Please please please may someone give me advice. Since I was 11 weeks pregnant, now 21 weeks, my blood sugars have ran high from around 3am until I wake at 6, highest being 16mml. The hospital team I'm under have been useless to say the least - saying oh keep doing what you're doing and look at an insulin pump. I've been giving myself a correction dose every morning of around 12- 16 units. My levemir at night is now 9 units and in the morning it is 9 units too. I'm really stressed out and feeling really down about this. I have not received the same level of care like I did with my first pregnancy. My hospital appts are every 3-4 weeks, rather than every week like my first. Please any advice??? Do I keep increasing my levemir at night? Been a type 1 for the last 15 years and have encountered nothing like this
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2nd pregnancy and blood highs during the night/morning
- Thread starter mrsnnm
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Inka
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What time do you take your evening Levemir @mrsnnm ? What time do you eat your evening meal? And what’s your blood sugar before bed? Do you have a CGM and what does your overnight line look like? Could this be Dawn Phenomenon and did you have DP prior to pregnancy? Finally, what were your pre-pregnancy Levemir doses?
Hey lovely, i take my levemir at 10pm and my evening meal is quite early as I look after our toddler so usually around 5 or 6pm. Before bed, my sugars are between 6 and 8 mmol. I do have a cgm, and honestly, it looks like it spikes upwards from 2pm but will remain on the number before bed before this. I had DP very early on in my diabetic diagnosis but nothing like this. I was on one dose of Lantus before pregnancy (24 units). Put on split Levemir at 11 weeks.
trophywench
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So you're still on nowhere near as much Levemir as you were Lantus, even though your body is trying to cope with more stress, ie your pregnancy. Firstly, for starters I'd try an extra unit of Levemir at 10pm and see exactly what that does to your overnight graph.
Then I'm gobsmacked at the vast amount of Novorapid you say you are jabbing as a correction dose. What on earth is your normal insulin to carb ratio? How much insulin per 10g of carbs?
Then I'm gobsmacked at the vast amount of Novorapid you say you are jabbing as a correction dose. What on earth is your normal insulin to carb ratio? How much insulin per 10g of carbs?
rebrascora
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Have they been encouraging you to increase your evening Levemir or given you advice about when to increase it if you are not able to contact them regularly. Ie. Some sort of protocol, like increasing it by 10% if you are high for more than 3 days.
It seems this problem has gone on rather a long time (10 weeks), particularly during a pregnancy.
I adjust my evening Levemir on a near nightly basis depending upon what I have done during the day activity wise. The great thing about it is that it is really flexible and will respond in real time rather than take days for any adjustment to fully kick in, so you can always adjust it back the next night if you get it wrong. Keeping a close eye on your levels via CGM is really important so that you can assess how the adjustment has worked and if you maybe need to adjust it more until you find a better balance.
When do you inject your morning dose and your bolus insulin for breakfast? I find it really helpful to inject as soon as I wake up and before I get out of bed so that morning insulin gets as much of a head start as possible before my feet touch the floor. I appreciate as a pregnant lady a visit to the bathroom might be something that is more urgent but then I would take my insulin with me and inject in the bathroom..... I keep my pens in their case under my pillow so it is the very first task of the day after switching the alarm off and scanning my Libre. The sooner I get than insulin in, the sooner it starts working and stopping my levels from going higher.
Anyway, those are just my thoughts as someone who uses Levemir and absolutely loves it and it's flexibility but I confess I have never been pregnant, so can only comment from a general use of Levemir perspective.
Good luck finding a strategy that helps you manage the problem.
Another thought..... if you eat really early, a bedtime snack which is slow release can sometimes calm the excessive release of glucose by the liver in the early hours, so maybe a slice of seedy granary bread with cheese or peanut butter (not sure if either of those suggestions are suitable during pregnancy or a couple of digestive biscuits bolused for, if your levels are stable in the 6s and 7s might work to settle your liver down a bit overnight. The longer the liver goes without food the more likely it is to think you are starving and release more glucose, so topping up a bit before bed can help for some people.
It seems this problem has gone on rather a long time (10 weeks), particularly during a pregnancy.
