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Struggling With Highs In Early Pregnancy

Discussion in 'Pregnancy' started by FingersCrossed, Jun 26, 2018.

  1. FingersCrossed

    FingersCrossed · Active Member

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    Hi there,

    I've never posted anything on a forum before, so this is all new to me. Eek! I'm just looking to see if anyone else has experienced anything similar to me and what the outcome was. I'll try and keep it as clear as possible, but feel free to ask more questions if I don't make sense.

    I'm 39 years old, type 1 diabetic, on an insulin pump that uses Novorapid only, 5 weeks pregnant and super resistant to insulin.

    I have a four year old boy and when I was pregnant with him, my levels were pretty low for the first few months. I've recently been pregnant and miscarried just over two months ago, when I was appropriately eight weeks. That time I struggled for a few days to get my sugar levels down by increasing my basal rates, then my control was fab - if anything, on the low side. (To be honest, I think I just needed a few carb-free days to see what my basal was doing and to adjust it as I'd put weight on and probably needed to up my basal before the pregnancy to tweak my control.) I got my latest HBa1c just after the miscarriage and it was 6.5 (old money) so I was chuffed with that.

    This time around I am really confused and frustrated. I don't know what's going on. I only found out 8 days ago that I was pregnant. My control prior to that was ok, not fabulous with a few highs, but most days I was waking up with a blood sugar of between 7 and 10. Since finding out, and especially from 5 days ago, I've been 15 quite a few times and often 11, 13, etc. I'm gutted about it as my body is not responding to insulin how it normally does, with my first pregnancy 5 years ago, or the recent one two months ago. Last week I was on 52.8 total basal, and now I'm on 86.80. It's making marginal reductions but nowhere near as tight as I want things. Today I woke up with a bg of 13, took 10 units of insulin (much much much more than I'd usually take to reduce this) and it only went down to 10 a few hours later. I had no food at all, not even milk in a cup of tea to get it down first. In fact, I've had no carbs at all today to see what's happening. I did get to 5.8, 6.3 and 7 ish for most of the day, but tonight after tea, it was 12 again. I took 12 units to get my bg down to 9. My tea was homemade chilli with no rice. I take 1 unit for 5g of carbs for bolus, so I over estimated 20g for a few pulses and a bit in sauce, and took 4 units of insulin. I wouldn't even usually need to bolus for this kind of meal as it's carb free really. So I've taken 3 extra units and I'm at 8 now. This amount of insulin is crazy. Anyone got any insight or tips?

    I'm sure I'll get there, but I'm confused and getting a bit upset every high I get as I feel guilty and don't want what happened last time to happen again.

    I hope that makes sense and someone out there is or has experienced the same with a bit of advice or reassurance.

    Thanks very much.
     
  2. kitedoc

    kitedoc Type 1 · Well-Known Member

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    Hi @FingersCrossed,
    I gather that urine infections are more common in pregnancy and wonder if that might be a cause of this upset in your BSLs. Perhaps speaking with your doctor ASAP would help sort this possibility out. Infections may push BSLS up ++.
    Also you need to ask your diabetes nurse and doctor about the restriction you are placing on food intake as a way to reduce BSL rises and bring BSLS down more quickly. You and baby need energy, vitamins, minerals, protein etc. And I hope you have been advised to take and are taking an approved mineral and vitamin supplement for pregnancy. Also no carbs in in this situation might lead to ketones forming and ketones increase insulin resistance, another reason to speak with your doctor ASAP as well as ensuring you have the means to measure ketones ( I gather there are some gluco-meters which can measure ketones using special strips.)
    Best Wishes !!
     
  3. FingersCrossed

    FingersCrossed · Active Member

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    Hi kitedoc,

    Thanks very much for your reply.

    I got a bg of 7.5 before bed at 10.30pm last night due to all the correction doses. I tested at 1am and I was 11 so I took a 6 unit correction and increased my basal again and I was 7 this morning - at last! So I've gone from 1.9 units hourly to 3.8 or 4 in the space of a week - I expect this increase in trimesta three but not now. Very odd.

    I am testing for ketones which I don't have and am on vitamins and the diabetic-recommended folic acid dose. Also, it was mainly just yesterday I went carb free to try and spot any patterns etc as I have the same concerns and want to eat right to hopefully keep this pregnancy. (Bg levels were good last time I misscarried so I think that loss was chromosomal or age related maybe).

    You're right, I know I need to speak my diabetic nurse and hopefully get a blood test. She's on holiday at the moment and I'm waiting for someone to get back to me in next few days, which is why I reached out here to see if anyone else has been in the same boat.

    I'm thinking maybe it's due to infection; my body not responding to insulin as I'm much bigger than 5 years ago (serious action is needed after this pregnancy if it goes well, I know); multiple pregnancy; or something is wrong with pregnancy.

    Thanks.
     
