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Sobriquet

Very early first trimester - high readings

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Sobriquet

So - after, a whole one month of trying - I am pregnant again - but getting pregnant was never the problem, and i am hoping to stay pregnant this time, after 2 recent miscarriages.

 

I am really really trying to keep the BG down to the recommended level -

  • I eat low(er) carb (below 100g per day, only meat, cheese and non-starchy veg - main carb intake is 100ml yogurt per day),
  • inject an hour before i eat anything (hurrah for Humulin, the tortoise of 'fast' insulins),
  • i don't snack (even though i am ravenous most of the time)
  • i walk a lot,
  • exercise 2-3 times a week....

And damn me if my 3-4 hour pp and fasting blood sugar won't very happily waft up to between 130-160... This is not a rebound, there has been no massive low in between. I thought bg was supposed to come down for the first trimester? Is this a sign of another miscarriage? Or is it just that my honeymoon is over (6 months post dx type 1 - although i'm hoping 1.5)

 

This didn't happen before i fell pregnant - i had pretty good control, my hb1c was 5.3.

 

I have started injecting 1.5 units Humulin in the morning on waking to deal with DP, but that is not enough - i will try 2 tomorrow. I have upped my NPH by 1 unit morning and night, and introduced another shot at 3pm.

 

I have upped my carb/ insulin ratio to 2:1 (it was previously 1:1).

Is there anything else i can do? I am trying really hard not to worry, but I am sick of looking at my meter and bursting into tears because of high readings despite discipline and hunger (and because hormones, let's not forget those).

Or is it just a sign that my body is rejecting the pregnancy again?

 

Sorry for all the questions but I'm out of ideas to try!

 

 

 

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Tanikit

Go and ask for a pump - push for one. I did two pregnancies on multiple injections and it was hellish. Usually sugars drop in weeks 8-14 though even this can vary. Your NPH needs to STOP right now - it is highly dangerous in pregnancies despite being the only insulin registered for pregnancies and tested for them as its absorption is variable - if you have to be on long acting then Lantus or Levemir would be much better - again a pump is better.

 

Nonetheless sugars do vary so do not panic. You will also get hungry and possibly have cravings and then the hormones change throughout pregnancy - this is all normal. Through the  second pregnancy I was often injecting 10 times a day and testing all the time (10-12 times a day) and I still could not get it right - however my child is a happy healthy 3 year old now.

 

If your doctor does not take you seriously about the NPH (and preferably the pump too) then change doctor - it is very important. You will not get the stability you need on it - it is possible to produce a healthy baby on it, but it is unfair on you to have to go through that when there are better options available.

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Lizzie G

I agree with everything Tanikit says about NPH;  I only ever used it to supplement Lantus when I was on injections (at my own insistence to help with the fact that I need double-triple the amount of basal insulin overnight as during the day), but its quite unpredictable, very peaky, and I would imagine extremely difficult to separate cause an effect if you have anomalous readings.  Try and switch immendiately to lantus or levemir and get pumping if possible (although to be honest, getting used to a pump can create its own challenges and im not sure that it is something I would embark upon during pregnancy).

 

For me, one of the earliest signs of pregnancy was needing more insulin; quite a bit more insulin, both in terms of basal, and bolus.  I think I experienced lows at one point around the 12 week mark in one pregnancy, but I never had the lows that were advertised as being an inevitable part of a type 1 pregnancy, so dont worry, its just as normal to be the other way.  the only thing about it though, is during the first trimester, changes can happen quite quickly and lows could kick in anytime so just be vigilant.

 

remember that all you can do is your best.  Look after yourself by eating well, resting plenty, taking your high strength folic acid and other supplements, being kind to yourself, and doing your best with your diabetes management, you cannot do better than that.  unfortunately plenty of miscarriages happen, regardless of whether you have diabetes or not.  I doubt there is a single woman with type 1 diabetes that can honestly say there hasnt been a time where they have been pregnant and freaked out by the odd high number, particularly in the first trimester when you know that all the organs are being formed.  please dont beat yourself up. just do your very best, try to learn something each time you have an issue (but without getting into the over-analysing cycle) and move on from it.

