Gestational Diabetes- fasting #'s, were you started on bedtime insulin?

[SuperKat]

I have been seeing a diabetes educator and she has been saying for over two weeks that she was going to recommend that my doctor start me on a bedtime dose of insulin because of my fasting numbers. For the past couple of weeks my numbers have been below 100mg (5.55 mmol)- they have never gone above that, they are 75% of the time below 89mg (4.94mmol). I wake up a couple of times at time to pee (I drink a lot of water at bedtime), and a few times I have gotten up to test and my numbers are always between 85-100mg (4.72-5.55mmol).

The educator said she wants to start me on 8 units of insulin though at bed time. And she is basing it off 2 numbers a week being too close to the edge (she said 89mg (4.94mmol) and 98mg(5.44) were the same thing to her...

My Ob/gyn has said that as long as my numbers don't go above 100mg (5.55) for the fasting numbers they are happy.

Does it seem like the educator is jumping the gun to you guys? At what point were you put on insulin?

 

[080509]

I'm type 1 but personally i wouldn't go on insulin until your fasting numbers went over 6 continuously. This is my 3rd pregnancy being diabetic and some mornings i wake with fastings of 8mmol, they don't seem bothered unless its continuous. Also i would probably start with less than 8units of basal, probably 4 then work up from there. I'm only on 8units at the moment and i sometimes go low over night x

 

[SuperKat]

Thank you for your response! Going low overnight is a concern I have for sure because my numbers stay steady through the night, I've checked on several nights and they are always just a bit above what they say fasting should be...I would think taking 8 units would make it drop really low...I am going to bring my paperwork to my doctor, he won't prescribe it I don't think if he sees what my numbers have been. (The diabetes lady has no intention of telling him the numbers, she is just going to make the recommendation that I be started on 8 units at bedtime!)

 

[shambaby]

Definitely show your doctor your numbers - they all seem really good to me! I'm diet controlled GD and they want my morning reading below 6.0mmol! I would be very worried about hypo's with bedtime insulin with those numbers. How are all your other readings? Are you on any daytime insulin?

 

[SuperKat]

Nope, no daytime insulin. My daytime numbers are usually around 6.11 (110 range) after eating, and within an hour or two tend to be in the fasting range. The educator lady said she believes that people
re started on insulin too late and that everyone that might need it should get
Started on it sooner rather than later...so it seems like she is exercising her own opinion in my care and I'm not sure my doctor would agree with her at all.


Now, if I cheat and have frozen yogurt my numbers have gone to 9.16 (165), but they drop pretty quickly, by two hours after eating it they are in a normal range.

 

[shambaby]

That makes no sense - insulin is to correct high blood sugars which you don't have. If you start treating it early when levels are normal they will end up low. Think your 'educator' needs educating!

 

[SuperKat]

LOL yea, that's what my mom said! She is a registered nurse and thinks the educator is out of her mind. What gets me is that this lady has been throwing out the insulin card for 3 weeks now, it is like she just can't wait to get me on it. It's starting to make me wonder if she owns stock in the company they get the insulin from, hahaha.

...she's definitely had me getting really upset with myself over numbers. This week I have had 2 morning wake up numbers that were high for me at 5.66 (102), and 5.83 (105)....the rest have been around 5-5.33 range (90-96)...so, I am pretty certain she will be writing a recommendation on Monday for me to be started on 8 units at bed time.


It has me wondering though, if I were to be put on insulin for those number, what could I expect? Since my numbers aren't going higher than the 5's at bedtime- or any time while I am sleeping- should I expect 8 units to drop it really low? How much would 8 units likely drop it to? Can't a blood sugar dropping really low like that be harmful to the baby in the same way a really high blood sugar would?

 

[shambaby]

Sorry, not being on insulin I don't know quite how it would affect your numbers, but it would bring them down - that's the point. You could try posting on the GD support thread, there are ladies on there on insulin so they might be more helpful.

Low blood sugar wouldn't be harmful in the same way, but it is harmful and you need to make sure the balance is right. All your numbers seem normal to me. Have you been given targets they want you to stay within?

 

[080509]

They say (in most people) 2units of background lowers it by 1mmol, however as pregnancy progresses we get verrrry resistant to it! So 8 units of background may only lower by 1mmol or 2mmol, but even so it could still dip in the night.
I'm currently on 8 units of of background, but since becoming pregnant i've only put that up from 6units, my last pregnancy by the end i was on 60units of background, so although i said 2units will lower by 1mmol, that wouldn't mean i would drop an extra 30mmol's by taking the 60units i was on in third tri last time, its just pregnancy made me very resistant to it, so it was like injecting water lol.

Either way i wouldn't worry for now, your numbers look really good! Because they are good if you was on insulin and your levels dropped, there is a chance you could push it up too high from treating the low, which if you didn't go on insulin in the first place you wouldn't of gone high in the night.

Sorry if thats a big ramble! What i'm meaning is sometimes when i drop to around 2mmol, i will drink a sugary drink and half hour later be at 10mmol, its a losing battle sometimes lol.

 

[SuperKat]

Thank you girls for your responses!

As far as targets go, the educator wants them below 4.94 (89) and is prepared to recommend that I be started on insulin if it goes above that more than twice in a week (she will simply write a note to my doctor recommending that he start me on it, without telling him the numbers, and most doctors here will go ahead and follow the advice- that is typically how it works here). My doctor, however, has told me that they are happy as long as my numbers are below 5.55 (100). -which they have been, with the exception of two times in the past 3 weeks, those two times they were at 5.66 (102) and 5.83 (105), and i believe I tested a bit too soon (7ish hours for fasting instead of 8, and I had frozen yogurt that evening).

The rest of the day the educator said my numbers shouldn't go above 7.22, and they haven't.

I am planning to cancel my appointment with the educator tomorrow, and am going to bring my food journal and numbers directly to my doctor so they can see whether or not I need insulin at bed time (since the educator says I need it).

 

[luvmykidsx3]

it doesnt sound right to me.Also when i did get a confirmed diagnosis with my youngest son i was doing insulin shots more than once a day.With my oldest son it wasnt as severe and i was on a glyburide pill.

 

[hardatworkmom]

My fasting numbers were high every morning and they put me on a pill before bed and it dropped them done to normal.

 

[midori1999]

I think your educator sounds a bit ridiculous tbh. What is a diabetes educator anyway? Presumably not a doctor as you have mentioned seeing doctors too?

I have GD, although I am being treated as type 2 as it was very early onset. (I don't have type 2 though) I also had GD in my last pregnancy and that was insulin controlled. This time I am on metformin and insulin. I have to keep my fasting below 5.5 and my pre meals below 6, but I don't have to test after meals.

If you have to keep your levels below 4.9, then you only have a very small window in which to keep them before you hypo. (which is where your blood sugar goes too low). This is extremely dangerous to you, especially if it happens while on insulin and overall it would be safer all round for you and your baby if you were getting the odd high reading. Also, although you may well need insulin later on, being on insulin medicalises your pregnancy a lot more and has implications for the birth. If you stay diet controlled you will have a lot more choices at the birth.