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Type 2 Please Help: Pregnant and cant control sugars

A

Anni86

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5
Hello All,

Please help! I dont know what I should do.

I was diagnosed with type 2 diabetes a few months before I fell pregnant. I took Metformin to control my sugar levels.

Im now 18 weeks pregnant with twins, and on insulin and Metformin. I take 18 units of insulin before lunch and dinner, insulin before breakfast.

Im finding it a struggle to eat (being vegetarian) and control my sugars but Ive taken advice and doing my best to implement a good eating plan.

Of recent - i just dont understand my bg results.

For example - Ive been advised by my specialist to have an ideal reading of 7.5 after 1hr and 6.5 after 2hrs.

Tonight after dinner my results were
After 1hr: 7.7
After 2hrs 7.9
After 2.5 8.3 (

Why are my results getting higher?? Shouldnt the insulin start to kick in around 2 hrs???

Im getting so worried and anxious. Every day is becoming a struggle. Im frightened that my insulin dosages will be just increased indefinately. Im trying to understand my results so I can modify what Im doing to have a healthy pregnancy.

Thank you in advance.
 
 
Don't panic. I would say in my humble opinion, you are doing fine. If your blood glucose measurements are below 8.5mmol and above 4mmol that's really good and not challenging your health a great deal. My understanding of the situation is: that physiologically your organs/body starts to have a problem with a blood sugar above 10.6mmol and below 2.1mmol so if you can avoid measurements like that it's good. Yes it would be ideal to stay at 4.4 _5.5mmol but the range your getting is not bad. It's also good to have as level a blood glucose as possible and avoid big fluctuations. Oatcakes, humus,porridge are good carbohydrate for this, slow steady release. Hope that's helpful.
 
Blip22 - Thank you so much for your reply. It gives me the reassurance I need.

I have started to become so particular about my sugar levels, that its driving my paranoia at times. Being pregnant, I know that the hormones are effecting the results too. But whatever I seem to do appears to be futile.

Ive cut my diet so lean; reduced my portions and im having more regular meals/snacks. Even then, the results start to creep up a bit. It makes me angry at myself.

I worry so much that Im hurting my babies by not getting the levels down to the prescribed. It becomes a catch 22 between trying have a sustainable and sufficient diet; maintaining my sugar (and maintaining my sanity)

I really appreciate your response.
 
I’m not t2 so can’t advise on levels but wanted to say try not to worry - remember stress will mess with your BG too. Seems like you’re doing a good job at the mo and you’re growing two actual human beings!!
 

This isn't correct. The targets for pregnant ladies with diabetes are much tighter, because of the risks to the foetus caused by high blood sugar. Pregnant targets are <5.3 fasting, <7.8 1 hour after eating and <6.4 2hours after eating - https://www.nice.org.uk/guidance/ng3/ifp/chapter/your-blood-glucose-levels-during-pregnancy

@Anni86 if you aren't meeting those targets how are you managing you insulin? What insulin are you taking? Are you carb counting? Are you pre bolusing?
 
Congratulations on your pregnancy!

Are you carb counting and adjusting your meal time fast-acting insulin according to the carbs you're about to eat? Are you taking both a basal long-acting insulin and a bolus (meal) fast-acting insulin? It would help if you could write a little more about your insulin regime like their names, etc.

What are you eating for your meals? Have you seen a dietician to help you manage your blood sugars and get the right nutrition for your twins and for you? Some obstetric diabetes clinics have dieticians attached, so if you haven't seen one it might be worth asking.

Do you have any constrictions on the amount of activity you can do? Sometimes even something as simple as doing some housework or tidying after eating can help keep your blood sugar down.

It sounds like you're doing ok Blood sugar control is much harder in pregnancy, so don't underestimate how well you're doing coping with all of this as well as carrying twins
 
lou258, catapillar and zand - thank you very much for responding.

As catapillar's written, my targets are more specific being pregnant.

I'm currently on Levemir (8 units) before bed; and NovoRapid (4, 18, 18) before breakfast lunch and dinner. I also take Metformin 500mg twice a day.

Every week I email the endocrinologists office; they then adjust my insulin levels accordingly.

I'm finding it difficult to manage satisfying my hunger with the pregnancy, and maintaining the bg.

Being vegetarian, my diet has traditionally been high carb. Ive never carb counted, but now Im more wary of what I eat.

I'm trying to incorporate some protein (almonds, walnuts, dairy, pulse) in every single meal.

I did this yesterday, and my dinner results were still high as above in the first post. Its starting to get to me because the obstetrician informs Im also underweight.

Im scared that my insulin dosges will be just increased every week. I dont know how this will effect the babies or me in the long term.

My next plan is to see a dietician - I (surprisingly) havent been suggested one yet by my endo or obs. What can I do till then? Every meal I become paranoid.

Does any one have experience with such a scenario.

Any advice ir suggestions is appreciated. Pls help.
 
Carb counting doesn't mean not eating carbs or restricting carbs. It means adjusting you meal time insulin to accommodate how ever many carbs you are eating.

Your fixed doses of novorapid will be able to deal with a certain number of carbs and keep you in target. If you are exceeding that number then you'll go higher, if you do not meet that number you'll risk hypos. Has the endo given you guidance on how many carbs your fixed doses should be covering?

How carb counting works is you work out how many carbs 1 unit can cover, eg 1 unit to 12g of carbs, then you work out how many carbs in your meal and divide by the number 1 unit covers to get your dosage for that meal.

