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T2 6 weeks pregnant - poor control, in a mess

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J

JJ72

New Member
Relationship to Diabetes
Type 2
Sorry, this is going to be quite long.

I discovered I was pregnant a few weeks ago. A surprise. I am 37. I am about 6 weeks along. I have been T2 for almost 10 years, it was triggered by treatment for something in my 20s, and my control has varied over the years, I'm afraid depression over the last 2 years (bad Covid experiences not helping last year) have caused me to gain a lot of weight through comfort eating and my control has been pretty bad, I stopped testing altogether, just took my Metformin and hoped for the best. My HBA1C went up to 7.5 in April and I was advised to start testing again, I'm surprised it was only 7.5 as it was rare I got a reading that wasn't in double figures at any time of day (between 10 and 15). Obviously I know I only have myself to blame for this and feel terrible.

When I found out I was pregnant I was seen almost immediately by the DSN at the antenatal diabetic clinic. I had a bit of a meltdown but they were kind. I have been put on Humulin i once a day at bedtime, and Novorapid pre meals, and advised to test an hour after meals and first thing when I wake up. They want me 5.3 or less in the morning and 7.8 or less an hour after eating.

The starting doses I was put on a week ago were 3 or 4 units before meals and 6 of the Humulin at night. I've been increasing these gradually over the week and they are still not doing much. Yesterday I had 10 units before breakfast and lunch, 16 before dinner, 20 basal before bed. Fasting sugar this morning was 8.3 which is no different to what it was at 10 basal units. My readings after eating are normally around 9 or 10 still and although this is better than the readings I had pre insulin they're just not dropping beyond this. I know it doesn't help that I feel so incredibly sick and nauseous at the mo that I can't face anything but carbs - everything is turning my stomach.

Is it normal to be put on a very low dose and build up? All they said was if those doses don't work go up another 2 at a time until they do but they've quadrupled in a week. I feel like I'm missing something. I'm scared to keep going up a few units because I don't know what is normal or too much to be taking. Is 20+ Humulin i at night safe? Ultimately I had 36 units of bolus and 20 basal yesterday and feel like I may as well not have bothered, reading wise.

I'm also always yawning and hungry (even though I feel sick) and don't know if it's the hormones or insulin.

I'm scared I'm almost entirely insulin resistant now and feel under immense pressure to keep this little one alive. The guilt I feel is overwhelming and I feel like every day I'm going to lose the baby and know it will be my own doing.

I don't know when my next appt is, I guess I'll be sent one. I am not seeing a midwife for a couple of weeks yet.

Thank you if you're still reading. Any advice on dosing would be appreciated.
 
Firstly congratulations. And you can do this.

You need to turn the worry into action, the stress will not help your levels or baby so it’s important you look at the improvements you have already made. You have already achieved a lot.

Insulin will not make you tired, it’s the opposite, high levels will make you tired. And can make you feel sick too, or that could just be pregnancy. What do you like low carb that you can snack on?
I found eating stopped me feeling sick, doesn’t make sense but if I got hungry I felt sick.

When they first put you on any medication they go lower, and work up.
Don’t compare amounts to other people, and just keep adusting until it works. And pregnancy especially early on will lead to changes in your levels anyway. And it will be very changeable throughout your pregnancy, you will think you have got it and it will all change again so this stage now learning about what you need will help you out later on.

Please ask away, have a look at other people’s posts I knew there’s been a few T2 who have struggled but got there and have happy and healthy babies now, it can be done.
 
@JJ72 I second @PhoebeC in saying that you can do this 🙂 Think positive - firstly, you spotted you were pregnant nice and early so have got support quickly, and secondly the support you’ve got sounds excellent. You’ve been put on insulin without any delay or faffing about. That’s a good thing for you and baby🙂

It’s completely normal for insulin doses to start low and be built up gradually. That’s the safe way to find the amount you need. Have you also been told carb amounts to stick to for each meal? As you’re on fixed doses of the Novorapid you should have been. So, just as an example, you might be told have 40g carbs for breakfast and 8 units of Novorapid (those are just example figures - yours will be different).

