Hello!
I am type I since i was 8. Know i am 22. No complications so far.
I am curently 15 weeks and 4 days pregnant with my first child. Since I found out, I have been doing my best to have good bg’s. Trying too hard makes me go low, of course…but i am scared of hyperglicemia. It happens now and then for my bg’s to go up till 180-200, but i feel it and corect it immediatly. The average is 60-150. My endo says 60 is too low and that if after 2 hours post-meal it is 170 i should leave it that way and correct later if it doesn’t drop.
I am on apidra and lantus.
Today i talked to a mommy of a 3 year old. She had gestational diabetes and negative rh. Her baby was in a hypoglicemic coma after birth and know suffers from spastic tetraparesis and severe global retardation. Of course, that creeped me out.
What I want to know: which is more harmful for the baby, hypo or hyper? And what is considered a harmful hyperglicemia?
My endo told me once I got pregnant that my new “target range” was going to be 60-90. I was told to have my BG down to 140 one hour post meal and 120 2 hours post meal. At first I thought it was impossible, but I just started bolusing about 20-30 minutes before I’d actually eat so that my insulin would peak around the same time my food would be processed and my sugar would be peaking as well. (I’m not sure what you use to manage… I’m on the OmniPod.) Based on what I’ve been told thus far about pregnancy with diabetes, I’d say that you should get a second opinion on the thought process that 170 is ok 2 hours post meal. Obviously, things happen… we have diabetes and nobody’s balancing act is perfect… but it kinda scares me that she told you that its fine. Maybe she’s thinking about when you’re not pregnant??
Just think… Baby doesn’t have diabetes and baby’s pancreas is working just fine. So if you have extra sugar in your body, it will be absorbed and processed correctly in baby’s body… causing it to grow potentially too large, but also to produce extra insulin to account for YOUR extra sugar. That’s how these babies come out hypo… their bodies are already used to producing extra insulin and then all of a sudden when they are out of the womb, the extra sugar isn’t there… result = hypoglycemia. 
Hope that helps and you get some answers!
That is what i also know about how hyperglicemia affects the baby, but i’m not sure about what is too high for him. Over 140 i understand from what you say.
What about hypo?
I use solostar pens for both apidra and lantus.
I was always under the impression that hyperglycemia was more dangerous for the development of the baby than hypoglycemia. Sometimes lows happen, you treat them and all is back to normal shortly. Highs (oversimplified) can be persistent, cause more circulatory issues and can-over strain the baby’s body. If the mothers BG is too high, the baby’s body will overcompensate and send their BG low after birth.
Also be aware of a newborn’s normal BG levels. My daughter was born with a 42 BG and I freaked. While that is low (and it is a hotly debated topic) many specialists believe that a somewhat lower BG is normal for infants in the first 1-2 days (in the 50-70 range). I’ve also heard 60-80.
From what I’ve understood from my doctors, occasional lows and highs aren’t terrible, but both my OB and my endo have been more concerned about reducing my occasional highs than my occasional minor lows. But you don’t want to hang around 60, because babies need normal levels of glucose to grow properly.
I have the benefit of a pump that will tell me how much “insulin on board” I have when I think I need to correct a high. Sso if I were at 170 two hours after a meal, my pump would reduce my correction dose based on how much insulin I still have in my system… which sometimes means no correction dose at all!
Before I had the pump (which was before I was pregnant), my CDE told me that I could test at the 2.5 hour mark instead of exactly 2 hours and that I could go ahead and correct right then. My endo said she prefers three hours before a correction, so to be conservative if I correct earlier than that. Maybe you could ask him about correcting at two and a half hours, at least? Also, something I used to do when using pens, if I wanted to correct but knew that an entire unit would be too much, then I’d have a very small snack along with that unit so I wouldn’t go too low.
As for damagingly bad hyperglycemia, here’s what my doctors have said to me:
My OB: She doesn’t want to see anything over 135 after meals, maybe 140 is safe, but she’s really prefer under 135. She commented about the under 120 guidling my endo gave me, “She’s a lot stricter than we are.” I think though, that this is probably because OBs deal primarily with gestational diabetics, and her nurse practitioner said they usually don’t have control as tight as a type 1’s.
