Insulin resistance?

[beckyp]

I just logged on to write pretty much the same question and to ask for advice! I'm 27 weeks and the hospital told me at 23 weeks that my insulin requirements would be going up in the next couple of weeks....so far...nuffink!!! They think I'm still having hypos in the night (due to rebounds) but as I don't have more than 1 during the day I refused to lower my lantus (AGAIN). I started on 27 units of lantus and now I'm taking 20 - they want to lower it to 16-18. The doctor wanted me to boost my sugars before bed to the high teens so I wouldn't worry too much about 8 or 9 - the DSN told me that as long as I'm in single figures that I needn't worry....it varies depending on who you speak to and which hospital you go to I'm sure!

I'm setting 2 alarms a night (2am and 4am) so that I can catch any hypos or sort out any highs that I'm having. There's no indications of anything happening. Before pregnancy I used to wake up in the night if I was hypoing but since the beginning of pregnancy my hypo symptoms have either changed or disappeared. I can go as low as 1.6 without even realising - keep monitoring yourself regularly to catch any or to see patterns.

Also...fantastic news that the baby is coming up at the right size! I've got my 28 week scan next week so that'll be interesting with all the highs I have at night...thanks Dr!

 

[Northerner]

Becky, I don't know much about pregnancy, but surely advising high teens before bed is wrong? Wrong at any time! What are your waking levels like that might be making them think you are rebounding from night hypos?

 

[beckyp]

I was starting to think it was me being crazy and not the doctor! It's such a relief that you think so too!

The doctor says that I was taught the wrong thing 20 years ago and that nobody has ever 'put me right' - I'm sure insulting the DSN sitting next to him that saw me on a regular basis before pregnancy! He says that I was going for too long period between dinner and breakfast without carbs so suggested eating something before bed (even though the dietician sitting next to him told me 6 months earlier that I shouldn't need food in the evening if I eat my dinner at 6pm so that's why I stopped originally...but that's another story that's infuriated me!). He's also told me that they don't recommend that people have alarms in the night because it encourages correction doses meaning that you then have a hypo on your rebound....I'm in need of some up to date training after the baby arrives me thinks!

I'm now going to bed at around 9 or 10mmol, waking up with 13 or 14mmol at 3am and giving myself a correction dose which he says is the wrong thing to do and that I should wait until it's between 15 and 19 before correcting (I've ignored his advice so I'm sure I'm not helping matters). Sometimes I can wake at 4am and it'll be a decent level (last night it was 5.2 so I'll eat a biscuit to keep it from going hypo before the morning) and other times it'll be high again indicating that there's been hypo and rebound so I correct and then go back to sleep to wake with a normal level between 5-6. The frustrating thing is that the lantus seems to be the correct amount for during the day - I don't rise between meals or seem to have too many hypos. The only hypo I have is due to me walking the dogs a bit further in the morning or being a bit more active than other days or stupidly giving myself extra insulin for a meal and then not eat as much as I thought I'd eat - that was my problem on Christmas day!

Last night's figures were:
10pm - 20u Lantus - 10.9mmol
2am - 4u Humalog - 14.6mmol
4am - 1 Shortcake biscuit - 5.2mmol
8am - Breakfast 6.7mmol

The confusing thing for me is that I asked if the highs in the night would affect my HBA1C and he says that they wouldn't. He says that I could run during the night at 10-12mmol but as they are so well controlled during the day that would keep it down as it's based on an average of 3 months. How can I stay at 10 all night (with no hypos after I've reduced the lantus) and then not have highs during the day? I've been diabetic for nearly 20 years and it's only now that I'm pregnant, and need more knowledge than ever, that they are changing things and getting me more confused than ever!

I'm sooooooo looking forward to not being pregnant! At the beginning of the pregnancy I was so happy that I'd not experienced morning sickness, really bad hypos and the other horrid bits and bobs that can happen (diabetes or otherwise) but now I'm counting down the days to B-Day in March/April just so that I don't have to see the hospital so often!

I don't want to complain too much about them...I've been taking a lot of what they've said with a pinch of salt and been making the best of my own instincts for 6 months....just 3 months to go and it's done me no harm so far.

 

[Northerner]

Becky, it strikes me that this doctor is back in the dark ages. The kind of things he is saying belong to an earlier age when people had to eat at set times and 'feed' the insulin to prevent hypos. Could you speak to your nurse about possibly splitting your lantus to prevent the highs at night if it's OK during the day? Your levels shouldn't really be rising up to the point where you need a correction - really, that 'correction' should already be in place in the form of your lantus which is supposed to help mop up the output from your liver. I've heard other ladies here say that they have corrected at the levels you mention so I don't think he is up to date on that either. As for this nonsense about it not mattering that your levels are high through the night because you are OK during the day - does he not realise that this represents one third of every day?

I hope some of the other ladies with more experience than me come on and give you some reassurance, but it strikes me your instincts are correct - doesn't seem right that we often know more than the doctors does it?

 

[Emmal31]

I just logged on to write pretty much the same question and to ask for advice! I'm 27 weeks and the hospital told me at 23 weeks that my insulin requirements would be going up in the next couple of weeks....so far...nuffink!!! They think I'm still having hypos in the night (due to rebounds) but as I don't have more than 1 during the day I refused to lower my lantus (AGAIN). I started on 27 units of lantus and now I'm taking 20 - they want to lower it to 16-18. The doctor wanted me to boost my sugars before bed to the high teens so I wouldn't worry too much about 8 or 9 - the DSN told me that as long as I'm in single figures that I needn't worry....it varies depending on who you speak to and which hospital you go to I'm sure!

I'm setting 2 alarms a night (2am and 4am) so that I can catch any hypos or sort out any highs that I'm having. There's no indications of anything happening. Before pregnancy I used to wake up in the night if I was hypoing but since the beginning of pregnancy my hypo symptoms have either changed or disappeared. I can go as low as 1.6 without even realising - keep monitoring yourself regularly to catch any or to see patterns.

Also...fantastic news that the baby is coming up at the right size! I've got my 28 week scan next week so that'll be interesting with all the highs I have at night...thanks Dr!

Hi Becky,

Don't know whether you remember but I am also under the same hopsital as you and had my little girl almost a year ago.

I got exactly the same adivce with my lantus, I was getting insulin resistance and they *thought* it was because my lantus was too high so they told me to reduce it by 6units or something similar. It was a complete and utter disaster because although before I was having high's post meal's I was in single figures the rest of the time and because of the change to the lantus I was in double figures the whole 2-3 days I tried it their way with traces of ketones after the first day.

After that I decided to stick to my own gut feeling about advice they gave me. I was also told from the start to have a slice of toast before bed and not to inject to prevent hypo's during the night which worked for the first couple of months but I was told to continue that into the later months which just wasn't necessery and in fact took me into double figures.

Great news about baby measuring the right size. I think Jessica was until the 28 week scan when the resistance had been in play for a few weeks before. I hope that your levels sort themselves out and the hypo's stop xxx