Type 2s do generally take more insulin, especially during pregnancy, so don’t worry about that. You take what you need 🙂

I had awful nausea in early pregnancy and craved carbs too. It was slightly different for me because I don’t have insulin resistance but I did still have to think about what I was eating. You just have to watch your portions and try to bulk them out with non-carby things. I found it also helped to eat slowly. That helped the nausea.

You might be offered an appointment with a dietician soon. I was. For now, sticking to similar carb amounts each day for your meals will help you and your team work out what’s right for you.

Congratulations 🙂
 
Yes ask to speak to the dietitian, if you get a good one they are worth their weight in gold.

I was the same with carbs, and especially crisps, which I don’t even like normally, quavers where my morning sickness cure. Wouldn’t ever want to eat them now ha! But it was what I needed then.

Im only new to carb counting, even being T1 16 years, only really doing it the past year (benefit of covid for me) loads of help on here.
 
Hello, thank you everyone for replying, I really appreciate it.

I haven't been told to count carbs specifically, DSN just said "normal moderate amounts" and said not to limit them too much while pregnant. Honestly I am totally off meat and used to be a complete carnivore, I have never been very good with veg intake but can't stand the sight of anything green at the mo, I'm surviving on Weetabix, rich teas, crackers, toast - all the good stuff (!) It's no wonder my readings are high but I am trying not to eat vast quantities. Maybe something will switch in a few weeks and I'll start craving steak...

I'm also finding it hard to dose for 3 meals when all I want to do is graze to help with the sick feeling.

It's just so overwhelming - thank you so much for listening to my whinge this morning.
 
That’s wise not to limit the carbs too much. To be clear, I wasn’t talking about carb amounts in a “and don’t you dare eat more than that” way, only that you’ll find you’ll find a certain amount of insulin is needed to ‘cover’ a certain amount of carbs. So people can either use a ratio eg 1 unit of insulin covers 10g carbs, and then calculate how many units they need eg 40g carbs in a meal will, according to that ratio, need 4 units of fast-acting insulin - or they stick to a set amount of insulin for each meal and eat the carb amount that that covers.

Although that probably sounds excruciatingly tedious, it is important because it will help get good control of your blood sugar. Later on in pregnancy, you might also be told how to use your fast-acting insulin to correct higher than desired blood sugars. That’s a very useful tool.

Remember that pregnancy is stressful for most women whether they have diabetes or not. Try not to dwell on all the things that might go wrong (but probably won’t). Enjoy your pregnancy and take time each day to stop and stay calm. It really does help. I sat for a few minutes morning and evening just breathing quietly. Simple but calming. I also found it made me feel stronger.
 
Thanks for replying. I am trying to stay as calm as I can and recognise that I can only try my best. Can't be expected to get it right straight away.

Does anyone have any advice about the fact that I basically just want to graze? It's lunch that's the problem , I don't really want a meal as such, I'm not sure when or how much to dose.

I have a midwife appt scheduled for in a couple of weeks so if I'm still a bit stressed I'll see if she can be any help too even if she just refers me back to the antenatal team again.

Thank you for the support.
 
In theory you could snack but you’d probably have to take Novorapid if your snacks were carby - which is probably what you fancy. In early pregnancy I tended to go low so i treated those lows with food without insulin, and that worked ok for me because I was eating fairly frequently and that helped the nausea and desire to eat.

In later pregnancy, I did have snacks sometimes and I took fast-acting insulin for those, just as I would for a meal. I knew my insulin to carb ratio so simply calculated the carbs, took the right amount of insulin and ate. I felt confident doing that because I’ve been on insulin for many years. You’d have to check with your DSN about this. Do stress that you feel you need the snacks. You might be able to have, say, breakfast, mini first snack lunch, then a second snack lunch later on, with a normal evening meal. Do make sure your snacks aren’t all biscuit-type things if you’re replacing your lunch with two snacks. You don’t want to miss the nutrition opportunity of a good lunch.