  4. kitedoc

    kitedoc Type 1 · Well-Known Member

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    Hi again @FingersCrossed ,
    I do hope someone replies soon and glad that your BSLS are improving even though it has taken a 'bucketload' of insulin to get there.!! Could your GP urgently organise a urine test maybe,? I reckon you can prove urgency on the basis of your pregnancy, unstable diabetes and the possibility of a easily tested and treatable condition.
    Then if a urine infection is proven you have a course of action (antibiotics) before the nurse replacement person responds. If there does not appear to be a urine infection at least that delay time has been useful in ruling it out.
    Best Wishes....
     
  5. hboyt

    hboyt Type 1 · Well-Known Member

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    Hi there
    The best thing for me was being in touch weekly with a DSN at my diabetes clinic at the hospital. I never experienced any reduction in insulin requirements, only had a increase and ended up taking 3 times as much in the last weeks! Sounds ridiculous but normal apparently coz pregnancy increases resistance even more. Hope this helps and good luck in your journey ☺
     
  6. FingersCrossed

    FingersCrossed · Active Member

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    Thanks kitedoc. I got an appointment at my docs today but they wouldn't do bloods as I am well in myself. I found that a tad odd, but there you go. They're handing me over to the hospital - where my DSN replacement is still to get back to me. My sugar levels have been around 7 to 8 all day, so I'm hoping I'm cracking this by doubling my daily basal in less than a week and bolusing like crazy.

    Hi hybot - thank you for replying. I was the same when pregnant with my son 5 years ago. I remember near the end being on three times my normal amount of insulin, but I was super low in the first weeks and months. And also I was low a few months back from the 4 to 8 weeks I got to before losing the baby. This just seems crazy, but I'm feeling calmer today that I'm not super high.

    Thanks for replying.
     
  7. eeb123

    eeb123 Type 1 · Active Member

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    Hi @FingersCrossed, I recently changed to Fiasp which is a much quicker acting insulin than novorapid and it seems to have made the world of difference - perhaps ask your DSN if that’s an option in your area?
    Good luck, I know how stressful it is when you’re trying to get levels down xx
     
  8. kitedoc

    kitedoc Type 1 · Well-Known Member

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    But they will do a urine test your doctors and if you have an infection could a blood test not help as well????
     
  9. NicoleC1971

    NicoleC1971 Type 1 · Well-Known Member

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    Hi there and the whole pregnancy with type 1 thing is scary so am sending a hug. I have done it 3 times and each time was different but definitely had some bad spikes in the early days as well as lows due to being terrified of the highs. The stress of being pregnant after miscarriages and also caring for a young child could be makign all the insulin resistance worse so do see if you can manage that aspect in some way. This is much easier said than done but do try and get some time out to relax.
    Once you have ruled out having a UTI then it could just be that you do have a lot of insulin resistance in which case can you ask your dsn about taking metformin in pregnancy? If this isn't allowed then minimising carbohydrates from starches whilst continuing to eat adequate protein, fats and green leafy veg plus berries may be the only option.
    I mention the metformin because I've been type 1 for many years and have been offered it though not whilst pregnant.
    I hope you start to feel back in control soon and get the help you need at this key time in your pregnancy.
     
  10. kitedoc

    kitedoc Type 1 · Well-Known Member

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    Perhaps decline to leave until you have had a urine test. for infection. That is the minimum they can do for you. Just a suggestion !!!!
     
  11. FingersCrossed

    FingersCrossed · Active Member

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    Hi @eeb123 - thanks for that suggestion. I've never heard of Fiasp, but I'll bring this up at next appointment if I'm still struggling. Thank you very much for replying.

    Hi @kitedoc, and thanks again for your support. I had a diabetic dietician call me up today from my local hospital (the nurse at docs passed my details over yesterday). Basically as I've managed to get better control myself, they aren't wanting to do a urine or blood test despite me asking again today as this resistance is odd to me. I've asked her to ask a consultant at the hospital if there's any way they can ok this to rule anything out, and she said she'll call me back to let me know. Seems a lot of fuss just to do a simple few tests to me. I got a bg of 6.1 before bed, was 4.9 at 3am and 4.2 this morning, so I'm much happier. I felt borderline hypo, so I had a 20g carb toffee yogurt and a big orange, waitied 20 mins to bolus to give my sugar levels time to creep up a tad, took 7 units of insulin, but my bg was 12.4 an hour after, so maybe I need to adjust my bolus ratio to 1 unit for every 3gs of carbs. Madness.

    Hi @NicoleC1971 - thanks for your kind words - much appreciated as it's a lonley place at times, firstly people not knowing about the pregnancy, and secondly, people not getting basal/bolus/ratios/and the confusing world of being type 1 on a pump. It's a terrifying thing being pregnant and worrying about misscariage and how sugars impact everything. It's nice to know others have felt the same. We told close family last time two days before I misscarried at eight weeks, but this time we're just seeing how things go and, fingers crossed, we get to 12 weeks, will tell people then. I'd always thought Metformin was just for type 2 diabetics, but I'll keep all of this useful information in mind for my next appointment. I've got a feeling minimising carbs like you say, which I've been doing for a few days and eating lots of greens and protein will be my best bet at the moment. Thanks for taking the time to reply.
     
