High HBA1C during first trimester

[Sarah-Type1]

Hi everyone,
I was hoping someone could share their experience with me and give me some help.
I've discovered last week that I am 5 weeks pregnant (now 6) and during this time I had covid with terrible high blood sugars which had reached around 29. My HBA1C is currently around 68 and I know this is too high. I'm doing everything I can to keep my blood sugars in check but I have always had the problem of my sugars jumping up and down.
I just really need to know if anyone out there has had their HBA1C at 68 and managed to go through a normal pregnancy with a healthy baby.
I'm literally panicking and don't know what to do.

 

[Inka]

Welcome @Sarah-Type1 and congratulations 🙂 First of all, don’t panic. You’re not the only person who’s had high sugars early in pregnancy. The important thing is to work to minimise the highs now COVID has (hopefully) gone.

Are you taking the special high-dose folic acid? Have you informed your hospital team that you’re pregnant? What insulin(s) are you on, and do you have a Libre or CGM?

Do your blood sugars jump up and down at any particular times eg after meals? If so, you’ll probably find bolusing in advance of your meal helpful. There’ll be a sweet spot where you can inject enough in advance for the insulin to keep any spike low. You’ll also find you’ll be doing a fair bit of correcting during pregnancy as the targets are very strict. I had highs during my pregnancies. Not as high as 29, but mid-teens. Some of those were early in pregnancy. My children are ok. I know it’s stressful, but all you can do is focus on the future. Nobody will have perfect sugars throughout pregnancy - absolutely nobody. xx

 

[Sarah-Type1]

Welcome @Sarah-Type1 and congratulations 🙂 First of all, don’t panic. You’re not the only person who’s had high sugars early in pregnancy. The important thing is to work to minimise the highs now COVID has (hopefully) gone.

Are you taking the special high-dose folic acid? Have you informed your hospital team that you’re pregnant? What insulin(s) are you on, and do you have a Libre or CGM?

Do your blood sugars jump up and down at any particular times eg after meals? If so, you’ll probably find bolusing in advance of your meal helpful. There’ll be a sweet spot where you can inject enough in advance for the insulin to keep any spike low. You’ll also find you’ll be doing a fair bit of correcting during pregnancy as the targets are very strict. I had highs during my pregnancies. Not as high as 29, but mid-teens. Some of those were early in pregnancy. My children are ok. I know it’s stressful, but all you can do is focus on the future. Nobody will have perfect sugars throughout pregnancy - absolutely nobody. xx

Hi @Inka, Thank you for your message. Yes, I have informed all the relevant people and have all my appointments booked. I'm currently using the Libra but it's so inaccurate and unreliable that it's almost better not to use it. for example last night my alarm when off 4 times saying I'm having a hypo but when I check my normal meter I see my blood was at 5!
I'm using the omnipod which has been great and take the humolog.

My body is super sensitive to insulin so I'm constantly fighting with highs and lows. for example, I could never give myself the full amount of insulin I need for a meal because I will have a really bad hypo so I extend it over an hour or two but this then causes spikes. I've been told by my nurse that I need to keep my sugars at 3.9-7 which is just impossible I'm just having 6-7 hypos a day and feel exhausted.

 

[Inka]

@Sarah-Type1 Have you reduced your basal? I had to reduce mine by 25% in early pregnancy. Pregnancy hypos can be fierce. I also reduced my meal ratios. I sometimes had to snack after a meal and found this was a good way to ward off hypos and also stay in range. This is a feature of pregnancy - tiny adjustments this way and that on a daily basis. That’s what’s needed to keep in the tight range.

I do suggest you consider a basal reduction though. It helped me a lot.

 

[Sarah-Type1]

Thanks @Inka I'll give that a go, so far I have increased my Basal as I was spiking in the evening but given all the hypos I'll have to reduce it again.

Thanks

 

[Inka]

I found there was a pattern in pregnancy, which pretty closely matched the graph in Think Like A Pancreas: high very early on, then hypos started, then there was a period of fierce hypos, then those reduced as the insulin resistance increased. At around 22-26 weeks, the IR really kicked in, with another big kick at 30-32 weeks.

So, it’s normal to have to tweak and tweak again, for both basal and ratios. It sounds like you’re focussed on all this well. Do watch out for the hypos. They really can be sudden and fierce. I added hypo treatments everywhere.

 

[PhoebeC]

All I did was tweak my insulin on a daily basis. I never got IR but was on hardly any background at all, 4 compared to 18 no.

My Hb1ac was around 7, which is about 50 and Jemima is now 11 and fit as a fiddle. But we had an awful pregnancy and birth. Try not to worry it won't help, and just do what you can to get better control.

 

[Sarah-Type1]

All I did was tweak my insulin on a daily basis. I never got IR but was on hardly any background at all, 4 compared to 18 no.

My Hb1ac was around 7, which is about 50 and Jemima is now 11 and fit as a fiddle. But we had an awful pregnancy and birth. Try not to worry it won't help, and just do what you can to get better control.

