2nd pregnancy and blood highs during the night/morning

[mrsnnm]

@mrsnnm A pump would sort out that DP. However, if you don’t want one, or, at least, don’t want to change to one during pregnancy, then you could tentatively try an increase in your evening Levemir. You could also consider setting an alarm to bolus as the rise starts. If you did that, then you’d need to start with a tiny dose until you got an idea of how you reacted.

In one of my pregnancies (I’ve had three) I got some strange results overnight despite wearing a pump. I also didn’t have a CGM, so I’d set an alarm to test and eat or correct as needed. Yes, it’s a pain having to get up each night but I found it helped not only my control but my mental health too, and thus my sleep.

I too had to look twice at your ratios as I do 1 unit to Xg carbs. It’s honestly a lot easier to do it that way and makes working out changes simpler too. It looks like you already have a fair degree of pregnancy-related insulin resistance.

If you’re really unhappy with your pregnancy team, is there another hospital you could transfer to? I found all my care excellent.

I increased my Levemir last night by 2 units but noticed it didn't have much of an effect. I woke up during the night as I don't feel 100% and slowly injected basal at 2am I think and then again at 5am. Overall it was alot less correction dose - 7 units in total compared to the usual 13 units.

I've looked into moving hospitals but the reviews for diabetic maternity care are even worse than the one I am at. I've been assigned a midwife at the hospital who phoned me yesterday and she seems more understanding and less invasive. Like she wants to help so I'm hoping that continues. I might ask to see her more as its a shame that I had fantastic care with my son when I was pregnant with him. But we're in a different location now.

 

[mrsnnm]

It would be a valid reason not to want to change during pregnancy. It’s a very stressful time with Type 1 anyway.

@rebrascora I don’t think Lantus is approved/advised during pregnancy. Studies have suggested effects on the foetus’s growth. So I imagine that’s why the change to Levemir happened.

Yes I'm just worried, what if it doesn't work out, I'm messing around with the health of my baby.

Yes when I was pregnant with my son, I was advised to switch to levemir for the same reasons as you mentioned.

 

[mrsnnm]

If you use Dexcom and have an account you can also get access to more data via either online or their Dexcom clarity app - https://clarity.dexcom.eu/

There's allsorts of useful reports. See if you can get on there and have a look at patterns. The app is useful too for patterns as it shows 2 days, 7 days, then I think 14 and last month, and tells you if there is a trend.

Would i be able to use clarity with the dexcom one +? As in my last pregnancy as I was on dexcom g6 or 7 I think, so was easy to connect to clarity.

 

[mrsnnm]

This was my graph last night, so I'm thinking to increase Levemir again and decrease my dinner ratio, as i dropped a couple of times before this too.

 

[PhoebeC]

Hi @mrsnnm I have also been told to follow the 3 day adjustment guidance. Especially with background insulin. It's up to you but I would wait a few days before increasing again.

On changing from MDI to pumps in my experience it was a smooth transition, within a week my TIR and quality of life was vastly better and I wondered why I hadn't done it before. It is completely your choice and understand the added stress is not needed at this time. But for me it was no stress once I had made the change.

 

[rebrascora]

I would be cautious of changing too many things at once, so maybe hang fire on that change of ratio but be prepared to top up with a few carbs if you drop after your evening meal again. You said that you are struggling to eat, so maybe it isn't a bad thing to have a snack sometime after your evening meal.
It is best to just change one thing at once when you are adjusting insulin so that you can see the effect. If you make more than one change it is difficult to see what causes what.

I assume/hope you meant that you injected bolus insulin (ie corrections with fast acting insulin) twice through the night and not "basal" and that was just a typo? Easily done.

Have your meal ratios always been as you quoted them ie before pregnancy or have they been increased to what they are now during the pregnancy?

 

[mrsnnm]

Hi @mrsnnm I have also been told to follow the 3 day adjustment guidance. Especially with background insulin. It's up to you but I would wait a few days before increasing again.

On changing from MDI to pumps in my experience it was a smooth transition, within a week my TIR and quality of life was vastly better and I wondered why I hadn't done it before. It is completely your choice and understand the added stress is not needed at this time. But for me it was no stress once I had made the change.

I hear what you're saying with the adjustments thankyou. I think I'm just trying to get everything perfect.

Ohhh really? It's so lovely to hear such positivity with the pumps, I'll definitely consider. Was it easy to get your head around?

 

[mrsnnm]

I would be cautious of changing too many things at once, so maybe hang fire on that change of ratio but be prepared to top up with a few carbs if you drop after your evening meal again. You said that you are struggling to eat, so maybe it isn't a bad thing to have a snack sometime after your evening meal.
It is best to just change one thing at once when you are adjusting insulin so that you can see the effect. If you make more than one change it is difficult to see what causes what.

