Help! Pregnant and type one

Hi All.
I am a type one diabetic on Humalog and Levemir (7 units in the morning and 12 units before bed). I have recently found out that I am pregnant (about 7 weeks) and this is my first child. Up until now I have had my highs and lows but I have generally been quite well controlled following my attendance at a Dafne course about 3 years ago (hbA1c around 7.4%).

Since being pregnant my blood sugars have gone haywire especially during the night and in the morning. For example, last night I woke to test at 4am and was 11.2 so had 2.5 units to correct. I woke at 8am and was 14.1!!! Normally 1 unit would bring me down 3 units during the night.

Does anyone have any experience or advice of:
- ratio changes for meals and corrections during pregnancy?
- having to massively increase background or splitting the background into one dose before bed and one during the night?

I have been to see my GP and asked to be referred to the diabetic team at my local hospital but really need some advice as quick as possible.

Help

First question is do you still have your DAFNE guidebook.

If not, use the link at the bottom of the page here to contact this site to try and get access to the online guidebook or if you can still contact your course's centre, ask them for their code and input it through the user section here. There is a section on Pregnancy.

Can't help much more beyond that. I've never been pregnant before. Sorry.
Best wishes!

Have you not got a consultant led diabetic team, seeing as you have attended a DAFNE course......?

Hopefully when you get in contact with the proper clinic you can be referred to a specialized pregnancy/diabetic team......

Control needs to be much tighter when pregnant unfortunately.....

Congratulations on your pregnancy. I am type 1 and my little boy is now 2 years old. I am on an insulin pump which I went onto before I was pregnant. My control pre pregnancy wasn't brilliant but I had worked on bringing my HBA1C down to an acceptable range. I found early on in my pregnancy my insulin requirements went up but towards the end and afterwards it went down to being 0.5 per 1CP. All I can say is that you need to monitor it very closely & do lots of checking of your background insulin and CP:QA ratio. Have you contacted your diabetic team and advised them that you are pregnant? I was seen in the antenatal clinic about every 4-6 weeks, and had my hba1c checked before each visit.

My little boy was born 8 weeks premature (nothing to do with my diabetes) but because my control wasn't as good as it should have been, he weighed 6lb13oz at 8 weeks early, so being in control of your sugars is very important.

Hope that helps and good luck with your pregnancy

Thank you all so much for your replies. It has all come as a bit of a shock so hearing from other diabetics is really reassuring.

Thanks JWo for reminding me about the DAFNE book. I will have to dig it out from storage and have a look to see what it says about pregnancy. I know on the course we didn't cover pregnancy at all because most of the people attending were men and the rest of us didn't think it was applicable....

Novorapidboi26 - unfortunately I haven't got a consultant led diabetic team despite doing the course. I just fell back under the control of the local GP surgery who, although very good, just don't seem to have the expertise I need at this time! I am hoping a referral will come through quickly and I can get into the system as soon as possible. For once in my life I actually want to be seen by every diabetic specialist I can

RachelM1 - it's so interesting to hear of your experience especially with the insulin pump. I am presuming you can only go on that before you get pregnant and not after the event? It seems that my insulin requirements are going up through the roof which is why I think I will have to revisit my ratios, especially my morning one, and also my backgound nighttime injection. It is making me slightly stressed that I don't have tighter blood sugar control at this crucial stage! I have read all of the horror stories about diabetics with bad blood sugar control They don't paint a nice picture!

Thanks again all I really appreciate it.

Hi
My children are 19 and 22 now, so this is all a long time ago, and long before Dafne. I attended Addenbrookes hospital for diabetic check ups and as soon as i was pregnant (6 weeks) i was sent to the Rosie. Both of my children were 3 weeks early and weighed 6Lb 12oz and 8Lb. Towards the end of my pregnancies i was attending the Rosie twice a week. I was admitted to hospital once during my first pregnancy as i couldnt get my bloods down but that was the only time. I dont know where you live, but if you can get referred to the Rosie that would be my advice. Congratulations.

Hi. I've had two kids a girl and boy now 3 and a half and 17 months. Try not to worry too much as soon as you get referred to a consultant you'll probably be seen every two weeks and get loads if scans.
During both my pregnancies I hadn't taken part in dafne yet but my hba1c went down to 6.4 even though looking at my diary my bloods were all over the place, I took a lot of correction doses seen as I didn't want a 15lb baby😳 (they were 7lb 4 and 8lb 13 at 36 and 37 weeks)
If you're really interested in the pump discuss it ASAP as they would look into giving it to you in the second trimester.
Happy pregnancy x

Hi All

I attended my first appointment at the Rosie today and I have to say I was pleasantly surprised by it. I was seen by the consultant, a diabetic nurse specialist, a dietician and someone else who I am not too sure who they were but they talked to us about all the scans. I also had full blood taken. I feel so much better now I am under the care of Addenbrookes and I can email my blood sugar results to them to get advice. One thing I am a little hesitant about it that they seem to want me to lower my night-time background dose - but this was the one I was struggling with in terms of high blood sugar! I am a little scared by what might happen during the night tonight but I guess I need to try it to see if it works. It also looks like I might be heading in the direction of a pump, which is all totally new to me. I have never even seen one, let alone know much about it - so that's a good google session waiting to happen

Thanks you so much for your replies. I can't tell you how good it is to hear from other diabetic mums who have had successful pregnancies and healthy children. It's so easy to get drawn in to all the doom and gloom about diabetic pregnancies! So, thank you

Congratulations Aphriel
I am a Type 1 and have been for over 3 years and my daughter is nearly 6 mths old
I was looked after very well by the diabetic team at my hospital (Glasgow Southern General) and had numerous scans and fortnightly then towards the end weekly checkups.
I was always told that my Insulin requirements would increase rapidly especially in the last trimester but this never happened for me, if anything my insulin requirements plummeted in the last trimester and it's only now that they're almost the same pre-pregnancy.
It sounds as though Addenbrookes will take good care of you
All the very best and good luck! xx

Hi Aphriel. You are getting great advice from everyone although they are all correct in the need to try and get you blood glucose as tight as possible as quickly as possible. However getting pregnant with an HbA1c of around 7.4% is really pretty good and should reassure you. The problem is that pregnancy makes insulin less effective (insulin resistance) due to the hormones being produced but as Anele46 points out the amount of insulin resistance and hence the adjustment in ratios and background insulin varies hugely. Also people are often much more susceptible to hypos in the first third or so of pregnancy for reasons which are aren't altogether clear. I am also not clear why they want you to reduce your background and I would contact them early if this doesn't work. The team in Cambridge have lots of experience of pumps in pregnancy and this may well be your best bet if your morning glucose doesn't come under control as the pump allows you to reduce your background rate in the early part of the night (when risks of hypos are greater) and then automatically increase the rate in the early hours to prevent your glucose from being too high when you wake up. Simon