Bad Night of Levels

[cassandrajade]

Sorry if you don't understand half of this, but I'm not good with the technical terms of BSL levels.

History:
4 Weeks, 3 days pregnant.
Type 1 Diabetic since November 1992 (almost 18years with it now)
24 Units Lantus in evenings. 10 Units Humalog at meals.
Miscarriage in March 2010, diabetes was really badly controlled, no vitamins, excess caffiene.
Seeing my local GP for diabetes care right now, my last endocrinologist removed me from there list for missed appointment (although I did ring in advance).

Current problem:

• Last night (23.07.2010) and this morning (24.07.10)

• Went to sleep on a 3.1. Treated with a lolly and a glass of milk.

• One hour later it was 4.5.

• Feel asleep (pregnancy fatigue has me in it's grip) and didn't test again until my fiancee arrived home from work at 3am.

• Was 16.1!! Had 10 Units of Humalog.

• Went back to sleep.

• Woke at 5:33am. Level was 1.9!!.

• Again had lollies (too many in the end) and a vegemite sandwich.

• Had 5 units Humalog due to the excess intake of lollies.

• Woke 14.9.

I'm so stressed and I couldn't stop crying most of the night.
Due to my miscarriage in March i'm worried that any high will cause me to loss this bub too
I'm going to find an endocrinologist that I have to pay to see, even though we haven't got the money, so I can get this sorted asap.

[aiah23]

Sorry if you don't understand half of this, but I'm not good with the technical terms of BSL levels.

History:
4 Weeks, 3 days pregnant.
Type 1 Diabetic since November 1992 (almost 18years with it now)
24 Units Lantus in evenings. 10 Units Humalog at meals.
Miscarriage in March 2010, diabetes was really badly controlled, no vitamins, excess caffiene.
Seeing my local GP for diabetes care right now, my last endocrinologist removed me from there list for missed appointment (although I did ring in advance).

Current problem:

• Last night (23.07.2010) and this morning (24.07.10)

• Went to sleep on a 3.1. Treated with a lolly and a glass of milk.

• One hour later it was 4.5.

• Feel asleep (pregnancy fatigue has me in it's grip) and didn't test again until my fiancee arrived home from work at 3am.

• Was 16.1!! Had 10 Units of Humalog.

• Went back to sleep.

• Woke at 5:33am. Level was 1.9!!.

• Again had lollies (too many in the end) and a vegemite sandwich.

• Had 5 units Humalog due to the excess intake of lollies.

• Woke 14.9.

I'm so stressed and I couldn't stop crying most of the night.
Due to my miscarriage in March i'm worried that any high will cause me to loss this bub too
I'm going to find an endocrinologist that I have to pay to see, even though we haven't got the money, so I can get this sorted asap.

Why did you take 10 units to correct your 16.1 and 10 units at meals. Sounds like you're taking too much insulin and dropped low and then you're overtreating your lows. 10 units just dropped you 7.1 mmol/hr which is way too much. Did you choose 10 units arbitrarily? It sounds like it would have been safer to take 5-6 and then test 90 minutes later (yes you're going to be sleep deprived). if needed, you could take more humalog then if it's too high. What is your correction factor? During pregnancy, basals, correction factors, and insulin: carbohydrate ratios change substantially and frequently. Recommendation for treating lows: glucose tablets instead of lollies (they work a heckuva lot faster and it's easier to control how high your blood sugars rise after them). You may want to adopt the 15/15 rule. Give yourself 15g of carbs to treat your low, then 15 minutes later test again. If your blood sugar isn't up where you want it to be, consume another 15g of carbs and wait another 15 min to test. You didn't mention how big that glass of milk was but if it was large it could have had around 50g of carbs in it or more (lactose). I recommend that you try not to overtreat your lows.

