# What a week!



## Ponzie

Hi all, 

I'm new to the forum but have been T1 for 25 years. In the past week I have found out I am most probably coeliac (from a blood test result) and also just discovered I am pregnant! So its been alot to take in.

My last Hba1c was 50, but my consultant gave me the go-ahead to start trying due to my age (36). I am freaking out a bit as the past few days I have had highs every day. I just wondered if anyone had any advice on managing T1 and coeliac with pregnancy? Or just how to manage these highs! Many thanks


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## Inka

Welcome @Ponzie and congratulations   I had highs early in pregnancy but then had lots of lows so be prepared for things to change!

I used cautious correction doses if I was too high. Are your highs at a particular time of day?


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## Ponzie

Inka said:


> Welcome @Ponzie and congratulations   I had highs early in pregnancy but then had lots of lows so be prepared for things to change!
> 
> I used cautious correction doses if I was too high. Are your highs at a particular time of day?


Thankyou! Well I had about 5 hypos a day last week (before I knew i was pregnant) but thought this was due to antibiotics I was on as they always send me low.

Since then it has been sporadic but levels were fine all last night then shot up from 6am and were 9mmol by the time I woke up. Then I went for a walk before dinner today and they still crept up- and even with a correction and carb counting have been at 10 for a few hours after eating. I've done another correction since that and just hope they don't drop too low now!


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## Inka

Are you on a pump or injections? Could it be your basal needing to be adjusted? That persistent high after eating might be due to a basal issue. Do you have a Libre? Do watch out for your blood sugar dropping. Pregnancy hypos can come out of nowhere and be fierce. I always tested around 1/2am just to see how things were going.


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## Ponzie

Inka said:


> Are you on a pump or injections? Could it be your basal needing to be adjusted? That persistent high after eating might be due to a basal issue. Do you have a Libre? Do watch out for your blood sugar dropping. Pregnancy hypos can come out of nowhere and be fierce. I always tested around 1/2am just to see how things were going.


I've got a Libre but think I will be moved onto Dexcom now. Im still on injections as my nurse said there was no evidence the pump helped in pregnancy and was alot of work, so was reluctant to put me on it when I was planning pregnancy.

My basal has been adjusted over the last couple of weeks to address the lows, but now its gone the other way!

 The problem is my levels were fine all night and I'm scared if I up the basal (to address the waking highs) they will be too low in the night as this was an issue for me before anyway (lows for 3 hours at a time without waking- im a heavy sleeper! )


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## rebrascora

Hi and congratulations.

Firstly I should point out that I know nothing about pregnancy and diabetes but just wanted to ask which basal insulin you are using? A split dose Levemir basal might give you more flexibility if you are not on that already. Then you can adjust both the daytime and evening dose independently and also experiment with the timing to see if you can cover the times when you are going high better without going low at other times. An alternative would be to set an alarm for 6am and inject some quick acting insulin to cover the morning rise and then go back to sleep, if that is too early for you to get up assuming you can identify a clear and regular rise at that time of day.


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## Ponzie

rebrascora said:


> Hi and congratulations.
> 
> Firstly I should point out that I know nothing about pregnancy and diabetes but just wanted to ask which basal insulin you are using? A split dose Levemir basal might give you more flexibility if you are not on that already. Then you can adjust both the daytime and evening dose independently and also experiment with the timing to see if you can cover the times when you are going high better without going low at other times. An alternative would be to set an alarm for 6am and inject some quick acting insulin to cover the morning rise and then go back to sleep, if that is too early for you to get up assuming you can identify a clear and regular rise at that time of day.


Thankyou! yes I'm already on the split levimir which helps. I put it up last night and as I expected i was low from 3am until I woke up! I've spoken to my nurse today though and she said I'm doing OK with my numbers so far and not to panic (yet!) But now I will have to change diabetes team to the hospital where I am referred for maternity which is a shame.


