Pre-conception BG targets: How do you do it?

BG targets for pre-conception
before meal: 68–94 mg/dl (3.8–5.2 mmol/l)
1-hr post-meal: 103–139 mg/dl (5.7–7.7 mmol/l)
2-hr post-meal: 90–119 mg/dl (5.0–6.6 mmol/l)

These are the BG targets for pre-conception promoted by the diabetes and pregnancy clinic at my local hospital.

I cannot imagine how I could ever meet these targets. My 2-hr post-meal BG is usually between 126-162 mg/dl (7-9 mmol/l), and I often go low before my next meal. If I were 139 (7.7) one hour after eating, I'd be hypoglycemic constantly. (I use a pump, and I have a very low basal rate and I am very sensitive to insulin. My TDD is usually around 13.5 units).

Does anyone actually meet these targets? How?

I was told very similar targets. If you are unable to keep crashing, maybe your basal or i:c is off? I would try tweaking those and see if that helps you hit your goals. Do you have access to a cgm? I wore a blind one for one week prior to getting my dexcom and found that the blind study was very helpful in setting trends.

I also want to add that I do hit these targets often, but not all the time. Diabetes is hard, and pregnancy makes it harder. Good luck!

I agree! I've been trying to meet these targets pre and post meal and instead I seem to be constantly low. I think adjusting basal rates are the best way to go but I haven't mastered this yet. It's really trial and error. I did learn by one great Endocrinologist not to make too many changes at once. Try one change and monitor what happens, then adjust if needed before making a 2nd basal rate change. Also, wearing a CGM helps tremendously! Keep in touch...

Thanks, Kate and Katy for your replies.

Here are my basal rates:

12:00 AM - 0.200
5:00 AM - 0.300
9:00 AM - 0.200
11:00 AM - 0.300
3:00 PM - 0.175
5:00 PM - 0.300
8:00 PM - 0.425
10:00 PM - 0.200

I do agree that it might be a basal problem, but my basal rates seem so low already, I worry about reducing them further! Every time I try basal testing, I never finish, because I cannot bear skipping lunch a few times and skipping supper a few times. I would be so hungry (and grumpy!).

Nonetheless, I might try lowering them a tiny bit, as Katy suggests, but not making too many changes at once.

And no, I do not have access to a CGM. I live in Canada. Very few people have them here, as they are not covered by in$urance. ; )

The ONLY way that I found to meet these targets was to eat on a schedule... Basically I ate every three hours during the day (7am, 10am, 1pm, 4pm, 7pm, 10pm). This is my endo's protocol. I had a fixed amount of carbs and a fixed bolus which we adjusted from week to week. I think that the reason that I was able to have good postprandial numbers was that some of the bolus from the previous meal/snack covered the next one. If I was late with a meal or snack, I would have gone low.

Actually I think that eating this often also helped me to feel better during pregnancy. I am not usually a big "schedule" person, but this method really worked for me. It meant that I did not eat carbs other times, but I rarely craved them because I at scheduled snacks and no carb snacks in between if I was hungry.

My fasting was not always below 100... but I am going to work more on that before the next pregnancy.

I live in Hungary and CGMS is not covered here either. Just wanted to reassure that my pregnancy went very well without it!! I'm not saying that it would not have helped, but actually following the schedule (that I described below) made testing and adjusting more effective and I don't think that a CGMS would have made a big difference.

My endo does not do fasting basal tests. Basically using the schedule, I test before every snack/meal and one hour after some of them (measuring one hour after different ones each day). Each week we reviewed my numbers and she increased the basal if she say an increase from BEFORE previous snack to BEFORE next snack and she increased the bolus if she saw a jump from before to one hour after snack...

Let me know if this is not clear...

I find the idea of eating on a strict schedule very interesting. How many carbs were you eating at each meal time? What did you eat? How much insulin were you taking?

Here are some more details about my diet

I was taking about 28-30 units of insulin per day before pregnancy. During pregnancy, I think that I got to about 15 units per day and then up to 60 units per day. So I do not think that you should focus on how much insulin you need. There is no good or bad amount of insulin. You just need to figure the right amount to get the right blood sugars...