My endo: Regarding numbers I was getting in the 170 to 220 range for a little while, she said, “An occasional high isn’t going to hurt your baby as long as you correct it, but we want to see them as infrequently as possible.” Most of my numbers were pretty good except for a couple of those 170-220s in a week, and she said, “I’m not worried.” Not meaning that she thought those numbers were OK, but meaning that she didn’t think I’d hurt my baby would a few brief but bad highs.
About the woman with gestational diabetes, don’t let her scare you too much. Something that’s not in most of the literature you’ll find is that they tend to have more complications (and bigger babies) than a well-controlled type 1 pregnant woman. In fact, most of the scary stories and “rules” about interventions the medical world has for handling a diabetic pregnancy are based studies on them, not on us as type 1s using modern-day intensive insulin therapy. And while it’s not uncommon for them to take long-acting insulin, they generally don’t take any fast-acting insulin. So if they go high, they can’t bring it down as quickly as we can.
Thanks for the answers.
Lisa, maybe you can point me to that topic about lows. I dind’t find it.
It is hard to test often, in order to keep good numbers, beacuse here we get 1 test/day from the doctor, the rest we have to buy and they are pretty expensive. So far i’ve managed somehow to have enough, but i wouldn’t see how i could do it without at least 5 testing/day.
Do any of you have healthy babies even though during the pregnancy you had some lows and highs?
I’ve noticed that my need for insuline is starting to grow and it was hard to notice that without having a few highs. Also, a headache or hormonal changes reflect on the numbers, so they can’t be perfect all the time.
Insulin is too large a molecule to cross the placenta, so baby gets all of your extra glucose and none of your insulin. So baby has to overproduce insulin to regulate its high blood sugar, which is bad for the baby’s developing regulatory system and bad for baby’s weight gain. Lows should not hurt the baby unless you are so low that you lose consciousness and hurt yourself. Highs, however, are a problem. Try your best to adjust your insulin and diet so that you stay under 140 as often as conceivably possible and be aggressive with correcting highs - no waiting at 170. The baby is running a blood sugar of about 80% of yours most of the time, according to my perinatalogist.
Even with good control, the baby can still be hypo when born (babies born to non-diabetic mothers can have low blood sugar levels after birth, too). I was rh negative, too and my A1C was 5.7-5.9 the entire pregnancy. My daughter was at 42 mg/dl just after she was born. She was also pre-term and large for her gestational age (34.5 weeks and 8 lbs 6 oz).
I don’t say this to scare you, just that you can do everything right and still have a baby with low-ish bg after birth. It’s normal.
Today, my daughter is 3 and is absolutely normal in every way, with no apparent health problems. We’re ttc #2 and I wish I knew with #1 what I know about all of this now! I’m older but so much more educated (and experienced!)
Here are a few (varied) sources that say down to 40 mg/dl is normal in newborns within the first 3 hours after birth:
Oxfordjournals.org
emedicine
Stanford School of Medicine
Hope this helps! All the best to you!!
I guess it is also important that the neonatologist knows the mother has diabetes and treats the baby properly.
Due to how strict i’m trying to be, i still have hypoglicemia. At 60 i feel fine, but then it drops at 42.
My endo says 60 is too low, you all say numbers between 60-90 are preferable.
As hard as i try, i don’t seem to manage keeping it at 80-100 all the times. It’s either 120-150 or 60…
My doctors gave me a target of 70-100, with 140 being the peak 1 hour after meals. I’ve worked very hard to stay within this, but the reality is that every day isn’t perfect and you do your best without letting the stress get to you too much to make your blood sugars worse. There are a ton of factors during pregnancy that drive your sugars high or low (like fluctuating hormones), and you can’t always stay in the perfect range 100% of the time, but you just have to correct aggressively and treat lows as fast as you can. If it’s an option, the best thing you can do is get your doctor to write you a prescription for more test strips per day - testing more often per day will allow you to catch those highs and lows. My insurance company normally covers 10 strips per day, but provides me with 12-14 per day for pregnancy, along with a CGM that alerts you when you’re rising and dropping.