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## Inka

If you’re already on Levemir and putting it up made you go low from 3am then that’s not good. What time do you take your evening Levemir?

The beauty of a pump is that you can adjust the basal hour by hour eg for me in early pregnancy, I had no insulin for a couple of hours during the night, then the amount gradually rose hour by hour to deal with my Dawn Phenomenon and morning rise.

If you’re changing teams and they suggest a pump, don’t rule it out. They’re not that much work and they don’t have to be complicated. X


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## Ponzie

Inka said:


> If you’re already on Levemir and putting it up made you go low from 3am then that’s not good. What time do you take your evening Levemir?
> 
> The beauty of a pump is that you can adjust the basal hour by hour eg for me in early pregnancy, I had no insulin for a couple of hours during the night, then the amount gradually rose hour by hour to deal with my Dawn Phenomenon and morning rise.
> 
> If you’re changing teams and they suggest a pump, don’t rule it out. They’re not that much work and they don’t have to be complicated. X


Yes I have had problems with my overnight numbers for a really long time. My old diabetes team referred me for a pump (to the team i am currently with) but they did a good job of not really selling it! Its strange as an old consultant had the same attitude when I asked a few years ago about a pump. It does sound like a good solution if you can delay the insulin! 

My nurse has told me to eat dinner earlier as she thinks that's having an effect on my overnights? I take my evening levimir about 11.30pm usually and eat around 8.30pm.


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## Inka

I definitely agree about eating earlier @Ponzie I try to eat no later than 6pm-ish. It makes control a lot easier I find.

Pumps are fantastic for basal. Injected basal just sits there in a big old lump releasing itself over 12-24 hours at whatever rate. A pump only uses fast insulin and releases tiny amounts every few minutes so you never just have insulin releasing any old way it wants. The pump isprogrammed to mimic what your own pancreas would do. If you need more insulin before waking, the pump supplies it, if you need less from midnight to 2am, the pump can do that too - and to a very accurate level. You can also bolus precise amounts.


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## Ponzie

Inka said:


> I definitely agree about eating earlier @Ponzie I try to eat no later than 6pm-ish. It makes control a lot easier I find.
> 
> Pumps are fantastic for basal. Injected basal just sits there in a big old lump releasing itself over 12-24 hours at whatever rate. A pump only uses fast insulin and releases tiny amounts every few minutes so you never just have insulin releasing any old way it wants. The pump isprogrammed to mimic what your own pancreas would do. If you need more insulin before waking, the pump supplies it, if you need less from midnight to 2am, the pump can do that too - and to a very accurate level. You can also bolus precise amounts.


This does sound really good and I will definitely ask about it when I move to the new team! I feel like all my ratios and insulin need adjusting. Had breakfast and again today my numbers have shot straight up to 12 which is worrying me. I even waited 20 minutes before eating today! I've done a correction but my Libre arrow is still going straight up! Really hoping i can get this right soon


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## Inka

Try moving your breakfast injection 5 mins earlier. Do that for a few days to see if it helps. If not, move it another 5 mins earlier. If you’re not seeing any improvement from that, then maybe your ratio needs altering. I need most insulin for the same amount of carbs at breakfast and less the rest of the day.


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## Ponzie

Inka said:


> Try moving your breakfast injection 5 mins earlier. Do that for a few days to see if it helps. If not, move it another 5 mins earlier. If you’re not seeing any improvement from that, then maybe your ratio needs altering. I need most insulin for the same amount of carbs at breakfast and less the rest of the day.


OK thankyou I will try 25 minutes tomorrow and see what happens. Just feel so guilty i can't seem to sort these highs out. It sends my anxiety through the roof!


