Needed advice for insulin dosage please. Thanks

[Meliza]

Hi, I'm 43 and type 2 diabetic. HnA1c was 7.6 on my last blood test taken 11/11/18. I have managed to put down my sugar down between 6-8 for 2 months now and i've been religiously injecting insulin (Lantus) and metformin. My question is, if my sugar(before breakfast) ranges from 6.6 to 7.8, do i need to inject insulin? And how much dosage do i need? I've been injecting 8 to 10 units 2x a day depending on my reading. Am i doing right or wrong? I am also a 1st time mom to be at 8wks pregnancy. Thanks and looking forward for any advice i will receive.

 

[kitedoc]

Hi @Meliza, Congratulations on being a mother-to-be !!
Have you discussed your questions with your DN or doctor?
They are the ones who will know you best and are qualified to give your advice on your insulin dose etc., particularly at this time when diabetes control is so important for you and baby.

 

[Meliza]

Hi @Meliza, Congratulations on being a mother-to-be !!
Have you discussed your questions with your DN or doctor?
They are the ones who will know you best and are qualified to give your advice on your insulin dose etc., particularly at this time when diabetes control is so important for you and baby.

Hi kitedoc, thank you for your kind response. I haven't seen an OB specialist yet as my Doc. will refer me on my 11 or 12th week. I will see my doctor for my diabetes in Dec as i am out of country right now. The Doctor I'm seeing now just told me it's ok to continue to inject insulin and take metformin. I'm glad that i managed to lower down my sugar these days but confused if i need to inject or not. Appreciate any guidance for now.

 

[kitedoc]

Hi @Meliza, Perhaps speak with the doctor you are seeing now.

 

[EllieM]

Lantus is normally a long acting insulin, and typically lasts 24 hours. So it doesn't help with short term readings, though increasing the dose will obviously increase the background insulin in your system and thereby reduce blood sugars. I'm guessing that at some point you'll be given a short acting insulin to combine with the lantus, but I'm a T1 so can't say that with certainty as T2 pregnancies aren't the same.

Given the pregnancy, it would be good if you could talk to a diabetic specialist as soon as possible, a month is a long time in a pregnancy. As a T1, when I was pregnant I saw a DN as soon as I was aware of the pregnancy. Could you phone or email your clinic?

Good luck and congrats on the pregnancy. Presumably you're already taking the standard vitamin supplements etc for new mums? (Folic acid comes to mind.)

It's probably worth keeping a food and bloods sugar diary. When are you testing your sugars?

 

[SimonCrox]

Yes - totally agree with above. Congratulations. Best to get things checked out by diabetes team.

Metformin is probably safe and effective in pregnancy:-
http://care.diabetesjournals.org/content/34/10/2329
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5552827/

With the Lantus, I would stick to a regular dose and see what happens. If you keep changing the dose from day to day, you often end up chasing your tail and getting varying results. Folk on rapid acting analogues do give correction doses based on the glucose levels, and this can work very well. So seeing your diabetes team with your glucose levels on a stable dose of Lantus will let you decide what to do; alter Lantus dose or add rapid acting or quick acting to a meal?

The DM team will probably want you to test before each meal, before bed and 1or 2 hours after each meal - you may not have enough test strips. You will probably find your insulin requirements go up over the next 8 weeks or so.

Are you on any blood pressure tablets? I think ACE inibitors (eg rapimiprol, lisinopril) and ARBs / Sartans (eg candesartan) are not used in pregnancy? You are probably not old enough to be on a statin.

Might be worth taking some folate supplements because most UK citizens do not eat enough fresh green vegetables; any folate/folic acid tablets or mutivitamins will do.

Best wishes

 

[kitedoc]

Yes - totally agree with above. Congratulations. Best to get things checked out by diabetes team.

Metformin is probably safe and effective in pregnancy:-
http://care.diabetesjournals.org/content/34/10/2329
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5552827/

With the Lantus, I would stick to a regular dose and see what happens. If you keep changing the dose from day to day, you often end up chasing your tail and getting varying results. Folk on rapid acting analogues do give correction doses based on the glucose levels, and this can work very well. So seeing your diabetes team with your glucose levels on a stable dose of Lantus will let you decide what to do; alter Lantus dose or add rapid acting or quick acting to a meal?

