Really struggling

[Zoee3mma]

Heyy everyone,
I have been diabetic type 1 for 18 years ( I'm 26). I am 11 weeks pregnant with my first child!!
I have been given the dexcom, but I keep having really low lows and then shooting up really high!! For instance, from 2.6 - 18.9 with only 16g crabs!!
I am having more lows and highs! My diabetic midwife just tells me to follow sick day rules when I ring and ask for help!!
I am so lost and don't know what to do! I inject little amounts and my bloods just go up and then all of a sudden they will drop through the floor!!
Any advice or help would be great, I feel like I'm all alone and screwing everything up!!

Thanks ☺️

 

[Inka]

@Zoee3mma You’re not alone I’ve had three pregnancies with Type 1 and it’s hard work and there are always worries. Even women without diabetes worry during pregnancy. Of course, we have the added stress of trying to keep tight control.

What helped me was looking at a simple chart in Think Like A Pancreas (I’ll try to find the chart for you later). It clearly showed the usual pattern of pregnancy - the persistent lows and then the mad insulin resistance later. Just knowing what I was experiencing was normal, helped stop me panicking.

Sudden, fierce lows are a feature of the first half of pregnancy. They’re scary! You’re lucky having the Dexcom to warn you. Keep hypo treatments everywhere including by your bed.

Are you on injections or a pump? Can you give an example of an occasion when you dropped really low then shot up high? Eg was it after a meal, what did you have to correct the hypo, etc, etc. If you’re on injections, what insulins do you take and when?

 

[Leadinglights]

I assume the management of diabetes during pregnancy is rather different for somebody with existing diabetes than for somebody who develops gestational diabetes so it may be your diabetic midwife is not as experienced with the former so you may need to ask to see your obstetric team. You should anyway get more frequent check ups through your pregnancy.

 

[Zoee3mma]

@Zoee3mma You’re not alone I’ve had three pregnancies with Type 1 and it’s hard work and there are always worries. Even women without diabetes worry during pregnancy. Of course, we have the added stress of trying to keep tight control.

What helped me was looking at a simple chart in Think Like A Pancreas (I’ll try to find the chart for you later). It clearly showed the usual pattern of pregnancy - the persistent lows and then the mad insulin resistance later. Just knowing what I was experiencing was normal, helped stop me panicking.

Sudden, fierce lows are a feature of the first half of pregnancy. They’re scary! You’re lucky having the Dexcom to warn you. Keep hypo treatments everywhere including by your bed.

Are you on injections or a pump? Can you give an example of an occasion when you dropped really low then shot up high? Eg was it after a meal, what did you have to correct the hypo, etc, etc. If you’re on injections, what insulins do you take and when?

Thank you! Feel a little better to know it's not totally out the blue!!!

The highs come mainly during the night or mid afternoon! I am on novorapid and levemir. I carb count and I'm on a 2:1 ratio. I take 24 levemir at night and 10 in the morning

 

[Inka]

Ok. I found most of my hypos were before 1pm. Lots of times I’d have to eat extra carbs mid-morning to stop myself going constantly low. That didn’t happen so much in the afternoon but I didn’t go high. Perhaps I had a similar thing to you but not as extreme.

You say your ratio is 2:1 - just confirming what you mean by that? I say my ratios as 1:10, 1:12, 1:8 etc, where the 1 stays constant because it’s one unit of insulin and the second figure is the number of grams that one unit covers. I know people use different ways to express ratios and I’m not 100% sure what you’re saying. I thought at first you meant 2 units to 10g carbs but now I’m wondering if I’m wrong.

I have a pump and that did make things easier because I could adjust the basal much more precisely, hour by hour. Have you been offered a pump?

With your afternoon rises, are you sure your lunchtime ratio is correct? Do you have a half unit pen so you can do more accurate boluses and more precise corrections? Are you going low after lunch then shooting up high after you have carbs to correct that, or is your blood sugar going along in the normal range then suddenly shooting up even though you haven’t eaten anything?

For the nighttime highs, when do they tend to happen? I found I had to be more careful about eating my evening meal in good time and not having it too late during pregnancy.

Finally, are you confident in your basal amounts? Obviously you can’t do a basal test during pregnancy and things would be changing frequently anyway, but another possibility is that your afternoon highs might be to do with not having enough morning Levemir rather than your lunchtime bolus being wrong.

Sorry for all the questions! I found that pregnancy was a frequent process of tweaking insulin. Working out what might be the issue will allow you to tweak the right bit of your insulin.

 

[Bobbiete]

Have you not been offered an insulin? That will really help you to set your insulin doses hour by hour. It does make control much easier.
Sending you lots of positive energy…I’m 11 weeks 6 days and it is exhausting keeping it under control xx

 

[trophywench]

I think @Bobbiete meant have you not been offered an insulin pump.

