Not had a good week

[RuthieG]

Well after last week's great news and great results everything seems to have taken a nose dive.

I am now 27 weeks pregnant and did have pretty good control (and very good HbA1c) but this last week all my post-meal readings are high (9-11 ish).

I have tried tweaking my ratios so am now on 1:4.5g at breakfast (can't believe how much insulin I am having for breakfast!!!!), 1:8g lunch and dinner but I still had a high after breakfast (9.2) today. I will test post lunch in 45 minutes or so.

Any tips on what I can do apart from lower the ratios even more? They seem crazy low to me.

I am going to a pump user group at the hopsital later so I hope they can offer some advice that will sort things out quick.

It is so frustrating just when I was on a high and sorted last week everything has changed, even though I am eating the same. 😡

 

[Babysaurus]

Hi Ruth,
I've had similar, and also now have a ridiculous amount of insulin (34 weeks on Friday.) I have 2.5 units per 3, yes THREE!, grams of carbs for breakfast and still overestimate the carb count sometimes to keep things in check. This means that I am often having over 45 units for breakfast (which will be something like toast, not two massive boxes of sugar puffs!) which seems bonkers, I know!
Not sure what else to suggest to help other than to carry on doing what you're doing, but if someone at the pump user group has some good suggestions please let me know!

 

[RuthieG]

OH MY WORD!!!!!!!!!!!!!!!!!😱 What kind of ratio were you on pre pregnancy? When I went on the pump at about 12 weeks I was on 1:15g at all times and it is just going further and further down.

I wouldn't even know how to programme your levels into my pump!

If you have a high reading post meal how long do you leave it before changing the ratio? I try to wait 2/3 days to check I am not over/under counting but this seems like far too long and is stressing me out.

I will quiz the doctor tonight and let you know any little gems he has.

 

[Babysaurus]

I think it was 1 unit per 10 grams before, so yes it's quite a difference!

Spoke to one of the DSN's a moment ago and she said that, at 34 weeks, it is quite common to require what would normally be seen as a ridiculous amount of insulin. I also think it's going up quite a bit as I am higher than I ought to be when I wake up (been in the 7's, and normally in the 4/5's.) So, it's back to the 2am and 5am testing to see what's peaking when and then I can adjust the basal. Yawn!

I generally leave something 2 days before changing the ratio. Certainly no longer! Like you, it would stress me out and I also have at the back of my mind the fact that most, but not all (just to keep us on our toes!), diabetics need more and more the later they get. Have been told that this may start to go down though once I get to 36-37 weeks (in other words, just as soon as I have got used to it, again!)

 

[RuthieG]

I have just been to the pump user group which was alright actually. Better than I thought. It was a Q&A with the diabetes consultant (non-pregnancy) and some of the questions were a bit random but interesting nonetheless. Nothing pregnancywise though as I am pretty sure I was the only pregnancy one there so felt a bit selfish whouting out all my questions!

You are so close now aren't you? Are you all ready for the arrival of your hopefully little (but not too little) bundle of joy? I hope these babies appreciate what we are going through for them!!!

I have written a two page info document for my partner for the birth just with info about diabetes/pump/insulin/my patterns/ratios (although he knows alot anyway) so that he can help me in making sure the nurses and doctors know all about my care when the time comes to be admitted, rather than sliding scale me without a blink of the eye.

At the user group sliding scale was mentioned (in terms of general hopsital admission) and the consultant said they find the education of clinicians and nurses in inpatient situations quite fristrating and that often with pump users sliding scale is not necessary, although obviously it might be, but he said it shouldn't be a blanket 'pump off, drip in' kind of attitude.

 

[MrsCLH]

Just wanted to say I'm sure that when I was pregnant they said 26 weeks was when you would start to notice a massive jump in your insulin requirements so sounds normal to me. By the end of my pregnancy I was on about 5 times the amount of insulin at breakfast than I'd been on pre-pregnancy, worst time of day for me. I used to wait for 3 out of range readings before I adjusted my dose but I hated being high so I corrected with any reading over 10 and then just did a couple of extra tests later to avoid hypo. Not what they recommend I know but like you I just found being high so horrible! Good luck, you will be fine, sounds like you're doing all the right things 🙂

 

[Monkey]

Another one saying yes, sounds very familiar! A couple of years ago for me, but certainly by the end of my pregnancy I think I was injecting 8 units for 10g of carbs in the morning - fairly similar to babysaurus!

To be fair, the other mealtimes were less bonkers (I think 4 or 5 per 10g) but still considerably more than I was used to.

I think I tried to do 2 days before making any changes, altho I know it's really hard to do that.

Sounds like you're doing all the right things tho.

 

[Babysaurus]

Its good to hear others have had similar experiences - I too am especially prone to high readings despite masses of insulin in the mornings but it does get, relatively, more sensible in the day.

 

[trophywench]

What a lot of preg ladies do, at this stage is to take sufficient bolus to prevent too a high spike, then have a planned snack at 2 hrs post meal to prevent the hypo.

Also, do you inject well BEFORE you eat? - that helps iron out the spike but doesn't stop the need for a snack. Of course with having such a low - or high? - carb ratio at that time, it doesn't need to be a very big snack at all.

 

[sorcha]

more and more insulin

I had my babies a few years ago and by the end of my third pregnancy I was injecting about 300 units every day, and about a third of that before breakfast! My HbA1c was always within the approved range, and I never had hypos. The third pregnancy was unexpected (unplanned) and I didn't realise I was pregnant until nearly halfway. (I did a pregnancy test and got a false negative, so put the tiredness down to the diabetes!)

But despite the enormous amounts of insulin, everything went absolutely fine. I had a few 9.9s and the occasional scary 13 (usually after lack of sleep rather than naughty cake). The thing I think helped the most was daily exercise. That also meant that when time came for the delivery I was pretty physically fit, despite being overweight. All three of my babies were normal weight and completely healthy.

Basically, pregnancy hormones make it hard to regulate blood glucose levels and insulin needs are bound to rise. I reckon as long as you're not having hypos, take as much insulin as you need to keep your HbA1c healthy.

Good luck!

 

[RuthieG]

Thank you all it is really reassuring. Today I tried 1:3.5 for breakfast and was 8.4 afterwards so maybe I am getting there (for now until it all changes again!!). I have corrected a little but maybe I shouldn't really when it is only a bit high. i will be hypo in an hour or so no doubt, so will have a snack shortly.

I do inject about 15 minutes before I eat which definitely helps.

The last post (Sorcha) re having the odd 13 but everything turned out fine is really good to hear and I am always very very worried with anything above a 10, especially if it doesn't come down straight away.

I probably do over correct sometimes when this is the case if I am honest.

Thanks for sharing all your experiences and reassuring me.

As an aside I also read a thing the other day (a medical journal but can't remember what) that said HbA1c is basically no use through pregnancy and post prandial ranges are more important. That worried me even more because that is what is all over the place at the moment. Eeek