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## rebrascora

If it gives you confidence to experiment a bit with the timing of your breakfast bolus, I can tell you that I need to inject my Fiasp 45mins before breakfast and Novo(not so)Rapid took well over an hour otherwise I would spike up to 15 and then come crashing down to 5 later, none of which was pleasant. My consultant was horrified that I waited so long between injecting and eating breakfast, but he can't deny the results on my Libre graph. The rest of the day I only need 20 mins but breakfast time is always much longer. 45mins would be way too long for some people and they would likely hypo, so gradually increasing the time by 5 mins every few days is important until you find your "sweet spot" I also inject an extra 1.5-2 units with my breakfast bolus before I get out of bed to deal with Dawn Phenomenon (DP) or in my case, Foot on the Floor (FOTF) syndrome as my levels start to rise as soon as I get out of bed on a morning. That extra insulin to cover that plus my extended bolus time means that my levels decline slightly after getting up and then slowly rise to about 7/8 after breakfast and then settle back down to a nice 5-6. Feels so much better having more stable readings on a morning with nice rolling hills on my graph rather than the upheaval of sharp peaks.

If you are going low at 3am, a bedtime snack like some cheese or cooked meat or nuts might help you... ie protein and fat for slow release during the night.
Do you have a half unit pen? Sometimes a half unit difference on your overnight Levemir dose particularly, can make a significant difference in helping you balance your levels better.

Again, I have no knowledge of pregnancy with diabetes so these are just general diabetes management suggestions.


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## Ponzie

rebrascora said:


> If it gives you confidence to experiment a bit with the timing of your breakfast bolus, I can tell you that I need to inject my Fiasp 45mins before breakfast and Novo(not so)Rapid took well over an hour otherwise I would spike up to 15 and then come crashing down to 5 later, none of which was pleasant. My consultant was horrified that I waited so long between injecting and eating breakfast, but he can't deny the results on my Libre graph. The rest of the day I only need 20 mins but breakfast time is always much longer. 45mins would be way too long for some people and they would likely hypo, so gradually increasing the time by 5 mins every few days is important until you find your "sweet spot" I also inject an extra 1.5-2 units with my breakfast bolus before I get out of bed to deal with Dawn Phenomenon (DP) or in my case, Foot on the Floor (FOTF) syndrome as my levels start to rise as soon as I get out of bed on a morning. That extra insulin to cover that plus my extended bolus time means that my levels decline slightly after getting up and then slowly rise to about 7/8 after breakfast and then settle back down to a nice 5-6. Feels so much better having more stable readings on a morning with nice rolling hills on my graph rather than the upheaval of sharp peaks.
> 
> If you are going low at 3am, a bedtime snack like some cheese or cooked meat or nuts might help you... ie protein and fat for slow release during the night.
> Do you have a half unit pen? Sometimes a half unit difference on your overnight Levemir dose particularly, can make a significant difference in helping you balance your levels better.
> 
> Again, I have no knowledge of pregnancy with diabetes so these are just general diabetes management suggestions.


Thanks! you sound like me- my levels can be fine on waking then 30 minutes of me getting up they are really high! I've gone back to giving a couple of units in the morning but need to catch it even earlier I think. 
Its strange with the timing of insulin isn't it- at dinner if I do it more than 10 minutes before, I hypo while I'm eating! Unfortunately I don't have a half unit pen but will add to the list to ask my diabetes nurse about. I will also give the bedtime snack a try tonight to see if I get a better result thanks!


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## Inka

Ponzie said:


> OK thankyou I will try 25 minutes tomorrow and see what happens. Just feel so guilty i can't seem to sort these highs out. It sends my anxiety through the roof!



Dont feel guilty - you are sorting it, it just takes a little time. I had 11, 12s and 13s in early pregnancy. All my children are ok. Don’t get stressed, hard as it is. Keeping calm can really help both you and baby. I used to stop and do breathing exercises when I started worrying, and, daft as it might sound, they really helped.

I kept glucose drinks by my bed and snacks like biscuits too. Pregnancy hypos are very different from normal ones and they seem to appear quickly. I also put Dextro round the house.


