Help please

[NatalieC88]

Hi all

I am currently 21 weeks pregnant with my first baby and have been a type one for almost 10 months.

I'm really struggling with keeping my sugar levels stable and am having lots of hypos, especially at night, which is causing a bit of concern. I spoke with the DSN yesterday and it has got to the point where she is actually wondering if I have been diagnosed correctly as I'm only on miniscule amounts of insulin but I'm still having hypos. She did not however, offer any guidance as to whether I'd need any tests or whether anything can be done to determine whether I do actually have type one. She just said to do finger pricks (I have a libre at the moment) over the weekend and we would talk again next week.
Has anyone experienced anything similar or does anyone have any advice ref moving forward? I'm a bit in shock and it's worrying enough for my baby when I'm having hypos anyway.
Would really appreciate some advice.
Many thanks

 

[Inka]

Hi @NatalieC88 As you’re so recently diagnosed, you could have some functioning beta cells which are contributing insulin. Most importantly, has your insulin been reduced to help stop these hypos?

When I was pregnant with my first baby, at one point of the pregnancy I was only have 2 units of basal (yes, two - not a typo) My basal needs didn’t increase until later in the pregnancy. I don’t remember exactly when but something like 26-28 weeks. I’m definitely Type 1 as I had antibody tests.

So - don’t assume you’re not Type 1, but do get help with reducing your insulin.

I presume you’re carb counting?

 

[Inka]

Also, what insulins do you take and when?

 

[NatalieC88]

Also, what insulins do you take and when?

My basal has recently been switched from tresiba to levimir. I have 6 units in a morning and 2 in an evening and I'm still having hypos on a night.
Novorapid on a 4-4-5 basis, I'm not carb counting yet, my course got cancelled due to coronavirus.
I am in regular contact with my DSN over phone and email and we are reviewing the insulin weekly.
Just to clarify it is the DSN questioning the diagnosis not me, but maybe as happened with you and my needs will increase as baby grows. It's a bit confusing atm.

 

[Inka]

It’s good that you’ve been swapped to Levemir as that gives you far more flexibility 🙂 That is, you can adjust the evening dose that covers you during the night, separately from your daytime dose.

I totally understand that it was the DSN that questioned the diagnosis not you 🙂 I hope I didn’t come across wrongly. Because of what happened to me, I’m always a bit jumpy when there’s any mention of taking small amounts of insulin meaning a person can’t be Type 1.

Carb counting isn’t hard and you don’t need a course to do it If you’re happier doing a course, there’s an online version called BERTIE (I’ll find a link in a moment). Diabetes is complicated - as I’m sure you’ve already found out prior to getting pregnant! Getting a balance is hard eg if somebody’s basal dose is a bit off, it can have a knock-on effect on their bolus dose (meal time insulin)

I found sticking to the same breakfasts and lunches helped (not exactly the same but similar carbs) as that cut down one variable and gave me one less thing to think about.

I know you have the Libre, but when I was pregnant I set an alarm for 2am every night and got up and tested. That way, I could eat if necessary or correct any high sugars. Even if I didn’t need to do anything, I found it a reassurance. I kept hypo treatments by my bed (I found liquid ones best. They’ve messed up Lucozade now but regular Coke is still ok).

Another thing to do is have your evening meal no later than 6pm to make sure your mealtime insulin is leaving your system when you go to bed. You could even consider a small bedtime snack. Personally, I’d reduce your nighttime Levemir to 1 unit if you’re having hypos. There’s no rule to say you must have nighttime basal and early in my pregnancy I actually had no nighttime basal (then went to one unit, then to two units).

 

[Inka]

BERTIE link below for you or anyone browsing this and interested:

https://www.bertieonline.org.uk/

 

[Pigeon]

I had lots of hypos too, my insulin requirements went down by about 25%until 26 Weeks, then it went up and up after that. Just keep testing and adjust as you go! Best of luck

 

[trophywench]

Yeah - the 2nd trimester usually needs a lot less insulin whether you've been T1 for years or not so it's not unusual. I loved Levemir cos it's so easy to adjust and were it me I'd reduce the nightime dose to 1u too - you'll very soon know whether that's OK or not as soon as you look at the morning trace tomorrow!

Requirements shoot back up again in the final trimester - so very very necessary to adapt doses every time you need to - some land up on 3x their 'normal' amounts of it! And then plummet back down to 'normal' just after giving birth - it's pretty well instantaneous so pretty gobsmacking all in all. You will get there though! Just takes time and patience ……..

 

[everydayupsanddowns]

Sorry to hear your diabetes is giving you the runaround @NatalieC88

The BERTIE course is well worth doing since your education has been put on hold. It will give you a bunch of extra tips and strategies to try, and to be able to try to understand and adjust to the craziness of BG fluctuations during pregnancy.

The Diabetes UK “learning zone” has got a bunch of useful information in it too.

