[e||ement]

my gosh, this is tough, trying to get such tight control. and i'm only 5 weeks along.

i need some guidance. i've been testing like every hour and my 2 hr pps are higher than my 1 hr, and keep going up (for the last two days) so i've just increased my basal by 10%. hopefully that helps.

but, i'm on NPH, and last night i tested every few hours to see if i could catch the peak (i've not been able to catch it before), and you know what? i don't think there IS a peak. that's what i've concluded.

i was at 7.5 at bedtime (11:30pm) and i took 1u of rapid because i knew my numbers would rise. 1u would (pre-pregnancy) drop me 6 mmol/l. i took 10u of NPH at the same time.

at 1:30 am i was 6.0
at 4:00 am i was 7.0
at 7:00 am i was 6.7
at 8:00 am i was 6.2

pretty consistent, right?

so i just took a half unit of rapid, and have yet to eat anything. we'll see what it does.

what can i expect in terms of insulin increases throughout the pregnancy???

oh how i wish my endo was back from holiday.

[belyro]

I don't know how feasible it is for you, but I found the pump and CGMS to be invaluable during my pregnancy. I could not have kept the control I did without them. The ability to adjust basal rates at different times of the day made a big difference, as did the ability to see trends with the CGMS and to catch highs/lows before they got too out of hand. (I had nighttime lows a lot during my pregnancy, so I really relied on the CGMS.)

It's so important to be flexible, because just when you get it figured out, it changes. That's why watching trends is really useful.

I dealt with my endo a lot while pregnant, but I also saw my CDE (certified diabetes educator - a nurse) on a very regular basis. She was able to help me with the hands-on problem-solving much more than my endo. She was great!

Also, do remember that, while bad bloodsugars aren't good for the baby, neither is stress (especially if it contributes to high blood pressure). I know it's really hard not to stress out and not to worry what even one bad reading is going to do to the baby, but try to keep it all in perspective and take some deep breaths. It sounds like you're doing great, so I think you can afford to relax a bit without risking getting out of control.

Take care!

[sarahspins]

You shouldn't expect a ton of change throughout the first and most of the 2nd trimesters over your typical PMS type insulin needs (due to progesterone).. your insulin needs may actually decrease towards the end of the first tri... and you may find yourself having lots of random lows (this actually has less to do with your own insulin requirements and more to do with baby's increasing needs for glucose from your bloodstream).

That said though, since your fasting number is higher than your corrected bedtime number, and you're definitely not going low, I would suspect you need more overnight. Likely through the day as well.

An overnight basal test with NPH may not show you much of any "peak" in insulin action - if you have much of a dawn phenomenon the NPH will counteract it when it "peaks" and your levels may stay relatively steady. The fact that your #'s were up around 4am and came back down later sort of supports this. My dawn phenomenon kicks in around 4am, and I need a LOT more insulin to counteract it (which is easy with a pump).. it's actually interesting to see on the CGM graphs, on the nights where my basal rate increase doesn't kick in early enough (since it really seems to vary based on when I go to sleep), I can easily spike to 300+ from 100-120. When I was on MDI (using Lantus for basal) I actually used a bit of NPH to counteract my DP.. if I took it right at bedtime it would peak for me right at the right time. That peak would not usually result in a drop, but just in the prevention of that rise.

[e||ement]

thanks guys

sarah...good point about the NPH peak and DP...i never thought of it that way. i'll try going to bed tonight with a lower number and i'll test again and see where it takes me. i think you might be right.

in the past two days i've upped my bolus ratio dose by 20% as well.

and i'm making a more conscious effort with pre-bolusing and splitting boluses to match the peaks with digestion.

anyway...hopefully i don't get the same craving as i did with my last pregnancy...CEREAL! i ate it for dinner more nights than i'd like to admit! LOL. the other craving should be ok...cheese and olives ;-)

[Belle'sMama]

Ellement I'm only a week behind you and I guess I forgot how insulin resistant I was when I first got pg with my now 2.5 yr old! I've had to increase my insulin level every few days already! Of course, I am SO worried about the highs I had about 5 days after ovulation (400!) but I am trying to be positive and tell myself that it wasn't for days straight or anything like that and just try and get them down now and from now on. The lowest I could get my BS down yesterday was 95 and that didn't last long. Woke up at 113 this morning, it should be lower but at least it was better than yesterday's fasting which was 250! My DE thinks my basals are already a little high so I changed my sensitivity and my target to 100 from 110 (was my pre-pregnancy target) I am meeting with my endo on Friday though so we'll see. Are you on a pump? I've had the CGM sensor for the past 3 wks and am really hoping it will help.

[e||ement]

hi belle'smama ;-)

yah, it's crazy how much insulin needs change so early! i've upped by basal by 10% and increased my bolus figures by 20%...just in the last few days!

that...plus splitting boluses...seems to be working better. i still have to work on the evening/sleeping numbers, but i went to bed with 4.7 last night and woke up at 5.9 today, so there's a little improvement.

i don't see my endo until next friday!!! grr!!! so i'm thankful i have all you to bounce my ideas/concerns off of.

i'm not pumping (i'm only about 10 months into my diagnoses) but i am going to a pumping information night at my diabetes education centre later this month.

i'm not sure that's the route i want to take, but i thought i'd sign up and see what it's all about!

[Brookie]

Hi,

All I can tell you is that at 5-6 weeks my insulin requirements went up drastically, but around 7-8 weeks they started to fall quickly as the baby was developing and getting bigger. I think it might be the hormone changes at first, but be careful you don't get too many lows in the near future. The little baby can use a lot of gulcose which is why your requirements may drop. It's different for everyone, but that's what happened for me I'm 10 weeks now.