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Pre- Pregnancy Advice Please!

CranberryIce

Well-Known Member
Messages
410
Type of diabetes
Type 1
Treatment type
Insulin
Hello, New on here.

My current Hba1c is 57% I have been advised to try and conceive once I have reached a Hba1c between 43-48.

I am on Novorapid and Lantus. I tend to float around 55% but then tend to hit lows.

I am now trying to test after meals too- to see where I am going wrong. I am
tightening up on my diet too. Is there anything else I should/could be doing?

Sadly, there is no pre pregnancy clinic where I am. I have not had much help
or access to diabetes nurses either.

I am desperate to conceive and really want to reduce my hba1c as quickly ans safely as possible.


Sorry I am still using % for Hba1c.

Any advise/tips would be really appreciated.

CI x
 
Hi!
I think you actually using mmol, as 43-48 is the target prepregnancy.
Couple of things to look at: when are you getting your lows, when do you take your Lantus and at what dose, what are your carb ratios for each meal, are you carb counting accurately and how many grams of carbs are you taking, when are you getting your highest readings, what your readings are 2 hours after meals.

Knowing how prepregnancy clinics think, they would (rightly) first look at your hypos and trying to elimimate and reduce those. .
 
Sorry that sent before I was finished. Let me know what your current details are and I can tell you what my prepregnancy clinic advised me. I've spent a considerable amount of time with them over the past few years. Good luck! Xx
 
I wake up on lows or dip low in the night . I am gradually decreasing my night time Lantus dose. Currently taking 9 units between 10-10.30pm.

Highest reading is usually after breakfast (a reading of anything between 11 and 16). So I have recently increased my morning/breakfast ration to 1:2. Which has made some
difference but then I tend to go low by lunchtime! Does that mean my morning Lantus dose (10units) may need to be reduced?

Am I making too many changes at once? I just want to fix it all!

I am using the carbs and cals book and app, weighing my food and generally avoiding and having as little bad carbs as possible.

My readings from today:

6.30am- 3.7 (treated hypo) + breakfast
7.15- 7.2
9.15am- 12.3! (corrected using 2 units QA)
10.30- 10.1 (Snack plus 1 unit for correction)
12.20pm- 7.5
3.15pm- 2.6
4.45- 3.6 (by this point fed up of feeing low and may have over treated hypo)
6.30pm- 10.5
9.15pm- 9.7

I am confident with all my carb counting today.

Should I always correct a high reading in-between meals?


Sorry for the long post! I appreciate your reply <3

Thank you x
 
^ to add to this: been up for the last 20minutes with another low!

Did test at midnight and had dropped from 9.7 to 5.3 so was expecting this to happen.
 
CranberryIce said:
^ to add to this: been up for the last 20minutes with another low!

Did test at midnight and had dropped from 9.7 to 5.3 so was expecting this to happen.
Click to expand...
Hi!
So I'd first address the lows you are having and I would guess this is Lantus dose related.
You already split your Lantus dose? What precipitated this change? Peaks at six hours I think. I worry about telling you to increase or decrease anything incase it causes you to suffer any hypos but generally speaking.

My issue with Lantus was that to get rid of hypos, I ended up having highs (which I then overtreated with rapid acting). My instinct has always been to address highs first but I learnt in my first pregnancy that hypos need to be addressed first.
Hypos are so dangerous is pregnancy and so exhausting anyways. I lost all hypo awareness in pregnancy #1 and it was scary.
I wouldn't say you are wrong to correct highs with rapid acting but always address hypos first, is what has been drummed into me. To be fair I have a lower HBA1c than ever since following this rule.

Aside from pregnancy clinics, are you under hospital care? You really need to be seeing someone who can issue you with your folic acid 5mg and look at your doses and insulin. Your GP will probably issue you the prescription but it's maybe not really enough support. It's a high risk pregnancy potentially and you want the best possible start.

In my fist pregnancy I just got pregnant (ignoring all help stupidy as my HBA1c was within range) and afterwards was referred by my consultant to the diabetes nurses. For my second pregnancy I have been under the nurses care since preconception and my insulin has been completely changed, this pregnancy is so much easier as a result.

I would really push to be seen by a nurse or switch to a hospital that has the preconception or pregnancy clinics run by the nurses team. I see the consultant every four weeks (I think they see some people more than this and others less) but the nurses I am in at least weekly contact with.

I just feel the level of care I've received should be accessible to all diabetic women. I can't understand how it varies so much.
Xx
 
I’m going to say this from my heart. Even if a pre conception clinic is two miles away, Pls go. I do not recommend you getting advice from anyone on this issue. Pregnancy is a serious medical condition for all types of diabetics. Please note that the diabetic nurses are also trained in dealing with pregnancy women so even if you can’t go to the pre conception the nurses can help.
 
Thank you lovely! I saw a consultant today- she advised to deal with the hypos first. Other than that she seemed to have no idea what was going on and gave me the go ahead to conceive with 58mmol! Grrrrr!!!!! The meeting with the nurse was worse. Because I have done DAFNE she told me I didn’t need any support, I know what I am talking about...!

I asked and pushed for pre conception care but she said they don’t offer it at my hospital. So basically I have to do this by myself

My local GP is more useful so will try and see him.

She kept talking about my insulin sensitivity? It doesn’t help that in the last few weeks I have been making lots of dietary changes etc which have all thrown my sugars all over the place.

Sorry for the rant. I have never felt so alone with my diabetes :’(

I have been on a split dose ever since I started Lantus as prior to Lantus I was suffering night time lows too.

Before I relocated to where I am- the care I received was outstanding! So I am constantly comparing it to that- so I know what I am going through/being offered is less than minimum.
 