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## Ponzie

Inka said:


> Dont feel guilty - you are sorting it, it just takes a little time. I had 11, 12s and 13s in early pregnancy. All my children are ok. Don’t get stressed, hard as it is. Keeping calm can really help both you and baby. I used to stop and do breathing exercises when I started worrying, and, daft as it might sound, they really helped.
> 
> I kept glucose drinks by my bed and snacks like biscuits too. Pregnancy hypos are very different from normal ones and they seem to appear quickly. I also put Dextro round the house.


Thankyou  yes my OH keeps telling me I'm doing my best and that's all I can do. Luckily I am still working at home for now so don't need to worry too much about having hypos when I'm driving. The hypos i had last week (4-5 a day) were really out of the blue and came on quick so were probably related.

 I think I will look into pregnancy yoga to help try and keep me calm - im a worrier at the best of times!


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## Inka

I used some of the Hypnobirth stuff, and just did a mindful breathing exercise where you put your hands gently on your tummy, breathe in slowly through your nose, feeling your chest/tummy gently inflate with your breath, hold that for a 2 or 3 seconds, then blow the breath out slowly and gently  through your mouth. Take a few seconds rest then repeat the whole thing three times.

Your OH is right   You’re obviously working really hard and are really aware of things.


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## Ponzie

Inka said:


> I used some of the Hypnobirth stuff, and just did a mindful breathing exercise where you put your hands gently on your tummy, breathe in slowly through your nose, feeling your chest/tummy gently inflate with your breath, hold that for a 2 or 3 seconds, then blow the breath out slowly and gently  through your mouth. Take a few seconds rest then repeat the whole thing three times.
> 
> Your OH is right   You’re obviously working really hard and are really aware of things.


Thankyou thats really helpful i will give that a go! Im looking into yoga as well to see if that helps.

Despite me waiting 40 minutes (!) to eat breakfast this morning (and doing 2 units on waking) my sugars still went to 10 after I ate. I reckon I need a ratio of about 1:5 in the mornings!


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## Inka

You could try changing your ratio. What is it at the moment? You might also find you need a slightly different ratio for different breakfasts. I do - weirdly I need less insulin for the same carb amount of croissants than cereal   

My breakfast ratio is my highest ratio and always has been. In pregnancy, it was the breakfast ratio that was most affected by the later insulin resistance. I think many people find that.

I’d eat exactly the same breakfast tomorrow and try a slightly different ratio. Don’t jump up with your ratio, take it cautiously. Also, try it for 2 or 3 days before deciding whether it works or not. I found pregnancy a time of pretty constant change with insulin amounts.


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## Ponzie

Inka said:


> You could try changing your ratio. What is it at the moment? You might also find you need a slightly different ratio for different breakfasts. I do - weirdly I need less insulin for the same carb amount of croissants than cereal
> 
> My breakfast ratio is my highest ratio and always has been. In pregnancy, it was the breakfast ratio that was most affected by the later insulin resistance. I think many people find that.
> 
> I’d eat exactly the same breakfast tomorrow and try a slightly different ratio. Don’t jump up with your ratio, take it cautiously. Also, try it for 2 or 3 days before deciding whether it works or not. I found pregnancy a time of pretty constant change with insulin amounts.


I was on 1;9 ratio and tried 1:7 today but weirdly my numbers were the same after eating! I will try 1:5 tomorrow and go from there I think. I've been doing corrections afterwards but then it does go a bit too low.

Weirdly when I did my DAPHNE course, both myself and someone else commented on how cereal caused a massive spike! I now only have a small handful on yoghurt which doesn't have such a big impact or porridge which seems to work slower.


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## Inka

It is weird your numbers were the same. Do you think this was just a fluke day, where something else affected your blood sugar? I never like to take one day as proof because so often something else interferes with things.

If it was me, I’d try 1:6 first as a halfway step.

Edited to add - yes, proper porridge is ok for me too.


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