Please help! .newly diagnosed type 1 - confused

[Charlotte Nahal]

Hi everyone

I am brand new, I have read lots of posts before which have been so helpful but now I have decided to get involved and feeling increasingly anxious and would love to hear some opinions on my situation.

I'm 32, 34 weeks pregnant with my second baby. I had gestational D with my first child, she is now 3 which was managed with metformin. I had her at 37.5 weeks spontaneously 2 days before planned inductions. Avani was a perfectly healthy little girl, 6Ibs 2oz.

I had the 6 wk post partim check on my sugars and passed the organge sugary drinks. About a year ago I was noticing signs of thirst, fatigue, weight loss and was convinced something was going on. I had a glucose monitor so decided to keep a track of my sugars over 4 weeks and they were high after carb heavy meals, HBA1C was 6.3 and they don't diagnose until 6.5.

Had further HBA1C's every 3 months with very similar results.

When I feel pregnant I was given a new meter and told that if I had high readings 3 times to call the diabetic midwife. Within 12 hours I was on metformin max dose. 2000mg (i was 9'wks pregnant). I started insulin at 18 weeks and asked the doctors to test me for type 1 as it didn't feel right that GD should start this early. The GAD test came back strongly positive in August and I have been diagnosed with LADA.

My insulin requirements have increased as have my hypos, I'm very insulin sensitive and have ended up in hospital with hypos in September that would not alleviate.

My insulin requirements have doubled in the last few weeks, this is me now

Breakfast - max 10g carbs (16 units fast acting)

Lunch - max 40g carbs (12 units)

Dinner - don't tend to carb count (10 units)

Bedtime - Humilin I (22 units)

I have also continued to take my metformin with each meal time (1500mg per day)

I do suffer from hypos between breakfast and lunch, I have to eat several times, generally my readings are as follows;

Fasting - 6.7
After breakfast - 9ish

30 mins after I test I get a hypos (3ish) which I have to treat.

After lunch - 8

After dinner - 8/9

Before bed - 7ish

These last few days I have really struggled as my blood sugars are higher than usually both fasting and after meals so I have had to increase my fast acting and long acting doses but today I have notice my sugars not coming up, since this morning (when I had a high reading after breakfast 13) I have struggled to keep out of hypos clutches! I've had to test like 12 times to make sure I am treating them.

Not sure what to do about my bedtime
Insulin when I have struggled to get my sugars up.

I am worried I am doing the right thing I am so new to this. I spoke to my diabetic
Midwife on Thursday and she said I was doing everything right, correcting when really high and keeping an eye out for the hypos but I feel a bit lost.

Had a scan a week ago due to reduced movement and baby is already 6 pounds and on the 95th centile. I know this can be inaccurate so trying not to worry too much but it's hard.

Have an appointment with my consultant on Tuesday about induction, they are talking about 38 weeks which is still a month away! I am so worried I am going to end up in hospital with hypos or something!

Wish I was further along and baby could arrive now and I could stop feeling so anxious.

Sorry for the long post - any words of wisdom would be greatly appreciated.

Thank you

Charlotte xx

 

[trophywench]

Ni Charlotte - I'm not at all surprised you feel you are struggling - but OMG!! - pregnancy on it's own is difficult enough but if you're diabetic you can multiply that by about 100. BG is notoriously mega difficult to control and virtually everyone struggles - especially in the last trimester. It's not at all unusual to need two, three or four times as much insulin than you needed the day before you conceived. ie I'm trying to say that it sounds to me that you aren't at all awful - you're perfectly NORMAL in fact for a pregnant diabetic!

I'm going to highlight your questions to @grainger cos she's currently expecting her second and hopefully can be more helpful than me!

Good luck anyway - and look forward to the day you can meet your baby and you suddenly don't need anywhere near as much insulin, if any for a while at least, with LADA! (you do know that's pretty instant, after you've done all that work, don't you?)

 

[grainger]

Hi Charlotte

Firstly congrats! 34 weeks is fantastic and the last month will fly.

Hypos are a nightmare in my opinion. I can only tell you my personal experience but I understand it’s incredibly common to hypo after breakfast - this is because we have to give ourselves such a huge dose of insulin to stop the spike but then plummet. My diabetes team have always recommended that you have a sort of mini breakfast after the first to slow/stop that low - for me during my first pregnancy I ate a banana after my post breakfast test and this helped to reduce the number of hypos I was having. Might be worth speaking to your team to see if they’d recommend similar for you.

Are you experiencing hypo symptoms? If you are then unfortunately it’s more a case of just keep doing what you’re doing. Little and often eating and regular testing can help reduce hypos.
Not sure why you aren’t carb counting your dinner? Are you pretty consistent with what you eat? I can’t really say what to suggest if any changes at night - I’d keep doing what you are doing looking at your bedtime and fasting levels.