I think that probably differs depending where you live, same as not every hospital offering the same makes or models of pumps.

 

[Zoee3mma]

I'm freaking out even more now, the diabetic midwife rang me and has said that when my bloods go high after eating ( they come back down) I am dangering my baby!!! I don't know what to do!! My bloods are normally now between 5-9 which is the best I've had in 18 years and I thought I was doing so well but now I don't know what to think!! The midwife isn't offering any support really!!!

 

[Inka]

Don’t panic @Zoee3mma xx This can be sorted. A few short-lived highs are ok. You just have to minimise them and if you get a high, correct when necessary.

Who is this midwife? You should be being seen at a specialist diabetes centre and by the diabetes team as well as your midwife. Have you phoned your DSN?

 

[Inka]

What I did to stop spikes was work out how far in advance I had to bolus for each meal. If, despite that, I spiked high, I corrected carefully. I tested at one hour as well as two hours. Your targets should be something like under 7.8 at one hour and under 6.5 at two hours.

Yes, those are tough targets and you won’t get them right all the time, but pregnancy with Type 1 is an active process of controlling a number of times through the day.

It could also be your basal needs adjusting. That’s why you need the help of a DSN.

 

[trophywench]

So - what advice has the Diabetes Midwife been able to give you, to minimise both hypos and spikes?

 

[Zoee3mma]

So - what advice has the Diabetes Midwife been able to give you, to minimise both hypos and spikes?

Nothing really!!! I was having some spikes and they told me to follow sick day rules!! I feel really alone and I don't have anyone to help!!

 

[Inka]

@Zoee3mma Can you just confirm - is it a “diabetes midwife” you’re seeing or is it a DSN? When I was pregnant I saw a multi-disciplinary team. The midwives did all the normal checking my baby things, but anything to do with diabetes was dealt with by a DSN. My diabetes consultant was also sometimes present at my clinic appointments.

I saw the multi-disciplinary team at a hospital, but between those checks I also saw a local midwife attached to my GP surgery just to check my blood pressure, etc. This local midwife did not get involved with my diabetes.

It would really help if you could make clear who exactly you’re seeing and speaking to as I’m still unsure.

Your highs can be sorted. You just need to use your insulins to do that. It is full-on during pregnancy but you have the Dexcom to help you. If you’re happy to post a graph here, you’ll get more detailed suggestions about what the issue(s) might be and what others in your situation have done.

 

[PhoebeC]

@Zoee3mma Can you just confirm - is it a “diabetes midwife” you’re seeing or is it a DSN? When I was pregnant I saw a multi-disciplinary team. The midwives did all the normal checking my baby things, but anything to do with diabetes was dealt with by a DSN. My diabetes consultant was also sometimes present at my clinic appointments.

I saw the multi-disciplinary team at a hospital, but between those checks I also saw a local midwife attached to my GP surgery just to check my blood pressure, etc. This local midwife did not get involved with my diabetes.

It would really help if you could make clear who exactly you’re seeing and speaking to as I’m still unsure.

Your highs can be sorted. You just need to use your insulins to do that. It is full-on during pregnancy but you have the Dexcom to help you. If you’re happy to post a graph here, you’ll get more detailed suggestions about what the issue(s) might be and what others in your situation have done.

I agree with Inka.
you need a DSN and a diabetic consultant. I’ve never heard of a diabetic midwife before. My DSN was on call most of the time. And she even helped sort of I needed to see say they midwife.
Short term highs won’t do much harm to baby.
With pregnancy it changes on a day to day basis and it’s harm to manage but not impossible. Try not to stress and just look at if there’s a pattern you can find.

Can you test your background insulin? I would do that I think, if you know your background is right the novorapid is easier to work with.
Take care

 

[grovesy]

Diabetic Midwife's have been around in some places for quite a few years, they usally work as part of a multi discipline team.

 

[Inka]

Are they midwives with extra experience in diabetes @grovesy (ie a bit like the GP nurses who are diabetes ‘expert’ nurses) or are they actual DSNs? If it’s the former, @Zoee3mma would probably be better speaking to her DSN.

My DSN had extra pregnancy training and dealt with pregnant women with diabetes. She was quick to help me with pump adjustments in great detail. Her knowledge was excellent and she was extremely helpful.

 

[grovesy]

Are they midwives with extra experience in diabetes @grovesy (ie a bit like the GP nurses who are diabetes ‘expert’ nurses) or are they actual DSNs? If it’s the former, @Zoee3mma would probably be better speaking to her DSN.

My DSN had extra pregnancy training and dealt with pregnant women with diabetes. She was quick to help me with pump adjustments in great detail. Her knowledge was excellent and she was extremely helpful.

It varies like everything else.

 

[Inka]

It varies like everything else.

Thanks @grovesy It doesn’t sound like @Zoee3mma has the support she needs.