And there’s a basic overview of carb counting here: https://www.diabetes.org.uk/guide-t...-and-diabetes/nuts-and-bolts-of-carb-counting

 

[rebrascora]

I am really surprised at a DSN making such a suggestion. They should be experienced enough to know how much insulin needs can vary from person to person and particularly so during pregnancy.
There was a lady on my DAFNE course who had been a Type 1 diabetic for 50 years (obviously not pregnant) and she only needed 3 units of basal insulin (Lantus) for the whole 24hr period each day and still hypoed almost every night but went high during the day. It would be ridiculous to suggest that she wasn't Type 1 just because she needed so little insulin. We are all different.
You have been given some great advice above. I hope you find it helpful and good luck with your pregnancy.

Another member here has just given birth to a gorgeous little girl, so I hope you stick around and update us when your time comes.... it brightens us all up to see such wonderful happy news.... and photos of course!

 

[trophywench]

Could be that @NatalieC88 is going through her honeymoon phase, typical it should arrive just at the worst time instead of first semester or last one.

You need to do whatever you need to do Natalie, so the forum will try to help you find your way through the maze where we can.

 

[NatalieC88]

Thank you so much for all your replies. Bit of an update for you all. I'm now on zero yes zero Levemir on a night and am still having hypos. My consultant thinks I'm still in the honeymoon phase but it's a bit concerning that despite the drop in insulin I'm still dropping on a night and am having to get up and eat at 3am. Not sure how we move forward from here, my daytime control has remained pretty stable. Just hoping to get my daughter here safely in September and hopefully things will stabilize x

 

[trophywench]

Would it be an alternative to eat some slower release carbs, so it doesn't hit your system like a ton of bricks, last thing at night so you can get a good night's sleep?

So - a small amount of carb, some fat and some protein - eg a cream cracker, well buttered, with a thick slice of cheese, cos the body takes a lot longer to turn both fat and protein into glucose than it does carb.

 

[NatalieC88]

Would it be an alternative to eat some slower release carbs, so it doesn't hit your system like a ton of bricks, last thing at night so you can get a good night's sleep?

So - a small amount of carb, some fat and some protein - eg a cream cracker, well buttered, with a thick slice of cheese, cos the body takes a lot longer to turn both fat and protein into glucose than it does carb.

Thanks for your reply. I'm willing to try anything atm so I'll give it a go

 

[Inka]

My nighttime insulin was minimal during the 1st and most of the 2nd trimester even though I’d had Type 1 for years (I’m on a pump and reduced each hour right down way below what I’d normally have) but I still got up at 2am to check my blood sugar and eat if necessary. I wouldn’t have slept else.

Pregnancy and delivery do weird things to your body even when you’ve had Type 1 for years. For me, it was like being cured. I could miss boluses and stay in range.

Is it possible some of your daytime insulin eg the morning Levemir and/or your evening meal bolus has a tail of action that’s still affecting your blood sugar when you go to bed? What blood sugar do you go to bed on? And do you always have a bedtime snack?

 

[Walaa]

Dear Inka,

Thank you so much for sharing this information and your experience.

I had the same experience before and because of the Hypo I miscarriage my baby last year!!
Since then, I am trying to get the diabetes levels in target to avoid having this experience again next time Inshallah!

I just have a question, what do you usually do if you woke up at 2am and found out the your diabetes level is high?

Again, Thank you so much, much much appreciated!

 

[Inka]

Hello @Walaa 🙂

I’m so sorry to hear about your miscarriage. How awful for you

I’ve just read some of your other posts. I agree that if you’re Type 1 you need insulin. In the U.K there are special hospital clinics for people with diabetes who are trying to get pregnant or are already pregnant. If you have anything similar available to you that would be good.

With the insulin - try to get an insulin injection pen that does half units not just whole units. That way you can have smaller doses if needed. An insulin pump is also excellent because it lets you adjust your insulin to suit your needs more exactly. It’s particularly helpful in pregnancy.

To answer your question: if I was pregnant and tested at 2am and my levels were high, I would take a tiny amount of fast-acting insulin (eg Humalog or Novorapid) to bring them back into range. But to do that you need to know your ‘correction factor’ - that is how many mmols one unit of insulin will drop your blood sugar. At night I always aim for a higher blood sugar than I would during the day when I need to do a correction dose. So, always careful but even more careful during the night.

I see that you’re eating a keto diet. I personally wouldn’t do that during pregnancy. I would eat a moderate amount of carbohydrate and use my insulin to control my blood sugar.

If you’re recently diagnosed, you’re probably still making a little insulin of your own, so you might only need small doses of insulin. In early pregnancy, you might need tiny amounts as this is when hypos are most likely.

 

[PhoebeC]

@NatalieC88 this sounds exactly like what happened to me, apart from I was sick with morning sickness/low levels with every hypo. Just to add to the fun.

My insulin went from pre pregnancy 8/10/12 for meals and basal 20 to 2/2/4 for meals and 8 basal. I don't know what the route cause was as we didnt find out before she was born. All I can say is don't be afraid to lower the levels as you need to.

How is baby measuring? She was measuring bigger because she was draining all my glucose into herself and getting nice and plump. In addition we had extra fluid, to do with the extra waste from baby eating so much ha!