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What am I doing wrong? Insulin.

M

mdsremos

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14
Morning, I'm hoping someone can please give me some advice.
I am 23 weeks with gestational diabetes which has been insulin controlled from 13 weeks (Xmas Eve). I have Metformin SR 500mg morning and evening with Novarapid before each meal. I currently have 15 units before breakfast/14 units before lunch/18 units before tea which are in relation to my 1hr post meal numbers which currently are not within target and I am increasing by 1-2 units every 2-3 days when I have 2 consecutive over target numbers.
This morning I FINALY got a 7.6 (UK target is below 7.8 for pregnancy) having had weetabix for breakast...pre-breakfast 5.0, ate at 7.50am, post breakfast 9am 7.6 - HYPO 2.6 at 10.20am completely out of the blue!
I know I have to snack between meals but I feel like I have to constantly graze to prevent a hypo (some are more noticable coming on than others) but at my current stage of pregnancy I am not hungry and eating for the sake of it but meals such as a simple slice of buttered toast or a lunch of a tuna/mayo sandwich take my post meals well over the target....I am so fed up :(
 
I'm T1, so things might be a little bit different, but the principles are likely to be the same - my thoughts here...

Presumably your doses are fixed so there's no actual carb counting happening here?

Apologies if this is already super obvious to you, but in a very brief nutshell, the insulin you inject counteracts the effect of the carbohydrates that you eat on your blood glucose levels.

Not all carbs are equal, however - 10g carbs in, say, ribena and 10g carbs in, say, chocolate won't have exactly the same effect on your blood glucose.

Ultimately, they will make your blood glucose rise by the same amount, but the ribena will do it a lot more quickly than the chocolate.
Sadly, you can't make your injected insulin match the timings, only the ultimate effect, so that, whilst you theoretically need the same amount of insulin for these two examples, you won't see the same short term effect. The ribena would be likely to *spike* your blood glucose after drinking it, as the action of the carb is faster than the action of the insulin. Ultimately, as the insulin effect kicks in, your blood glucose will drop again.
The chocolate, on the other hand, will affect the blood glucose more slowly, so may match the action of the insulin a bit better and the spike will be gone or less.

I suspect that your weetabix example is (partially, at least) explained by this. Weetabix (and lots of cereals) would make my blood glucose spike, as it is reasonably fast acting for me.
To counteract this, you have taken more insulin, which has worked in the short term, but means that ultimately you have more insulin than is needed for the carbs, so you are having to eat to avoid hypos.

It's not very easy to avoid this - some strategies are either to eat slower acting carbs (there are some Glycaemic Index lists knocking around the Internet which provide a general idea of which things are faster/slower) or (I do this, but it can be a bit scary and takes trial and error) inject your insulin a bit longer before you eat, so that the peak of the insulin action will coincide with the peak action of the carbs on your blood glucose.

Or just don't worry too much that you're having to "feed" your insulin, as long as it's working. It would be different if you were going to be doing it forever, but hopefully in your case, it should be temporary!
 
They are giving you a 1 hr post meal target of 7.6? That's pretty tight to be honest. 7.6 after 2 hours would be a lot easier to achieve.

I am sure your concerned to get the best for your baby, but also don't worry about it too much. You might want to read around the Internet on gestational diabetes... let's just say there are different opinions on how serious it is (or isn't).

(ahem or whether it's made up by doctors who don't understand it's a normal part of pregnancy for many women ahem)
 
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