# Support with hitting post meal blood sugar targets (to gain approval for IVF treatment)



## seawaves (Nov 23, 2022)

Hi, I am new to this forum but would really appreciate your ideas, suggestions and a bit of cheering me on. I have been managed by the pre-pregnancy team at my diabetes clinic for 3 years and am now at the last stage before securing approval for IVF. I have worked hard to hit my HbA1c targets (down to my lowest ever result of 42) but I have now been asked to hit the fasting target (5.3) and the 1 hr post meal target (7.8) the same as for pregnancy and I am really struggling to find recipes that help me to do this. The stress of trying to do this and knowing my approval to start IVF treatment is depending on me achieving these tight targets, has been really tough. Any suggestions on books, blogs, support groups, recipes, etc for managing diabetes through fertility treatment would be really helpful, all the things I have found so far are for during pregnancy not in relation to fertility treatment. Many thanks for any suggestions. 

(N.b I am managed on NovoRapid, Levemir and Metformin. I am either an unusual type 2 diabetic (diagnosed at 19 with no risk factors and not insulin resistant according to my diabetes team) or a rare MODY type (its not the main genes I've been tested) I'm just regularly told I'm really unusual!


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## SB2015 (Nov 23, 2022)

Welcome to the forum @seawaves .  I am glad that you have found us.

I cannot help you with pre pregnancy advice but reading the title of your post, I can offer these suggestions for addressing post meal spikes

Pre-bolus for your meals
it takes time for the Novorapid to get going and in order for this to meet the glucose from your carbs head on many of us find that injecting a while before we eat helps with this.  The timing varies for each of us and can vary through the day, so it takes a bit of trial and improvement.  It can be anything between 15-45 min in general, so start cautiously and keep an eye on your levels.

Identify the impact of different foods
If you are using a sensor, or just be keeping records of what you are eating alongside levels before and two hours after meals, you can see if certain f are more spikey for you. I was surprised how porridge sent my levels so high so quickly, even though I thought it was a healthy option.  We are all different and have to find what works for us.

Look at portion sizes.
The bigger the meal the higher the spike will be.

Dont sit down for 15 min
After each meal I try/to do something for at least 15 minutes.  We try to go for a walk, or just do something around the house.  I was amazed how some Himalayan spikes flattened out to some nice Lakeland fells by doing this.

I am not sure how helpful these ideas are for particular circumstance, but they may help you.  You are clearly motivated to get into the IVF list and there will be lots of ideas from people on here.  There is a parents section where you might get more targeted advice.  Whatever you find, just let us know how you get and keep coming back with any questions that arise.


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## Inka (Nov 23, 2022)

Welcome @seawaves  I’m not sure about the IVF bit but there have been a number of threads from people pre-conception here so hopefully they’ll help you, if you have a read around.

Interesting re your diabetes type. You might find you need to read threads from both Type 1s and Type 2s and pick out what suits you.

Do you have a Libre?

The fasting target requires you to run lower than you might normally overnight. You might need to adjust your insulin - do you have a half unit pen? If you’re getting higher numbers because of Dawn phenomenon or ‘foot on the floor’, do tell your team. I’ve had three pregnancies and sometimes I didn’t hit that fasting target even though I have a pump - how far off are you?

For post-meals, you need to correct more than you would normally. Test at 1hr as well as at 2hrs. I found I needed to get the correction in and, if I dropped a bit low later, simply eat a few carbs to bring me up a tiny bit. Pregnancy and pre-conception is hard work because of the strict targets, and I found the diabetes needed more active management through the day - monitoring, a tiny nudge of correction dose, etc. Keeping active after meals helps too.

I didn’t eat a special diet. I ate what I needed for pregnancy and used my insulin quite ‘forcefully’ to keep to the targets.


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## Inka (Nov 23, 2022)

To be clear, it’s not the recipes, it’s the insulin


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## helli (Nov 23, 2022)

Inka said:


> To be clear, it’s not the recipes, it’s the insulin


Is it also about the timing of the insulin?
If I inject at the "right" time, I can see very little rise but if I inject late, I see quite a spike. 
The LIbre has really helped with this for me. It alos highlighted how sloe NovoSluggish was for me and provided the justification for Fiasp.

(Not that this was related to pregnancy - just an observation I thought may be useful.)


