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major short term insulin resistance - help!

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the_anticarb

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Wondering if anyone can advise, this is a complex problem.
I am an insulin dependent MODY, before pregnancy was using a 1u per 10g carbs.
Now I am five months pregnant and become very insulin resistant in the morning although later in the day back down to 1u per 10g.
So this morning for example I had a bacon bap estimated to be around 50-60g carbs so had 18u novorapid on a 3u to 10g ratio and one metformin and 1 hour post reading was 11.5 :shock:
Had a correction dose of 1u insulin and then 1.5 hours post was 9.5, 2 hours post was 6.5 and 2.5 hours post is 5.7. I'm worried now that the insulin will keep acting even though the resistance due to the pregnancy hormones will fade (as the hormones are strongest in the morning) and make me go hypo.

The insulin does seem to be working but lagging behind the food.

I've never taken this much insulin at once before, in the past this would have been major overdose territory.

Thinking I should just severely limit carbs in the morning to no more than 20g.

What do you think?

Thanks
 
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
 
Wow never heard of anyone who found their diabetes easier to control during pregnancy than before.

I need to be careful with increasing the basal as there is such a difference between my insulin needs in the morning as opposed to later in the day.

So I'm on a 3:1 ratio in the morning and then 1.5:1 lunchtime and 1:1 later on.

It's making me very good at arithmetic!

So wouldn't want to take a massive dose of lantus am and then it's still affecting me 12 hours later.

I am seeing a DSN about all this and she has recommended increasing the ratio from 2:1 to 3:1 but increasing it is not solving the problem and if I increase it more it will just make me go hypo more later in the day.

So I'm thinking of having locarb high protein shakes for breakfast from now on and seeing how that works
 
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 :)
 
Thanks - have never had probs with lantus before been on it 10yrs or so. I understand the problem to be that the pregnancy hormones which are highest in the morning, interfere with the action of the insulin to effectively block it, so you are just injecting loads of insulin which is having very little effect. I mean, a bacon bap is hardly a massive breakfast carb wise and to take 18 u of novo and still be 11 an hour later is pretty strange for me. In the past 4u would have prob been enough to cope with that amount of carbs. By lunchtime the pregnancy hormones are wearing off and then my ratios are much lower. By tea time a 1:1 ratio is fine.

The only way forward, as far as I can see it, is to have limited carbs in the morning which is what I will try although it's difficult when you're pregnant and hungry.
Ate a low carb diet last year for 8 months where I had limited carbs all the time, and survived that, so I know how to do it - and I can eat carbs again after mid day so it's not all bad.

I'll let you know how it goes
 
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.
 
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