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caught in insulin spiral!

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the_anticarb

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HI everyone, not sure if someone can help out a bit here. As some of the regulars on here may remember, I am pregnant. I am taking increasing amounts of insulin due to insulin resistance in my pregnancy. I'm now at the point where it's not unusual to take 25-30 u novorapid per meal - before pregnancy i'd be taking 3-4 units per meal. Problem is at that high dose it tends to get very unpredictable, plus my ratios are changing throughout the day. So I start on a 6: 1 ratio (ie 6 units novo per 10g carbs) but by the evening I am on 2:1. I am getting caught in something of a spiral which goes something like this - blood sugar too high - worry about baby - inject correction dose - crash too low and have a hypo - eat more carbs - bounce back up high.

I'm also finding myself getting very hungry which is common at this stage in pregnancy anyway (28 weeks) and also this time of year especially when it's cold outside.

It's so hard to predict my insulin needs as the goalposts are constantly changing, eg my nightime basal needs upping by 1u every three days or so. So inevitably I'm having to correct the highs with a correction dose and correct the lows with sugar/carbs which is meaning my eating is very erratic and I'm hardly eating any sensible planned meals now = eating rubbish which is quickly prepared like toast with jam to bring me out of a low (after I've had the initial glucose of course).

As I'm so worried about the effects of high blood sugar on the baby, I'm perhaps erring on the side of over-injecting as I feel more comfortable psychologically with being hypo than high, although the hypos lead to highs of course as I am then over treating them.

Getting very frustrated, can anyone help?

Thanks
 
Hi

Not sure what your TDD of insulin is at the moment but what you need to do is to separate your correction dose from your bolus dose. If you divide yr TDD into 100 that will give you a rough idea how much 1u of insulin will drop your bg by. As a very rough guide 1u of bolus will drop bg levels by 2mmol as a correction. If you are correcting to a low target of 5, and find that 1u makes yr bg drop by more than 2mmol, then you are in trouble. Try correcting to a higher target like 7 for a while so if your bg level is on 12, take 7 away from 12 = 5. You've then got to do a correction to cover 5 which will be 2.5u plus yr carb ratio. That way you should be able to get yr bg levels to be a bit better balanced so that you don't have to keep using glucose to take yrself up.

Lucozade although its great for hypos, it can at times make bg rise up too much very quickly. I just use about 50ml now and that will get me from bg of 3.5 upto a level of 6 within 20mins.
 
Thanks iHS but problem is as my ratio changes so much through out the day, due to pregnancy hormones, I have no idea what my correction dose is now. It's hard enough to work out my carb ratio dose let alone the correction dose - I'm just stabbing in the dark most of the time. Sometimes a correction dose of, eg 2u novo, works just fine and other times it makes me plummet. It's a constantly moving feast as my ratio is changing all the time throughout the day but also my total amount of insulin I need (is this the TDD you refer to? pls clarify) is increasing day by day too so it's all constantly going up.
Also the targets for pregnant ladies is so strict, basically to stay around 6 (4-6 before meals and not go above 8 one hour after meals.)

I am in contact with the DSN via ante-natal and she's good but even she can't work this one out!
Thinking my only hope is to just eat a set amount of carbs at each meal, maybe eat the same things every day, very boring for a bit but will make it all a bit more predictable.
I've got 10-12 weeks to go so not forever
 
Hi
Do you split your long acting i.e am & pm?
obviously i am not talking form experiance of being pregnant (i'm a bloke lol) but i recently experianced unexplained day time highs and was correction dosing quite a lot of Novorapid.
Eventually i realised that my night time was not coverinmg throughout the day and realised (after months of experimenting) that by spiltting my long acting done the trick.
 
yup already done that I take a dose of long acting at 10pm and another one at 8am. I just seem to need exponential amounts of insulin, have gone from 4u lantus to 18u lantus for my evening dose, and from 1u novo per 10g carbs with breakfast to 7u novo per 10g carbs....all in the last 2 months of my pregnancy.
Then come the afternoon the insulin resistance wears off and I crash down to readings of 2s and 3s
 
Hi Anti carb....