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## seawaves (Nov 24, 2022)

SB2015 said:


> Welcome to the forum @seawaves .  I am glad that you have found us.
> 
> I cannot help you with pre pregnancy advice but reading the title of your post, I can offer these suggestions for addressing post meal spikes
> 
> ...


Hi, thank you so much for your response. This has provided me with really helpful suggestions of where to start. I do try and move around after my evening meal as I know that makes a real different (I love the way you described the peaks from Himalayan spikes to Lakeland fells, I am using that from now on, it makes the geographer in me happy  ) but I hadn't thought of applying this to other meals.

I have started working out what food works well (meals with nuts or meat protein, soup and toast) things that impact me the most seem bizarrely to be some pulses (mixed bean chilli is horrendous for me) and I also can't do porridge but I will investigate this further.

I also didn't know how long it can take Novarapid to take effect, that's so useful to know. I will discuss with my diabetes care team at my next appointment.

Thank you for helping to give me some faith back I can do this. I will keep you posted on how my adventure goes.


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## seawaves (Nov 24, 2022)

Inka said:


> Welcome @seawaves  I’m not sure about the IVF bit but there have been a number of threads from people pre-conception here so hopefully they’ll help you, if you have a read around.
> 
> Interesting re your diabetes type. You might find you need to read threads from both Type 1s and Type 2s and pick out what suits you.
> 
> ...


Hi thank you for your helpful reply. Shall keep an eye on the different threads and see which seems to suit me best. 

I don't currently have a Libre but is I think something I will ask my team about.

oo no I didn't know a half unit pen existed, may be something to think about as I am currently on low does. So I am not miles out for my fasting results (normally low 6's and then sometimes I get it right on the target) normally seems impacted when I don't sleep well or needed a light snack in the evening so don't go too low over night).

Thank you for all your suggestions 

I have never tested 1hr and 2hr post meals but this seems something could help going forward as sometimes I've missed the one hour target and then really dipped afterwards.


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## Inka (Nov 24, 2022)

A Libre would definitely help you. For a start, it will make it easier to do basal tests so that you can ensure your basal insulin is at the right level. If your team are being strict with pre-conception targets, then I think it would be fair to give you one. 

Is it your IVF team or your diabetes team pushing you to meet the targets? Your HbA1C is very good and below the recommended level for pregnancy.


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## seawaves (Nov 26, 2022)

Thank you for all your helpful suggestions, it's really meant a lot to me during a challenging week. I've started moving for 15 mins after every meal (definitely helped with my post breakfast results as these have now been in target , and it's nice to have this break before working on a screen). Monday I will ask my team about the timing for NovoRapid before food and also if I can have a Libre. Will keep you posted on how it goes!


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## seawaves (Dec 8, 2022)

seawaves said:


> Thank you for all your helpful suggestions, it's really meant a lot to me during a challenging week. I've started moving for 15 mins after every meal (definitely helped with my post breakfast results as these have now been in target , and it's nice to have this break before working on a screen). Monday I will ask my team about the timing for NovoRapid before food and also if I can have a Libre. Will keep you posted on how it goes!


Hi. An update and also a Libre 2 question. I have been given a trial of a Libre 2 (although this is not guaranteed going forward as its normally only given to type 1 diabetics). I have completed the Libre Academy training and understand the difference between the interstitial result and blood glucose result and I understand that there is a time lag. What I am struggling to get my head around is the likely length of the time between the results (I think this can be anything up to 15 mins) and therefore how do I take this into account for my 1 hr post meal result. This is my assumption I wanted to check with you lovely people. I log my notes on the app with exact times of things, i.e meals. insulin etc but test taking into account the time lag. i.e say I injected Novorapid at 8.55, started eating breakfast at 9 am, I would need to scan at 9 am and then rescan at 10:15 to take into account the time lag (with finger pricking I would just normally do this at 10 am). Am I correct with this? Secondly the Libre has highlighted that although I ate a small carb and protein snack before bed I was hypo (3.6) between 3 am and 6 am. Is this something I need to inform my diabetes team about. I think this forum is forum is fantastic, without it I know be panicing quite a bit now but know you will be able to help


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## Inka (Dec 8, 2022)

Personally I wouldn’t use the Libre if you’re looking for a super-accurate post meal result. Granted it wasn’t available during my pregnancies, but I have it now and I think what I’d do is scan with the Libre frequently between 1 and 2hrs post meal but for the ‘official’ figures at 1hr and 2hrs I’d fingerprick.

