Hello

[Walaa]

This is Walaa Elsayed, an Egyptian, I'm 28 years old, married!

 

[rebrascora]

Hi and welcome Walaa

How long have you been diabetic and which insulin(s) do you have? How are you managing your condition? Do you have any of the tech stuff like Freestyle Libre or an insulin pump or are you on multiple daily injections?

Please feel free to ask if there is anything you need help with. The forum is a fountain of knowledge and experience so hopefully you will find it as hugely beneficial as I do.

 

[Walaa]

Hello dear!
Thanks for the quick response!
I have diabetic since 2017, type 1
During first two years, I started with Hemaloug mix (I'm not sure about the spelling) until April 2019
Then, I got pregnant and my diabetes levels were not controlled well!
Then, the doctor changed the insulin to Lantus (once a day) and Novorapid. I
On 2nd of June, I miscarriage my baby!!!! It was a very stressful and painful experience especially I tried to get pregnant since my marriage in 2017 !!

Now, I started a new plan since Feb 2020, I went to Nitration and diabetes doctors and they advised me to start a diet called Keto diet and advised also to start working out twice a week and I stopped taking the inslulin and now I depend on bills only with physical activity and I lost a lot of Kgs and now I'm 63 Kg!
At the beginning of this new life style, the results were great! but now I cannot control my diabetes levels and I'm planning as well to get pregnant and I am so afraid to have the previous experience again!
I need a helpp

 

[rebrascora]

Oh goodness! I am so sorry that you miscarried. That must be such an ordeal! And now to be pregnant again will be a worry with that at the back of your mind.
It sounds like you need to start on insulin again. During pregnancy, Blood Glucose levels are much less stable from what I have read and need close control to ensure the baby stays healthy... as well as yourself. I believe that here in the UK it is not unusual for women who managed their diabetes without insulin before pregnancy, need it whilst they are carrying a baby and they get very close monitoring and support to make sure their Blood Glucose levels stay in range. I do not know what the medical system is in Egypt but I think you need to go and see a doctor and get referred to a diabetic specialist to get help if you are able.... or ask for some insulin and start using it to lower your BG levels if they are going high.

It is very surprising that you managed without insulin on a Keto diet if you are Type 1. I follow a similar way of very low carbohydrate eating but I still need insulin to cover the protein I eat (edited to add and to cover the output from my liver). Are you quite sure you are Type 1? Did they do GAD antibody tests and C-peptide tests to diagnose you? It sounds like you have lost a lot of weight from your comment which would suggest you were quite overweight when you were diagnosed... that would be another indicator that Type 2 diabetes was more likely, which would tie in with a Keto diet enabling you to come off insulin. Either way, it sounds like you may need to start insulin again and you will need to speak to a doctor about that.

To give you a bit of hope, we have a member here who had 2 miscarriages before recently giving birth to a little girl and she has been using insulin during her pregnancy to help control her levels when she did not need it before, so this situation is not uncommon.

Hopefully others more experienced will be along soon to give you more advice.
Wishing you lots of luck with this pregnancy. Perhaps reading some of the posts on the pregnancy section of the forum will help you find support and peace of mind.

 

[Robin]

This rings a lot of alarm bells. If you have Type 1 diabetes, it means that you do not make your own insulin, and cannot do without it. No doctor should advise someone with Type 1 to try and manage on diet and exercise alone.

 

[Walaa]

Oh goodness! I am so sorry that you miscarried. That must be such an ordeal! And now to be pregnant again will be a worry with that at the back of your mind.
It sounds like you need to start on insulin again. During pregnancy, Blood Glucose levels are much less stable from what I have read and need close control to ensure the baby stays healthy... as well as yourself. I believe that here in the UK it is not unusual for women who managed their diabetes without insulin before pregnancy, need it whilst they are carrying a baby and they get very close monitoring and support to make sure their Blood Glucose levels stay in range. I do not know what the medical system is in Egypt but I think you need to go and see a doctor and get referred to a diabetic specialist to get help if you are able.... or ask for some insulin and start using it to lower your BG levels if they are going high.