Fawn

[cassandrajade]

Why did you take 10 units to correct your 16.1 and 10 units at meals. Sounds like you're taking too much insulin and dropped low and then you're overtreating your lows. 10 units just dropped you 7.1 mmol/hr which is way too much. Did you choose 10 units arbitrarily? It sounds like it would have been safer to take 5-6 and then test 90 minutes later (yes you're going to be sleep deprived). if needed, you could take more humalog then if it's too high. What is your correction factor? During pregnancy, basals, correction factors, and insulin: carbohydrate ratios change substantially and frequently. Recommendation for treating lows: glucose tablets instead of lollies (they work a heckuva lot faster and it's easier to control how high your blood sugars rise after them). You may want to adopt the 15/15 rule. Give yourself 15g of carbs to treat your low, then 15 minutes later test again. If your blood sugar isn't up where you want it to be, consume another 15g of carbs and wait another 15 min to test. You didn't mention how big that glass of milk was but if it was large it could have had around 50g of carbs in it or more (lactose). I recommend that you try not to overtreat your lows.

Fawn

Thanks for the advice.
I'm currently without a diabetes team as i've had to switch and I'm having difficulties coping.

[AngelKitty]

Congratulations on your happy news

I'm a T1 and 14+ weeks pregnant.

The best advice is to try and not stress, stress makes our BGLs worse. Plus you really need to get off this high-low BLG rollercoaster.

Test, test, test - all the time.

Try and keep your carb intake to moderate and try treating your lo's with glucose tablets instead of lollies (especially if you can't control yourself with the lolly bag!)

It is extremely important to maintain tight blood sugar control during the first trimester of pregnancy, this is when your baby's organs and body structures are forming.

It takes hard work, discipline and commitment, but it can be done - especially when you think of your reward at the end (your beautiful baby).

[Subby]

You didn't mention how big that glass of milk was but if it was large it could have had around 50g of carbs in it or more (lactose).

Hold on, low or high fat milk is typically 12-15g of carbs per 250ml. It's a but dramatic to think of a glass being 750+ml. I agree the point that the most important thing here is the carbs involved, is important.

But anyway, Cassandra, I wanted to emphasis what's been said here by the previous posters - the best way to help yourself avoid and minimise these situations is be very careful with your corrections, and keep your hypo fixes very controlled.

I stopped fixing with nice stuff like lollies, chocolate, anything like that, a long time ago and being very controlled with my fixes - for me 10-15g of simple sugar in the way of glucose tabs, table sugar, or controlled juice, (I get those little popper tetra packs, I can't keep big lots of juice in the fridge - or I will drink it!) means I get the needed raise but not too high. It's one thing you can do that's quite simple and effective to stop the need for further corrections, further fixes, ups, downs, the whole rollercoaster. I'm a pretty undisciplined person, but having boring controlled fixes this way and simply banning myself from nice foods when low, wasn't that hard and helped me 500% with this issue. If I really want something I like but probably shouldn't have, I have it away from hypos and bolus for it, that way it's not involved with hypos.

Hope thing are feeling more even by now.

[cassandrajade]

Congratulations on your happy news

I'm a T1 and 14+ weeks pregnant.

The best advice is to try and not stress, stress makes our BGLs worse. Plus you really need to get off this high-low BLG rollercoaster.

Test, test, test - all the time.

Try and keep your carb intake to moderate and try treating your lo's with glucose tablets instead of lollies (especially if you can't control yourself with the lolly bag!)

It is extremely important to maintain tight blood sugar control during the first trimester of pregnancy, this is when your baby's organs and body structures are forming.

It takes hard work, discipline and commitment, but it can be done - especially when you think of your reward at the end (your beautiful baby).

Yeah i know the importance of keeping it in control, and i'm doing it alone so it's alot harder.
After this episode yesterday I was lower all day, (between 3-4) which my doc said is quite normal during pregnancy. (the whole going low easily)

[2high]

Hi Cassandra,

I'm Katie (Kit), 26yo, t1 for 18 years, and just over 33 weeks pregnant in Melbourne.

Its typical in the first trimester, especially the first 10 weeks, to be low a LOT... my first thought when I saw the bounce from 4.5 to 16 was that you'd had another low in your sleep and rebounded from your liver releasing too much glucose... it happens! I know its hard, but try setting an alarm to wake up and test overnight.