For your nighttime hypo, did the Libre alarm sound? Always confirm hypos with a fingerprick especially at night as you can get compression lows if you lie on it (not a real low). But if you are hypo, then yes, tell your team when you speak to them.


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## seawaves (Dec 20, 2022)

Inka said:


> Personally I wouldn’t use the Libre if you’re looking for a super-accurate post meal result. Granted it wasn’t available during my pregnancies, but I have it now and I think what I’d do is scan with the Libre frequently between 1 and 2hrs post meal but for the ‘official’ figures at 1hr and 2hrs I’d fingerprick.
> 
> For your nighttime hypo, did the Libre alarm sound? Always confirm hypos with a fingerprick especially at night as you can get compression lows if you lie on it (not a real low). But if you are hypo, then yes, tell your team when you speak to them.


Hi, I hadn't heard of compression lows before but I think that's exactly what happened as I got the alarm the next night and tested my blood glucose and it was 5.3. The CG monitor has helped identify trends but I have also been doing my fasting result and my 1hr post meal checks (the ones I have been asked to monitor) via blood glucose. I have my appointment with the consultant tomorrow - wish me luck!


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## Inka (Dec 21, 2022)

Good luck @seawaves !


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## seawaves (Dec 28, 2022)

Inka said:


> Good luck @seawaves !


Hi thanks for the good luck! I gained approval from my consultant . Woo! I still need to get a few more of my fasting blood sugars on target but 83 % of my results were within my target range (3.5 - 7.8) from my CG monitor. This means that I can start IVF shortly (maybe even next month!)


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## Inka (Dec 28, 2022)

Brilliant news @seawaves ! Sending you a huge load of luck for 2023!   XxX


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## rebrascora (Dec 28, 2022)

Congratulations on doing so well and getting the nod to start treatment and very best of luck with it.


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## seawaves (Friday at 1:40 PM)

Hi, so thought I would provide an update. I have been given by treatment plan (starting in February!). Trying to be cautiously hopefully, but not to think too far ahead. Its hard when this journey has taken 6 years to get to this point. Slightly scared how I will react to the meds but just going to try and take it one thing at a time. Thanks to your input and suggestions I'm getting more to grips with the post meal targets (timing of insulin and moving post meals really helped) but I am struggling with my fasting ones. My target is 5.3 and I've upped my Levemir slightly as advised by my team but my average is more like 5.8-6.0. If I move too much in the evening I can then go hypo overnight so I wandered if there was anything people found helpful with hitting fasting targets. Does a small protein snack before bed help? If so do you have suggestions on what this could look like? (I know my sleep patterns also affect this and it and that has been a bit hit and miss recently due to a family bereavement). I know its very trial and error and everyone is different but I would really value your suggestions that have worked for you


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## Inka (Friday at 1:46 PM)

I found only a pump helped me sort my basal overnight and early morning @seawaves Is that an option for you? On injections I found I either hypo’d early in the night or had a strong Dawn Phenomenon. I don’t think I’d have achieved the targets without my pump.

Having said that, the fasting target you’ve been given is strict. I was told to stay below 6, which was more achievable.

Sorry to hear about your family bereavement x


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## rebrascora (Friday at 1:50 PM)

So pleased to hear you have a Go Ahead date for treatment and you have found prebolusing has reduced your meal spikes. Do you have a half unit pen for the Levemir if you are having difficulty fine tuning it? I always have to reduce my evening basal if I have exercised during the day and Levemir gives you the flexibility to do that whereas some of the longer acting basal insulins like Tresiba are not responsive enough to do that. Or as you have considered a high protein snack at bedtime. A couple of handfuls of roasted peanuts works well, but you have to be disciplined, espcaially if you buy large packs, because once you start it is hard to stop  and I can often end up with a lovely straight line in the 9s  all night after I got carried away and ate more than I should.  Cheese is also very good, maybe with a couple of oat cakes.  

Anyway very best of luck with your treatment when it starts and do let us know how you get on. I am sure we are all rooting for you!


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