It is very surprising that you managed without insulin on a Keto diet if you are Type 1. I follow a similar way of very low carbohydrate eating but I still need insulin to cover the protein I eat (edited to add and to cover the output from my liver). Are you quite sure you are Type 1? Did they do GAD antibody tests and C-peptide tests to diagnose you? It sounds like you have lost a lot of weight from your comment which would suggest you were quite overweight when you were diagnosed... that would be another indicator that Type 2 diabetes was more likely, which would tie in with a Keto diet enabling you to come off insulin. Either way, it sounds like you may need to start insulin again and you will need to speak to a doctor about that.

To give you a bit of hope, we have a member here who had 2 miscarriages before recently giving birth to a little girl and she has been using insulin during her pregnancy to help control her levels when she did not need it before, so this situation is not uncommon.

Hopefully others more experienced will be along soon to give you more advice.
Wishing you lots of luck with this pregnancy. Perhaps reading some of the posts on the pregnancy section of the forum will help you find support and peace of mind.

Thank you dear so much for the information you shared with me and for this a positive news!
I just want to highlight that when I diagnosed with diabetes, I wasn't overweight. I gain a lot of Kgs after taking the insulin!

I did GAD test and the doctor confirmed that I'm type 1!!

For the insulin, I prefer to take it for sure but I'm afraid too as i was talking insulin during my pregnancy and I was suffering from Hypo a lot!! i think that's why the miscarriage happened!

So, now I am between taking insulin and struggle again or continue taking bills only and the diabetes level get high!!

PS: I started in a low carb system two days ago as per doctor's advice and the situation is getting worse!
Also, now I am working on getting pregnant again and I am so afraid!!

At the end, sorry if my English is not good enough 🙂

 

[Walaa]

This rings a lot of alarm bells. If you have Type 1 diabetes, it means that you do not make your own insulin, and cannot do without it. No doctor should advise someone with Type 1 to try and manage on diet and exercise alone.

Thank you so much dear! I will contact him today I'll see!!

 

[rebrascora]

Well in that case since you are definitely Type 1, it sounds to me like you have been in the "Honeymoon period" where your body was still producing a little insulin and the Keto diet enabled your pancreas to cope for a few years with the small amount it was managing to produce.
By the sound of things, your honeymoon period is coming to an end and you need insulin because your body is no longer able to produce enough to keep you alive and healthy, let alone get you and a baby safely through pregnancy.

From what I have read, Hypos are not a threat to the unborn baby but Hypers (high BG readings) are and these are more likely to trigger a miscarriage, so do not be frightened of using insulin and if you want to stick with your Keto regime and just use minimal insulin which is what I do, you are much less at risk from hypos.... but getting your BG down steadily into the normal range is vital and without insulin that will not happen. If you have some insulin left over from when you previously used it, it may well be out of date so please see a doctor and get some professional help.

As a matter of interest, what sort of BG readings are you getting?

Also, it is recommended here for ladies trying to get pregnant to start on a high dose of Folic Acid and maintain that through the pregnancy. I don't know if the same applies in Egypt but you really need to discuss all of this with diabetes specialists.

Can I also just say that you should in no way apologise for your English.... I am extremely impressed with it and I am sure you are making yourself understood extremely well and perhaps even better than some people whose first language is English.

 

[Walaa]

Thank you Barbara so much for your kindness and support.

Yes, I'm taking Folic acid since I diagnosed with diabetes. 5mg every day.

Recently, my BG reading are so high
fasting 200
after 2 hours 250
PS: the fasting is always high and I don't know why even when I was taking insulin!
and sometimes my reading before going to bed was in range and when I wake up I found it high!!!!!!!!

I think I need more education in diabetes to understand what's going on !!