Not sure if it helps...but I could have written your post 5 years ago....because that was exactly the position I was in.......except that my blood sugar would plummit so quickly, I had about 5 hypos, so bad, I needed an ambulance...and at the time I was treating my hypos with a certain "jelly based sweet"...luckily for her, my baby was a girl, otherwise we would have been tempted to call her "Harry Bo.."

Knowing that you are not alone helps...but not much! My insulin went up a great deal as well. I dealt with it on a test corerect basis too...as it was for a finite period. Are you being looked after by a specilist diabetic midwife and consultant? If not, get in touch with them ASAP. With hindsight, I think an insulin pump would have helped me...as you can adjust the basal with the flick of a switch...and you are not stuck with what you injected a few hours ago. Maybe this is an option...although changing from something you are familiar with is difficult at any times, especailly when your body is anything but stable. I am very sensitive to insulin...even now, if I am going shopping, I have to cut my basal by about 40%...this would have been useful when pregnant.....being able to tweak it to what I was about to do would have been invaluable....2 of my sever hypos were caused by the "exercise!" of going to a clinic appointment, and having to walk from the hospital to the bus (about 300m!!).

You are doing the absolute best that you can do, and unfortunaetly, there is little else youcan do, other than test, and monitor you insulin on an an almost hourly basis. My 2nd pregnancy was so different from my first...far easier, and easier to manage diabetes wise..despite having a 1 year old at the time...the thing is, I don't thknk I did anything different, it was just one of those things. I think the only thing youcan do is get the experts to help...in my case they were pretty rubbish with the diabetes, but, they did make sure that baby was alright, and gave me information about what was going on, how she was, and what was best for her. The mum is still their main concern, which feels odd, but having them checking that evrything was OK in there...and advising what was best for baby, did stop me stressing quite so much. It also gave me time to come to term with the fact that I probably wouldn't get to 40 weeks.

Oh, and if you are still at work...stop as soon as you can! I stayed on to the last minute, and did neither of us any favours!
 
Hi Sugar2 thanks for your reply. Good to know that I am not the only one to go through this. Well the good news is the baby is absolutely fine had his growth measured today and he is right on average, so that makes all the hypos worth it! I was explaining to the trainee midwife that I feel like it's a choice between my health and his, if I don't inject enough insulin then I will go high which is bad for baby but if I do I will go low which is bad for me, but I can take a few knocks whereas he is so vulnerable, I would willingly go hypo even more than I already do if it means baby is safeguarded from the high blood sugars. Obviously the ideal is that I don't go too high or too low but that's just not a realistic prospect with the amount of insulin I am taking at the moment, and in particular the way it is changing not only hour to hour but day by day! I am seeing a new consultant tomorrow about possibly going on a pump, I think will help a lot as I won't have to work out whether to fiddle with the lantus or the novo.

I'm working for the next couple of weeks then finishing at xmas, although if I keep having lots of hypos at work may just throw in the towel a bit earlier, had a scary hypo in the office yesterday (went down to 2.5 didn't realise until I did the test) and scared a few people so my boss has basically said to finish if I am not fit to work, but left ball in my court for now.

Finger's crossed for my appointment tomorrow - hope they will put me on pump! plus a CGM if poss as I am testing sometimes hourly and my fingers are running out of prickable areas!
 
I can totally sympathise with you I had my not so little baby 15 weeks ago I ended up testing about 8 times a day as everything was so erratic and spent most of my pregnancy in a hypo got my hba1c down to 55 I took 8 units before but ended up on about 28 per meal and for all my hard effort I got a 12lb 13.5 oz baby born at 37 weeks!
 