I agree with Katy - slow and steady wins the race. Maybe try attacking one meal at a time. When I lower my basals, I usually do it by .05 or .1 unit at a time. Since yours are so small, I wouldn't make any drastic changes.

How are your fasting bg's? If they are good then you can rule out tinkering with the overnight basals.

Just remember that you will get them all figured out and then they will change again. Thankfully, the prenatal vitamins will help you keep the hair that you don't pull out! haha!

I have done overnight basal testing, and that rate is fine. I've done morning basal testing, with less success (I generally go low before lunch). I haven't even tried afternoon or evening basal testing. Seriously, how can anyone skip lunch or supper? They're the highlight of my day!!

Wow. Thanks for the information. Very helpful!

I agree with the previous posters. I am 39 weeks pregnant, and I have found it easier than I thought it would be (although not "easy") to hit those post prandial targets. I was having problems initially with crashing from meal boluses 2 hours pp (one hour was often fine), so I upped my basal rates around meal times.

I stuck to a fairly regimented breakfast, but not nearly as much so with lunch and dinner, but I found a way to make it work. My A1c has been 5.3 or lower the entire pregnancy (was 5.6 at conception and lowest was 4.8).

However, later in pregnancy HAS impacted my digestion - it has slowed down - so I really have to watch after 2 hours pp, because sometimes it does CRAZY things, even with reliable meals. Test, test, test. That is the real reason I've been able to keep my A1c's so low.

Test frequently, correct aggressively, and don't be afraid to tinker with basals...but really one step at a time so you can figure out what's going on!

I could skip lunch or dinner, but DO NOT take away breakfast! haha! I become a disaster without it! :)

That was the schedule I was on too, and at the between meal were snacks of 15 carbs, a protein, and 1/2 cup of whole milk. I wasn't on a pump or CGM. It was Humulin R and NPH. The doctor would change the insulin amounts according to my insulin and carb records and my pre and post prandial readings. There was lots and lots of food, insulin, and carb diaries for the doctor.

I'm hoping to officially start my pre-pregnancy routine in June.

Best wishes!

I have an office job. Lunch is what keeps me from going crazy. If I ever do get around to lunchtime basal testing, I will need to find a way to distract myself from the fact that I'm starving.

It is so daunting and overwhelming. I am in a preconception program now, mainly to figure out the right basal/bolus rates for me and to get my A1C under 6.5 so I can get the go ahead to conceive. I have been doing this for 3 months now and it is so much work. I have similar goals, they want me 70-90 at fasting, 90-100 pre-meal and 100-110 post meal. It is so tight, and I have been running high prior to this program that when I get near this level I often go low-- sometimes it just seems impossible! The one thing that they keep telling me is that I have to be comfortable going low, cause when you are pregnant it happens often and hitting these numbers the first 12 weeks are super important. I talk with my Diabetes educator/nurse every week and go in every two weeks to review all my sugars, food diaries and pump settings. This really helps me stay accountable and on track. If this is something you can do I highly recommend it. Each visit we fine tune something and my numbers are coming down. Agree with the other users change one thing at a time, cause if you do diet, exercise, and pump rates changes all at once you won't know what worked. I also have found that a regimented eating schedule really helped. I am on a strict 1500 calorie meal plan that is relatively low in carb and includes lots of lean protein,veggie, fruit and dairy options. Also eating about every 3 hours to keep everything steady. Another thing that has helped me is that 2x a week I will try to eat the same exact thing, at the same time, do same workout, etc so I can see any patterns/trends in what my Bolus and Basal rates are doing. The scariest part to me is all the lows, cause it happens often but is just part of the process. I got a CGM and that has really helped me ease my mind, especially overnight. When I feel overwhelmed or that it is impossible I come to this site and read all the wonderful and inspiring stories of other women who have done this. I also try to take it one day at a time and do the best that I can and try to not beat myself up if I have a high or a low- it is all just part of the process. Good luck to you!