There is a free NHS course on carb counting online - https://www.bertieonline.org.uk

It's worth bearing in mind that it probably takes 15 minutes for novorapid to disperse around the blood to the right places and maybe more like 20 minutes before it starts working. So if the aim is to avoid post prandial spikes it's worth pre bolusing but be cautious and ready to eat in case you don't need to pre bolus so early and it starts dropping you quicker - see what time frame works for you by edging forward by 5 mins and testing.

Increasing the meal time insulin dose won't have any ill effect on you or baby, short term or long term.
 
As @catapillar says, you need some help and advice about carb counting so that you can make sure you're taking the right amount of insulin for the carbs in your meal. Just taking, say, 18 units but eating varying amounts of carbs for your meals in a week won't give you smooth sugars.

Something else you could ask about is splitting your Levemir dose. Many people find it doesn't quite last the full 24 hours, so taking it twice a day (splitting the total amount obviously) might give you better coverage, and would also allow you to adjust each of the two doses separately to better cover the day and the night.

You could also ask about correction doses - taking small amounts of insulin to bring you back into range if you need it. Getting a pen that does half units of insulin would be helpful too.

Yes, being vegetarian can make things a little harder but hopefully the dietician will help you with that. I notice you mention pulses. They're generally low GI so have a slower effect on your blood sugar. That could explain why your blood sugar was continuing to rise after eating. You can still eat pulses, but you might need to adjust the timing of your insulin sometimes so that it covers the slower rise.

You shouldn't be hungry and underweight Make good use of the dietician and get them to help you plan a good diet with sufficient nutrients and calories. You're growing two new humans after all!

Don't be worried about your insulin needs increasing. Firstly, that's normal as pregnancy progresses. Some ladies here have tripled or even quadrupled their insulin doses during pregnancy. This is due to the placental hormones increasing insulin resistance. Secondly, you need the amount of insulin that you need to eat a proper diet and keep your diabetes tightly controlled. That's the most important thing. After you have the babies, your needs will drop drastically.

Don't panic - your results are only slightly out of range. With a little more knowledge and a little help, you should see some improvements Make a list of everything you want to ask about and make sure you get the support you need. Never be afraid to ask questions rather than just follow orders. The more you understand what's happening, the more confident you'll feel.
 
It will take time for the changes to take affect. I am low carbing and vegetarian... however I just had my baby, though I understand your predicament.

I agree with zand and catapillar. You can be veggie and low carb and satisfy your hunger. It will take more than a day to happen and it will be harder to control with twins (double hormonal trouble).

I don't need to hammer in how important it is to control Bgl... you probably have already had that from the doctors and they gave you that advice for a reason. I can't though say don't worry about it all I can say is do your best and what happens will happen and as long as your tried your best you can't blame yourself (though we still do) when things don't go to plan... which most pregnancy and labour don't regardless of diabetes.
I really do hope you give low carb a bit more time, it worked for me, though I only had the one to contend with. I was able to keep control without meds for the whole time... this time round anyway. I would call and try to see your diabetic consultant and speak with him, he may have a better idea about what to do and how to help as I haven't had twins... ever... so the impact of a multi pregnancy is different to a single one.

Wishing you best of luck.
 
catapillar - Thank you so much for your response and for the clarification on carb counting. My endo has not mentioned this to me before - Im glad Im on this forum! I shall read up about this and raise this during my next appointment.

zand - Thank you so much for your response, and the reassurance. Ive been feeling alone at having to deal with this - neither my husband nor family seem to understand what I’m facing. They assume it should be easy for me to just consume anything as Im pregnant. With everything else happening, I find myself just tired and frustrated and sad. Especially when I find myself being hungry and so concious of bg. You made great points - being hungry isnt the way to go; and there is a way to manage all this - I just need to get the knowledge how.
Next appointment with endo - I will have to ask about splitting Levemir and correction dosages. I am looking at dieticians around my area and I hope they can provide helpful guidance.
In terms of pulses - can you tell me whether I should be having such steep spikes in bg after consumin? I noticed that with insulin, after eating 1hr, my results were 13! And another hour after after they dropped suddenly to 7! Is such a spike and drop safe?

busydiabeticmum - Thank you so much for responding. Its great to hear your experience. Thank you for the reassurance that it can work out even being veg! Ive started researching low carb alternatives - and as youve mentioned, I think it will take a bit of time getting used to. With a bit of organisation and research and meal prep, it will definately help. Im half way through my pregnancy, and I suppose nows better than later/never to make good dietary changes.

If any one else has any advice / similar experiences, I would much appreciate to hear them.
 
If you want to know some recipes there is a page here that gives some good tasty ideas (sorry I am not knowledgeable enough to know how to link it) I do things Kylie mushroom soup, stir-fry, there was one recently for tacos.... that was really nice. Cauliflower pizza worked well and actually tasted nice as well as cauliflower cheese (just use a bit of cream instead of white sauce) you also have low carb muffins... there are lots of good alternative for favourite dishes so you can fill up, not be hungry as well as like the food and not badly effect your bg.
Hope you find the page on here and get inspired.
 

Hi again

Pulses can have a varying effect on blood sugar, depending on what kind they are, how they're cooked, and your individual response. With the blood sugar results you listed, it seems like you had roughly the right amount of insulin (you were at 7 two hours after eating) but you spiked above the one hour target. What was your blood sugar before eating? If it was in range and you spiked to 13, then you should consider having your Novorapid slightly earlier to give it a chance to start working n order to avoid that initial spike.

Many people on meal-time insulin find they need to inject it more in advance of eating. In pregnancy, this could be even more helpful. Do NOT try this without advice, and when you do, move the time of your Novorapid very gradually. You'll probably find different times n advance work best for different meals.
 
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