Hi Phoebe, Thanks for your message this has calmed my nerves a bit as my HBA1C is now in the 50s mark. I'm finding I'm having to knock my background down a lot too so glad it's all normal. Could I ask if you're daughter has ended up with diabetes as well? my whole family has diabetes so I'm just assuming it's going to be a given for my children to have it too so was curious to know if that was the case for you or anyone you knew?

 

[PhoebeC]

Nobody in my family apart from me has it, my great gran was 92 when she died so knew a lot of our family history and also some on my dads side. As far as we know nobody else has had it.
No she’s not got it yet and she’s 11.
I believe it is more likely if you dad has it than mum. I remember 10% more likely but I’m not sure what parent that is.

Not sure if that helps.

 

[Simone rahman]

Hi everyone, I’ve just found out on Friday that I was 5 weeks pregnant! I’m so happy and so excited however my blood levels are out of control. My pregnancy wasn’t planned at all. I have met with my midwife and they have started me on 4 units of 2 different kinds of insulin and to inject with every meal. My bloods are still ranging between 9-16. Can anyone advise if my bloods will drop anytime soon or do I need to speak to my midwife again as I am really concerned. Thank you x

 

[Leadinglights]

Hi everyone, I’ve just found out on Friday that I was 5 weeks pregnant! I’m so happy and so excited however my blood levels are out of control. My pregnancy wasn’t planned at all. I have met with my midwife and they have started me on 4 units of 2 different kinds of insulin and to inject with every meal. My bloods are still ranging between 9-16. Can anyone advise if my bloods will drop anytime soon or do I need to speak to my midwife again as I am really concerned. Thank you x

I don't know about insulin but I hope you are having folic acid usually a high dose is prescribed.
I think if you are in any doubt and feel you need more support then yes you should ask your midwife. There is usually a specialist diabetic midwife attached to the clinic.
Congratulations anyway.
There is a section on the main site about gestational diabetes which you may find useful.

 

[Inka]

Hi @Simone rahman Congratulations on your pregnancy 🙂 What insulins are you taking (names plus any extra letters or numbers after the name)? It’s very usual to start people on a lower dose of insulin than they need, then gradually build it up. Have you been given any guidance about how many carbs to eat per meal?

It sounds like you might need more insulin. Phone your midwife/diabetes nurse and let them know the blood glucose numbers you’re getting.

@Leadinglights I think Simone is Type 2.

 

[Leadinglights]

Hi @Simone rahman Congratulations on your pregnancy 🙂 What insulins are you taking (names plus any extra letters or numbers after the name)? It’s very usual to start people on a lower dose of insulin than they need, then gradually build it up. Have you been given any guidance about how many carbs to eat per meal?

It sounds like you might need more insulin. Phone your midwife/diabetes nurse and let them know the blood glucose numbers you’re getting.

@Leadinglights I think Simone is Type 2.

So it is only called gestational diabetes if you develop it during pregnancy?

 

[Inka]

So it is only called gestational diabetes if you develop it during pregnancy?

Yes, gestational diabetes is a special kind of diabetes that only develops during pregnancy. It usually goes away immediately after delivery but people who’ve had it are at a higher risk of developing Type 2 later in life.

 

[merrymunky]

My HBA1C was 89 when I conceived this baby bum now 31 weeks pregnant with a boy and thanks to the insulin my levels are right down to 41 and baby is growing perfectly.

It wasn’t an ideal situation going into this pregnancy as with my last one I had lost a lot of weight and carefully planned it all. This was a happy surprise while I wasn’t at my healthiest!

 

[Vickylou1807]

My HBA1C was 89 when I conceived this baby bum now 31 weeks pregnant with a boy and thanks to the insulin my levels are right down to 41 and baby is growing perfectly.

It wasn’t an ideal situation going into this pregnancy as with my last one I had lost a lot of weight and carefully planned it all. This was a happy surprise while I wasn’t at my healthiest!

This has just eased my mind so much…. I’m planning a baby in the next few months and my HBA1C is currently 90 I’m trying so hard as of 3rd January to get it down but hearing how successful you are makes me feel a lot better. Can I ask what you have done while pregnant to help get your HBA1C down? Thanks Vicky x

 

[merrymunky]

This has just eased my mind so much…. I’m planning a baby in the next few months and my HBA1C is currently 90 I’m trying so hard as of 3rd January to get it down but hearing how successful you are makes me feel a lot better. Can I ask what you have done while pregnant to help get your HBA1C down? Thanks Vicky x

To be perfectly honest it’s all been down to careful medication control. I am on metformin anyway as standard but in pregnancy with type 2 diabetes I am given insulin too. I take insulatard slow release overnight and novorapid for meal times and corrections in the day. My actual eating hasn’t been great but the insulin has given me the leeway to actually eat to my appetite as my food preferences went haywire and all I seem to want is food I shouldn’t really eat as a diabetic! I eat healthy where I can but this gives me some freedom. It’s going to be harder for me when I come off the insulin after the birth as I’ll be back to metformin and diet control and it’s going to be bland and challenging with a newborn and a toddler keeling me on my toes.