Also, those first trimester lows can be more stubborn to treat, but you just have to be patient with them. I've found dried fruit to be wonderful, just 15g or so of carb, followed by a SMALL glass of milk, or some cheese or peanut butter, and I tend to hold ok... just don't be surprised if your lows seem to not be responding, or just holding steady... they seem to just take more time in early preg, or they did for me, anyway.

You're also more insulin sensitive in those first months, so you'll need less insulin for your corrections... try taking around half of what you normally would for starters, just be conservative... and feel free to PM if you need!

Kit.

[glorymarian]

Hi again,
Do not be so worried, my doctor said that only long term of high glicemic level could harm the baby.
In my case when my glycemia increased inexplicable in two hours after I ate and took my right dose of fast insulin Humalog, I have to increase Lantus { the basal insulin} but of course during the next day.
When I want to correct a high glycemia I use a less dose of Humalog because the glycemia is back to normal in about 40 minutes anyway and I can prevent a next hypo.
A high dose of Humalog do not decrease glycemia faster.
For my hypo , one or two spoon of honey in milk or tea is very and fast useful.
Take care with hypo too, especially when you are sleeping and tired and you can not feel it.
Au revoir, Gloria

[Lizzie G]

Hi there

Well congrats on being pregnant.

It sounds like you are having a few issues that can be ironed out maybe by quantifying things a bit better and working out in a bit more of a formulaic way how much you need to correct lows, and to correct highs as you seem to be bouncing a little between the two...

Firstly - sounds like you are massively over-treating your lows. I know they make you really hungry and stuff; I find its a lot easier if you specifically treat the low with fast acting glucose and then if you feel hungry also, eat and bolus cautiously.

So for example. If my blood sugar was 1.9 (iv never got this low and can imagine its hard to do anything but stuff as much food as you can into your mouth!!!) i would immediately take 3 glucotabs, each containing 4g carb. normally each tab raises me by about 1. and i would sit down. i would then probably have a sandwich or cake or whatever and bolus normally, and everything would work out fine without a massive high.

Secondly, when you are high you need to be a bit more specific on your corrections. so for example, i find each unit of insulin brings my bloodsugar down by 2. so if my blood sugar was 10 i would try taking maybe 3 units. but be careful of 'stacking'...remember each bolus takes around 3 to 4 hours to work so if you already have an active bolus make sure you take it into account!

different people find different things in pregnancy, personally i have found my insulin requirements have increased a lot in the first trimester from a total of about 35 to 55 units per day, so make sure that rather than listening to what you are told is going to happen by a doctor or anyone else that you listen first and foremost to your body - test plenty and understand what is going on.....if you are struggling with your control generally pick up a copy of 'think like a pancreas' from amazon quick sharp as the principles will serve you excellently....

cant think of much else, just look after yourself, dont beat yourself up when you have a high or low reading focus instead on understanding why it happened and how you can improve things. this is not a piece of advice i am good at following myself, but when you are finding things difficult the easiest way of dealing with it is to eat the same amount of the same thing, figure out how much is the right amount of insulin and then use that to calibrate your insulin ratios generally and become a bit more varied as you see how your body reacts...

hope some of this helps...i know its really hard work but you can totally do this, and you dont need to rely on any doctors to get really good control - read the right books and ask questions here, you will be surprised by how quickly you become the expert!!!

xxxxxx

[AngelKitty]

Yeah i know the importance of keeping it in control, and i'm doing it alone so it's alot harder.
After this episode yesterday I was lower all day, (between 3-4) which my doc said is quite normal during pregnancy. (the whole going low easily)

Hi there, I just noticed that you live up north

NDSS / Diabetes Australia has a service available to diabetics where you can speak to a Diabetes Educator / Diabetes Nurse over the phone. I've done this a couple of times when I needed some quick advice and my DE was on leave.

If you would like the phone number, please PM me and I would be more than happy to give you the info.