The DM team will probably want you to test before each meal, before bed and 1or 2 hours after each meal - you may not have enough test strips. You will probably find your insulin requirements go up over the next 8 weeks or so.

Are you on any blood pressure tablets? I think ACE inibitors (eg rapimiprol, lisinopril) and ARBs / Sartans (eg candesartan) are not used in pregnancy? You are probably not old enough to be on a statin.

Might be worth taking some folate supplements because most UK citizens do not eat enough fresh green vegetables; any folate/folic acid tablets or mutivitamins will do.

Best wishes

And please ensure you are taking iodine in whatever supplement you choose.

 

[Meliza]

Hi @Meliza, Perhaps speak with the doctor you are seeing now.

Thank you. I'll definitely do that.

 

[Meliza]

Lantus is normally a long acting insulin, and typically lasts 24 hours. So it doesn't help with short term readings, though increasing the dose will obviously increase the background insulin in your system and thereby reduce blood sugars. I'm guessing that at some point you'll be given a short acting insulin to combine with the lantus, but I'm a T1 so can't say that with certainty as T2 pregnancies aren't the same.

Given the pregnancy, it would be good if you could talk to a diabetic specialist as soon as possible, a month is a long time in a pregnancy. As a T1, when I was pregnant I saw a DN as soon as I was aware of the pregnancy. Could you phone or email your clinic?

Good luck and congrats on the pregnancy. Presumably you're already taking the standard vitamin supplements etc for new mums? (Folic acid comes to mind.)

It's probably worth keeping a food and bloods sugar diary. When are you testing your sugars?

Thank you for you time replying to my query. Yes, i am checking my sugar 3 to 4 times a day just to make sure it doesn't go higher, so i can plan mt next meal. So far my sugar are on normal range or just above normal, depending on what i ate.. i check at 7:30am before i take my metformin and insulin then at 12noon and 6:30pm for insulin and metformin and dinner. Lastly before bedtime, just to see how much is my sugar.

And yes, i do take prenatal vit and omega3. Thanks for the advice.

 

[Meliza]

Yes - totally agree with above. Congratulations. Best to get things checked out by diabetes team.

With the Lantus, I would stick to a regular dose and see what happens. If you keep changing the dose from day to day, you often end up chasing your tail and getting varying results. Folk on rapid acting analogues do give correction doses based on the glucose levels, and this can work very well. So seeing your diabetes team with your glucose levels on a stable dose of Lantus will let you decide what to do; alter Lantus dose or add rapid acting or quick acting to a meal?

The DM team will probably want you to test before each meal, before bed and 1or 2 hours after each meal - you may not have enough test strips. You will probably find your insulin requirements go up over the next 8 weeks or so.

Are you on any blood pressure tablets? I think ACE inibitors (eg rapimiprol, lisinopril) and ARBs / Sartans (eg candesartan) are not used in pregnancy? You are probably not old enough to be on a statin.

Might be worth taking some folate supplements because most UK citizens do not eat enough fresh green vegetables; any folate/folic acid tablets or mutivitamins will do.

Best wishes

Thank you for taking your time & helpful reply as well as the links that i can read later on. I inject between 8 to 10 units of Lantus if my sugar is between 6-8 range and 12 to 14 if sometimes 10-13. Just am/pm only together with 500 metformin same time as insulin. If my sugar reading is between 4-5.2, i don't inject insulin but i am very careful of what i will eat. I also don't drink any soda or juices anymore. I drink infuse water consist of fresh Lady finger, ginger and lemon grass all through out the day and eversince i started drinking that, 2 months ago, my sugar came down. I don't have any other health issue like HB, although my family has history of Hb pressure.

I have other sugar blocker like Glyxambi & Glipizide, but i stopped taking them as i don't want to take too much drugs into my system and stick with insulin as thats what's needed in my body plus trying to eat healthy diabetic diet. But I'll have to check with my diabetic doc in 3 weeks time. I'm glad i came across this forum and to each and everyone for being helpful giving advices based on profession and experiences. More power to you all!

 

[Meliza]

And please ensure you are taking iodine in whatever supplement you choose.

Thank you. I'm taking prenatal vitamin and it has iodine already.