 

Im not sure where you are based but I am in the UK and  my last pregnancy I insisted on going to one of the best teaching hospitals and was under the care of some really excellent obstetricians involved in front-line research.  I had already taken it upon myself to take a daily 75mg (baby) aspirin as had heard it can reduce chances of miscarriage etc, and when I told doctor 20 weeks into my pregnancy (the first time I saw that one) he was pleased I was taking it and says he recommends to all pregnant women particularly those at risk of problems with placenta, blood pressure etc, so might be an idea, it certainly doesnt do any harm (although my secon son does have 6 fingers on each hand lol :D).

 

Good luck, try and not worry and enjoy each moment. xxx

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Sobriquet

Thanks ladies, I will do my best- Lizzie, so good to hear about your experience, I have not read about that anywhere!

I have been asking about a pump, and will continue to do so - It is tricky to change endos, we don't have a lot of them available, and it can take months to get an appointment - literally.

 

I'm based in Germany, and I am with a fertility clinic that has its own endocrinology experts who focus on diabetes... however, i have yet to see them. Maybe they can help. My gynae referred me there, as he doesn't have the resources to do all the tests that i need - as an older diabetic, first timer with 2 MCs behind her - I think he was terrified! :ahhhhh:

 

I have an appointment there tomorrow, I will ask about the baby aspirin as well, I have been taking folic acid since the last pregnancy. I'm thinking i might need progesterone as well, just really hope he listens to me.

 

And I'll take my chances with the 6 fingers - we have a piano here, so... could be the next big thing!! :D

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Elizabeth_

Hi Sobriquet! I hope you had a good appointment. Just wanted to offer my experience (so far), since it varied so much from what I expected from reading about t1d pregnancy in books and online:

 

I am a fairly new t1d (diagnosed 11/18/13) and have stayed on pen injections since being diagnosed. I am 37 and knew I wanted another child faster than I could learn to use a pump. I use NPH (Humalin) overnight and fast-acting Novolog for meals (I used Humalog early on and switched in an attempt to get a better deal from my insurance — no difference in effectiveness for me). I really recommend a fast-acting insulin added to your treatment if possible.

 

I've maintained what I guess they call an exchange diet and tack on extra units of Novolog when I eat something extra (more carbs). It's imperfect — not as precise as the pump — but it's been working for me. The biggest challenge all along has been that fasting number; for a while I was actually taking too much NPH overnight and that was causing my readings to go higher. I'm at week 29 now and basically have to add units of NPH every few days.

 

Counter to that log-flume analogy that is all over the place, my insulin needs skyrocketed pretty much as soon as I figured out we were pregnant. The entire first trimester was me adding more insulin (triple, quadruple my usual amount). Since then, things have been pretty steady with an occasional increase. For me, eating the exchange diet breakdown has kept things fairly even. I learned that snacks are an important part of my diet and help keep my sugars more even. Early on I got a ton of hypos because I was being SO aggressive about my blood sugars. I learned that straight sugar was a needed emergency supply in my bag at all times (Mentos: 3g of carb each and travel well). I also learned that I absolutely had to have a snack before bed.

 

Anyway, this is the breakdown I follow. I'm not a nutritionist or low carber, but you might see something here that helps. I understand how hard it is psychologically to deal with disappointing numbers. Just keep trying your best! One thing I read that encouraged me was that occasional spikes aren't dangerous to the baby, it's prolonged periods of high numbers that are problematic. And make sure you are getting enough calories — you need them for you and the baby.  :)

 

Breakfast: 1 protein (7g protein), 2 starches (30g total carb)

Snack: 1 protein (7g protein), 1 starch (15g total carb) — I frequently eat a protein bar for snack

Lunch: 3 proteins (21g protein), 2 starches (30g total carb), 2 vegetables (2 cups raw or 1 cup cooked), 1 fruit (15g total carb)

Snack: 1 protein (7g protein), 1 starch (15g total carb)

Dinner: 2 proteins (14g protein), 2 starches (30g total carb), 1 vegetable

Snack: 1 protein (7g protein), 1 starch (15g total carb) — if I'm under 120 I'm supposed to eat an additional starch serving

 

Good luck! I hope you are feeling better soon!

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