I adjust my evening Levemir on a near nightly basis depending upon what I have done during the day activity wise. The great thing about it is that it is really flexible and will respond in real time rather than take days for any adjustment to fully kick in, so you can always adjust it back the next night if you get it wrong. Keeping a close eye on your levels via CGM is really important so that you can assess how the adjustment has worked and if you maybe need to adjust it more until you find a better balance.
When do you inject your morning dose and your bolus insulin for breakfast? I find it really helpful to inject as soon as I wake up and before I get out of bed so that morning insulin gets as much of a head start as possible before my feet touch the floor. I appreciate as a pregnant lady a visit to the bathroom might be something that is more urgent but then I would take my insulin with me and inject in the bathroom..... I keep my pens in their case under my pillow so it is the very first task of the day after switching the alarm off and scanning my Libre. The sooner I get than insulin in, the sooner it starts working and stopping my levels from going higher.
Anyway, those are just my thoughts as someone who uses Levemir and absolutely loves it and it's flexibility but I confess I have never been pregnant, so can only comment from a general use of Levemir perspective.
Good luck finding a strategy that helps you manage the problem.
Another thought..... if you eat really early, a bedtime snack which is slow release can sometimes calm the excessive release of glucose by the liver in the early hours, so maybe a slice of seedy granary bread with cheese or peanut butter (not sure if either of those suggestions are suitable during pregnancy or a couple of digestive biscuits bolused for, if your levels are stable in the 6s and 7s might work to settle your liver down a bit overnight. The longer the liver goes without food the more likely it is to think you are starving and release more glucose, so topping up a bit before bed can help for some people.
Not at all. I was going to add another 2 units of Levemir tonight. Yes I'm on Apidra so because I'm waking up so high, my usual correction dose of 4 units wasn't doing anything at all. My values are 4:1 breakfast, 2.5/3:1 lunch and dinner 3:1
To be honest no they haven't. They know what I've been doing and kept saying to do what I've been doing whilst saying an insulin pump would be better. I honestly feel neglected and very dismissed in this pregnancy so I've been trying to do this all myself.
I completely agree with the cgm monitoring. I have been but i find it's been an ongoing loop. It's been very tough
Thankyou so much, I appreciate your advice.
I definitely need to eat more. I've been struggling with the demands of parenting and ongoing sickness but I will definitely have something to eat before bed, thankyou
rebrascora
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Just to clarify, are those insulin:carb ratios or carb:insulin ratios. What I mean is for breakfast.... do you take 4 units of insulin for every gram of carbs
OR
1 unit of insulin for every 4g of carbs?
OR
1 unit of insulin for every 4g of carbs?
Sorry for not being clear so 4 units of insulin to every 10g carbs for breakfast. Lunch is 3 units of insulin to 10g carbs and near enough same with dinner
rebrascora
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Ah, so old school Carb Portions!
Must confess I was a bit concerned that you must be suffering huge insulin resistance using 4 units for every single gram of carbs!
Generally the advice is increase in 10% increments which would be 1 extra unit of Levemir on an evening if you currently take 9 units, so maybe try that tonight and see how that works for a couple of nights and then increase it again as necessary.
I am really sorry that you are feeling so unsupported. It sounds like they have spat the dummy out because you are not on a pump, which is a very unprofessional response and starting a pump during pregnancy must be quite a daunting prospect as there is such a lot to learn. It sounds like they have changed your basal insulin to Levemir instead though and then not given you the support you need and whilst Levemir is a fab basal in my opinion, it can be quite a big change and learning to adjust it to what you need takes time. Add in pregnancy hormones and the pressure to meet pregnancy BG targets and it must be equally daunting. Hopefully you can make some small steady changes which will improve things. I think my advice would be, don't be frightened to experiment, but do always keep one eye on safety, so keep changes small initially until you see how your body responds.
I know there is a strong tendency for them to start people on an even split of Levemir but it is probably quite uncommon to actually need the same dose morning and evening. My needs are the opposite of you in that I need a large dose in the morning.... currently 22 units but only a very small dose at night or sometimes even none if I have been very active. I have had a couple of inactive days recently so I jabbed 5units last night, up from 3.5 the night before which I am pleased to say were pretty much spot on educated guesses..... I don't always get it right, but just wanted you to know that it has that flexibility once you understand how it works and how your body responds to different circumstances like exercise and in your case most likely hormonal changes.
If you want to post some of your daily graphs we can perhaps give you a few pointers as to what we might do if we were trying to improve them for ourselves.