I assume/hope you meant that you injected bolus insulin (ie corrections with fast acting insulin) twice through the night and not "basal" and that was just a typo? Easily done.

Have your meal ratios always been as you quoted them ie before pregnancy or have they been increased to what they are now during the pregnancy?

I hear what you're saying with changing my Levemir and meal ratio at the same time. I think I'm feeling the stress and wanted to make sure all was okay

Yes I'm so sorry, didn't realise there was a typo. I always correct with my short acting insulin Apidra

No they've increased, especially breakfast. That's been the biggest increase, before I was on around 2.5:1 with breakfast and before with lunch and dinner around 2/2
5:1

 

[rebrascora]

I can understand you must feel quite stressed about all this especially when you are pregnant but taking a slower more methodical approach will help in the long run. You say it has been like this for 10 weeks so don't expect to fix it in 2 days and certainly don't expect perfection or try to achieve perfection as that is where madness lies. None of us achieve perfection, even when not pregnant so go easy on your self and look for the small wins. I would say that graph looks quite a bit better than the previous one but obviously you did 2 corrections through the night which will have helped it.
When you get close to the correct basal dose things can change quite significantly and you don't want things suddenly swinging the other way and have nasty hypos or start a rollercoaster of highs and lows as that can be really hard work both to treat but also emotionally. One step at a time is the way to approach it, but your overnight corrections were obviously good decisions, so well done on those.

 

[mrsnnm]

I can understand you must feel quite stressed about all this especially when you are pregnant but taking a slower more methodical approach will help in the long run. You say it has been like this for 10 weeks so don't expect to fix it in 2 days and certainly don't expect perfection or try to achieve perfection as that is where madness lies. None of us achieve perfection, even when not pregnant so go easy on your self and look for the small wins. I would say that graph looks quite a bit better than the previous one but obviously you did 2 corrections through the night which will have helped it.
When you get close to the correct basal dose things can change quite significantly and you don't want things suddenly swinging the other way and have nasty hypos or start a rollercoaster of highs and lows as that can be really hard work both to treat but also emotionally. One step at a time is the way to approach it, but your overnight corrections were obviously good decisions, so well done on those.

Thankyou so much for your advice lovely, i really appreciate it, you are 100% right

I hear you entirely thankyou

Awww thankyou so much, I really appreciate it

 

[PhoebeC]

Ohhh really? It's so lovely to hear such positivity with the pumps, I'll definitely consider. Was it easy to get your head around?

Yes for me it was very easy, a set up day with the supplier, and the DSN team, other T1s. I did my research in advance when choosing pumps, when I knew which one I would be using.
If the team are pushing you towards it then perhaps they feel more able to help you that way and their support would be better. Maybe ask about the process and support next appointment. Also there is after baby, that time was crazy from what a remember, a pump would have been great then.
They don't fit everything but I has really helped me.

And yes as @rebrascora said small changes, 1 at a time, over a few days, don't rush and end up with a different problem.
The background change makes sense, well done on that, just be patient when making changes.

 

[mrsnnm]

Yes for me it was very easy, a set up day with the supplier, and the DSN team, other T1s. I did my research in advance when choosing pumps, when I knew which one I would be using.
If the team are pushing you towards it then perhaps they feel more able to help you that way and their support would be better. Maybe ask about the process and support next appointment. Also there is after baby, that time was crazy from what a remember, a pump would have been great then.

That's amazing to hear! I think they want me to use the closed loop circuit pump beginning with y...I can't remember exactly what it's called.

That's very true. I just don't appreciate the way they've gone about it like when I've asked for advice for the current problem, the immediate response has been pump, instead of saying, oh in the meantime try this.

Yes, after I had my son, I had multiple lows per day. Like honestly easily above 7, it was alot. Do you find the pump has been helpful for you as a mum?

 

[PhoebeC]

Yes, after I had my son, I had multiple lows per day. Like honestly easily above 7, it was alot. Do you find the pump has been helpful for you as a mum?

My daughter is now 14 so its less care at that age. It would have made a difference I can say that.
I had a horrible pregnancy, birth and afterwards.

To be honest my NHS care was rubbish until I moved to a different NHS area in 2019, since then my care and health have vastly improved.

I do wonder if id have access then to the tech and support I have now how different that pregnancy would have been, and if we would have had more children.

When I had my sterlisation last year, I really didn't want to go on the sliding scale, or have anyone else manage my diabetes. I kept my CGM and pump on during the operation I had explained to the doctors what to do if needed. I managed my diabetes, they monitored while I was out and coming round, nobody needed to do anything, no sliding scale, once I was fully back awake I took back over. I then managed it completely in my recovery and my diabetes behaved during my healing/recovery. It was completely different to substations before, I was in control, it was all stable. I do believe these things allow us to heal better, feel mentally better. This is a game changer in my opinion.