Try to relax about the weight etc. I know non diabetics who have had huge babies and diabetics who have little ones. Also my son was 95th percentile and i was worried but at 38 weeks when we had him he turned out to be a nice healthy 7lb 12oz. It’s human nature to worry but you are doing brilliantly!!! It’s such a huge learning curve pregnant or not and pregnancy combined with seven thousand hormone changes just makes our lives so much harder.

Your diabetes team are there to answer any questions you have so don’t be frightened to ask.

Remember - you are doing the best you can do. Your numbers are mainly single figures which is absolutely fantastic. You will find you probably become more and more resistant during the last month but just test, adjust repeat and you’ll be fine!

Keep smiling. Your new arrival is almost here (I’m at 21 weeks so a long way off!)... I look forward to hearing fantastic news in a month. If you want to ask me anything feel free to - I might not have the answers but always happy to try 🙂

 

[grainger]

Oh and as Jenny said - the minute you have this baby your insulin requirements will change so I’d check with your team beforehand what they’d like you to do 🙂

 

[Cleo]

Hello and welcome Charlotte,
As people have said, you are doing an amazing job. Diabetes and pregnancy is incredibly difficult !
I wonder if you're taking too much metformin ? In both my pregnancies I was put on Merformin in the 3rd trimester to help with the insulin sensitivity. i started taking 2 tablets a day but that made me have hypos so as soon as I decreased to 1 tablet daily it helped and the hypos stopped.
In any case, if it were me I'd contact your diabetic team tomorrow just to let them know that you're having these issues.

Good luck and in few weeks you'll be holding your baby and all of this will be a distant memory !! Xx

 

[New-journey]

Hi everyone

I am brand new, I have read lots of posts before which have been so helpful but now I have decided to get involved and feeling increasingly anxious and would love to hear some opinions on my situation.

I'm 32, 34 weeks pregnant with my second baby. I had gestational D with my first child, she is now 3 which was managed with metformin. I had her at 37.5 weeks spontaneously 2 days before planned inductions. Avani was a perfectly healthy little girl, 6Ibs 2oz.

I had the 6 wk post partim check on my sugars and passed the organge sugary drinks. About a year ago I was noticing signs of thirst, fatigue, weight loss and was convinced something was going on. I had a glucose monitor so decided to keep a track of my sugars over 4 weeks and they were high after carb heavy meals, HBA1C was 6.3 and they don't diagnose until 6.5.

Had further HBA1C's every 3 months with very similar results.

When I feel pregnant I was given a new meter and told that if I had high readings 3 times to call the diabetic midwife. Within 12 hours I was on metformin max dose. 2000mg (i was 9'wks pregnant). I started insulin at 18 weeks and asked the doctors to test me for type 1 as it didn't feel right that GD should start this early. The GAD test came back strongly positive in August and I have been diagnosed with LADA.

My insulin requirements have increased as have my hypos, I'm very insulin sensitive and have ended up in hospital with hypos in September that would not alleviate.

My insulin requirements have doubled in the last few weeks, this is me now

Breakfast - max 10g carbs (16 units fast acting)

Lunch - max 40g carbs (12 units)

Dinner - don't tend to carb count (10 units)

Bedtime - Humilin I (22 units)

I have also continued to take my metformin with each meal time (1500mg per day)

I do suffer from hypos between breakfast and lunch, I have to eat several times, generally my readings are as follows;

Fasting - 6.7
After breakfast - 9ish

30 mins after I test I get a hypos (3ish) which I have to treat.

After lunch - 8

After dinner - 8/9

Before bed - 7ish

These last few days I have really struggled as my blood sugars are higher than usually both fasting and after meals so I have had to increase my fast acting and long acting doses but today I have notice my sugars not coming up, since this morning (when I had a high reading after breakfast 13) I have struggled to keep out of hypos clutches! I've had to test like 12 times to make sure I am treating them.

Not sure what to do about my bedtime
Insulin when I have struggled to get my sugars up.

I am worried I am doing the right thing I am so new to this. I spoke to my diabetic
Midwife on Thursday and she said I was doing everything right, correcting when really high and keeping an eye out for the hypos but I feel a bit lost.

Had a scan a week ago due to reduced movement and baby is already 6 pounds and on the 95th centile. I know this can be inaccurate so trying not to worry too much but it's hard.

Have an appointment with my consultant on Tuesday about induction, they are talking about 38 weeks which is still a month away! I am so worried I am going to end up in hospital with hypos or something!

Wish I was further along and baby could arrive now and I could stop feeling so anxious.