Pray for me 🙂

 

[SB2015]

Welcome to the forum @Walaa

As others have said, since you have tested positive for T1 you I’ll need some insulin from somewhere. It may be that with a low carb (keto) diet you have managed to get the insulin needs down to the amount the your last few Beta cells are producing, but since your levels are now not settling it sounds like that Hineymoon period is over. You will increasingly need insulin, and I suspect that if you are trying to get pregnant, you need to be referred to a specialist who will support someone with Diabetes through the planning and pregnancy. It is difficult to manage levels during pregnancy but important to do so as this impacts on the baby’s development

Please ask to be referred to a specialist and also ask your GP about returning to using insulin. As. Type 1 you will need to inject and the multiple daily injections which you had switched to will make it a lot easier to manage than the mixed insulin.

 

[rebrascora]

OK, so a fasting reading of about 11mmols (200 divided by 18) is not great but not desperately bad yet. And going up to 14 2 hours after food.... we use different units for measuring BG here, so need to convert it so we can understand the readings.
I think you are right that you need more support and education. Are there courses for diabetics that you can attend? Here we are referred onto them by our Health Care Professionals. We have one called DAFNE (Dose Adjustment For Normal Eating) which I believe has been exported worldwide.... Don't let the "Normal Eating" bit put you off if you are happy with Keto, it is still very helpful in learning how to manage your levels with insulin.

 

[Walaa]

250 mg means 13.9 !!!!!!!!
200 mg means 11 !!!

Thank you so much for you help and support dear

 

[Walaa]

Welcome to the forum @Walaa

As others have said, since you have tested positive for T1 you I’ll need some insulin from somewhere. It may be that with a low carb (keto) diet you have managed to get the insulin needs down to the amount the your last few Beta cells are producing, but since your levels are now not settling it sounds like that Hineymoon period is over. You will increasingly need insulin, and I suspect that if you are trying to get pregnant, you need to be referred to a specialist who will support someone with Diabetes through the planning and pregnancy. It is difficult to manage levels during pregnancy but important to do so as this impacts on the baby’s development

Please ask to be referred to a specialist and also ask your GP about returning to using insulin. As. Type 1 you will need to inject and the multiple daily injections which you had switched to will make it a lot easier to manage than the mixed insulin.

Many thanks for your advice.
I'll call GP today and discuss with him this point ..
bs you mean specialist for the pregnancy ? right?

 

[rebrascora]

Many thanks for your advice.
I'll call GP today and discuss with him this point ..
bs you mean specialist for the pregnancy ? right?

You should really be looking for a diabetes specialist nurse I believe who would be trained in maternity care. Hopefully someone will correct me if I am wrong, but I don't think any of the maternity staff would know enough about diabetes to support and advise you. Your first step would be to go back to the specialist diabetic clinic which I assume would be located at your nearest main hospital. Do you have a direct contact number for them? If not then you may need to ask for a referral through your General doctor. I am not sure what the lock down situation is in Egypt but here it is pretty difficult to get hospital referrals at the moment so you might be best putting your baby plans on hold until you are able to get an appointment and your BG under control.
It sounds like you do have insulin so please do make sure that it is in date if you are using it. Once you have opened and started using a vial, cartridge or pen, it should usually be discarded after 28 days and may start to degrade after that, particularly in a hot climate, so if what you are using is old then that may be why you are not seeing your BG levels respond to it's use.

 

[everydayupsanddowns]

Welcome to the forum @Walaa

So sorry to hear about your miscarriage

Wishing you all the best for your new attempts to get pregnant.

It is really important that you take your insulin.

As a T1 you will not be making enough insulin for your body to function properly - not just around food and carbohydrate - but all the time 24 hours a day. Your Lantus (background) insulin deals with your body’s needs between meals and overnight and your Novorapid (meal/snack) insulin deals with the carbohydrates in your meals. If yoi are continuing to eat a low carbohydrate diet, you will need to reduce your Novorapid doses, bit you will still NEED to take some insulin.

Hope you can get your BGs more into range - which is really important if you are trying to get pregnant. And in the UK the guidelines for BG levels during pregnancy are quite strict and challenging to achieve (different points during pregnancy need very different insulin doses) so I agree with others that you need specialist support from a trained healthcare professional who specialises in T1 diabetes care.