That is something I am
looking into. Trying to find the nearest pre-conception clinic. I will be going back to my GP to try and see what he can do xxx
 
Yeah it's really tough. Lantus I found very tricky. Both of my pregnancies have been totally different, I was on Lantus first one, insulin pump with this one.
A question though, if you consultant is telling you to first address hypos (which is standard good advice) then what is the plan for addressing them that you have been guided with. Is there a next steps if you can't remedy the hypos? As in switching to another insulin, insulin pump?
My current insulin resistance is ridiculously high, it's like a totally different language to before pregnancy.
Then the beginning of pregnancy I had to reduce my doses by about 40% due to increased sensitivity. I've now swung all the way to the other side. I'm curious to see what dose I'll end up on by the end of pregnancy.
Glad to hear your GP is helpful.
That's something. As PP as said though, the nurses are really great with the pre-conception and pregnancy clinics. Hope you can find a way to one. Xx
 

ah congrats on your pregnancy

She suggested reducing lows by reducing my evening bolus ratio- did not even mention my basal.

My lows are less frequent now- over the week of constant testing I can see a much clearer pattern and I am sure it is my basal dose.

I used to take 10 units in the morning and 8 in the evening. I am now on 7 and 5. Lowest number of units- (it feels odd)

The GP mentioned a pump but as I want to conceive asap she said a pump will take time to adjust to etc

Hopefully I get my sensor tom so can start using my libre.

I have a follow up with my GP next week- he suggested another insulin of things didn’t settle. I can’t remember the name but it is meant to help reduce hypos. I said I would read around and research it.

Have you ever been told if their are insulins which are better for pregnancy:

I’ve only ever been on Lantus so feel nervous with the thought of changing to a new insulin.
 

I don't think there are better insulins for pregnancy but some newer LA are better for reducing hypos. This time round they wanted me to try firstly splitting Lantus dose, then tresiba as it works more steadily over 24 hours, then pump.

I started pump in June and was told Id need to be wait until stabilized on it until TTC. To be fair this was only a matter of a month. Although I got my pump about 2 days after them suggesting it so that was unusually rapid pump access.
I think Lantus can work just fine for lots of people. My HBA1c was great throughout my first pregnancy, it was the hypos that were the issue for me. If you can sort that issue as you are then it bodes well.
 

Thank you

I’ve been on Lantus for so long and hypos have never been an issue. Maybe its just a blip?

I am testing more regularly and recording so hopefully I will be able to fix this. Hypos are reducing and I have clear/obvious patterns where my bg drops now.
 
Hopefully just a blip. Have you ever had a within pregnancy target HBA1c while taking Lantus without experiencing hypos? That's what I couldn't achieve personally. It can obviously be done though, ultimately the insulin just didnt suit me.
Have you got your libre? How are you finding it? Xx
 
No I have never achieved a Hba1c within that range- lowest is 53. In all honesty I’ve never tried my best to get it lower- my consultant has always been ‘happy with my control’ so I’ve just always assumed I would be ok. Like I said before, my consult would be happy with me conceiving with a a1c of 58 but I wont put myself in risk- or will do everything I can to minimise it x

Has your Hba1c always been in the ideal for pregnancy- or did you have to work to get it there?


I have a follow up appointment this coming week, so hopefully they will then clarify my next steps.

I have my libre- going to start using it tomorrow! Have you got one? Any tips? xx
 
Hi. Just to add you will need prescription folic acid too! You are trying fantastically hard but do try hard to enjoy the pregnancy when it happens even if it is a medicalised one. You will likely be in better shape than many others who don't have to pay any attention to their diet. Also as you already know there i s no perfect regime to match insulin to food although I think the combo of pump and fsl can optomise things, so be prepared for the changes that those hormones will bring bearing in mind that you may well have time to adjust to the pump depending on how long it takes you to conceive or could switch to non hormonal contraception whilst you are getting the hang of the pump/
 
55 down to 48 isn't much of a drop so should be perfectly achievable.

The first thing to get righ with diabetic management is your basal dose. Have you basal tested to see how your lantus is working for you?

Here's a guide on how to basal test - https://mysugr.com/basal-rate-testing/ - it's got the values in mg/dL so divide by 18 to get to mmol/l.

To avoid night time hypos - which really must be a priority, one nocturnal hypo is too many - you might need less lantus to go to bed with. DAFNE advise reducing pm basal dose by 20% after one nocturnal hypo to avoid it happening again.
 

I have been taking a prescribed dose of folic acid.

I am so glad I found this forum. Just hearing other peoples experiences or getting advice from people who actually understand how it feels to constantly battle with highs and lows - is a godsend.

I am so excited about starting with the libre. I know it wont fix my levels but it will me getter a better idea of where I am at.
 

Ah thank you as my hba1c is always around that level I have just assumed it will take me a very long time to bring down.

I have been wanting to carry out the basal tests but as I keep hypoing (which has improved) I have not yet tested. I have had two nights in a row where I have not had any hypos in the night nor have I woken up low. But on both nights I have slept with a reading of 8 and woken up on 5- so its still dropping?

Prior to that I was going hypo every single night one after another - but was advised not make a change to my bedtime lantus every day- to make an adjustment and wait a few days for it to settle- it never did so I continued to reduce slowly.
 
*update*

After months of battling with health care professionals for advice I should have received anyway- I finally got referred to a pre-pregnancy clinic!

They were pleased with the steps that I had taken (thanks to this forum) and have given me small targets to work on.

Only one appointment so far, but it was incredibly useful and I am so glad I preserved.

So for others in the same boat- don’t give up!
 
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