Hello. I’m 6 weeks pregnant and I try my hardest with my diet but I just can’t get my levels stable. I met with the consultant today and as much as he was lovely he didn’t really know what to suggest. Says I’m getting to many highs and to many lows. I explained that I’m injecting to stop the highs then getting more lows and vice versa. I’m on 13 lantus in morning and 1 at bed time. I went Down to half a unit of lantus at one point as I was getting hypos through the night. Consultant has suggested going up to 14 in morning. Today I had a sandwich which wss 25g carbs a yogurt which was 5g I was 6.3 before eating then shot up to 11 after. He wanted me to stick to my ratios of 1-10 aswell. Not sure what to do.
Highs and lows - so worried
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JoKalsbeek
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Can you request a FSL and a pump, if you don't have those already? Just a T2 here, with no knowledge of insulin beyond what the cat needs (so that counts as no knowledge at all) but I just hope you'll be okay. Hope someone'll be along soon to help!
They did offer me a pump ages ago but I declined just felt like I wasn’t ready for it. Thank you
SamJB
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I'm no expert in being pregnant with diabetes (I'm a man!), but as always getting your Lantus dose correct is the most important foundation of control. Personally, I don't see the benefit of splitting the Lantus dose, especially as you're giving yourself so little at night.
From Gary Scheiner's Think Like a Pancreas book, to basal test don't eat or inject fast acting within a few hours of bed, then for every 1.6mmol/l change in overnight levels adjust your Lantus by 10%. My Lantus dose changes nearly every day and I swear by this this technique. I take my Lantus in the morning, so I can react immediately to any changes.
Once your Lantus dose is correct, then you can figure out your carb:insulin ratio. Most people are on 1:10, but I'm on 1:5, so you could need to change.
Always log everything, so that you can calculate things correctly.
From Gary Scheiner's Think Like a Pancreas book, to basal test don't eat or inject fast acting within a few hours of bed, then for every 1.6mmol/l change in overnight levels adjust your Lantus by 10%. My Lantus dose changes nearly every day and I swear by this this technique. I take my Lantus in the morning, so I can react immediately to any changes.
Once your Lantus dose is correct, then you can figure out your carb:insulin ratio. Most people are on 1:10, but I'm on 1:5, so you could need to change.
Always log everything, so that you can calculate things correctly.
Hi. They’ve suggested I don’t do basal testing now as I’m pregnant so they don’t want me missing meals
SamJB
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Hello @Lucielu
Sorry i'm slightly confused as to why they suggested not trying basal testing when you are quite clearly having issues - as long as you carb count and take quick acting insulin then doing some fasting tests and missing one meal at a time this should not do you any harm, it's more risky to be yo-yo ing with your control then missing a meal, can you check with your DSN instead ?
It's also less risky than changing your basal insulin which can take a few weeks to settle down.
Ring your DSN and check with them instead, I suspect that they were assuming you would be eliminating a day's worth of meals when you can simply omit one meal at a time to review your basal rates, it's the only solution I can think of in your situation to check, also ask for a continuous glucose monitor if you don't already have one, this would also help to see patterns etc, so libre sensor, you should get access as your pregnant. A pump would of been an easier solution but again as your already pregnant it's not wise to be making the leap now but certainly something to think about afterwards.
Sorry i'm slightly confused as to why they suggested not trying basal testing when you are quite clearly having issues - as long as you carb count and take quick acting insulin then doing some fasting tests and missing one meal at a time this should not do you any harm, it's more risky to be yo-yo ing with your control then missing a meal, can you check with your DSN instead ?
It's also less risky than changing your basal insulin which can take a few weeks to settle down.
Ring your DSN and check with them instead, I suspect that they were assuming you would be eliminating a day's worth of meals when you can simply omit one meal at a time to review your basal rates, it's the only solution I can think of in your situation to check, also ask for a continuous glucose monitor if you don't already have one, this would also help to see patterns etc, so libre sensor, you should get access as your pregnant. A pump would of been an easier solution but again as your already pregnant it's not wise to be making the leap now but certainly something to think about afterwards.
Hi. I’ve just spoken to DSN and I’m going to meet with her tomorrow as I don’t feel completely happy with no solution really. I have the libre I love it. With injections though and basal testing do I need to fast for diff meal times because I can’t change the lantus amount throughout the day anyway would just be one set amount?
Sorry so for over night that’s fine I can keep a check on that but how do I basal test in day? Because I’m not on a pump so wouldn’t really benefit me basal testing diff meal times because lantus is one dose not diff thoughout day? Would I say miss breccie? Or miss lunch?
SamJB
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I'm on Novorapid & Lantus, not on a pump and I basal test by the method described above (included below, to save you scrolling). I don't fast, or skip meals and I don't know how you can effectively calculate the basal dose by skipping meals.
Don't eat or inject within a few hours of bed, then for every 1.6mmol/l change in overnight levels, adjust your Lantus by 10%
Don't eat or inject within a few hours of bed, then for every 1.6mmol/l change in overnight levels, adjust your Lantus by 10%
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Good plan - you need a plan of action to stop this pattern of high/low so hopefully you can review and do some thing about it.
Your lantus dose is purely a background insulin so it doesn't matter if you eat/when you eat etc, it's purpose is to simply cover the 24 hour function of maintaining stable glucose if no food was eaten, your quick acting insulin covers your food/carb intake so if you miss a meal you shouldn't need to take it, perhaps for corrections if your going high but that's it.
It's great you can see her tomorrow too, let us know how you get on ?
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Hi @Lucielu Also just to add, it's not unusual to spike to say 11 mmol/l a couple of hours after eating, it's more important to be back in single figures before next mealtime. If you take a correction dose 2-3 hours after eating because the libre is telling you that your at 11mmol/l then you run the risk of a hypo as you've still got fast acting in your system and you're stacking your insulin. Not sure what timing your readings are ?
Hi. Because I’m pregnant I’ve been given strict readings to stick to. Fasting 4.0-5.3 , pre meal is same and 1 hour after no greater than 7.8
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Hi @Lucielu Ok that's very tight parameters to work towards, I had gestational before I was dx type 1 about 10 years ago, but mine came at 23 weeks and I don't remember being given much guidance/support and to simply work on single figures, although on insulin. I think it's important that you get guidelines to work towards but are also fully supported too, otherwise this becomes a very hard task, try not to stress and hopefully your DSN will be more helpful in getting you where you need to be.
SamJB
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Lantus lasts 24 hours, so the morning Lantus you inject will still be in your system until the morning dose. Therefore the overnight basal test is valid for the morning dose
NicoleC1971
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Not sure how any type 1s can achieve those very tight boundaries without a pump. I am not suggesting you get one as that's up to you of course.
I've done 4 t1 pregnancies and each one was hard in terms of control although I was super motivated obviously not to mention terrified! All 3 developed healthily in spite of some highs and lows which is no guarantee for you but I wondered if in trying to be perfect you are over correcting and ending up low or are you eating less due to nausea perhaps? It is too early in your pregnancy for you to be getting more insulin resistant so I just wondered if that was really the problem assuming that your basal rate was okay previously.
I've done 4 t1 pregnancies and each one was hard in terms of control although I was super motivated obviously not to mention terrified! All 3 developed healthily in spite of some highs and lows which is no guarantee for you but I wondered if in trying to be perfect you are over correcting and ending up low or are you eating less due to nausea perhaps? It is too early in your pregnancy for you to be getting more insulin resistant so I just wondered if that was really the problem assuming that your basal rate was okay previously.
Yeah like I thought that I would experience for hypos but I haven’t been. If anything my corections aren’t working. I’ve been given Fiasp to try now
