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Maintaining hypo awareness with target pregnancy levels

ArtemisBow

Well-Known Member
Messages
312
Type of diabetes
Type 1
Treatment type
Insulin
Going into this pregnancy, my overall control was good (hba1c 6.2), but I was having issues with my waking levels being over 6 or 7.

My DSN and I split my Lantus from 10 in the morning to 5&5 which helped a bit but I was still above 6, and then increased the evening so that I take 5 in the morning and 6 in the evening. The good news is, this has worked - I am now waking up between 3.7 and 5.0, which is the target.

I'm just a bit concerned that when I wake up in the high 3s, often I have been running there for a few hours beforehand according to my libre. I don't really feel hypo in the high 3s on waking.

I know it's not doing any harm to the baby, I'm just concerned my hypo awareness is being eroded, and the normal method of running high for a while to fix it is not an option. Is this just something that I need to be aware of and continue to test regularly so I don't get caught out?
 
Hi I would test a lot. Have you set your alarm to test a couple of times a night? Can you give half units? What about the timing of your evening lantus?

Hypo awareness can go in pregnancy.
Well done for being in the ranges!
x
 
I haven't been waking to test at night (I wasn't advised to do this), but with the libre on I can see what's happening. I can give half units on my Novorapid but the Lantus pen is whole units only. At the moment I am taking the Lantus at 7am and 7pm but could take the evening later possibly?
 
I wasn't on lantus during my pregnancies but was prior. (Was on pump). Might be worth just seeing if the timings make a difference.

I would highly recommend testing during the night. It's the only way you can tell for definite what's happening. Surprised you haven't been advised to do this. X
 
I've been told to test pre breakfast, and one hour after each meal. I was already doing before and after every meal, plus other ad hoc ones for driving etc, so maybe the advice is different depending on the hospital!

Is there a reason to have BG tests rather than the FGM in the night? I think waking to test could actually distort the picture as I tend to get a small BG raise just from getting up and walking around. It's also not really conducive to getting a good night's sleep, but if there's a good reason to test in the night I will do it.
 
What does your monitor say during the night? Do you start to drop at a certain time? What are you when you goto bed? Could you maybe have a snack to keep your sugars a little bit higher?
 
On Monday night I was 6.4 just before bed at 22:30, and woke up at 3.8 at 6:30. The libre shows I went just below 4 and stayed there from about 2am. I'd say that was a fairly typical night, usually the drop happens somewhere between 1 and 3am.

Last night however I was woken at 2am because I had dropped to 2.7. I had been exercising last night so not unusual to go lower, but I'd had a snack before bed which brought me up to 8, so that's still a big drop. I'm thinking I may need to bring my evening Lantus back down to 5 as with lows every night for a few days this might be my system making some more insulin.
 
I'm on a pump and have no experience of Lantus, but I found that I sometimes had hypos at a similar time during the night. I set an alarm for 2am every night and tested. That gave me peace if mind, but also meant I could assess my blood sugar and eat if necessary. I only ate a little - just what I needed to keep my blood sugar up.

I found this drop happened even after I'd adjusted my basal rate, and I was happy to deal with it as described above. It worked well for me. As my pregnancy progressed, the lows disappeared mainly, so then I used my nightly check to see if I needed a small correction dose.
 
Hi azure - would you correct a hypo if it was a minor one? I.e. 3.8 or 3.9? I ask because on the pregnancy targets fasting is something like 3.5 - 5.0, so if it's the middle of the night and a long time since eating/taking insulin, essentially it's a fasting test.

They are going to start me on a pump in January which I hope will help.
 
Hi I would have something to raise it into the 4 range. Too low isn't good for you.

I would either trying dropping a lantus unit or have some long acting to eat before bed and see what that does.

I personally don't think I could have done either pregnancy without a pump.
 

Everyone is different, but personally I woukdnt have corrected a 3.8 or 3.9 if I was up and about to have breakfast. If I did feel the need to correct, it would only be a tiny bit eg a swig or two of Lucozade. This would only be in case I felt the meter could be slightly out or if I was going to be active or delay eating in some way. I would be aware of it though so would have hypo treatments near (I had them in every room when I was pregnant). As my pregnancy progressed and I felt clumsier, I may have erred in the side of caution and had the tiny bit of Lucozade. I would also watch my blood sugar after breakfast in case the lower start to the day continued during the morning.

Just my own experience. Your body may react differently, and obviously if you're at all unsure, correct and monitor closely. It's a fine line to walk during pregnancy.
 
Thankyou both. I decided to reduce my Lantus back down to 5 last night, and I stayed above 4 all night which is good. One of the things I have always struggled with is how sensitive I am to both insulin and glucose - 1 unit is a 4mmol drop, and one jelly baby is a rise of about 2.5mmol. With the window for pregnancy being even smaller than usual, staying between the lines is challenging.

Hopefully the pump which allows for much finer tuning of doses will give me the precision that's required, but I've another month to go first!
 
It's definitely hard but honestly it's all worth it!
Once you have your baby in your arms....

In hospital with my 2yr old at the moment who just diagnosed type1 so trying to get to grips with her requirements and understand her swings. Thanks goodness for grandma who is looking after the babies at home.
 

Hi Hun, try getting the little tiny packs of jelly babies, they are smaller so don't raise you as much per sweet I have found xx
 

Hope your daughter is doing ok @1Sarah1 xx
 
I'm so sorry to hear that @1Sarah1 . Wishing you strength through this difficult time.
 
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