[all4lukas]

I have been type 1 for 18 years and am now on my second pregnancy. With my first child I didn't have a pump and was very excited about the more stable control I would have this time because my pump works so well. My fasting are OK. My 2 hour post meals are not where they need to be but my 4 hour checks are perfect. So my Dr keeps decreasing my carb to unit ratio (I started at 9carbs/1 unit, 2 weeks later he moved it to 7carbs/1unit, 2 weeks ago he moved it again to 5 carbs/1 unit). I am only 18 weeks along here! So now that he has changed the carbs to unit ratio my 2 hour checks are better, but at 4 hours I am bottomed out at 30-50 mg/dl. He suggests we fix this by decreasing my basal, but I just cannot grasp how that works (and it doesn't seem to be). I basically HAVE to eat every 2 hours or so to keep my sugar level from plummeting. Has anyone else ever had this experience? It seems to me that maybe I need to change insulin types if this one isn't working fast enough. I don't know what to do, but I don't want the baby to have complications from all this mess. Please help!

[sarahspins]

Yikes.. okay, first, your carb ratio was probably correct before... especially because your #'s were good at 4 hours, you just need to pre-bolus earlier so that more of the insulin is available to match the digestion of your food. If you weren't, or were only bolusing 10-15 minutes before eating, try waiting longer.. I am comfortable with 30 minutes and more now that I've been wearing a CGM. You might also look into the possibility of using a "Super" bolus... you can read more about that here: The Super Bolus

Basically, a super bolus gives you some of your basal insulin along with the meal insulin, while you set a temp basal that is very low - this allows more insulin to be in your system immediately after a meal to limit any big spike, without making you bottom out later from having "too much" on board.

Second, which insulin are you using? If you are already using a rapid insulin (Humalog, Novolog/NovoRapid, or Apidra) it's unlikely you'd notice a huge change in switching insulins.

Also, to reassure you, I've had two endos and three different OB's tell me that running a tiny bit high (like 160 range) after meals is better than being low... in fact my CDE actually told me recently that anything <65 while pregnant CAN be dangerous I had lows less than half that (low 30's) on a daily basis with my first baby (I was on R and N back then) He is/was fine, but it scares me to know that now. I don't mean to scare you either, but just to suggest that you do whatever possible to prevent those.

I've also done one pregnancy pumping (Novolog) and one on MDI (Lantus and Novolog), and pumping made handling labor (and after labor) easier, but honestly in terms of day to day control, I didn't really see vast differences... the key to successfully managing a diabetic pregnancy is just to stay on top of changing insulin requirements, how you are getting the insulin helps, but it's not the end-all solution.

[belyro]

I've had the same problem in the past. If my 2-hour post-prandials were good, I'd be low by the 4-hour mark. THE answer for me (I capitalized "THE" on purpose) was the Super Bolus. I had to set my basals remarkably low (we're talking 0.05u/hr) for a number of hours after eating and then take large meal boluses. It made a HUGE difference in my control. I had tried everything else before that, and nothing ever worked as well as the Super Bolus.

I didn't have this problem while pregnant because I was already Super Bolusing

Good luck!