You might find this ‘Information for the public’ version of the UK guidance for T1 pregnancy helpful

About this information | Information for the public | Diabetes in pregnancy: management from preconception to the postnatal period | Guidance | NICE

www.nice.org.uk

 

[Walaa]

Welcome to the forum @Walaa

So sorry to hear about your miscarriage

Wishing you all the best for your new attempts to get pregnant.

It is really important that you take your insulin.

As a T1 you will not be making enough insulin for your body to function properly - not just around food and carbohydrate - but all the time 24 hours a day. Your Lantus (background) insulin deals with your body’s needs between meals and overnight and your Novorapid (meal/snack) insulin deals with the carbohydrates in your meals. If yoi are continuing to eat a low carbohydrate diet, you will need to reduce your Novorapid doses, bit you will still NEED to take some insulin.

Hope you can get your BGs more into range - which is really important if you are trying to get pregnant. And in the UK the guidelines for BG levels during pregnancy are quite strict and challenging to achieve (different points during pregnancy need very different insulin doses) so I agree with others that you need specialist support from a trained healthcare professional who specialises in T1 diabetes care.

You might find this ‘Information for the public’ version of the UK guidance for T1 pregnancy helpful

About this information | Information for the public | Diabetes in pregnancy: management from preconception to the postnatal period | Guidance | NICE

www.nice.org.uk

Thank you so much for your advice and sharing this information with me! Much appreciated.

Now, Elhamdullah I am getting better, my blood sugar is started to be in range
I spoke with psychologist and I found out that my blood sugar was getting high because of my anxiety and stress.

I just have one concern, I am wondering about the reason that makes fasting blood sugar level high!
Yesterday, I worked out for 30 minutes before going to the bed, and the blood sugar level was perfect, now when I woke up I found that my fasting blood sugar is a little bit high 153mg approximately 8 mmol!

 

[Walaa]

You should really be looking for a diabetes specialist nurse I believe who would be trained in maternity care. Hopefully someone will correct me if I am wrong, but I don't think any of the maternity staff would know enough about diabetes to support and advise you. Your first step would be to go back to the specialist diabetic clinic which I assume would be located at your nearest main hospital. Do you have a direct contact number for them? If not then you may need to ask for a referral through your General doctor. I am not sure what the lock down situation is in Egypt but here it is pretty difficult to get hospital referrals at the moment so you might be best putting your baby plans on hold until you are able to get an appointment and your BG under control.
It sounds like you do have insulin so please do make sure that it is in date if you are using it. Once you have opened and started using a vial, cartridge or pen, it should usually be discarded after 28 days and may start to degrade after that, particularly in a hot climate, so if what you are using is old then that may be why you are not seeing your BG levels respond to it's use.

Many thanks dear for your advice and support! 🙂

 

[grovesy]

Thank you so much for your advice and sharing this information with me! Much appreciated.

Now, Elhamdullah I am getting better, my blood sugar is started to be in range
I spoke with psychologist and I found out that my blood sugar was getting high because of my anxiety and stress.

I just have one concern, I am wondering about the reason that makes fasting blood sugar level high!
Yesterday, I worked out for 30 minutes before going to the bed, and the blood sugar level was perfect, now when I woke up I found that my fasting blood sugar is a little bit high 153mg approximately 8 mmol!

I suggest you do a forum search for Dawn Phenomenon.

 

[rebrascora]

I agree, your higher fasting readings are almost certainly due to Dawn Phenomenon. It is believed to be a throwback to prehistoric days when we didn't have cupboards and fridges to store food so our bodies needed a boost of energy to go out and hunt or forage for our first meal of the day. The liver increases output of glucose to provide our muscles with fuel to hunt down a woolly mammoth etc. For some people this happens in the early hours, particularly at this time of year when the days are long and dawn is early. Other people like me are fortunate that their body waits until we get up and I then use some NovoRapid insulin to counteract it even if I am not having breakfast..... it usually needs 1.5-2 units for me but everyone is different. I do wonder if having black out blinds or eye covers might stop it kicking in so early for people who wake up to it's effects ie. high fasting readings or if it is part of our individual circadian rhythms..... because some people are naturally alert and active early morning people whilst others sleep later and are more productive in the afternoon/evening.