major short term insulin resistance - help!

Hi,
I don't know what you know about diabetes and pregnancy, but your insulin requirements will increase as the pregnancy progresses.
I''ve had 3 children, all while I've been type-1. in contrast to your experience, I found my diabetes control much more stable easier to control during the pregnancy than when I wasn't! I presumed was a result of the stability of the hormones, ie, no monthly cycle. My insulin requirements doubled by the end of each pregnancy, which meant I had to take extra care when the children were born, but don't recall any major probs.
I was on Human Insulatard & actrapid with 2 of the pregnancies & Insulatatard and Humalog with my 3rd. What basal insulin are you taking?
it could be that raising your basal might ease the problem, it could help with the after meal spikes hypos, as you wouldn't need so much Novorapid with meals, thus avoiding hypo risk.
Sorry I can't help more, hormones are the very devil at times :cry:
Are you seeing a specialist who deals with diabetes in pregnancy?
take care
Jus

Hi again,
I see your problem, has your dsn given you any explanation why you might be happening? Does Metformin keep you low for a while after you take it, could that be the reason you're low later in the day?
Don't know much about Metformin, but I was on Lantus for 4 years and had a dreadful time on it. One of the problems I had was inconsistency in BG control, it just didn't work for me at all,although it seemed to at first which was strange. I had days when my BG was high for no reason, and days when I was going down to the 2s wthout any humalog at all, it was very scary, especially as I was told Lantus could not cause this problem, but it definately did, and many others report the same problem unfortunately.
Fingers crossed your current problem is a temporary one, and as the pregnancy continues things will settle. Not sure, but I think there's a section for diabetes in pregnancy on this forum somewhere, might be worth a look, you might get some more helpful advice.
Jus

Hi again,
Maybe it's a "dawn phenomenon" thing, which in many people causes BG to rise early in the morning. I've never suffered from it personally, but know of people who have struggled with it. There's been lots of threads about it on this forum, do a search and you might find something useful there.
I have such hormonal probs with my cycle,must be my age my poor husband always knows when I'm due before I do. Permanent pregnancy would be the ideal for me, but 3 is enough, they're wonderful but tiring. I hope you're enjoying your pregnancy despite your BG hiccups.
Jus

I am seeing significant short-term insulin resistance caused by stress, either emotional (e.g., workplace) or physical (response to exercise).

I'm a 46-year-old male who has had Type 1 diabetes for 26 years. I have used an insulin pump with various rapid-acting insulins (e.g., Humalog) for 20 years, and have used a Dexcom continuous glucose monitor for about a year and a half. In the last 5 years my control has gotten progressively worse, since starting a new career. Six months ago an acquaintance gave me a book, "Dr. Bernstein's Diabetes Solution". Its central tenet is to reduce carbohydrate consumption to a bare minimum (Bernstein describes this as "switching to protein as your source of carbohydrate"), and thus minimize insulin bolus amounts.

This has dramatically reduced the greatest sources of errors in my blood sugar control: glucose intake from complex carbohydrates and insulin boluses to compensate. It has also laid bare the effects of stress on my metabolism.

Instead of a dawn phenomenon, the dominant trend I see now is the "get up in the morning and go to work phenomenon". After consuming less than 5 grams total carbohydrate at breakfast, my blood sugar starts to climb about an hour after breakfast and an hour before leaving home for work. I do adjust the basal rate to try to compensate and usually take correction boluses, but they only serve to limit how high I get (usually to the 150 - 250 mg/dl, 10.0 - 13.0 mmol/L range). I have to be very careful, because around 11 AM the blood sugar starts to decline. If I have taken too much corrective insulin, it will plunge. This rarely happens on weekends or during vacations. Similar effects are seen after cardiovascular exercise (even without work stress). Especially stressful periods at work magnify the problem.

My theory is that stress hormones (cortisol, norepinephrine, possibly others) cause short-term insulin resistance in my system. I can take enough insulin to saturate the working insulin receptors; the rest of the receptors are somehow disabled and unused insulin circulates freely in my bloodstream until the stress hormones wear off. Then the disabled insulin receptors are re-activated and the free insulin goes to work.

I have talked with my endocrinologist about this and searched for articles online, but have found very little information about it; this thread is one of the few hits. I'm trying to find a method to follow to reduce the blood sugar rise by computing a correction dose that will bring it down correctly without taking me too low. I would be very interested in comparing notes with others who have encountered this phenomenon.