 

[mrsnnm]

My daughter is now 14 so its less care at that age. It would have made a difference I can say that.
I had a horrible pregnancy, birth and afterwards.

To be honest my NHS care was rubbish until I moved to a different NHS area in 2019, since then my care and health have vastly improved.

I do wonder if id have access then to the tech and support I have now how different that pregnancy would have been, and if we would have had more children.

When I had my sterlisation last year, I really didn't want to go on the sliding scale, or have anyone else manage my diabetes. I kept my CGM and pump on during the operation I had explained to the doctors what to do if needed. I managed my diabetes, they monitored while I was out and coming round, nobody needed to do anything, no sliding scale, once I was fully back awake I took back over. I then managed it completely in my recovery and my diabetes behaved during my healing/recovery. It was completely different to substations before, I was in control, it was all stable. I do believe these things allow us to heal better, feel mentally better. This is a game changer in my opinion.

I'm so sorry to hear you had a horrible pregnancy, birth and after birth do you think it was coz of your diabetes at the time?

I'm so glad you're receiving better NHS care now.

Your story is honestly so enlightening and positive ✨️ I'm so glad it worked for you. I am definitely considering. I think it's hard to make the change and I don't want it to be more stressful.

 

[PhoebeC]

I'm so sorry to hear you had a horrible pregnancy, birth and after birth do you think it was coz of your diabetes at the time?

Yes, definitely.

 

[Inka]

I increased my Levemir last night by 2 units but noticed it didn't have much of an effect. I woke up during the night as I don't feel 100% and slowly injected basal at 2am I think and then again at 5am. Overall it was alot less correction dose - 7 units in total compared to the usual 13 units.

Hopefully that was a typo @mrsnnm and you meant that you injected your bolus at 2am and 5am? Your basal dose will probably increase quite a lot in the second half of pregnancy. Although you didn’t see much difference with an extra 2 units of Lev, it’s better to increase it gradually over a few days rather than make a big change. As said above, change one thing at a time and try to get that as right as possible. Don’t worry about getting it perfect as things will change again very soon.

Don’t try to solve your DP with basal increases as that could lead to nasty hypos earlier in the night. The best solution is a pump (I’ve programmed mine so that it stops the DP) and second best is probably to wake to correct.

 

[trophywench]

The pump beginning with a Y - the Ypsopump, used with CamAps and Libre3 to closed loop. Myself and Patti both get on great with it, however Lauren who like yourself is pregnant did not find it so and was allowed to swap back to the pump she was OK with pre preg. (Patti and I are both well beyond the menopause so not hindered with the vast hormonal changes and strict BG requirements of pregnancy)

 

[mrsnnm]

I increased my Levemir last night by 2 units but noticed it didn't have much of an effect. I woke up during the night as I don't feel 100% and slowly injected basal at 2am I think and then again at 5am. Overall it was alot less correction dose - 7 units in total compared to the usual 13 units.

Hopefully that was a typo @mrsnnm and you meant that you injected your bolus at 2am and 5am? Your basal dose will probably increase quite a lot in the second half of pregnancy. Although you didn’t see much difference with an extra 2 units of Lev, it’s better to increase it gradually over a few days rather than make a big change. As said above, change one thing at a time and try to get that as right as possible. Don’t worry about getting it perfect as things will change again very soon.

Don’t try to solve your DP with basal increases as that could lead to nasty hypos earlier in the night. The best solution is a pump (I’ve programmed mine so that it stops the DP) and second best is probably to wake to correct.

Hey there, yes I mentioned to @rebraon here that it was a typo. Im really sorry if I caused any confusion or offence here. I was super tired. Yes I've kept my Levemir at 11 units and it worked well last night, just had to inject 4 units of short acting at 5am.

Looking at my graphs, I'm now unsure if it is a dp, as it did rise consistently throughout the night rather than a spike.

 

[mrsnnm]

The pump beginning with a Y - the Ypsopump, used with CamAps and Libre3 to closed loop. Myself and Patti both get on great with it, however Lauren who like yourself is pregnant did not find it so and was allowed to swap back to the pump she was OK with pre preg. (Patti and I are both well beyond the menopause so not hindered with the vast hormonal changes and strict BG requirements of pregnancy)

Yes that is the one as they mentioned about the Libre 3 with it and the CamAps. Ahhh that is so interesting to hear about how it didn't work for a lady who is pregnant. I'll definitely bear this in mind too. Yes it is really strict requirements in pregnancy, I'm hoping I'm slowly getting there as I'm noticing small changes so far which is good. One being I'm not correcting high numbers of short acting insulin like before which was 13 units. Most I've done since Levemir increase is 5 units short acting as a correction

 

[Inka]

No need to apologise at all @mrsnnm 🙂 I don’t remember when exactly I increased my basal during pregnancy. I did it in little steps, but I do know most of the increase was in the 2nd half. By the end of my last pregnancy, my basal had almost quadrupled!