Giving me more tests is not an option here, it doesn’t matter if i am pregnant. I have to buy the rest of the tests, but as i said, they ar expensive.
I also test at least 8 times a day, i couldn’t do it otherwise.
The last couple of days i’ve managed to keep my numbers between 70 and 108, with a few exceptions. I’ve discovered that if i am not so stressed about keeping them good, i have better numbers.
Today I got great news. My HbAIc is 6,1. When i found out i was pregnant, it was 7,3. I’m almost 20 weeks now. I hope I get it lower or at least keep it this way.
I have a question: if my numbers are between 100-120 2 hours after meals, at 3h i get a hypoglicemia if i don’t eat something (a banana for ex). What can i do to avoid that, but keep the good numbers too? I take 13 units of lantus in the evening. Should i take 12, even 11? Would that help?
Congrats on the AWESOME A1c!
I am eating a snack every three hours. So the only concern is making sure that the bedtime bolus is not too big. If you don’t want to snack that often or to have a fixed schedule, then you might try giving a little bit smaller boluses, but giving them earlier. Are you waiting to eat after you give your insulin?
Thanks!
I learned from here to wait before eating, so i do it…wait 10-15 minutes and it seems to work fine. But when my numbers are 60-80 i eat right away.
So at those snaks you don’t make insulin, you take them in order to keep your numbers from going down?
By bolus you mean the short-acting insulin, that i take pre-meals? I’m thinking that i should try reducing my long-acting insulin.
I take a bolus with every snack. The times that I eat are: 7h, 10h, 13h, 16h, 19h, 22h.
I meant just that that I’m not seeing the low at 3 hours because I am eating again and taking some extra bolus too.
Are you ONLY going low 3 hours after eating or at other times during the day too? Of you reduce your long acting insulin, then you might go high at other times of the day. You can try to change it by 1-2 units and see.
Do you change your insulin doses? Or dose your doctor do it?
By the way, I’m not so far away from you (I live in Hungary!)
I’m going low even at night or in the morning. Last evening i took 12u of lantus instead of 13. My bg was 104 at 6am and 100 at 9.30 am (when i ate). The last 2 mornings it was between 54-66, not good.
It’s curious because i have 2-3 great days with numbers between 70-110, but then i have 1-2 days when it just doesn’t drop under 130, although i do the same things and eat almost the same things.
I usually change my doses. My doctors sugests sometimes, but his suggestions are not always the most proper ones for me.
Is the sistem better in your country? Do you at least get more test then we do here?
I read your posting, you seem to have a great meal plan, but i’m not sure it would work for me.
It sounds like lowering your Lantus was the right decision then!
I think that the system here is OK, but it depends a lot of your doctor. I have a really good doctor who I trust a lot. She strictly enforces this diet. Some parts of the diet are really helpful – some are not as important in my opinion. But since I trust her and like her, I decided just to follow it and I have gotten used to it by now.
I have found that I have very different days as well when I do everything the same! If you think about the fact that your hormone levels are changing even day to day, then it makes more sense why we have to always change our insulin throughout pregnancy. For me, I had to lower my insulin doses from weeks 9-19 every week. Since week 20 (now I’m in 24), we have been increasing it. I go up to 160 at some point every day now, but then I need to increase the insulin then. This way I prevent it from going even higher.
Here the government pays for 5 test strips per day. I have to buy extra. My doctor sometimes helps by giving extra if she can. I am now petitioning to get 10 strips per day from the government, but they don’t usually give it.
Still it’s better than here; i get 100 tests every three months, along with my insulin prescription, meaning 1 test/day. I test at least 8 times a day.
I couldn’t imagine only testing once per day. We don’t get any tests from the government in America (unless you’re Type 2). I pay for insurance and then pay for prescriptions. I get 10 strips per day because that’s what I pay for. Testing 1 time a day is so dangerous. So scary for people who can’t afford to buy more test strips!
It is indeed scary!
I have modest incomes so i can’t really afford them, but i get some help from family. Buying them all the time would mean more than half my salary. I also had a friend in USA that used to send me tests, but times had changed.
In America type 2 gets more tests than type 1? Here type 2 gets nothing…very sad.