Sorry for the long post - any words of wisdom would be greatly appreciated.

Thank you

Charlotte xx

Hi Charlotte
You have had excellent advice from Grainger and others, who have the experience which I don't. I just want to send all my support and hope this last month goes very well and you soon are holding your beautiful baby. Do keep writing and sharing if you need to, you are doing amazingly well.
Jo

 

[Charlotte Nahal]

Wow what wonderful support thank you so much! Just to hear I are doing a good job from people who have way more experience in this than me is so lovely.

I loved the suggestion of the follow up mini breakfast, I kind of do that now when I see my levels dropping - I don't feel it until I am sub 4 and then get in a panic and tend to over treat. Once I was 2.2 and I had just parked up and had no idea it was that low, 5 mins later I couldn't walk or talk or anything. Thank god I got some help from passers by. Scary!!

I didn't think about the metformin actually, that is a good idea to check with my diabetic team tomorrow to see what they think. They tend to just adjust the insulin and don't like me to mess with the metformin but it's a good suggestion.

Yesterday and today has been quite a stark contrast, much less insulin required to get a normal reading which was a little concerning. Last night I had to eat a bowl of rice crispies and a packet of belvits breakfast biscuits before it was at a safe level to sleep. It was 1am
When I finally felt satisfied with the reading! And today, For example I forgot my quick pen at lunch and so only had my metformin, had a chicken wrap salad and chips and it was 8.9. Now I know this is still over target but a week ago it would have been 12/13. Again tonight at dinner, went for a curry for our wedding anniversary - had white rice and everything and only had half my insulin and it was 6.3, dropping to 5.1 two hours after eating.

I have taken my usual nighttime long acting as don't want to wake up with high numbers as makes me feel so ill but I am a bit worried this could signal a problem? I researched this and it said it would be something with the placenta? I'm definitely going to call the team tomorrow and ask their opinion.

It's such a minefield isn't it! I am looking forward to things levelling out after baby arrives although I have heard that I will need background insulin now I am LADA?

Once again that so much to trophywench, Jo, Cleo and Grainger for replying and your supportive words, means a lot Xxx

 

[SB2015]

You are still in early days Charlotte. Levels will settle as the team hel you to get the right ratios for your insulin. Be patient with yourself, and recognise that you are learning how to do a complicated job of work, that your pancreas was diong without you knowing before.

Keep asking questions

 

[Charlotte Nahal]

Thank you SB2015, I know it's a journey and I need to give myself a break. I just worry not about me really but my baby. I've had a lot of other complications in this pregnancy- I had to have an MRI at 13 weeks, I've had SPD and been on some strong pain killers since July and I recently got a bilateral kidney infections and needed an chest x ray and was on morphine. This on top of the diabetes has been a challenge not to worry about little bubba.

Thanks for your support x

 

[PhoebeC]

You are doing great!keep your chin up and dry not to worry.

I was super sensitive to insulin during my pregnancy, all my meds more than halfed! And my long acting was hardly anything at all.

Sounds like you’ve got a good team to support you.
Take care x

 

[trophywench]

Definitely please do ask them about the placenta failing thing - it was the first thing I thought about TBH when I read that bit of your post - although ISTR someone saying when that happens it absolutely plummets. I hope it isn't!

 

[Charlotte Nahal]

Thanks Phoebe and Trophywench,

Update on today, spoke to my diabetic team who wanted me in for monitoring.

CTG was fine, heartbeat dropped to 54 and I almost died but apparently baby had moved!! They were happy with the trace.

Scan was also fine, normal fluid and cord blood was nice and strong and no resistance. They won't do a growth scan as only had one a 9 days ago.

The spoke to me and she said she is no expert on diabetics in pregnancy- it looks like I am taking too much Insulin? Mmm I said well it's served me ok for the last couple of weeks?

She didn't want to comment as I am seeing my own consultant tomorrow morning who can ad use me.

Today I had a hypos before lunch even through I snacked well, therefore with lunch I had no meds at all, no metformin/insulin and sugars were normal 6.3. That's what made me call the diabetic team.

Dinner I had fresh pasta with sauce and had 8 units and sugars were 8 - I would not have been able to get away with this a week ago. It was a test really to see if it had returned to normal or not.

Just had a snack before bed, sugars 6 and I will take my long acting Insulin and see what tomorrow brings.

Thank you for all your messages, I also read Twinchy's post from 2010 with her experience which I felt was very helpful.

Hope everyone has a good evening x

 

[PhoebeC]

Hope your okay today?

If you are hypoing or eating more carbs on the same insulin then you may need to lower the insulin but your consultant will be the best person to confirm this.

Take care x