Hope a little supper snack with cautious bolus helps to settle your liver down a bit.
Must confess I was a bit concerned that you must be suffering huge insulin resistance using 4 units for every single gram of carbs!
Generally the advice is increase in 10% increments which would be 1 extra unit of Levemir on an evening if you currently take 9 units, so maybe try that tonight and see how that works for a couple of nights and then increase it again as necessary.
I am really sorry that you are feeling so unsupported. It sounds like they have spat the dummy out because you are not on a pump, which is a very unprofessional response and starting a pump during pregnancy must be quite a daunting prospect as there is such a lot to learn. It sounds like they have changed your basal insulin to Levemir instead though and then not given you the support you need and whilst Levemir is a fab basal in my opinion, it can be quite a big change and learning to adjust it to what you need takes time. Add in pregnancy hormones and the pressure to meet pregnancy BG targets and it must be equally daunting. Hopefully you can make some small steady changes which will improve things. I think my advice would be, don't be frightened to experiment, but do always keep one eye on safety, so keep changes small initially until you see how your body responds.
I know there is a strong tendency for them to start people on an even split of Levemir but it is probably quite uncommon to actually need the same dose morning and evening. My needs are the opposite of you in that I need a large dose in the morning.... currently 22 units but only a very small dose at night or sometimes even none if I have been very active. I have had a couple of inactive days recently so I jabbed 5units last night, up from 3.5 the night before which I am pleased to say were pretty much spot on educated guesses..... I don't always get it right, but just wanted you to know that it has that flexibility once you understand how it works and how your body responds to different circumstances like exercise and in your case most likely hormonal changes.
If you want to post some of your daily graphs we can perhaps give you a few pointers as to what we might do if we were trying to improve them for ourselves.
Hope a little supper snack with cautious bolus helps to settle your liver down a bit.
Yes sorry, i was diagnosed at 18 so pretty much 15 years now so when I was referred to DAFNE, I learnt the ratio as 3:1 etc
I will do most definitely. I'll keep increasing as the concern before was i was dropping low middle of the night and it seemed to rebound into a high but that is not happening anymore so before I was reluctant to increase Levemir whereas now it is definitely needed in my opinion.
Yes I completely agree. I've noticed everytime I've reached out for support over this it's the same line of "oh we are not sure. Just continue what you're doing but an insulin pump will be better". So reluctantly I gave in feeling like this is the only way they'll help me, then I have been messed about with the delivery of the pump, and the training being cancelled so I told them that I will not continue to feel pressurised. Exactly that, it's already daunting learning something new but I didn't want to do that in pregnancy. With Levemir, they didn't suggest it. I asked them to be placed on Levemir as it worked really well for me in my first pregnancy with my son so I thought it would have the same effect. It has during the day but night time/early morning is still a huge battle. I'm looking at placing a formal complaint against the hospital to be honest as they've been rude face to face aswell at my appointments.
Originally my night time levemir was higher than the day, but with everything going on, I've been just adding and subtracting the units myself so now it's even keel for night and day. Ahhh I have heard mixed things with the Levemir requirements for type 1s, so yes our requirements are opposite. How have you been finding your sugars during the day?
I will definitely post last night's graph and the night before, thankyou so much ❤️
And fingers crossed lovely
rebrascora
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My daytime levels are mostly really good and my daytime dose is pretty stable at 22 units as soon as I wake up but my night time dose needs a lot of adjustment as I am prone to nocturnal hypos if I do lots of exercise/activity on consecutive days so I have to give a bit of thought to my evening dose most nights. I love that Levemir allows me to do that. I average 85-90% TIR sometimes I can get up to 95% but happy between 80 and 90%.
I did a little experiment last summer where I stopped my L and just injected my bolus insulin every couple of hours to crudely simulate what a pump does and it was really interesting. I could usually get away with just waking up once during the night to inject a couple of units of Fiasp to keep me in range and a couple of units every 2 hours during the day. After 10 days I gradually reintroduced Levemir thinking I might manage to get my split a bit less uneven, but it went back to the same split as before. It was a really interesting experiment and I documented it on the forum including my daily graphs and how much insulin and how often I injected. I think I was injecting about 10-12 times a day but my total insulin usage dropped about 20% doing it. I basically have my high alarm set at 8.2 and I injected 2 units every time my alarm went off. I follow a low carb way of eating which made it all easier in my opinion because my levels don't normally spike much after meals so I don't get high alarms very often. Anyway, I am definitely not suggesting you or anyone else do that but just highlighting how interesting it is to assess basal needs and how different people's needs are.