  12. NicoleC1971

    NicoleC1971 Type 1 · Well-Known Member

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    I am on here loads so feel free to message me anytime. Metformin is first line for type 2 but I have been offered it as a type 1. Because there are type 2s who take it and have babies I am fairly sure it is safe but obviously one for the DSN/Doc. Hoping all goes well for you and yours. Also as you've had miscarriages in the past could you request a 9 week scan to reassure you?
     
  13. FingersCrossed

    FingersCrossed · Active Member

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    Hi @NicoleC1971 - thank you, that's very sweet of you. I've had a couple of good days' control, followed by the beginning of a lower spell today (4 hypos today so far). It's a rollercoaster. Mind you, I feel much happier having mild hypos (3.5 at lowest) than constant highs that won't respond to crazy amounts of insulin.

    I've got a scan booked in for 11th July (if I make it that far) which would make me 7+3 weeks pregnant. I'm worried because what happened last time but trying to take each day as it comes. Only thing I can control (to some extent) is my diabetes so I'm focussing on that and day-to-day life.

    Thanks again for your support.
     
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  14. kitedoc

    kitedoc Type 1 · Well-Known Member

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    Hi again @FingersCrossed So glad to here you have tamed the sugar rises !!
    Best Wishes for the scan and your continuing pregnancy !!:):):)
     
  15. FingersCrossed

    FingersCrossed · Active Member

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    Hi @kitedoc - thank you for the good wishes.

    I've been having loads of hypos this last week (probably heat and hormones) so my total basal has reduced from 98 units in 24 hours to 74 units. It's gone from one extreme to the other in the space of two weeks - really odd.

    Last night I had a hypo at midnight and again at 4am, so I've reduced my basal again tonight and bought a fan as I desperately need a good night's sleep. This heat is killing me.

    I've got a scan on Monday when (hopefully if nothing happens in the meantime) I'll be 8+1 weeks along. I keep on thinking "imagine if that crazy insulin resistance was because I'm expecting twins" but then I remind myself to take every day as it comes as I know all too well how things can develop.

    Take care and thanks again for replying.
     
  16. kitedoc

    kitedoc Type 1 · Well-Known Member

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    Hi @FingersCrossed,
    It sounds like a really rough ride on a hyperloop !!(just imagining, Elon Musk would no doubt be complaining and expecting his engineers to fix the darned thing asap) !!
    Please check with your diabetes doctor about adjustments. My personal rule of thumb is 20%.+, depending on how things are going. Your adjustment may well be different but I hate to think of you suffering from too little or too much adjustment of insulin. !! Best Wishes for the scan result !! Toes and fingers crossed.
     
  17. FingersCrossed

    FingersCrossed · Active Member

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    Thanks again for your support. I had a scan today and they seen a baby and heartbeat (measuring at 7+5 weeks but I think I'm 8+1 weeks). I'm relieved but still worried and just wanting to be under the radar for a few weeks and keep my control as good as I can. I looked on my graphs on my meter yesterday which is linked to my pump and for 75 percent of the time my bg is 8 or under and over that the rest. Mind you, often that's just 8.5 or a random 10 etc. It's really tough to control in pregnancy and I panic every time I get a high, but I'm acting fast and trying to stay calm. It's nice to know others on here have felt exactly the same.
     
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  18. NicoleC1971

    NicoleC1971 Type 1 · Well-Known Member

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    Thank you for the update. Isn't it amazing they can measure something so tiny. An error of 1 week could be attributed to not knowing when you actually conceived given that the standard dating method is 1st day of last period and conception occurs at about 2 weeks after that. Hope you do make it to the 9 week mark. As you say Fingers Crossed!
     
  19. FingersCrossed

    FingersCrossed · Active Member

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    Thanks @NicoleC1971 - Yes, it's so clever how they can measure something so little. At my first scan with my little boy who's now 4.5 years old, he was 3.3mm at 5+5 weeks. Now I know how lucky I was to have found such a pounding heartbeat at such an early stage of pregnancy. I feel I've lost my innocence with my misscariage 3 months ago, so I'm much more measured and guarded now. I'm pleased about today, a little drained, but happy. It measured 13mm and I suppose it's only measuring three days earlier than my dates tell me, and for my misscariage 3 months ago the dates were around two weeks out, which might have been because the poor thing wasn't growing right. Thanks for your good wishes. I hope you are well too.
     
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  20. FingersCrossed

    FingersCrossed · Active Member

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    Hi there, just a quick update to say I'm 13 weeks pregnant today and all looked good yesterday - touch wood - at my dating scan. Massive phew, for now anyway.

    I'm continuing to have loads of hypos, thankfully less through the night and more through the day, but I'm trying to sort this. I was given a Libre sensor for continuous monitoring yesterday so I'm over the moon and hoping this will help me spot trends etc. I was excited I could use an app on my phone to scan it, but it's not letting me do this right now. Anyone else know how to add a device on the Libre? It's saying I needed to have scanned app within the first hour or setting it up with the sensor, which I didn't, but there's no option to add the app. I'm just getting a pretty unhelpful error message.

    Hopefully the teething problems will settle and I can start getting my sugars a bit more steady. My HbA1C was 48, 6.5% ish, so I'm happy with that, just could do without as many hypos.
     
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