I hope you’re feeling ok in yourself and enjoying pregnancy amongst all the added diabetes stuff.
 
Thanks, I think I will look into the carb ratio thing or discuss it with DSN if I get chance to go back as it sounds worth working out as I'm still definitely very carby at the mo, which I do need to get a handle on but ugh, just can't yet.
Still can't get my head round how little difference a 26 unit basal shot is having on my morning readings compared to the 6 I started with. Still, I'll keep cranking it up and see what happens!
 
Well done on swinging into action @JJ72

Hopefully you’ll soon be able to find a bit of a balance between your meals and your insulin doses. Should make things a lot easier when you can know what you are aiming for.

I can imagine it must be frustrating not seeing much of a positive effect from your doses yet, but if it’s any consolation I’ve been playing the game for 30 years and still I have times where insulin appears to be as effective as injecting water, then all of a sudden - BAM! One tweak finds the sweet spot and it clicks into place.

Congratulations on your pregnancy! Look forward to hearing more from you as it progresses.
 
Thank you ever so much!
Ups and downs so far... I have had a few milder hypos during the day (cue emergency haribos) and I think I am working out that the Novorapid actually takes longer to kick in for me and I need to take it longer than the 10-20 minutes before eating that was suggested. The units are high, but I'm trying to ignore that as it's the readings that count. Still struggling with reducing carbs, and not grazing, but trying.
The humulin i, I got up to 42 units at bedtime and started to see a bit of a drop but still not enough, then tried 43 last night and woke up at 1am having a bad hypo, BG was 2.9 or something, dripping in sweat and OH had to feed me jelly babies as I couldn't move - never happened to me before and I was so scared, now dreading it happening tonight too. More stress...!
But, slowly getting there - this seems a really supportive forum, thanks for checking in.
 
Every night when I was pregnant I set an alarm to test my blood sugar to avoid hypos like that @JJ72 They’re horrible, aren’t they? Not only did the alarm help me ward off hypos, it gave me some peace of mind too.
 
That's not a bad idea Inka. Certainly hate the idea of it happening while I sleep.
I seemed to be ok last night having knocked a unit off but then my BG was 6.5 when I woke up which is "too high" (I can't get my head around that, for me that's fantastic) - not sure how to find the magic middle ground, maybe another unit or two but with a small snack before bed eg crackers might help. Worth a try?
 
I agree, 6.5 sounds like a brill waking reading, but I know nothing about pregnancy readings except that control needs to be very tight.
I agree crackers with some fat and protein would be good so cheese or pate or a boiled egg with some mayonnaise at bedtime would help stabilize overnight levels a bit. Good luck! You are doing great by the sound of it.
 
You could try a snack @JJ72 It would take a bit of experimentation to find the right amount. It’s very hard keeping strict control, and I found I was often nudging things this way or that. I’d have a small amount of carbs as a bedtime snack with something like peanut butter to make them absorb slower.
 
Thanks everyone - bedtime snack tonight and I'll see how I get on!
I am aiming for 5.3 or below apparently. Seemed unobtainable when I first posted (feel so silly about that now!) but can't be far off cracking it, hopefully.
 
JJ72 said:
Thanks everyone - bedtime snack tonight and I'll see how I get on!
I am aiming for 5.3 or below apparently. Seemed unobtainable when I first posted (feel so silly about that now!) but can't be far off cracking it, hopefully.
Click to expand...

Yes, it really is an active project. Pregnancy means really, really active controlling of your diabetes. It’s definitely full-on!

It sounds like you’re doing very well though. Test, test, test is my advice. Sometimes you’ll feel you’re ‘eating to the insulin’ but that’s because the target range is so small and so strict. It’s totally worth every minute though. Xx
 
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