Finding meeting targets a challenge, please help.

[Catherine4188]

Hello all,

I am currently 8 weeks pregnant and I'm seeing a weird trend this last 7 days as I have a Libre. My evening readings after tea seem to stay within target for the hour or 2 after eating and then slowly climb. I'm going to bed with readings of 6-8mmol instead of 5s from a week or so ago. I've adjusted my ratio from 0.4 per 10g to 0.7 per 10g and it's making no difference. Over night I always come down to 4s so my dose must be correct but I don't understand the slow climb.

Also I'm currently using novorapid and to stop spikes I'm taking it 40-50 minutes before eating. It's working well during the day but it's becoming a real challenge to keep this routine up with work. Im a teacher and so I have set lesson times and breaks. I can't inject during a lesson to prebolus and it's just generally making life a challenge as I'm very nauseous and sometimes feel like I need to eat to feel better but can't because I have to wait 45 minutes for my insulin to kick in.

Any advice would be so very helpful. X

 

[Bon83]

I really sympathise with you - my diabetes started in pregnancy and the expectation of the nursing team to stay in strict targets is a lot of pressure. However we do it for our babies, I can tell you are really motivated to do it . I found it hard at work because I had appointments with the public BUT in hind sight I would've been a lot more forceful with my employer about what I had to do for diabetes care! I maybe even would've gone off sick the amount of stress it caused me! I have a few ideas about the evening climb but talk to your team aswell. I find if I have a lot of protein with a meal it can cause a rise a lot later on as I think it takes longer to digest? And is doing things whilst your novo rapid is starting to wear off. I also used to have a small snack two hours after initial insulin injection and evening meal. I think this helped me because it kept my matobolism ticking over? I was really strict with eating at first but the nurse told me I need to eat plenty (not loads and loads obviously) but if you feel hungry you need something.

 

[Catherine4188]

I really sympathise with you - my diabetes started in pregnancy and the expectation of the nursing team to stay in strict targets is a lot of pressure. However we do it for our babies, I can tell you are really motivated to do it . I found it hard at work because I had appointments with the public BUT in hind sight I would've been a lot more forceful with my employer about what I had to do for diabetes care! I maybe even would've gone off sick the amount of stress it caused me! I have a few ideas about the evening climb but talk to your team aswell. I find if I have a lot of protein with a meal it can cause a rise a lot later on as I think it takes longer to digest? And is doing things whilst your novo rapid is starting to wear off. I also used to have a small snack two hours after initial insulin injection and evening meal. I think this helped me because it kept my matobolism ticking over? I was really strict with eating at first but the nurse told me I need to eat plenty (not loads and loads obviously) but if you feel hungry you need something.

Thanks for your reply. I am extremely motivated as this is a pregnancy following a miscarriage when I was initially undiagnosed but had a hba1c of 104. This time as I am aware of my diabetes I am going the rule the hell out of it to make sure that if this pregnancy isn't successful, I can't blame myself for it.

I did have some protein tonight (pulled pork) but the rest was bread, salad, potato, coleslaw so I'm not sure if that would slow things down. Maybe I'm eating too much? I know eating a lot slows digestion. I'm just so nauseous and haven't eaten much all day by tea time I need a good meal. It's tough but the reason I ask for help is so I can get thing controlled. X

 

[Bon83]

Thanks for your reply. I am extremely motivated as this is a pregnancy following a miscarriage when I was initially undiagnosed but had a hba1c of 104. This time as I am aware of my diabetes I am going the rule the hell out of it to make sure that if this pregnancy isn't successful, I can't blame myself for it.

I did have some protein tonight (pulled pork) but the rest was bread, salad, potato, coleslaw so I'm not sure if that would slow things down. Maybe I'm eating too much? I know eating a lot slows digestion. I'm just so nauseous and haven't eaten much all day by tea time I need a good meal. It's tough but the reason I ask for help is so I can get thing controlled. X

Do you have a diabetic midwife to call? Mine was very helpful. Xx

 

[Catherine4188]

Just my DSN, I have a midwife but she isn't a diabetic specialist. I'm going to call the DSN tomorrow to see what they can think of too. X

 

[himtoo]

Hi @Catherine4188
no specific help from me -- but huge hugs at the great job you are trying to do !!

am tagging @azure and @tigger to hopefully come along and offer some support !!

best wishes to you and your expected baby !!

 

[tigger]

Congratulations on your pregnancy and well done on your rates so far. They're really impressive! I have 4 children and in my last pregnancy I got a pump which made life considerably easier. It sounds like you're doing a great job but have a think about whether swiching to a pump might help. It does give a lot more flexibility particularly with pre-bolusing.

After supper has always been a hard time for me and I think @azure too. The suggestion she gave me which worked is doing exercise after you've eaten. It really helps speed up absorption. This can just be taking washing up and down the stairs or walking up and down a few times but it does make a big difference to me not being sedentary.

