Please help - highs then hypo

Yes, it's not just you. That pattern implies that your basal rate is too high. You need to do some basal testing. After that you may very well need to check your insulin:carb ratio for your boluses.
Look at these 2 pages:
http://www.salforddiabetescare.co.uk/index2.php?nav_id=1007

http://www.salforddiabetescare.co.uk/index2.php?nav_id=2006
You can do it, and you can do it without all the hypos. It may take two weeks to get it under control, but I'm sure you're motivated.

You should learn how to do these tests and interpret the results yourself because you probably will have to do it all again at least once each trimester as your weight and insulin resistance change throughout the pregnancy.

Hi and congratulations on your pregnancy

I've started a new thread for you so your post isn't missed.

Have you tried injecting your fast acting insulin a little bit in advance of eating so that it's working earlier and catches your high? You may be able to reduce your bolus a tiny bit then and avoid the low after.

Have you been offered a pump? That can help with control, especially during pregnancy.

I know what you mean about having to eat to treat the hypo. At one stage I always had to have a small snack after a meal because my BS went too low. The hypos did reduce a lot though after the first trimester.

Does the high then low pattern happen after every meal?

I'm 31 weeks and having the same issue - unfortunately I haven't found a solution to bring it down to where I want it 1 hr post meals. I do my breakfast bolus 45 minutes before I eat, but I still shoot up to 10 around 1hr-1.5hrs after and I'm back to normal by about 2hr-2.5hrs. If I do it any earlier I go low before I eat. My basal testing indicates my rates are perfect, and if I change my ratio or increase the basal I go low 2 hours after eating.

My doctor knows and has just advised me to keep doing what I'm doing because she doesn't want to see too many lows - there's no point in correcting the post meal highs because I'm eventually coming back down. At lunch I try to do it around 30 minutes before I eat, but same thing happens - shoot up for a bit before eventually coming back down in range or low. Some days my body cooperates and I manage to stay on an even keel, but other days it shoots up and I wait half hour and it's dropping back down.

It's hard to reach a balance. Like someone else suggested, it does sound like you're basal rate/long acting (depending on if you pump or are on needles) needs to be dropped a bit so you don't go low (I assume you aren't correcting the 1hr post-meal - you shouldn't be if you're going low later). And it also sounds like you'll need to try and bolus for your meals earlier like I am.

Hi Alex I had the exact same issue early on! My DSN advised only 2hr post meal readings and when assured me that as long as they were coming down by dinner then it was ok. We also tweaked my background insulin on nearly a weekly basis! It's hard work but sounds like your doing a great job! xxx

I was told to test 2 hours after meals too. It seems to vary depending where you are. I was told that as long as I was back in range two hours after, it was ok. If I felt at all high though I sometimes tested early so I could think about what to do and do extra tests.

I was told my BS shoukd be below 7.8 two hours after meals, but I actually tried to keep it lower if I could, especially for the evening meal because I'm not very active after that, unlike breakfast and lunch.

I don't know if you can request a pump? The way you can change your basal rate at different times of day is so helpful. You can also programme it to deliver a percentage of your bolus over a longer period of time which can be so helpful. That said, i still have your issue sometimes. I try and get my post-meal in range then snack to avoid the hypo that follows.

I'm on my second pregnancy at the mo - had terrible hypos at the beginning but after 12 weeks they got much less frequent. Good luck!

Have u thought about glycemic index of the food your eating?

Alexm5079 said:

Hello guys. I appreciate that this post is a year old but i really need some advice. I am type 1 diabetic and have been for 10 years. I have completed the dafydd course same as daphne but welsh version. My ratio is 1unit per 10g of cars and 1 unit reduces level by 2. I have had a little boy 2 years ago and all successful and well. However i am having the same issues again. My hba1c is 7.4% and it was 7 last time (i did get it down to 5.7%) but during the whole 9 months i suffered witg hypos 3 times a day or more. I am now having the same issue. Basically ive been told i need to have a fasting level of 6, then less than 8, 1 hour post meals. Whats happening with me is my levels are say 9.7 1 hour post meal and then 2 hours post im getting 2.7 and this is happening all of the time. Im getting sick of it now and im wondering if there is anyone else who has had this issue and how did u combat it? I ended up putting on 4 stone in my last pregnancy and i dont really want to go down the same road again as ive just managed to lose it. Im now 5 weeks. Please help guys, nurses seem to think its just me, but i cant see that being the case x

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Hi there, congratulations on your pregnancy! I've only been diagnosed a year but have been on the DAFNE course and learnt the importance of getting your basal dose correct. Could I suggest you try going carb-free but still test as often? It's the only way to work out if your background dose is too high as it's the only insulin working in your body.

Alexm5079 said:

Hey all. Thanks for your replies. Im currently injecting a lot of levemir around 10pm everynight im taking 48 units. So perhaps i should cut back on that? I was taking 30 units a couple of weeks ago but ive just been under pressure trying to get my am results less than 6. Its still happening. My insulin to carb ratio is 1:10 and no i cant get the pump, I already asked for it and was told my diabetic care was to good for one! Yet ive heard how they are better for everyone. My ranges are now 5.5am 7.4 1 hour pose meal, 4.1 2 hours post meal (hypo). Then ill have 4 gluco tabs. Same thing then throughout the day. The trouble is i dont feel much like eating but then im having too.
Can you advise on how much u would reduce your basal by? X

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Hi, wow to me that sounds like a huge amount but I'm fairness I think I'm still in the honeymoon period as I'm taking 10u of Levemir at 8AM and 5u at 8PM. DAFNE suggests making an adjustment of 1-2 units at a time, and allowing a couple of days of monitoring so you can check for a pattern. Personally I'd try decreasing your 10PM dose by 2 and see how you get on.