Your insulin:carb ratios are higher than mine and I do wonder if your bolus insulin might perhaps be propping up a basal insulin deficiency during the day. I generally use a very rough 1:10 ratio but because I don't eat a lot of carbs I can't be too far out, so I don't worry about being exact or even carb counting to any great extent. I don't weigh or even really really measure much anymore. I think of a number and then correct later if the high alarm goes off. It takes a lot of the mental strain out of my diabetes management but I do inject more frequently than the typical 5 times a day.
I did a little experiment last summer where I stopped my L and just injected my bolus insulin every couple of hours to crudely simulate what a pump does and it was really interesting. I could usually get away with just waking up once during the night to inject a couple of units of Fiasp to keep me in range and a couple of units every 2 hours during the day. After 10 days I gradually reintroduced Levemir thinking I might manage to get my split a bit less uneven, but it went back to the same split as before. It was a really interesting experiment and I documented it on the forum including my daily graphs and how much insulin and how often I injected. I think I was injecting about 10-12 times a day but my total insulin usage dropped about 20% doing it. I basically have my high alarm set at 8.2 and I injected 2 units every time my alarm went off. I follow a low carb way of eating which made it all easier in my opinion because my levels don't normally spike much after meals so I don't get high alarms very often. Anyway, I am definitely not suggesting you or anyone else do that but just highlighting how interesting it is to assess basal needs and how different people's needs are.
Your insulin:carb ratios are higher than mine and I do wonder if your bolus insulin might perhaps be propping up a basal insulin deficiency during the day. I generally use a very rough 1:10 ratio but because I don't eat a lot of carbs I can't be too far out, so I don't worry about being exact or even carb counting to any great extent. I don't weigh or even really really measure much anymore. I think of a number and then correct later if the high alarm goes off. It takes a lot of the mental strain out of my diabetes management but I do inject more frequently than the typical 5 times a day.
rebrascora
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That is a very clear upward trend on your overnight graph so if that is consistent over several days then definitely looks like a Levemir increase would help.
I suspect the suggestion for a pump is because it can help where you have different basal needs at different times of the day and they are assuming the problem is Dawn Phenomenon.
Please bear in mind (like most on the forum), I have no medical training so only going from my personal experience of T1. (I have no experience of pregnancy.) Your Libre graph suggests your BG is constantly rising rather than spiking at 3 or 4am which, to me, suggests you need more basal all night than needing to deal with DP.
However, do you have a reason for not wanting a pump?
I resisted being attached 24 hours a day for many years. Now, I wouldn't want to go back to MDI. My pump give sme much more freedom and is much easier to make changes to my doses.
I realise everyone is different but it might be worthwhile considering.
Good luck.
Please bear in mind (like most on the forum), I have no medical training so only going from my personal experience of T1. (I have no experience of pregnancy.) Your Libre graph suggests your BG is constantly rising rather than spiking at 3 or 4am which, to me, suggests you need more basal all night than needing to deal with DP.
However, do you have a reason for not wanting a pump?
I resisted being attached 24 hours a day for many years. Now, I wouldn't want to go back to MDI. My pump give sme much more freedom and is much easier to make changes to my doses.
I realise everyone is different but it might be worthwhile considering.
Good luck.
Inka
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@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.
Inka
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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.
PhoebeC
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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.
That is really interesting about the short acting insulin over the Levemir. I increased my Levemir last night from 9 to 11 units. It had some effect but not much so I will increase again tonight. I was so shattered and emotionally tired yesterday that I was in bed by 8pm after I put my son down. With my ratios, I'm going to adjust dinner today as I've noticed, I'm having consistent lows after dinner.
I completely agree, I increased my Levemir last night, it didn't make much of a difference so I will increase again tonight. I also feel the fact I'm having a few lows after dinner is not helping either so I'm going to lower the ratio for dinner too.
Honestly with the pump, I know it's a huge change and my worry is what happens if it doesn't work out for me, just more stress in this pregnancy that I don't need. I am happy to consider if I'm experiencing problems still.
Thankyou so much