The thing to be careful about in early pregnancy is actually going too low. You can have rapid drops as a result of the hormones. It sounds from your libre as if you have this under control at night but do keep an eye on this. This was actually the reason I got the pump okd so fast in my last preganancy. In my previous ones I had had comas in the 1st trimester because of sudden drops at night.

Are you under a hospital team? Have they prescribed you 5mg folic acid? How often are you being seen? Everywhere is different but I was always seen around the 5-6 week mark by the consultant (both obstetric and diabetic).

Morning sickness is very unpleasant. Ginger tea is good and plain crackers. Little and often helps some people too. Is there anyway you can eat in class if it's something small like that? If so you could pre-bolus in a break and still have something to eat.

Good luck.It sounds like you're doing well and give yourself some credit for it. I know how hard it is being pregnant after a miscarriage but all you can do is try your best and take each day as it comes. Wishing you all the best.

 

[Kateyo]

The good thing is you've spotted a trend and so now you know when and what you need to watch for so well done for that because it's not easy with all those hormones!! it sounds as though your BS is coming down to 4s again without any corrections so thats good. Have you been able to basal test to rule that out? Not easy I know esp at this stage when baby needs lots of nutrients for its development and mum is starving (and nauseous - I remember it well!!) but if you could do that for a few nights it would at least rule in/out a basal issue. You're doing so well managing it, it's not easy so don't be too hard on yourself!

 

[azure]

I agree with Tigger that you need to watch out for lows. Mine started at around 8 weeks so just be careful about ramping up the insulin too much. Maybe watch over a few days, then see if it needs a slight increase but be aware it might then need a drop! That's what happened to me - highs early on then the lows kicked in, so my insulin was up and down.

It doesn't sound like you're eating too much to me

Do you teach primary or secondary?

 

[Catherine4188]

I agree with Tigger that you need to watch out for lows. Mine started at around 8 weeks so just be careful about ramping up the insulin too much. Maybe watch over a few days, then see if it needs a slight increase but be aware it might then need a drop! That's what happened to me - highs early on then the lows kicked in, so my insulin was up and down.

It doesn't sound like you're eating too much to me

Do you teach primary or secondary?

Thanks for the advice. I'm having lows but it's due to not eating at all or much at all between meals due to nausea. The lows are not too bad tho 3.5-3.9s. Only had 1 or 2 lower than that.

I teach secondary, I teach DT so lots of very busy practical lessons which I can't just inject in, my students are aware of my T1 and are really helpful when I need to have something sugary in lesson.

I spoke to the DSN and dietitian today who suggested splitting my evening bolus. I'm going to try it. I have an appointment Trent with them next week to check on progress. My highs aren't really high highs, around 7s and 8s in the 2+ hours after evening meals. So they aren't too worried. I just am because I'm a control freak. X

 

[azure]

It's a balance between control and relaxing @Catherine4188 as I'm sure you know. I completely understand you have special reason to be ultra tight with your control, but it sounds like you're doing really well

I had some 11s and 12s early on before my lows started, and all was ok with my son

I don't know what to,suggest with the teaching. Obviously a pump would make bolusing easier but I don't know if that's something you'd consider or want.

 

[Catherine4188]

It's a balance between control and relaxing @Catherine4188 as I'm sure you know. I completely understand you have special reason to be ultra tight with your control, but it sounds like you're doing really well

I had some 11s and 12s early on before my lows started, and all was ok with my son

I don't know what to,suggest with the teaching. Obviously a pump would make bolusing easier but I don't know if that's something you'd consider or want.

I've just been at the hospital today and had a viability scan. I saw the baby and heart it's lovely heart beating. They are over the moon with my diabetes control and my new hba1c is 35! So happy. Thanks for all the advice. X

 

[azure]

I've just been at the hospital today and had a viability scan. I saw the baby and heart it's lovely heart beating. They are over the moon with my diabetes control and my new hba1c is 35! So happy. Thanks for all the advice. X

Awwww! So lovely <3

Just take one day at a time, keep calm (I truly believe that that sends good vibes to baby) and keep up all the good work. XX

 

[Scarlet10]

Great control and hba1c well done

 

[Catherine4188]

Just thought I'd give an update. On Thursday we went for our 12 weeks scan and everything was great. Baby looks healthy and was kicking up a storm, rubbing their hands past their face and jumping about. We are actually 5 days further on than we thought, so baby is 13 weeks 1 day today.

Thanks for all your advice and support, you have helped us get here. Xxx

 

[azure]

Excellent news @Catherine4188 !

Your hard work has helped you most. Keep going - and enjoy every minute. You'll be surprised how quickly the next trimesters go!

 

[hboyt]

my new hba1c is 35

WOW! I was thinking my 45 was good....i would love to be able to get to 35!