Thanks Naomi - but your baby was ok? That's all that matters that they are ok in the end but I can imagine must have been v scary that they grew so bid - did you have a c-section?

Fingers x'd mine will stay within the average growth measurements doc seemed to think if I can keep things in control then I will 'get away with it', doesn't help that its coming up to christmas and I'm so hungry and there are so many nice things to eat about, but I just inject like a maniac to counteract the carbs.

Seeing the consultant this morning re pump so fingers x'd for that

Cheers

PS I have been given confilcting advice on whether to have a normal breakfast or two mini breakfasts two hours apart , do you remember what you did?
 
Anti=carb,

If you got to 2.5 and didn't know, then you really shouldn't be driving. I was the same...and had to stop driving for a while. I took myself of the road, before an accident or the DVLA or my consultant did it for me! The good news though is that it was caused by the frequesnt yo yoing, and many hypos. I got my awareness back okm once I could control my blood sugar better.

Certainly not trying togive you a lecture! But it could be one more thing, if you drive to work etc?

Great news about baby...this will be teh obnly time in their life, when you will want them to be "average"!
 
Hi Ya

I am another one of those that has been thru it as well so definately not alone!

I have had 2 children 1 was 9lb 5oz and my youngest was 9lb 8oz I had c sections for both, so yes diabetics do have big babies most of the time :)

My first I wasnt too bad I kept my sugars as low as possible but again a constant battle to keep them level due to the increasing hormones etc
However my 2nd who is 4 now well that pregnancy was totally different, as well as having constant battles at keep my sugars to a good level I was also going thru laser treatment to my eyes :( in the end they had to stop because I was so worried about having the laser whilst pregnant and getting myself into a right tizwas and my sugars use to jump up high as a kite.
Being pregnant will always be a task for a diabetic its the hardest thing at the best of time to keep sugars as stable let alone being pregnant havin another little life that depends on your health to be good whilst growing inside of you, Whilst being a diabetic.
You are obviously doing a great job as your baby is a nice average size :) it will be worth the constant battle when you hold your little bundle in your arms thats for sure. :D

I must state that I learnt how to control my hypos as when I did drop low I use to eat and eat and eat till I stopped feeling shakey and ended up with high bloods later on, I now have about 3 gulps of lucazade and half of a banana or 3 or 4 rich tea and the horrible thing is you have to wait till your out which isnt the nicest feeling when your feeling shakey :( and just want to eat your way out.

As much advise I can give will not really help due to eveyone's body is so different however the advise of a pump may have been better, as stated you dont have to flap around panicing with corrections doses as this is done with a flick of a switch! not that I know about pumps, the only thing I do know is that they are a neat little thing as my Niece has one and she is 12.

I wish you all the luck in the world and remember all this hard work will be worth it in the end :D

Take Good care and keep us updated

Kaz
x
 
Thanks all it is sooooooo good to come on this forum and not be alone! At the new hospital yesterday (I've transferred due to moving house) they have said I can go on a pump but it won't be available for two weeks, now I am a bit scared as I kind of know where I am with the basal-bolus even though getting lows and highs I feel comfortable working out my dose and correcting. So not sure whether to switch to the pump and have a period where it may be less well controlled at first (which woudl be ok if not pregnant) or just stick with the devil I know.

Feel like I can't do right for doing wrong at teh moment though, had breakfast apx 50g carbs and injected on a 7:1 ratio so that's 35 units (the highest you can do in one dose with that pen - eek!) was 10.3 one hour after so thinking that's clearly not enough but will see me through til lunchtime at least, then by noon (2 hours later) it is 2.8 so how it can crash up and down so quickly I don't know but it seems whatever they tell me to do, it doesn't work so dunno if the pump would be any better for that kind of thing or if I'd just have the same problems but with the pump. (thanks for your pm by the way sugar2)

As u say so long as baby ok is main thing, they will induce me at 38 weeks now (hurray!) cos the sooner he is out of my wonky body, the better!
 
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