade - I used to be aware when I got to 4 but over the past week I'm getting down to 3.2 before really feeling it.

I think you are right that a low GI diet may help as my highs are generally caused by post meal spikes and at the moment I'm eating a portion of carbs with every meal. I'll also try to bolus earlier before meals to see if that makes a difference.

Thanks for all of your help & advice - this has helped to calm me down and given me lots of pratical ideas for trying to improve things rather than just panicking!

Hope all continues to go well with you & your twins,
Carole
 
I'm 27 weeks in my first pregnancy. I was an anxious, nervous wreck for most of my first trimester - it took a while to get more comfortable but you'll probably find the further you get the less anxious you feel, even with some of the swings. My endo helped calm me down quite a bit because I'd always feel like such a failure going into the appointments and she really re-assured me that what I was dealing with was normal. My endo doesn't test for A1C's at this point in the pregnancy anymore because of all the changes and that was a big relief for me - felt like some of the pressure was off.

My A1C was (I think) 7.3 going into pregnancy. By about 15 weeks I had it down to 6.2, even with the swings. I also used to notice my lows around 4, and that has gradually lowered. My doctor advised me that if I test at 4 but don't feel it, wait 10 minutes and test again before treating because pregnancy bloodsugar targets are closer to 3.5-5.8 (unless of course I feel low at 4).

It took until the 2nd trimester to get a better meal routine down, but I had to be more strict with my meal times - not the amount I was eating, but the times - so breakfast has to be between 9-10:30; lunch between 12-1; dinner 5:30-6:30, etc. I've had to move to bolusing 45 minutes before my breakfast because post-meal spikes are my biggest issue at the moment.

It's pretty much impossible not to feel frustrated, but try not to put too much pressure on yourself. At the best of times keeping diabetes in check is an art, not a science and our bodies are now dealing with a whole new set of variables. I've had diabetes for 19 years (tomorrow!) and been pumping for 15 and over the past 6 months I feel like I've been re-diagnosed. I've always been able to have good control for myself and I'm not used to not knowing how to respond.
 
Thanks so much for sharing your experience and understanding how I feel - it is really encouraging to hear how you managed to improve your A1C and that the pressure has lifted a bit for you now. I will definitely take a closer look at my meal routine from now on and try bolusing earlier before meals to avoid spikes. Congratulations on your pregnancy and happy diabetes anniversary for tomorrow!
 
Hi Carole congratulations!
I'm also 8+1 weeks pregnant T1 on insight pump! It's great to know someone else is going through the madness!
I've mostly just hit the hypo stage although I'm not too bad during the day, at night I've been having 4-6 hypos per night.
When I saw my consultant yesterday she said 8-14 weeks is the least important part for the baby's development. She said all the vital development was up to 6 weeks so that part is done. And all the nasty effects of high bs are due to hyperinsulinaemia in the baby which doesn't start until the baby has its own pancreas (14-16wks). This made me feel loads better.
She told me to 'take a chill pill' lol.
She said this is the only time in pregnancy wher they care more about the mother (hypos) than the baby.
I hope that helps
 
Hi Willertime, congratulations also on your pregnancy and thanks for your message It is reassuring to hear what your consultant said, maybe I should also take a chill pill! I'm now up and running with the Dexcom G4 continuous glucose monitor and finding it helpful to identify trends in my glucose levels so that I can catch hypos / hypers earlier on. Hopefully you'll move out of the hypo stage soon, best of luck with the rest of your pregnancy!
 
Hi Carole,

Was just wondering how you are getting on with the dexcom? Is it accurate and comfortable?

My wife is about the 8 week mark and we're thinking about ordering a dexcom too.

Thanks
 
Hi Crumpy,

I'm 5 days into using the Dexcom and finding it helpful so far with identifying trends and warning me of low & high blood sugars before I may have noticed them with my blood glucose meter. Setting up the receiver & transmitter was easy and while the sensor that is worn on the body looks a bit big and bulky it has been comfortable to wear and is discreet under my clothes. Inserting the sensor is also straightforward and painless (there are some handy tutorial videos on the Dexcom website to guide you through each stage).

I'm finding the Dexcom particularly helpful at night time because before I was having to wake myself up during the night to check my sugars and wasn't really sure exactly what my pattern was but now I can sleep easier knowing that Dexcom will wake me up if things go awry

The only minor downside is that the Dexcom doesn't 100% accurately match the glucose readings captured with a finger prick meter because it measures the glucose levels of fluid in skin cells rather than blood so I have been finding that the readings are often 1 or 2 mmol/l out. Also there is a 10 minute lag between Dexcom readings and meter readings so it's important to bear this in mind when deciding about any bolus or hypo treatment action to take. You have to still use the blood glucose meter as usual rather than to rely just on the Dexcom to make any decisions because its role is more to show trends & patterns than to act as a meter.

Overall I would definitely recommend getting the Dexcom because it provides a lot of insight and also reassurance. I'm still getting used to it but am already enjoying the benefits and can see it will be a great tool throughout pregnancy.

I hope that helps!
 
Thanks Carole for all your information. It's very helpful.

One further question if you don't mind me asking- did you opt for your stomach area for the sensor or arm?
 
I've got it in my stomach and have been assured by the ante-natal diabetes nurse this morning that it is perfectly safe there throughout pregnancy
 
Were you able to have a healthy pregnancy? I’m finding myself in the same boat and I’m just so depressed thinking theres no way my baby is safe. I am testing over 10 times a day and my dr and I cant lock it down. Im so worried and in need of hope.
 
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